An ovum capture inhibitor (OCI) in endometriosis peritoneal fluid: an OCI-related membrane responsible for fimbrial failure of ovum capture

The present study was conducted to assess the mechanism of in vitro interference with fimbrial ovum capture by the ovum capture inhibitor (OCI) which we have recently demonstrated in endometriosis peritoneal fluid (PF). A golden hamster oviduct exposed to either endometriosis or nonendometriosis PF for 20 minutes at 37 degrees C was examined by scanning electron microscopy. Exposure of the oviduct to endometriosis PF reduced fimbrial activity of ovum capture and developed an OCI-related membrane on the fimbria, by which fimbrial cilia were completely concealed. This was not the case for nonendometriosis PF. Subsequently, an oviduct having been exposed to endometriosis PF was retrogradely flushed, by which the OCI-related membrane was ballooned and removed. The flushed oviduct resumed its activity of ovum capture. The OCI-related membrane appeared a cause of OCI interference with fimbrial ovum capture by preventing the contact between the fimbrial cilia and the cumulus oophorus.     

Psychological aspects of perinatal loss

PURPOSE OF REVIEW: Parents are attached to their unborn children, and loss around the time of birth is a serious trauma. Parental grief is a normal response, and may last for many months. Clinicians have always sought to implement practices that will help recovery, and for a generation, have advocated that parents have contact with the body of their dead infant, believing that this will facilitate mourning. Review of the literature shows that no previous systematic evidence has ever been offered to support this practice. RECENT FINDINGS: Recent research throws doubt on the therapeutic value of the practice of encouraging contact with the dead infant. These findings are outlined and discussed. SUMMARY: Following an outline of what is already known about the psychological effects of perinatal loss, the paper focuses on the evidence that aspects of psychosocial management are associated with better outcomes. It goes on to describe the cultural context in which psychosocial management changed and parents were first encouraged to see and handle their dead infant, and explores the distinction between the medical and cultural models which may frame this behaviour in very different ways. Finally, it briefly discusses the ethical position of staff who advise parents about their choice to see or not see their infant's body.     

Ovum donation: Ethical and legal aspects

The newer technologies of assisted reproduction offer the infertile couple a wide spectrum of choices according to their specific problem. A relatively newer technique is that of ovum donation, whose technology is now well established. However, as with other newer technologies, it has given rise to new dimensions of ethical and legal issues which have to date not been fully appraised. It is very difficult to find a legal consensus under international umbrella to the specific issues involved in ovum donation. This is due to the different cultural, religious, and time influence atmosphere prevailing in the various parts of the world. Each society should develop its own statutes on ovum donation. A frame of ethical guidelines should be established by international organizations that may help each society issue its own regulations.     

The fimbrio-ovarian relation and its role on ovum picking in unexplained infertility: the fimbrio-ovarian accessibility tests

OBJECTIVE: To study the ovum pickup mechanism and the fimbrio-ovarian relation in fertile women and cases of unexplained infertility and to design a method for investigation and anticipation of the state of ovum pickup. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and gynecology Kasr El Aini Hospital, Cairo University, Egypt. PATIENTS: Fifty fertile and 25 cases of unexplained infertility. INTERVENTIONS: In all of cases the fimbrio-ovarian relation is studied by determining the length of the free ovarian border between the ovarian ligament and the fimbria ovarica that contains the corpus luteum (the ovulation border), the site of ovulation on that border and the length of the fimbria ovarica. It is also determined by a simple test "The fimbrio-ovarian accessibility test." The fimbriae are held by non-traumatizing grasper and their ability to reach and/or to cover the ovulation site are taken as a prove for successful ovum pickup. In addition, cases having suspected failed ovum picking are treated by controlled superovulation, also by drilling of the ovary at an accessible site to the fimbria ovarica and by freeing short fimbria ovarica with or without its advancement on the ovulation border. RESULTS: The ovulation site is found to be usually accessible to the fimbrial end of the tube (94%) in the fertile cases and not accessible (92%) in the infertile cases. Correction of the fimbrio-ovarian relation in the infertile cases was associated with a cumulative ongoing pregnancy rate of 68%. CONCLUSION: Failed ovum pickup should be considered one of the important causes of unexplained infertility. The suggested "fimbrio-ovarian accessibility" test may be useful for the elucidation of the state of ovum pickup in infertile cases. Correction of the fimbrio-ovarian relation, to make ovum pickup possible, should be considered a method for treating such cases.     

