Stress spikes of hyperprolactinaemia and infertility

Using couples with unexplained infertility as clinical models,a sub-group of approximately one-third separate out with highstress profile scores and intermittent mild elevations of pro-lactin‘spikers’. Pregnancy rates in such women when treatedwith a combination of clomiphene citrate and bromocriptine arefound to be significantly more successful than placebo.     

Assessment of sperm function for IVF

Recent advances in our ability to understand and manipulatethe fundamental mechanisms regulating human sperm function haveled to the development of a new generation of diagnostic techniques,designed to give objective data on the functional competenceof human spermatozoa. These techniques have proved to be ofvalue in predicting the ability of patients' spermatozoa tofertilize the human ovum in vitro and in the evaluation of techniquesand reagents of relevance to the therapeutic application ofIVF, including sperm preparation protocols and reagents forthe artificial enhancement of sperm function. Moreover the useof sperm function tests has shed light on the biochemical natureof the lesions pre sent in the spermatozoa of subfertile males,with particular emphasis on the role played by reactive oxygenspecies. As a result of such studies we are now in a positionto adopt a more rational approach to the development of modifiedIVF protocols for the treatment of male infertility.     

Cervical surgery in infertility

We wish to stress three original techniques among the numerousoperations which can be performed on the uterine cervix forthe treatment of infertility. The first treatment is for cervicaldysplasia of the cervix, a conization performed by electrosurgeryunder local anaesthesia, using a metallic handle of 23 mm, associatedwith vaporization by a CO2 laser at the edges of the resection.This technique, used for 125 patients, has permitted adequateresection. The rate of incomplete resection is > 10%. Thismethod has preserved the possibility of pregnancies withoutabortion. The second technique is the surgical repair of a largepost obstetrical split of the cervix by an abdominal exposure.After dissection of the bladder, the vagina is opened longitudinally,the cervix exposed and repaired carefully. Four patients whohad previously had four to six abortions between 4 and 6 monthsof gestation, succeeded in achieving a full term pregnancy bythis technique. The third technique is the resection of theisthmic septum by microscissors or microelectrocautery underlocal or general anaesthesia by hysteroscopy. Twelve cases,five with primary infertility, seven with second infertilityand habitual abortions, were operated on by this technique in1986-87. Four pregnancies have resulted.     

Histopathological diagnosis of hypercurved seminiferous tubules

A simple method for the recognition of hypercurvature of the seminiferous tubules in otherwise normal biopsies from infertile males consists of the recognition of characteristic 'figure 8' profiles of sectioned seminiferous tubules. Nineteen cases of morphometrically verified hypercurvature and 24 controls were tested in order to determine the validity of the method, which showed virtually no overlap in the two groups when at least four x 100 fields were assessed for 'figure 8' and grazing profiles. A recommended diagnostic approach, with cautions concerning pitfalls, is presented, and incidence, pathogenesis, and potential treatment are briefly discussed.     

Persistent Erection (Priapism) for Months with Concomitant Infertility in Rats due to Protein-Energy-Malnutrition

Monatelange Erektion (Priapismus) mit konsekutiver Infertitität bei Ratten als Folge von Protein-Energie-Mangelernährung
Wachsende, männüche Sprague Dawley Ratten wurden 22 Wochen lang mit einer halbsynthetischen, 9% Rohprotein enthaltenden Diät gefüttert, wobei Kasein (Kontrollgruppe; I) oder Weizenbrotkruste (Gruppe II) die alleinigen Proteinquellen darstellten. Das Kontrollfutter in reduzierter Menge, in Anlehnung an den Futterverzehr der Krusten-Ratten, wurde einem dritten Kollektiv verfüttert (pair-fed-Gruppe; III). Nach 6 Versuchswochen zeigten sich in den Gruppen II und III erste pathomorphologische Genitalveränderungen, die sich in einer monatelangen Erektion manifestierten. Bei 97% der Krusten-Ratten, 67% der isoenergetisch gefütterten Kasein-Ratten, jedoch bei keinem Kontrolltier entwickelte sich am Ende des Beobachtungszeitraums eine Dauererektion. Nach der 15. Versuchswoche erzielten die pair-fed-Ratten 17%, die Krusten-Ratten nur 5% des Gewichtszuwachses der Kasein-Kontrollgruppe. Im Reproduktionstest mit gesunden weibl. SD-Ratten erwies sich nur 1 von 6 Krusten-Ratten als zeugungsfähig, nach anschließender 5wöchiger ad lib. Kasein-Wiederauffütterung konnte eine 83% Fertilität beobachtet werden. Der Pathomechanismus der nutritiv induzierten Dauererektion wird auf die ausgeprägte marastische Stoffwechsellage zurückgeführt, bedarf jedoch weiterer Aufklärung.     

