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PID is the major cause of tuboperitoneal infertility. Management of tuboperitoneal infertility associate surgery and IVF the choice between these two technique is depending of the stade of the tubes evaluated by HSG, salpingoscopy and laparoscopy.
Disorders of thyroid function may cause infertility in women. Substitution with thyroxine will facilitate conception not only in women with manifest hypothyroidism, but also in patients with subclinical hypothyroidism. Thus, any screening program in female infertility should include a TRH-test.
According to different Authors, varicocele incidence in unselected population fluctuates from 8 to 22% but in selected population affected by sterility incidence ranges from 21 to 39%. However other Authors have demonstrated that about 50% of patients suffering from varicocele have semen alterations. Various mechanisms have been suggested for testicular dysfunction associated with varicocele: intrascrotal hyperthermia, reflux of renal and adrenal metabolites from the renal vein and hypoxia. The most important semen alterations are observed in patients suffering from grade 2 and 3 varicocele and especially these patients must undergo surgical operation. According to recent findings, better results about the improvement of semen quality are obtained by operating children in puberal age. This clinical approach allows a prevention of testicular hypotrophy or, when this is already present, its reversibility. Varicocele surgical treatment makes use of traditional techniques microsurgical or not and mininvasive techniques. After renouncing of intrascrotal varicocelectomy, traditional techniques provide ligature and section of ectasic spermatic veins, after a surgical high (at level of the internal inguinal ring) or low (over inguinal canal) skin incision. Microsurgery allows recognition and protection of lymphatic and arterial vessels and execution of microsurgical anastomosis between venous spermatic and ileo-femoral circle vessels, when this is necessary. Internal spermatic vessels and vas deferens can be visualized through the laparoscope and so laparoscopic varicocele treatment was suggested. These new techniques and traditional operation are burdened with the same percentage of relapses but in laparoscopic procedure complications are more important. Recently radiographic occlusion techniques are also utilized (internal spermatic vein retrograde scleroembolization); the percentage of relapses is between 4 and 11%, with no risk of postvaricocelectomy hydrocele but with risk of loss of kidney (migration of the ballon or coil into the renal vein). Surgical treatment of varicocele produces a significant improvement in semen analysis in 60 to 80 per cent of patients affected by testicular dysfunction. Pregnancy rates after varicocelectomy are including from 20 to 60 per cent with most series averaging about 35 per cent.
Two cases are reported of infertile women who developed cold-induced digital vasospasm (Raynaud's phenomenon) on low-dose Parlodel (5.0 to 7.5 mg/day). The cases are reported to alert clinicians to the potential relationship between Raynaud's phenomenon and low-dose Parlodel usage in women using the drug for hyperprolactinemic or infertility indications.
OBJECTIVE: To evaluate the outcome of IVF in patients with stages III and IV endometriosis. DESIGN: Retrospective study. SETTING: The Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel. PATIENT(S): Fifty-eight patients with stages III and IV endometriosis and 60 patients with tubal infertility. INTERVENTION(S): IVF-ET for all couples. MAIN OUTCOME MEASURE(S): Fertilization, pregnancy, and birth rates. RESULT(S): The comparison between patients with endometriosis and those with tubal infertility indicated that the former had a poor IVF outcome in terms of reduced fertilization rate (40% vs. 70%), reduced pregnancy rate per cycle (10.6% vs. 22.4%), and reduced birth rate per cycle (6.7% vs. 16.6%). The differences were statistically significant. CONCLUSION(S): The results show an unfavorable outcome of IVF-ET in patients with endometriosis when compared with those who have tubal infertility.
