Assisted conception in HIV discordant couples: evaluation of semen processing techniques in reducing HIV viral load

Artificial insemination with motile spermatozoa prepared from HIV-infected men using standard procedures has been employed with many HIV-discordant couples. We have demonstrated that processing semen from HIV positive men can reduce HIV levels, measured as HIV1 RNA copies/ml using nucleic acid based sequence amplification (NASBA), to undetectable levels (less than 400 copies/ml) but not in all samples. We believe that all processed samples should be tested prior to insemination.     

Assisted reproduction and the male

Male reproductive problems are the commonest single cause of infertility and respond poorly to conventional treatment. Because of this, and because of the importance of co-existing female pathology, the techniques of assisted reproduction have acquired an important place in the management of male infertility. For many couples with a male factor, conventional in vitro fertilisation and embryo transfer will be appropriate. However, for those who fail with IVF, or whose semen is too poor (perhaps below 0.5 × 10⁶ progressive spermatozoa/ejaculate), the techniques of micro-assisted fertilisation show much promise. These include partial zona dissection (PZD), sub-zonal sperm insertion (SUZI) and intracytoplasmic sperm injection (ICSI) the latter showing much promise, with pregnancy rates in excess of 30% per cycle being reported. However, the diagnosis of ‘male-factor’ infertility remains problematic, as does the intelligent selection of couples for treatment by these techniques.     

Cerebral palsy and assisted conception

Assisted reproductive technologies have been widely used over the past 30 years, and 1% to 4% of births worldwide are products of these technologies. However, adverse health outcomes related to assisted reproductive technologies, including cerebral palsy, have been reported. We extracted and reviewed all relevant studies cited by Medline from 1996 to 2010 evaluating the role of assisted reproductive technologies as a causative factor for cerebral palsy and poor long-term neurologic outcome. The research suggests that multiple pregnancy, preterm delivery, and babies small for gestational age are factors in the development of cerebral palsy. The vanishing embryo syndrome may also play a role. We review the evidence for these potentially causative factors, as well as their implications for embryo transfer policies.     

Endometrial dating in the conception cycle.

OBJECTIVE: To investigate endometrial dating during the conception cycle. DESIGN: Endometrial biopsies of the last half of the luteal phase of conception cycles were dated based on urinary luteinizing hormone (LH) surges. SETTING: Endometrial samples were obtained from women attending the fertility clinic of the Department of Obstetrics and Gynecology at Gunma University Hospital. PATIENTS: One hundred eighty-five women, of whom 15 (8.1%) conceived during this study. MAIN OUTCOME MEASURES: Urinary LH surge, serum progesterone (P) levels, and endometrial dating. RESULTS: All 10 women who conceived showed 2 or within 2 days in-phase endometrial biopsies on days 7 to 11 after the LH surge. In 4 of 5 women biopsied on day 12, an unequivocally delay in the stroma was found, i.e., a persistence of edema and poor development of predecidual reaction. Since serum P levels in conception cycles were significantly higher than in nonconception cycles on days 10, 11, and 12, we interpreted this delay in the stroma as a consequence of conception. CONCLUSION: Endometrial specimens during the last half of the luteal phase of conception cycles are in-phase until day 12. On day 12, gestational hyperplasia causes apparent out-of-phase.     

Studies on human conception

In vitro and clinical research into the mechanisms of human conception is described. The author discusses his own work and relevant literature in the field. The points under study include the growth of follicles, the timing of ovulation, the biochemical changes in preovulatory follicles, fertilization and cell-splitting in vitro, and the endocrine control of implantation. Results of the various clinical experimentation are graphed and tabulated. It is hoped that such research will add to the accumulated knowledge of human physiology and help in the treatment of certain forms of human infertility. It was found that mild hyperfolliculation could be achieved by use of hormonal preparations to induce follicular growth and ovulation. Human menopausal gonadotropins were used to stimulate follicular growth, and human chorionic gonadotropin was used for inducing ovulation. Follicles near the time of ovulation were expected to have low levels of estrogen and high levels of PGs (prostaglandins). Assays of steroids in different follicular fluids revealed considerable variation in the levels of estrogen and progesterone. PGs obviously play an important role in preovulatory follicle biochemistry. In vitro methods for inducing fertilization and cleavage were also tried. Areas for further study are outlined.