Showing papers in "Acta Europaea fertilitatis in 1988"

Seminal tract inflammation and male infertility. Correlations between leukospermia and clinical history, prostatic cytology, conventional semen parameters, sperm viability and seminal plasma protein composition.

Abstract: A retrospective clinical evaluation of various types of semen analyses from infertile couples attending our Infertility Clinic was undertaken with the scope of studying the possible correlation between seminal inflammation and infertility. The parameters considered were leukospermia (severe, slight, constant or non-constant), clinical history (anamnestic data possibly inferring inflammation), conventional semen parameters, sperm viability (as assessed by capillary tube in vitro penetration test) and seminal plasma proteins patterns (SDS-PAGE). History data such as dysuria, urinary infection, cystitis symptoms and hematospermia were found to be significantly more frequent in infertile men with than in those without leukospermia. Leukospermia in itself did not seem to affect the conventional semen parameters such as total sperm count, motility (at 45 and 180 min) and/or morphology. The seminal volume could represent an exception to this rule. Furthermore, leukospermia did significantly affect sperm viability as evaluated by the capillary tube penetration test. Leukospermia was also significantly coupled to alterations of the seminal plasma protein composition (increase of the albumin concentration, decrease of prostatic markers and other anomalies).

Increased thrombin generation in normal pregnancy.

Abstract: The aim of this longitudinal study was to evaluate whether an increased thrombin generation takes place in normal pregnancy by determining fibronopeptide A plasma concentration in 24 women at three stages of gestation The activity of the main blood clotting inhibitors, antithrombin III and protein C, and platelet agregability were also investigated Our study showed a significant rise of fibrinopeptide A plasma levels already manifest at the first trimester Antithrombin III activity was found to slightly but significantly decrease during pregnancy, whereas protein C levels showed a moderate, significant increase A slight platelet activation was observed in the second and third trimester These findings indicate that during pregnancy a new equilibrium of blood clotting system arises, shifted to a hypercoagulable state which leads to the increased risk of thromboembolism observed in pregnancy

Pentoxifyllin treatment of oligoasthenospermic men.

Abstract: A randomised group of 90 men with idiopathic oligoasthenozoospermia was subjected to control study with pentoxifyllin. Pentoxifyllin was given to 51 men 1200 mg daily for 3 months. The other group of 39 infertile men was followed during the same period of time. Significant improvement was observed, in treated group, in percentage of motile sperms and normal shaped sperms after 3 months treatment. This study emphasizes that pentoxifyllin is a relatively good drug for restoring sperm motility and morphology in oligoasthenozoospermic men.

Influence of abstinence length on ejaculate characteristics.

Abstract: In order to study the influence of sexual abstinence on sperm concentration and semen volume, we have evaluated 195 semen samples of healthy individuals, grouped as follows according to abstinence length: A) 2-4 days; B) 5-7 days; C) more than 7 days. Differences between semen samples collected at home or at the laboratory were also studied. Semen volume was smaller in group A than in group B and C (p less than 0.01), while no significant difference was found in sperm concentration among the three groups. The place of collection did not affect semen characteristics. These results suggest that while a shorter abstinence is associated with a smaller semen volume the length of abstinence does not affect sperm concentration.

Seminal plasma fructose and glucose in normal and pathological conditions.

Abstract: A total number of ninety four semen samples were analysed which included normozoospermia (39), oligozoospermia (6), oligoasthenozoospermia (10), asthenozoospermia (15) and azoospermia (24). A positive correlation (r = 0.344) was existing between sperm count and motility in normozoospermia. Seminal plasma was estimated for fructose (94) and glucose (73). It was found that there was a statistical difference between the values of oligozoospermia and all other groups studied for fructose. A strong positive correlation (r = 0.394) was existing between percentage of motility of spermatozoa and fructose in normozoospermia showing that fructose is very essential for increased number of motile spermatozoa. Likewise a relationship (r = 0.451) was seen between sperm count and glucose in normal. This gives an impression that both these are regulated by one source.

Sodium and potassium in normal and pathological seminal plasma.