Families created through ovum donation: A preliminary investigation of obstetrical outcome and psychosocial adjustment

Purpose This study attempted to obtain preliminary followup information regarding obstetrical outcomes and the psychosocial well-being of families created through ovum donation. There is presently very little known about this population with respect to obstetrical care, health status of offspring, family and marital relationships of recipient couples, or how couples feel about having chosen ovum donation as a family-building option.Results Fifty-nine couples were initially surveyed and, ultimately, extensive information was obtained for 30 husbands, 31 wives, and 51 offspring. There was a very high percentage of cesarean section deliveries (81.6%), and although a few children experienced health problems at birth, they are all now in good health and developmental milestones are within normal limits. Information was also obtained about breast-feeding experiences, choice of donor (known) [sister] or anonymous), reasons for choosing ovum donation over other parenting options, and the impact of this choice on marital and family relationships. Demographic data were also obtained.Conclusions For many infertile couples, the long struggle to become parents culminated in a successful birth, and the experience of pregnancy seemed to meet a need to be both biological and psychosocial parents. In general, subjects were extremely cooperative with the investigation and they indicated a desire to learn as much as possible about the psychosocial status of families created through ovum donation. As the assisted reproductive technologies move rapidly into the 21st century, it now seems imperative that health and mental health professionals gain more knowledge about the impact of third party reproduction and the psychosocial adjustment and well-being of families created by this medical technology.Presented at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, April 3–7, 1995, Vienna, Austria.     

Hormonal considerations in early normal pregnancy and blighted ovum syndrome.

The hormonal profiles of six pregnancies which terminated in miscarriage with the blighted ovum syndrome have been studied and compared with those of a group of patients similarly studied who had clinically normal pregnancies terminating in live birth at term. The serum chorionic gonadotropin (HCG) values were below normal or at the lowest limit of normal in five of six patients. Three patients had progesterone values within 1 SD of the normal, with normal serum estradiol values. It was concluded that the hormonal profile of early pregnancy is characterized by rising serum HCG and estradiol levels and a declining serum progesterone level from the 5th to the 8th week. The theoretical explanation for the dichotomy seems to be that the fetal adrenal anlagen, even at this early embryonic stage, can produce steroid precursors which are aromatized to estradiol. The production of progesterone, however, does not seem to be possible. Abnormal serum estradiol levels strongly suggest the absence of fetal development and a blighted ovum. However, no single hormonal level will distinguish between blighted ovum and potentially salvagable threatened abortion.     

