Biomedical subjects
J Papadimas
Publications and source records attributed to J Papadimas.
Therapeutic approach of immotile cilia syndrome by intracytoplasmic sperm injection: a case report.
OBJECTIVE: To present a case of immotile cilia syndrome, a very rare cause of male infertility and to evaluate the role of the recently suggested treatment by intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Tertiary-care academic hospital. PATIENT(S): One man with immotile cilia syndrome, showing no motile spermatozoa despite normal morphology and viability. INTERVENTION(S): The patient's partner underwent two cycles with IVF of the oocytes achieved by ICSI. MAIN OUTCOME MEASURE(S): Evaluation of ICSI procedure in cases of immotile cilia syndrome. RESULT(S): Thirty-three percent of the oocytes were fertilized and subsequently divided enabling ET in both cycles. CONCLUSION(S): Intracytoplasmic sperm injection seems to represent a promising approach to the problem of infertility in men with immotile cilia syndrome.
Pituitary-testicular axis in men with beta-thalassaemia major.
Delayed puberty and hypogonadism are frequently observed in patients with homozygous beta-thalassaemia. We evaluated the pituitary-testicular axis in 30 thalassaemic men, aged from 17 to 35 years who were regularly transfused and underwent chelation therapy, while emphasis was given to pituitary reserves of gonadotrophins and the correlation of hormones with serum ferritin (SF). The investigation included endocrinological examination, evaluation of serum basal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and gonadotrophin-releasing hormone (GnRH) test and also spermiograms. According to the results, patients were divided into three groups: group A, which included 18 eugonadal patients with moderately elevated SF, group B which included six patients who had hypogonadotrophic hypogonadism and excessive elevation of SF, and group C, which included six patients characterized as intermediate, with regard to sexual maturation and SF levels. In conclusion, beta-thalassaemia major leads to variable pituitary iron overload and thus hypophyseal damage. This endocrine disturbance is becoming less frequent nowadays with early and intensive chelation therapy.
Evaluation of different ovarian stimulation protocols for in vitro fertilization.
In this study we evaluated retrospectively the efficacy of five different ovarian stimulation protocols in an in vitro fertilization program, in which 512 women were involved. Ovulation was induced by the following protocols: group I (271 cycles): buserelin short protocol (1 mg/day, intranasally) with human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG); group II (45 cycles): buserelin (short protocol) with pure follicle stimulating hormone (p-FSH)/hMG/hCG; group III (24 cycles): clomiphene citrate (100 mg/day) with hMG/hCG; group IV (122 cycles): hMG (3 ampules/day) and hCG; group V (113 cycles): hMG/hCG and prednisolone (7.5 mg/day) after cycle programming with oral contraceptives. The lowest cancellation rate (3.3%) was noted in group I, followed by group V (9.7%). The highest number of follicles was observed in groups I (8.3 +/- 0.3; mean +/- SEM) and V (7.8 +/- 0.5). Also, more oocytes were retrieved in group I (7.2 +/- 0.3, p < 0.001), which were of good quality based on oocyte maturity as well as on the fertilization rate, and more embryos (4.5 +/- 0.3, p < 0.05) were developed. The correlation between estradiol and the total follicular volume on the day of hCG administration was also examined in the five groups. The best correlation (r = 0.6502) was found in group I, followed by group V (r = 0.5810). Significant differences were observed in the five groups with regard to the number of hMG ampules administered (p < 0.0001, F = 15.393) and the stimulation days (p < 0.0001, F = 35.32). Sixty-six clinical pregnancies were achieved: 37 (17.5%) in group I, seven (25.9%) in group II, one (10%) in group III, ten (15.6%) in group IV and 11 (15.5%) in group V (differences were not statistically significant). In conclusion, all five protocols were satisfactory in ovarian stimulation for in vitro fertilization, and gonadotropin releasing hormone (GnRH) analogs seemed to be more advantageous by reducing the cancellation rate, enhancing the number of oocytes retrieved and embryos developed and by improving the pregnancy rates.
Growth hormone, oestradiol, progesterone and testosterone concentrations in follicular fluid after ovarian stimulation with various regimes for assisted reproduction.