The gene for estrogen receptor-alpha (ERalpha) was disrupted in embryonic stem cells by homologous recombination and these cells were used to generate mice with a targeted mutation in the ERalpha gene (alphaERKO mice). It was found that males homozygous for the mutation are infertile, indicating that estrogen signaling through this nuclear hormone receptor is required for male reproductive function. Although spermatogenesis appears normal in juvenile and young adult alphaERKO mice, the sperm produced are unable to fertilize eggs in vitro. To determine whether ERalpha is required by somatic or germ cells in the male reproductive tract, we transplanted germ cells from homozygous mutant (ERalpha(-/-)) males to the testes of wild-type (ERalpha(+/+)) males depleted of germ cells by busulfan treatment. The recipients ('surrogate fathers') sired offspring heterozygous for the mutation (ERalpha(+/-)) and carrying the coat-color marker of the infertile donor males. This indicated that ERalpha(-/-) germ cells are able to produce sperm competent to fertilize when they are supported by ERalpha(+/+) somatic cells. When ERalpha(+/-) offspring produced by germ cell transplantation were mated to produce ERalpha(-/-) males, these mice were found to have the same phenotype as originally reported for alphaERKO males. These studies showed that male germ cells do not require ERalpha for regulation of their own genes for development and function, and strongly imply that somatic cells of the male reproductive tract require ERalpha to support the production of sperm that are capable of fertilization.
In vitro fertilization in the natural or spontaneous reproductive cycle was first described by Edwards and his colleagues in 1980 following the birth of their first natural cycle IVF baby 2 years earlier. Many groups attempted to follow their lead but it was almost ten years later that the next publication of success appeared (Foulot et al, 1989). The concept of IVF in the natural cycle is particularly attractive and so in 1987 our group also started evaluating the technique. Initial success in the patients with tubal lesions was not translated to patients with other infertility indications. Unfortunately the technique as initially developed was relatively inefficient with significant procedural losses at each stage. Over the succeeding four years a number of changes have been introduced and the efficiency considerably improved. Although these changes have improved take-home baby rates, overall pregnancy rates per embryo have not altered and are still lower than spontaneous in vivo pregnancy rates. It is likely that in the future, with current developments in culture techniques and greater understanding of gamete biology, this situation will change significantly.
The object of this study was to evaluate the efficacy of the newly developed cervical clamp double nut bivalve (DNB) speculum used for Fallopian tube sperm perfusion (FSP) with 4 ml of the inseminate, in comparison with standard intrauterine insemination (IUI) using a volume of 0.5 ml of the inseminate. Couples with unexplained infertility (n = 104), undergoing 202 cycles, were enrolled in this study. Cycles were assigned randomly to either IUI (group A, n = 92) or FSP + DNB speculum (group B, n = 110). Ovarian stimulation was achieved using three different ovarian stimulation protocols in both groups. The age and follicular development of the patients were similar in both groups. The serum hormonal measurements and the endometrial thickness was also similar on the day of human chorionic gonadotrophin (HCG) administration. The mean (+/-SD) number of motile spermatozoa inseminated was 44.83 +/- 16.57 x 10(6) in group A and 42.68 +/- 13.44 x 10(6) in group B. In group A (IUI). 11 clinical pregnancies (presence of gestational sac with heart beats) occurred (11.95% per cycle). In group B (FSP + DNB speculum) 29 clinical pregnancies occurred (26.36% per cycle). These differences were statistically significant (P < 0.001). The results of this study for the treatment of unexplained infertility indicate that this simple, well tolerated, inexpensive method of using the DNB speculum for FSP is more successful than standard IUI.
Seasonal variation has been found in various reproductive outcomes. As known causes for reducing the rate of success of in-vitro fertilization (IVF) cannot explain all the variation in IVF results, we studied whether the season had any additional explanatory power. The study population consisted of 1126 women who were treated for the first time with IVF at the University Hospital in Nijmegen, The Netherlands, between 1987 and 1993. Only first IVF cycles were analysed. After adjusting for confounding by the age of the woman, type of infertility, indication for IVF and year of aspiration, some seasonal variation was observed in the fertilization rate, embryo quality, pregnancy rate and birth rate.