Biochemical screening for aneuploidy in ovum donor pregnancies

OBJECTIVE: The purpose of this study was to compare the screening efficacy for aneuploidy detection in ovum donor pregnancies with the use of either the age of the ovum donor or the ovum recipient. STUDY DESIGN: Second-trimester biochemical screening for aneuploidy with alpha-fetoprotein, unconjugated estriol, and human chorionic gonadotropin was performed on maternal serum samples that were submitted prospectively from singleton ovum donor pregnancies. The calculation of aneuploidy risks were performed separately with the age of the ovum donor or the ovum recipient. Risks of >1 in 295 and >1 in 100 were used as cutoff values for the identification of screen-positive pregnancies for Down syndrome and trisomy 18, respectively. RESULTS: Samples from 93 ovum donor pregnancies were identified. The mean ages of the ovum donors and recipients were 27 years (range 20-38.5 years) and 43.6 years (range, 25.9-54.3 years), respectively. When the age of the ovum donor was used in the determination of aneuploidy risk, there were 9 screenpositive pregnancies (9.7%), whereas the use of the age of the ovum recipient resulted in 76 screen-positive pregnancies (82%). With the use of the McNemar test for paired observations, the proportion of screenpositive pregnancies with the age of the ovum donor (9.7%) compared with the age of the ovum recipient (82%) was statistically significant (P <.0001). The odds of being affected, given a positive result, were 1 in 9 (11%) with the age of the ovum recipient and 1 in 76 (1.3%) with the age of the ovum donor. The only fetus with aneuploidy (trisomy 18) was identified as being screen positive in both the ovum donor and ovum recipient calculations. CONCLUSION: In ovum donor pregnancy aneuploidy risk calculations, the use of the age of the ovum donor instead of the ovum recipient reduces the false-positive rate and improves screening efficacy.     

Early pregnancy factor: Tissues involved in its production in the mouse

The mouse, 24 h after mating, has been used as an experimental model to determine the site of production of early pregnancy factor (EPF). Results have shown that EPF is formed as two separate components, which appear similar to component A and component B formed after dissociation of EPF by 40% ammonium sulphate. Component A is produced by the oviduct during oestrus and pregnancy. It is present in serum during oestrus in an inactive form, that is, not capable of binding with lymphocytes. Component B can be produced in culture from the ovaries of 24-h pregnant mice. Incubation experiments described in this paper show that the production of component B can also be initiated from non-pregnant mouse ovaries, during oestrus or dioestrus, in the presence of both fertilised ovum and non-pregnancy pituitary but not in the presence of fertilised ovum alone. The pituitary from a 24-h pregnant mouse alone can also stimulate the production of component B from oestrous or dioestrous mice.To summarize, component A is derived from the oviduct and is oestrus-dependent. Component B, the pregnancy-dependent component of EPF, is produced by the ovary; its production can be initiated from non-pregnancy ovaries by the fertilised ovum in cooperation with the pituitary.     

Low dose oral progestogens in human fertility control (author's transl)

Low-dose progestin only contraceptive agents seem to respect the hypothalamo-hypophyso-ovarian system, thus respecting the physiology of the menstrual cycle, and to inhibit fertility simply by interfering with estrogen action at the level of the cervical mucus. The incidence of ectopic pregnancies is apparently greater with failure of this method than with failure of regular hormonal contraception. Postcoital single-dose progestin oral contraception acts at the level of the endometrium creating conditions unfavorable to nidation, and also on the cervical mucus and on the system of transport of the ovum. Both contraceptive methods are worth new and larger investigations to discover their limits and mode of action.     

The microsperm penetration assay: development of a sperm penetration assay suitable for oligospermic males

OBJECTIVE: To develop a specialized sperm penetration assay (SPA) for the evaluation of sperm from oligospermic patients. DESIGN: The development of the assay is in four parts: determine optimal sperm number; demonstrate quality control; establish statistical limits for fertile population; compare results to in vitro fertilization (IVF) outcome. SETTING AND PATIENTS: A group of 63 patients with oligospermia and/or poor motility and a group of 17 fertile donors were compared using the optimized SPA and the micro-SPA. Sperm from a third group of 35 patients were simultaneously incubated with human ova (IVF) and hamster ova (micro-SPA). MAIN OUTCOME MEASURES: Both types of SPA scores are expressed as a sperm capacitation index (penetrations per ovum). Outcome of IVF is expressed as a percent of ova fertilized. RESULTS: Using 25,000 sperm was found to be optimal. The normal fertile range was statistically determined to have a lower limit (-2 SD) of 2.0 penetrations per ovum. When scores from 63 male factor patients were compared using the optimized SPA, only 43% had sufficient swim-up sperm. However, the micro-SPA could accurately test 100% of the samples because it requires only one tenth the number of sperm. CONCLUSION: The micro-SPA provides a valuable diagnostic test for the evaluation of the male factor patient.     