Follicular fluid samples and oocytes were obtained from 75 women (87 cycles), who participated in an assisted conception programme. Determinations of the concentration of oestradiol, progesterone, testosterone and growth hormone were performed in all follicular fluid samples. Patients were stimulated with the following regimes: group A (24 cycles, 94 samples), human menopausal gonadotrophin (HMG) (three ampoules/day) and human chorionic gonadotrophin (HCG); group B (23 cycles, 53 samples), HMG/HCG with prednisolone (7.5 mg/day) after cycle programming with oral contraceptives; group C (40 cycles, 60 samples), buserelin with HMG/HCG. Oestradiol concentrations (mean +/- SEM) were significantly higher (P < 0.05) in group A (320.1 +/- 27.3 ng/ml) and those of growth hormone in both groups A and C (3.8 +/- 0.2 and 3.2 +/- 0.15 ng/ml, respectively), as compared to the other groups, whereas progesterone and testosterone concentrations were similar in all groups. The mean concentrations of oestradiol, progesterone, testosterone and growth hormone were significantly higher (P < 0.01) in follicular fluid with oocytes of intermediate maturity than with mature oocytes (382.5 ng/ml, 7847.5 ng/ml, 1704.5 ng/dl and 3.7 ng/ml versus 217.8 ng/ml, 5488.4 ng/ml, 1313.6 ng/dl and 2.7 ng/ml, respectively). On the other hand, only oestradiol concentrations were significantly higher in follicular fluid of fertilized compared to non-fertilized oocytes. Concentrations of the other hormones analysed, except growth hormone, were similar in follicular fluid from pregnant and non-pregnant women after assisted reproduction. Growth hormone, on the other hand, was significantly lower (P < 0.05) in follicular fluid from pregnant compared to non-pregnant women (2.8 versus 3.5 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
Evaluation of intrauterine insemination with washed spermatozoa from the husband in the treatment of infertility.
In this study, we examined the efficacy of intrauterine insemination with washed spermatozoa from the husband (AIH/IUI) in the treatment of infertility. A total of 127 treatment cycles were completed (1.95 cycles per patient). The indications for AIH/IUI were male subfertility (group I: 53 couples), cervical factor (group II: four couples), male and cervical factor (group III: six couples) and unexplained infertility (group IV: two couples). Sperm washing caused a reduction of the sperm concentration from 52 x 10(6)/ml to 44 x 10(6)/ml (P less than 0.08) and motility from 49% to 45% (P less than 0.03). Twelve pregnancies were achieved (18.5% per couple and 9.5% per cycle): eight pregnancies in group I (15.1%), one in group II (25%) and three in group III (50%). Of the 12 pregnancies, eight occurred in the first insemination cycle, three in the second and one in the third (1.4 cycles/pregnancy). Sperm motility was significantly higher in the pregnant than in the non-pregnant group (65.5% versus 46.4%, respectively; P less than 0.004), whereas no significant difference was observed in the sperm concentration between these two groups (39 x 10(6)/ml and 54 x 10(6)/ml, respectively). In conclusion, AIH/IUI is a technically easy and non-invasive procedure which offers a satisfactory pregnancy rate in selected couples with male subfertility and/or cervical factor infertility.
LDH isoenzymes in semen of infertile men.
LDH isoenzymes (LDH1, LDH2, LDH3, LDH4, LDH5, and LDHx) were evaluated in 68 infertile men and in a control of 10 fertile men. No statistically significant difference was found in the value of the 5 isoenzymes (LDH 1-5) in the different subgroups of infertile men and in the comparison of the infertile men with the control group. LDHx was detected in the infertile men, regardless of the cause of infertility, as long as the sperm concentration was greater than or equal to 16 million/ml, LDHx was not detected not only in all azoospermic men but, also, in those infertile men whose sperm count was less than or equal to 15 million/ml. There is a positive relationship (p less than 0.001) between LDHx and sperm concentration, but there is no such relationship between LDHx and % motility.
Spontaneous sexual development and menarche in a female with 17 alpha-hydroxylase deficiency.
Case report of a 46-year-old female with clinical and laboratory findings typical for 17 alpha-hydroxylase deficiency who had spontaneous menarche and thereafter regular menses until the age of 28, when menstruation stopped after right and left ovariectomy at the age of 27 and 28 yr, respectively. Common and electron microscopy study of one (left) excised adrenal showed no recognizable histological zones, nodular hyperplasia of the cells found normally in the zona fasciculata and complete absence of the cells of the zona glomerulosa. Treatment of hypertension with spironolactone (for 20 days) and aminoglutethimide (for 15 days) was ineffective, while glucocorticosteroid treatment was highly successful.
Hormone profile in infertile men.
Plasma basal levels of FSH, LH, prolactin, and testosterone were evaluated in 263 men with fertility problems. Significant increases in FSH were detected in all groups of infertile men except those with infection, varicocele, infection and varicocele, and obstructive azoospermia. No differences in LH were detected in all groups, except those with chromosomal testicular abnormality and idiopathic seminiferous tubular failure where significant increases were revealed. No differences in prolactin were detected, while a decrease was found in testosterone in the group with chromosomal testicular abnormality. FSH seems to be a most valuable hormone index in the routine workup of male infertility, while prolactin does not offer substantial information. The combined LH and testosterone evaluation might be of diagnostic importance in selected cases.