Special Antigens on Sperm From Autoimmune Infertile Men

ABSTRACT: Sera from three fertile men and four infertile men without sperm antibodies, 17 infertile men with sperm antibodies in serum and seminal plasma (S.P.), and 25 infertile men with sperm antibodies in S.P. were tested by Western Blot analysis against sperm membrane extracts and S.P. from fertile nonautoimmune men and infertile autoimmune men. Sera from fertile men reacted against common antigens with molecular weights (MW) of 28, 38, 48, 60, and 68 kD present on sperm from autoimmune and nonautoimmune men and special antigen of MW 76 kD on the sperm of fertile men. Sera from 15 of 17 (88%) autoimmune infertile men with sperm antibodies in serum and S.P. detected special antigens with MW of 58 kD (sera reactivity in 47% of these men), 43kD (in 29%), 30 kD (in 24%), 35 kD (in 18%), 52 kD (in 12%), 41 kD (in 6%), and 71 kD (in 6%) on the sperm of autoimmune men in addition to the common antigens. Sera from 15 of 25 (60%) men with sperm antibodies in their S.P. showed reactivity to special antigens with MW 52 kD (in 20%), 35 kD (in 16%), 41 kD (in 16%), 58 kD (in 8%), 70/71 kD (in 8%), 30 kD (in 8%), and 56 kD (in 4%). Sera from 18 of 42 (43%) infertile men with sperm antibodies also detected special antigens of MW 26, 46, and 76 kD present only in fertile men's sperm. Sera from only 15 of 42 (36%) autoimmune infertile men reacted against special antigens with MW 17, 20, 23, 30, 43, and 58 kD in the seminal plasma of autoimmune infertile men. Cross-absorption studies using sera from autoimmune infertile men further supported the presence of unique antigens on their sperm. It is proposed that the special antigens present on the sperm from infertile autoimmune men may be responsible for the enhanced humoral and cell-mediated immune responses observed in these men.     

Factors influencing the success of microsurgery for distal tubal occlusion

Summary Ninety-three infertile women with distal tubal occulsion were subjected to salpingostomy in 1982–1984. In 78 of them follow-up data were available for 2–5 years. Second look laparoscopy was performed in 47 patients at a median of 4 months postoperatively. It showed one or both tubes patent in 45 (96%). In the total series of 93 patients, 13% had live births, 7.5% spontaneous abortions, and 13% ectopic pregnancies. Severe adnexal adhesions and the extent of fimbrial damage found at operation or at second look laparoscopy were the most significant factors related to the poor outcome of microsurgery. Our experience suggests that cases with severe adhesions and poor tubal status should be primarily directed to in vitro fertilization program rather than to microsurgery.     

Trial of High-dose Testosterone Undecanoate in Treatment of Male Infertility

The effectiveness of high-dose testosterone undecanoate administered orally in suppressing spermatogenesis and eliciting the rebound-phenomenon was investigated in an uncontrolled clinical trial. Five men with fertility disturbances were treated for 10–12 weeks with 3 times 80 mg testosterone undecanoate daily. One patient achieved azoospermia and 2 oligospermia below 10 mill/ml, 1 suppressed to 27 mill/ml and 1 patient showed no effect. After cessation of treatment, 3 patients showed an increase in sperm concentration to greater than 50% of control values, one showed an increase of 35% and one showed a decrease in sperm count. The preliminary data suggest that although complete suppression of spermatogenesis is not uniformly achieved, a controlled study on the effects of high doses of testosterone undecanoate in male infertility may now be warranted.     

Pregnancy: Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: >5000 cycles at one centre

Cumulative pregnancy rates and pregnancy outcome analysis areuseful methods for advising an infertile couple of the probabilityof in-vitro fertilization (IVF) success. All 5209 IVF cyclesin 2391 couples at University Hospital, London, Ontario, Canada,over 10 years were studied. Cumulative pregnancy rates wereestimated using life table analysis. The Cox proportional hazardsmodel was used to estimate the influence of covariates. Oocyteretrieval and embryo transfer were achieved in 84 and 64% ofcycles initiated respectively. There were 644 intra-uterineand 24 ectopic pregnancies (13%/cycle initiated, 15%/oocyteretrieval and 20%/embryo transfer). Cumulative pregnancy ratesfollowing six cycles were: tubal 55%, idiopathic 65%, endometriosis60%, multifactorial 63% and male 40%. There were 68 spontaneousabortions (10.6%) and three induced abortions for congenitalanomalies. The multiple gestation rate was 22%. Caesarean sectionand preterm delivery rates were 35 and 20% respectively, duein part to the high proportion of multiple gestations. Of 15deliveries which resulted in stillbirths and/or neonatal deaths,12 were multiple gestations; 18 pregnancies (3.3%) were complicatedby congenital malformations. No increases in congenital malformationsor spontaneous abortions were identified. Cumulative pregnancyrates were lower in cases of male infertility. Success ratesdid not decline with successive IVF cycles. IVF is an evolvinginfertility treatment.