Familial gestational trophoblastic disease

Familial molar pregnancies and gestational trophoblastic disease are exceedingly rare. In this case report, a family including four sisters and their cousin had molar pregnancies. Eldest sister had repeated molar pregnancies. Second sister had early abortion at her first pregnancy and partial molar pregnancy following blighted ovum by intrauterine insemination at her second pregnancy. Third sister had two molar pregnancies in a 2-year interval. Fourth and youngest sister has had gestational trophoblastic disease stage 1, following complete molar Pregnancy at her first pregnancy. A paternal-related cousin of this family has had gestational trophoblastic disease following complete molar pregnancy at her first pregnancy. No members of this family, except eldest sister, has given birth to a child. CONCLUSION: complete and partial moles, repeated moles, gestational trophoblastic disease, early abortion, blighted ovum, and secondary infertility in this family demonstrate that a defective ovum with abnormal maternal genetic component is responsible.     

Tubal fertility]

Animal experiments with 110 female guinea pigs proved an external ovum passage in 14 per cent of cases. These results ask for the conversative character of operations on the adnexes in sexually mature females. Literature reports on several cases of external ovum passage postoperatively. We presume, however, that the phenomenon of external ovum passage also results with an anatomically and physiologically normal sexual system more often than books in out discipline normally report. The basis of this study, which has the aim to prove in an experimental investigation with guinea pigs the phenomenon of external ovum passage, represented the delivery of a patient in the department of Obstetrics and Gynecology at the University of G?ttingen, in whom precended operations of contralateral tube and ovary exstirpation.     

Ovum donation--a simplified approach

To date, ovum donation (OD) has involved luteinizing hormone (LH) synchronization between recipient and donor for normally cycling women, and a complex steroid replacement regimen given on a sequential and incremental basis for women with primary or secondary ovarian failure. The authors designed a simple hormonal regimen applicable to both normally cycling women starting early in the cycle, and to those with ovarian failure. It consists of administering 2 mg estradiol (E2) valerate orally three or four times daily, augmented with either 100 mg progesterone (P) in ethyl oleate intramuscularly daily or 100 mg oral progesterone (P) orally three times daily, starting on the day preceding the recovery of the donated oocytes. Gamete intrafallopian transfer procedure was undertaken for women with patent tubes and in vitro fertilization for those with obstructed tubes. The authors report their preliminary experience with 17 women who underwent ovum donation.     

Partial Hydatidiform Mole: Ultrasonographic Features

Four patients with partial hyatidiform mole managed at the Queen Mary Hospital, Hong Kong, are described. The diagnosis of blighted ovum or missed abortion was made on the sonographic findings prior to suction evacuation. The dominant features in these cases consisted of a relatively large central transonic area bearing the appearance of an empty gestational sac and surrounded by a thick rim of low-level placenta-like echoes; in contrast with the case of the blighted ovum, a well-defined echogenic sac wall is absent. In another 9 patients with molar pregnancy managed during the same period, the more typical 'snow-storm' vesicular appearance was present. It was concluded that the anembryonic appearance described should alert the sonologist and clinician to the possible diagnosis of partial hydatitiform mole. The evacuated material from the uterine cavity should be examined morphologically and if possible cytogenetically.     

Effect of preovulatory progesterone administration on the endometrial maturation and implantation rate after in vitro fertilization and embryo transfer

Fifty-two women, who had 62 ovum aspiration cycles, received a progesterone (P) supplementation of 100 mg/day that was initiated 10 hours before human chorionic gonadotropin (hCG) administration and was continued over the following 6 days. Forty-eight women who had 74 ovum pick-ups, but did not get P, served as controls. Forty-four (84.6%) women of the treatment group, and 40 (83.3%) of the controls had ovum fertilization and embryo replacement. The fertilization and cleavage rates and the mean number of replaced embryos per embryo transfer (ET) cycle did not differ between the groups. Endometrial biopsies, from treatment group women with no fertilized eggs, which were taken 48 hours after ovum pick-up, mostly revealed an "advanced endometrial dating," in relation to the "day of hCG." Pregnancy rate per ET cycle for the treatment group was significantly higher than that of the controls; 41.2% versus 23.3%, respectively. It is concluded that the higher pregnancy rate resulted from an improvement in uterine receptivity.     