The fact that male estrogen receptor alpha (ERalpha) knockout mice are infertile indicates a role for this receptor in male reproduction. Here, objectives were to evaluate ERalpha expression in male goat reproductive tissues at the transcriptional level using RNase protection assay (RPA) and in situ hybridization (ISH), and to clone a partial cDNA for caprine ERalpha using reverse transcription-polymerase chain reaction (RT-PCR). For RPA and ISH procedures, a radiolabeled antisense cRNA probe, generated in vitro from the ovine oER8 cDNA template, was employed. Evaluations were made on individual samples obtained from adult goats. Labeled cRNA sense probe was used as a negative control in ISH. A 530-base pair amplicon was generated by RT-PCR from efferent ductules (EDs), epididymis (EP), and testis, cloned from the ED and EP, and sequenced. The caprine ERalpha (cERalpha) cDNA displayed 81%-96% sequence identity with that of other species. A signal indicative of ERalpha mRNA was identified by both RT-PCR and RPA in all tissues, but was strongest in the ED. Compared with ED, ERalpha signal was sixfold lower in the EP, and 66-fold lower in the testis. Similarly, strong ERalpha expression was observed in ED epithelium, whereas little or no signal was detected in EP or testis by ISH. Thus, among different segments of the male reproductive tract and testis, the highest level of ERalpha mRNA expression was found in epithelium of the ED.
The reproductive system of male mice homozygous for a mutation in the estrogen receptor (ER) gene (ER knock-out; ERKO) appears normal at the anatomical level. However, these males are infertile, indicating an essential role for ER-mediated processes in the regulation of male reproduction. Adult ERKO male mice have significantly fewer epididymal sperm than heterozygous or wild-type males. Although spermatogenesis is occurring in some seminiferous tubules of 3- to 5-month-old ERKO males, other tubules either have a dilated lumen and a disorganized seminiferous epithelium with few spermatogenic cells or lack a lumen and contain mainly Sertoli cells. There are no obvious differences in seminiferous tubules at 10 days of age between wild-type and ERKO mice, but the lumen in ERKO males is dilated in all seminiferous tubules by 20 days. However, spermatogenesis progresses and similar numbers of sperm are present in the cauda epididymis of ERKO and wild-type males until 10 weeks of age. Disruption of spermatogenesis and degeneration of the seminiferous tubules become apparent after 10 weeks in the caudal pole of the testis and progresses in a wave to the cranial pole by 6 months. However, the seminal vesicles, coagulating glands, prostate, and epididymis do not appear to be altered morphologically in ERKO mice. Serum testosterone levels are somewhat elevated, but LH and FSH levels are not significantly different from those in wild-type males. Sperm from 8- to 16-week-old mice have reduced motility and are ineffective at fertilizing eggs in vitro. In addition, ERKO males housed overnight with hormone-primed wild-type females produce significantly fewer copulatory plugs than do heterozygous or wild-type males. These results suggest that estrogen action is required for fertility in male mice and that the mutation of the ER in ERKO males leads to reduced mating frequency, low sperm numbers, and defective sperm function.
A highly sensitive and specific two-site immunoradiometric assay (IRMA) for hCG has been developed and applied to the detection of the hormone in the urine of normal nonpregnant and pregnant individuals. The IRMA uses a solid phase coupled monoclonal antibody to the hCG beta-subunit for extraction of hormone from urine. The hCG extracted is then directly quantified by the binding of an affinity purified and radiolabeled rabbit antibody that reacts with the unique COOH-terminal peptide region of the hCG beta-subunit. The assay is capable of reliably and accurately measuring as little as 0.01 ng hCG/ml urine without interference from hLH. Assays of urine from normal men and nonpregnant women of reproductive age indicated that most individuals did not have detectable levels of hCG immunoreactivity, although a minority had minute amounts, with a mean value of approximately 0.01 ng hCG/mg creatinine. In contrast, all normal menopausal women studied had easily detectable levels of hCG immunoreactivity in their urine, with a mean value of 0.123 ng hCG/mg creatinine. A study of the excretion of hCG from three men injected with hormone for treatment of infertility indicated that after the first 24 h, hCG was cleared with a single exponential rate and was detectable to a level of 0.01 ng/ml. Application of the IRMA to measurements of hCG in the urine of two artificially inseminated patients indicated that the method was capable of detecting pregnancy as early as 9 days postovulation. The extreme sensitivity and specificity of the IRMA for urinary hCG in conjunction with the simplicity of assay performance and specimen collection should provide a substantial advantage over currently available methods for detection of early pregnancy and tumor monitoring.