Seminal plasma zinc and magnesium in infertile men.
Levels of zinc and magnesium were estimated in the seminal plasma of 83 men having various infertility problems. There was a wide overlapping of Zn and Mg mean values among the groups of normal and infertile men, a significant reduction in Mg mean value (but not Zn) only in the group with infection of the accessory genital glands, a very high positive correlation between Zn and Mg mean values in all groups, and a high positive correlation between either Zn or Mg and acid phosphatase (but neither fructose nor sperm count and forward progression) in men with infection, but not in the other groups. Measurement of Mg in seminal plasma can, in combination with other parameters of prostatic function, give useful information regarding male infertility problems, particularly in the case of infection of the accessory genital glands.
Evaluation of Hamilton-Thorn automated semen analysis system.
Sperm concentration and percentage motility values generated by the HT M-2030 system (CASA) were compared with those obtained by subjective semen analysis (SSA). Three calibrations arbitrarily designated as A, M, and D for gates and discriminators and three calibrations arbitrarily designated LI, MI, and HI for default pixel count (DPC) and default intensity (DI) were evaluated. The best correlation between CASA and SSA was observed utilizing M calibration (n = 114) with which sperm concentration was +0.3 x 10(6)/mL (r = .96) and motility was -6.3% (r = .89) compared to the values obtained by SSA. It was found that 35.9% of sperm concentration values and 34.2% of sperm motility values were within 10% of the values obtained by SSA. When sperm concentration was between 50 and 100 x 10(6)/mL the difference in motility was reduced (-3.2%) while the difference in sperm concentration was reversed (-2.6 x 10(6)/mL). LI calibration (DPC = 4, DI = 86) gave acceptable results with M calibration for sperm concentration (+2.1 x 10(6)/mL) and motility (-6.9%) compared to the values obtained by SSA. In the presence of sperm clumping, the difference between CASA and SSA was reversed for sperm concentration (+0.56 x 10(6)/mL for normal samples vs. -2.2 x 10(6)/mL for samples with clumping) and was reduced for sperm motility (-7.14% vs. -4.55%, respectively). HT M-2030 under proper calibration can be used as a rapid, objective, and reliable alternative to conventional semen analysis in routine and for research purposes.
Effect of follicular fluid on the kinetics of human sperm acrosome reaction in vitro.
The purpose of the present study was to evaluate the kinetics of human sperm acrosome reaction in vitro using the triple stain technique. Acrosome reaction was studied in sperm samples from 16 fertile men 2, 6, and 9 h after ejaculation, following incubation in culture medium (CM; Ham's F-10), with a mixture of CM and follicular fluid (FF), or with FF only. Incubation of sperm samples without the influence of any medium served as control. The highest proportion of living acrosome-reacted sperm after a 2-h incubation period occurred in samples incubated with FF (18%), followed by samples incubated with the mixture (15.2%), and then with CM (11.8%). The proportion of living sperm that had undergone the acrosome reaction in the control group was significantly lower (5.7%, p < 0.05). After 6 h of incubation, live acrosome-reacted sperm in FF had increased to 39%, in the mixture to 35.5%, and in CM to 30.5%, whereas in the control group the increase was only 6.3% (p < 0.05). After 9 h of incubation, the percentage of living reacted sperm showed a decline compared with the percentage at 6 h. This decline was greater in samples incubated with FF (from 39 to 19.8%) than in samples incubated with the mixture (from 35.5 to 23.6%). Samples incubated in CM only showed a small decrease from 30.5 to 28.4%, while in the control group this percentage decreased from 6.3 to 2.3%. In conclusion, incubation of sperm in suitable media favorably influences the acrosome reaction, inducing an increase in the percentage of live acrosome-reacted sperm.(ABSTRACT TRUNCATED AT 250 WORDS)
Azoospermia: clinical, hormonal, and biochemical investigation.
The aim of this study was to evaluate the clinical, hormonal and biochemical characteristics of infertile men with azoospermia. A total of 187 azoospermic out of 2610 infertile men (7.2%) were studied. Mean testicular volume and basal plasma levels of FSH were the most useful parameters concerning the evaluation of azoospermia. Basal plasma levels of LH and T were useful only in azoospermic men with hypogonadism, whereas plasma PRL levels, semen volume, and seminal plasma fructose levels were not found to be of common use except in selected cases.