Donation of fertilized uterine ova to infertile women

Nonsurgical recovery of a preimplantation conceptus from the uterus of a fertile donor woman with transfer to an infertile recipient woman and subsequent pregnancy has been described previously. In this report, we describe the performance of 56 nonsurgical uterine lavages, recovery of 23 ova, and transfer of 17 ova with production of 8 viable pregnancies. Four pregnancies resulted in healthy infants, two aborted, and two are progressing normally. We describe a case of a woman donating an ovum to her sister, with birth of a healthy child. We also describe a viable pregnancy resulting from nonsurgical ovum transfer to a woman with no ovaries. Donation of ova by uterine lavage is a new method of overcoming human infertility; it is nonsurgical, has a low complication rate, and may be repeated several times until it produces pregnancy.     

Endometrial response to the intrauterine device

The endometriums from 50 hysterectomy patient specimens were studied morphologically and biochemically to determine the effects of the IUD. 13 examples of endometrial histology were selected at different stages of the cycle to illustrate typical changes associated with the use of the IUD. 4 of the cases are presented as controls to illustrate differences between those patients using the IUD and those using no contraceptive divice. Histopathologic findings indicate that the IUD has the effect of altering the synchrony of the endometrial maturation so that the endometrium is out of phase with the ovum when and if it reaches the endometrial cavity. Further support of this idea is derived from studies on endometrial lipids. On the basis of the analysis of endometrial lipid patterns, it is suggested that the presence of an intrauterine contraceptive divice arrests or retards the biochemical maturation of the endometrium. An uterine environment, unfavorable to implantation, results from the failure to achieve biochemical maturation of the endometrium which is synchronous to that taking place in the ovum and in other sites of the neuroendocrine system concerned with implantation. It is concluded that the effectiveness of the IUD may be the result of interference with several factors in the reproduction process.     

The etiology of ectopic pregnancy

The cause of ectopic pregnancy is associated with two major categories: the integrity of the oviduct and the quality of the fertilized ovum. Several conditions that alter the tubal transport system include inflammatory insults, intrauterine devices, surgical manipulation, tubal ligations, salpingitis isthmica nodusa, DES exposure, and induced abortions. Risk factors that may theoretically alter ovum quality or the hormonal environment include ovulation induction, fertilization in vitro, delayed ovulation, and transperitoneal ovum migration. As we continue to investigate the fallopian tube and the fertilized ovum as unique entities, our knowledge will increase about the cause of ectopic gestations.     

Mutagenicity of vaginal spermicides containing nonoxynol-9 in a bacterial assay

OBJECTIVE: To evaluate the potential mutagenicity of 3 commonly used over-the-counter spermicidal gels containing nonoxynol-9 as the active ingredient. STUDY DESIGN: The gels were examined for their ability to produce mutations in a bacterial assay (Ames test). The results were compared with those from testing a series of nonantibacterial and antibacterial personal prwhen there is antibacterial personal products that come into contact with mucous membranes as well as some caustic, nonpersonal home products and a known mutagen. RESULTS: All 3 spermicidal gels were as mutagenic or more mutagenic than the other products tested in each category. Although activation by liver extract was required for 2 of the gels to show mutagenicity in this assay, the third was mutagenic without liver activation. CONCLUSION: Because of the intimate contact of spermicidal gels with human gametes and the possibility that components of the gels may be absorbed systemically and reach the unfertilized or fertilized ovum, the fact that these gels have mutagenic potential raises concern in cases in which conception occurs.