Abstract: A total number of 273 seminal plasma samples from normozoospermia (n = 91), oligozoospermia (n = 50), oligo-asthenozoospermia (n = 76), asthenozoospermia (n = 10) and azoospermia (n = 46) were analysed for sodium and potassium. A decreased sodium level was seen in pathological groups. A negative correlation was found to be in existence between sodium and potassium in seminal plasma in the groups studied except in azoospermia. Positive correlation was found between sodium and motile spermatozoa in normal and oligozoospermia. In oligo-asthenozoospermia it was negative. Potassium, was negatively correlated with percentage of motile spermatozoa in the groups studied.

Lymphocytes subset in hyperandrogenic women with polycystic ovarian disease.

Abstract: The correlation between the sex steroids and the immune system is already known but the relationships between testosterone, progesterone, estradiol, cortisol and the immune system are still controversial. The Authors have studied lymphocytes subset in ten women with polycystic ovarian disease (PCOD); it was observed: 1) a decrease of T8 in 64% and of natural killer activity (NK) in 60% of patients, and an increase of T4/T8 ratio in 55%; 2) a significant negative correlation between androstenedione and testosterone (P less than 0.05); 3) a significant positive correlation between the decreased T8 lymphocytes and NK cells and the increase of testosterone and androstenedione serum values. The data suggest that in PCOD a correlation between endocrine and immune system exists and the androgens can affect the lymphocyte subset.

Biochemical and physiological alterations in female reproductive organs of cyclic rats treated with aqueous extract of Moringa oleifera Lam.

Abstract: Biochemical and physiological alterations have been observed in the genital tract of female cyclic rats treated with aqueous extract of M. oleifera Lam. Its administration caused a significant increase in the glycogen contents, protein concentration, activity of acid and alkaline phosphatase and the level of total cholesterol in all the organs at initial days of treatment. However, at longer days of treatment the values revealed a significant depletion. Initially its administration stimulated the uterine structures, caused metaplastic changes in the cervical epithelium and provoked considerable cornification in the vaginal epithelium. At later durations significant inhibition in the histoarchitecture was observed. Biochemical observations supplemented with the histological findings have been correlated with the anti-implantation action of the aqueous extract in the light of its hormonal properties.

Endoscopic intrauterine resection: principles and technique.

Abstract: The adaptation of urologic resection techniques in the uterine cavity has made it possible to perform endouterine surgery. This technique also permits a complete histological analysis of all the resected tissues. In the opinion of the Authors this systemic intrauterine resection leads to a complete transformation of gynecologic surgery, since it permits a considerable reduction of the hospitalization and recovery period.

Urogenital inflammations: aetiology, diagnosis and their correlation with varicocele and male infertility.

Abstract: The urogenital inflammations may be considered as "apparatus pathology". We analyze only inflammatory diseases of the prostate gland, because it may be extensible to the entire male genital apparatus. Among aethiological agents of infections an important role belongs to Chlamydia and Mycoplasma; we describe various methods for diagnosis of the Chlamydia and Mycoplasma infections. When objective clinical findings are poor or absent (such in prostatosis and prostatodynia) the transrectal ultrasonography demonstrates characteristic pictures useful for diagnosis and follow-up. Our clinical data and anatomo-pathological remarks suggest a real correlation between varicocele and genital inflammations (26%). This association doesn't represent the only cause of infertility, but frequently reduces the probability of male fertility.

The effects of desogestrel and ethinylestradiol combination in normal and hyperandrogenic young girls: speculations on contraception in adolescence.

Abstract: Hormone profile and ovarian morphology were studied in two groups of adolescents (group 1:19 girls with slight signs of hyperandrogenism; group 2: 14 normal adolescents) in basal conditions and during a contraceptive combination of 30 micrograms ethinyl estradiol (EE) and 150 micrograms desogestrel (D). Treatment was associated with a low incidence of side effects in both groups. In group 1, acne generally improved within 12 months while hirsutism was only reduced in some subjects (58%) after 12 months of therapy (basal hair score 8.50 +/- 1.60 vs 5.81 +/- 1.53 p less than 0.001). Significant falls in plasma levels of LH, total and free testosterone and an increase in sex-hormone-binding globulin levels were observed during treatment especially in group 1. High percentage of multifollicular ovaries (75%) characterized hyperandrogenic subjects. Ovarian volume and number of follicles, higher in group 1 than 2 in basal conditions, showed a significant reduction in both groups and normal ovarian morphology was restored in hyperandrogenic subjects. Considering the high incidence of hyperandrogenemia in adolescence and its implications, our data suggest that the EE.D combination suits adolescent biological condition and is one of the suitable contraceptive methods in adolescents which also has therapeutic effects.