BACKGROUND: To compare the outcome of in vitro fertilization/embryo transfer (IVF-ET) in unexplained infertility and infertility associated with minimal peritoneal endometriosis. METHODS: A retrospective analysis comparing results of stimulation, sperm characteristics, cleavage, implantation and pregnancy rates in patients with unexplained infertility and peritoneal endometriosis associated infertility. Couples with tubal infertility constituted a control group. RESULTS: In the unexplained infertility and endometriosis groups similar response to stimulation, similar sperm characteristics and cleavage rates were observed. Compared with tubal infertility lower sperm motility was seen in the unexplained infertility group. Both non tubal infertility groups had lower cleavage rate than was seen in the control group. No differences in pregnancy rate were observed, but a significantly higher implantation rate was seen in unexplained infertility compared with tubal infertility. CONCLUSIONS: Couples with unexplained infertility and infertility associated with minimal peritoneal endometriosis have similar outcomes in an IVF-ET set up. Significantly lower cleavage rates in these groups compared with tubal infertility indicate gamete defects as possible causes of infertility.
The cervicovaginal and endometrial isolation rates of Ureaplasma urealyticum and Mycoplasma hominis and relevant demographic data were obtained at the time of laparoscopy in 193 women from infertile marriage. For comparative purposes, fertile women undergoing laparoscopy for tubal ligation (n = 56) or other purposes (n = 64) were also cultured. Blacks were more likely than caucasians to be infected with either organism in all population types (p less than or equal to .05); however, no differences were noted in cervicovaginal carriage rates for blacks in different patient populations. M. hominis was isolated more frequently from tubal reanastomosis patients and less often from infertile patients, p less than or equal to .001. No differences were noted among the infertile subpopulations. Although the isolation rate of U. urealyticum from the different patient populations was similar, one subpopulation within the infertile population (male factor) was identified in which the prevalence of ureaplasmal infection of the female's lower genital tract was over twice as high (p less than or equal to .005) as in other infertile women. Yet there were no statistically significant differences in the demographic data of this subpopulation as compared to the population of infertile women as a whole. No other clinical subpopulation with single or multiple diagnoses not including male factor had an increased prevalence of infection. Eighty percent of infected, infertile couples had no clinical evidence of male factor infertility, indicating that only certain individuals are affected. This possibly explains why previous studies involving small numbers of patients without regard to clinical subpopulations have failed to show significant differences between infected and uninfected couples.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: To investigate the pregnancy rate of frozen-thawed human supernumerary multicellular embryos that were cryopreserved after intracytoplasmic sperm injection or IVF. DESIGN: A clinical study. SETTING: Consenting patients in an academic research environment. PATIENTS: Couples with severe male infertility, indicated by failed or sporadic fertilization after IVF or subzonal insemination or by < 500,000 progressively motile spermatozoa in the entire ejaculate, and couples for IVF during the same period. INTERVENTIONS: After microinjection or IVF, the three best-quality embryos were transferred, and 1,171 embryos from intracytoplasmic sperm injection compared with 2,495 embryos from IVF were frozen with dimethyl sulphoxide. Of these, 413 and 969 embryos were thawed, respectively. MAIN OUTCOME MEASURE: The survival rate, the total and clinical pregnancy rates, the delivery rate, and the preclinical abortion rate were calculated. RESULTS: Fifty-three percent of the thawed intracytoplasmic sperm injection embryos survived. Twenty-two pregnancies have been established in 101 transfers, corresponding to a total pregnancy rate of 21.8% per transfer. The clinical pregnancy rate was 12.9% per transfer and the delivery rate was 5.9% per transfer. Of the IVF embryos, 51% survived and 37 pregnancies have been established in 253 transfers. The total and clinical pregnancy rates and the delivery rate were 14.6%, 10.7%, and 7.1%, respectively. The preclinical abortion rate was 40.9% for cryopreserved intracytoplasmic sperm injection embryos and 27.0% for IVF embryos. CONCLUSIONS: The high incidence of preclinical abortions after transfer of human embryos cryopreserved after intracytoplasmic sperm injection requires extension of the series.
The techniques of partial zona dissection, subzonal sperm insertion, and intracytoplasmic sperm injection have been clinically employed to alleviate aberrations of human gamete interaction. This article reviews the current status of assisted fertilization technology and its relevance in treating male infertility. Indications for the application of each technique and factors affecting outcome are discussed.
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