Clinical reproduction and fertility最新文献

The immunobead test (IBT) is a new method of detecting antisperm antibodies with the advantages of enabling determination of the presence of antisperm antibodies during routine semen analysis, immunoglobulin isotypes and antibody specificity for binding to sperm structures such as head or tail. The IBT is compared with the conventional methods of detecting antisperm antibodies in serum; the tray agglutination test (TAT) and the sperm immobilization test (SIT). Positive IBT (50% or more of washed motile sperm binding to anti-IgG and/or anti-IgA immunobeads) were found in 6.8% of 689 men being investigated for infertility. Both IgG and IgA were found to be present in all cases. The IBT correlated closely with the serum antisperm antibody tests; of the 202 men tested by all three methods, 200 (99%) were either positive for circulating antibodies and IBT or negative for both. No men with serum antisperm antibodies lacked local antisperm antibodies as detected by IBT, and only two men (1%) were IBT positive in the absence of either one or both types of circulating antibodies. Individually, the TAT and the SIT correlated equally well with the IBT; 97% and 98% of men tested by TAT and IBT, and SIT and IBT respectively, were either positive by both or negative by both. It is concluded that the IBT is an excellent procedure for the detection of sperm antibodies.

Concentrations of pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotrophin (hCG) and pregnancy specific beta 1-glycoprotein (SP1) were measured by radioimmunoassay in 164 serum and 29 tissue samples obtained from 87 non-pregnant and 29 pregnant women with either tubal (n = 16) or intrauterine (n = 13) pregnancies. Of the 47 serum samples obtained from patients with a tubal pregnancy only two were positive for PAPP-A, whereas in excess of 94% of the samples were positive for both hCG and SP1. Serial measurements of hCG, and SP1, demonstrated an apparently normal growth rate for the tubally implanted trophoblast for the first 6 weeks of pregnancy. Thereafter, the tubal trophoblast is compromised since the tissue content of PAPP-A and hCG was significantly lower than that in intra-uterine derived trophoblastic tissue. By contrast, the content of both PAPP-A and hCG was significantly greater in the trophoblastic, both intra or extra-uterine derived, than in the endometrial/decidual, tissue. Furthermore, the absence of immunoreactive PAPP-A and the severely depressed circulating levels of PAPP-A in women with tubal pregnancies can be attributed to diminished secretion of PAPP-A into the maternal circulation. Therefore, in conjunction with a positive pregnancy test and the patient's clinical history, a severely depressed or absent serum PAPP-A level may aid in the diagnosis of extrauterine pregnancy.

Peritoneal fluid (PF) volume and sperm survival (motility and velocity) were studied in PF from women with unexplained infertility, infertile women with endometriosis and fertile women without endometriosis using a laser light scattering technique. PF volume was significantly larger in the group of women with unexplained infertility (P less than 0.025) and in infertile women with endometriosis (P less than 0.003) when compared with fertile women. There was a significant reduction in the percentage motile sperm in women with unexplained infertility (P less than 0.001) and in infertile women with endometriosis when compared with fertile women (P less than 0.001). In infertile women with endometriosis a positive correlation was observed between peritoneal fluid volume and reduction in the percentage of motile sperms (P less than 0.01).

A study is reported of sperm autoimmunization in 707 men and its relationship with atherosclerotic coronary artery disease. The following groups were studied: healthy vasectomized men (278), healthy non-vasectomized men (231), vasectomized men with atherosclerotic coronary disease (ACD; 87) and non-vasectomized men with ACD(111). The gelatin agglutination test (GAT), tube slide agglutination test (TSAT) and sperm immobilization test (SIT) were used to detect circulating anti-sperm antibodies. Sperm antibodies developed within 6 months of vasectomy and persisted for more than 20 years. There was no difference in the incidence of antibodies in vasectomized healthy and ACD men. The results of this study provide no evidence for an association between cardiac disease and vasectomy.

The results of AID in a population with a high incidence of female factors is reported. Thirty-one patients started AID on 35 occasions resulting in 25 pregnancies and a cumulative conception rate of 71% at 8 months. Eleven patients with female factors present became pregnant. Some problems of AID practice in Lagos are highlighted.

The use-effectiveness of natural methods of family planning in lactation is evaluated by comparing the incidence of unplanned pregnancies in a group of nursing mothers practising these methods with the incidences reported previously in surveys of breastfeeding women using no contraception. The complexity of the physiological processes involved in the resumption of ovulation after term pregnancy is discussed in relation to NFP and the problems encountered by its users in the context of normal family life. The serum prolactin and gonadotrophin levels are correlated with the postpartum interval and nursing status of the participants and discussed in relation to NFP after childbirth.

The objective assessment of Danocrine (Danazol, Winthrop) in the treatment of endometriosis was hampered in the 1970s by the absence of a universally accepted classification. The American Fertility Society (AFS) classification, proposed in 1979, has now become widely accepted. However, there is a lack of recorded objective data utilizing the AFS score before and after Danazol therapy. In a series of 51 patients with endometriosis, who underwent laparoscopy, then received Danazol, 800 mg daily for 6 months, and had a repeat laparoscopy, there was a statistically significant improvement in the AFS score in Stage I and II disease.