Lyme Borrelia positive serology associated with spontaneous abortion in an endemic Italian area.

Abstract: Lyme borreliosis acquired during pregnancy may be associated with stillbirth and fetal malformations. This paper reports preliminary results of a study intended to evaluate the frequency of Borrelia burgdorferi infection associated with spontaneous abortion in an endemic Italian area.

Is hysteroscopy of value in the investigation of female infertility

Abstract: A prospective multicentre study was designed to ascertain the value of hysteroscopy in the evaluation of female infertility. The study comprises 619 CO2 hysteroscopies in women complaining of infertility. Four hundred and ninety nine examinations (80%) were performed without anaesthesia or cervical dilatation. Twenty eight cases of malformation were diagnosed. Adhesions were found in 68 patients (11%), polypi in 56 (9.1%) and submucous fibroids in 51 (8.2%). Endometrial hyperplasia was diagnosed by hysteroscopy in 67 patients, but there was only 42% histological correlation. Examination of the tubal ostia by hysteroscopy revealed 26 patients (4%) with unilateral tubocornual polyps and one with bilateral polyps. The correlation with hysterosalpingography (HSG) in 185 patients was poor. In 20% where the HSG was reported as normal there were hysteroscopically demonstrable lesions whereas there were false positive findings at HSG in 35% of cases. Hysteroscopy is the only technique which provides an accurate clinical evaluation of the uterine cavity although it does not provide significant information about the cervical canal or fallopian tubes.

Reproductive impairment of women with unicornuate uterus.

Abstract: The reproductive history of 18 women with a diagnosis of unicornuate uterus is reported. The study was conducted with retrospective analysis, and 7 patients with primary infertility were followed up for 1 to 6 years. Four patients had a cavitary noncommunicating horn, 12 a noncavitary rudimentary horn, and 2 no rudimentary horn. The cause of diagnosis was: primary infertility in 7 cases (39%), recurrent abortion in 6 (33%), obstetric complications in 5 (28%). Out of 7 patients that presented with primary infertility in 5 cases an associated reason was present. Twelve women had a total of 38 pregnancies, 21 (55%) ended in abortion, 3 in premature labour, 14 in term births, with a live birth rate of 39%. Of the 17 births 9 (53%) were in breech and 1 (1.6%), in transverse presentations and 11 (65%) were cesarean sections. Cervical cerclage, based on clinical or radiological indications, has been performed in 4 out 6 cases with recurrent abortion with improvement of reproductive performance in 3. Fetal survival rate passed from 0 to 83%. Reproductive impairment seems to depend equally on the difficulty in conceiving and on the reduced ability to carry a pregnancy to term.

Dibromochloropropane (DBCP) effects on the reproductive function of the adult male rat.

Abstract: In order to evaluate the effect of dipromochloropropane (DBCP) on reproductive function, groups of male adult Wistar rats were injected subcutaneously with different doses of DBCP. A strictly dose-dependent effect resulting in histological alteration principally toward the seminiferous tubules was observed. Sperm count and sperm motility showed azoospermia or oligoasthenospermia with a significative recovery in the lower dose of DBCP treated rats. Among the enzymatic activities evaluated as biochemical markers of testicular function: LDH was not appreciably affected by the DBCP treatment while GGT and NADPH-cyt P450-reductase significantly enhanced suggesting an induction of the detoxification processes.

Direct intraperitoneal insemination (DIPI) for the treatment of refractory infertility unrelated to female organic pelvic disease.

