Biomedical subjects
Publications and source records attributed to L E Karp.
We report on 2 cases of fetal congenital diaphragmatic defects with normal chromosomes among 105 patients referred for evaluation for low maternal serum alpha-fetoprotein (MSAFP) levels. The mechanism for this striking association is not clear. The association of low MSAFP levels and congenital diaphragmatic defects may have importance for MSAFP screening programs.
The biophysical profile assesses fetal well-being by evaluating five variables: fetal heart rate reactivity, breathing movements, gross body movements, muscular tone and qualitative amniotic fluid volume. These are estimated through nonstress test monitoring and fetal ultrasound. The biophysical profile reduces the high false-positive rate that is characteristic of single-parameter testing methods, and it can be helpful in monitoring high-risk pregnancies.
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Because most men with prenatal exposure to diethylstilbestrol (DES) are still young and have not attempted to father children, its reproductive effects are uncertain. In a previous pilot study, we had noted an association between in utero DES exposure and reduced penetration of zona-free hamster eggs by sperm. To test these findings in a controlled manner, we performed physical examinations on 51 men with in utero DES exposure and 29 unexposed men and evaluated the penetration of zona-free hamster eggs by their sperm. Epididymal cysts or abnormalities of the prostate, testicle, or penile meatus were present in 37% of men with in utero DES exposure, versus 4% of nonexposed men (P less than 0.001). The mean proportions of penetrated eggs were 25% after in utero DES exposure and 29% in the nonexposed group (P greater than 0.57). The genital abnormalities related to DES exposure were not related to reduced egg penetration. We conclude that in utero exposure to DES is not related to a significant change in the penetration of zona-free hamster eggs by sperm.
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We report on the incidence of Rh isoimmunization after genetic amniocentesis at our institution. In 115 Rh negative women who underwent amniocentesis and subsequently delivered Rh positive infants, there were 4 (3.4%) sensitizations before birth. This was significantly greater than the 1.5% rate of gestational sensitization found in pooled populations of women who did not undergo amniocentesis. We also noted a significant increase in the number of sensitizations that occurred before 28 weeks. The results were consistent with those of previous studies of this issue, and are discussed in relation to current policies for managing Rh negative women who have second trimester amniocentesis.
Human spermatozoa were separated according to their motility by centrifuging semen on discontinuous Percoll gradients. Fractions of the gradients were examined for sperm motility, velocity, viability, morphology, bacteria, and sperm function using the hamster ova sperm penetration assay. The percentage of motile sperm increased from 40% to 60% motile sperm in 60% Percoll to 90% to 100% Percoll. Sperm velocity increased proportionately. Staining showed that greater than 90% of sperm in the 100% Percoll were alive and had normal morphology, and that only sperm cells were found in Percoll concentrations greater than 80%. Sperm isolated in the 80% to 100% Percoll fractions penetrated hamster ova much more frequently than sperm found in the 60% to 70% fractions or than sperm that had not been separated on a Percoll gradient.
The males of 310 infertile couples and 30 control couples (current pregnancy) were evaluated with the sperm (hamster ova) penetration assay (SPA) and seminal fluid analysis (SFA). The SPA was found to have a sensitivity of 100% and a specificity of 97% compared to 41% and 90%, respectively, for the SFA. The highest degree of concordance of the two tests existed when both tests were abnormal and no female factor was identified. The poorest concordance occurred when the SFA was normal and no female infertility factor was identified. In almost all cases of unexplained infertility where no female infertility factor was present, the problem could be assigned to the man, as evidenced by an abnormal SPA. The SFA seemed to have some predictive value with respect to the outcome following treatment of the man.
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