Abstract: 344 couples with infertility unrelated to female organic pelvic disease underwent Direct Intraperitoneal Insemination (DIPI) for a total of a 429 DIPI cycles. Pregnancy per couple was 16.5% and per DIPI cycle 13.2%. DIPI was particularly effective in cases of infertility due to cervical mucus insufficiency and unexplained infertility with results respectively of 33.7% and 30.4% per couple and 30.7% and 28.7% per DIPI cycle. On the contrary, the results regarding male subfertility were 12.5% per couple and 10.5% per DIPI cycle. A significant difference was found (X2 A = 16.48, p less than 0.001) between these results and those of the group composed of cases of cervical mucus insufficiency and unexplained infertility. In cases of antisperm iso- and autoimmunization the results were on the whole poor, and were in any case influenced by corticosteroid pretreatment. The Pellet Swim-up Test (PST) proved to be a good prognostic sign for success of DIPI, since a significant difference was found between the PST group greater than or equal to 1.5 X 10(6)/ml (pregnancy per couple was 19.7% and per DIPI cycle 17.2%) and PST group less than 1.5 X 10(6)/ml (pregnancy per couple was 6.8% and per DIPI cycle was 4.5%) (X2 = 11.4. P less than 0.001).

Structure of rete testis, vas efferens, epididymis and vas deferens of langur monkey (Presbytis entellus entellus Dufresne).

Abstract: Morphological and histological features of rete testis, vas efferens, epididymis and vas deferens were studied in the langur monkey. Tubular extensions of rete were located towards lateral side of the testis. Its epithelium comprises mostly of cuboidal cells with hyaline cytoplasm. Three to nine bundles of vas efferens, emerging below the cranial pole of the testis, were observed. Vas efferens epithelium comprises of ciliated and nonciliated cells. Epididymis could be divided into six zones on the basis of cytological features. Principal cells, basal cells, apical cells and intraepithelial lymphocytes were observed in the epididymal epithelium, but their number, shape, size and location of nuclei varied in different zones. Vas deferens epithelium comprises of principal cells, basal cells, apical cells and few intraepithelial lymphocytes. Epithelium is surrounded by lamina propria, longitudinal, circular and longitudinal muscle layers.

GnRH agonists in the treatment of endometriosis.

Abstract: GnRH agonists, synthetic peptide analogs of GnRH, desensitize pituitary receptors for the native molecule, thus causing reversible hypogonadotropic hypogonadism. Numerous clinical studies have suggested that these compounds are efficacious in the treatment of endometriosis, but it is not clear whether they are superior to the other drugs used in treatment of this disease. The frequency of recurrence of pain symptoms at the end of treatment is high and the data on recovery of fertility are conflicting. Long-term administration of GnRH agonists is a safe and well tolerated treatment but its role in the management of endometriosis is still not well defined.

Severe ovarian hyperstimulation syndrome. Case reports.

Abstract: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction. It is most often associated with the administration of human menopausal gonadotropins (hMG) or purified preparation of follicle stimulating hormone (FSH), but has also been reported after clomiphene (CC) and in patients with hydatiform mole and chorioepithelioma. Moreover, OHSS has been observed in cases of multiple pregnancy unrelated to the use of fertility drugs. In recent years, the hormonal induction of ovulation has been practised to an increasing degree, partly due to the extended use in vitro fertilization (IVF) and gamete intra fallopian transfer (GIFT) techniques in the treatment of infertility. This trend will undoubtedly result in a growing number of patients with OHSS: For this reason, it is important to elucidate the pathophysiological mechanisms responsible for trigging this condition and discuss the treatment possibilities once it has arisen. We will present three patients who developed OHSS after different attempts at ovulation induction. Interestingly, aspiration of the follicles, which was carried out in two of the cases, did not influence the progress of the condition.

Cervical isthmic adhesions and the endometrium: hysteroscopic study (suggestion for an endometrial inhibiting factor).

Abstract: Our experience is based on 212 cases of uterine synechiae, 127 of which were located exclusively in the cervical isthmic area, while the entire cavity was free from adhesions. Notwithstanding this, many patients failed to achieve pregnancy until the scar was removed; likewise menstrual flow was improved after hysteroscopic removal of cervical adhesions. Is it possible to hypothesize an isthmic-endometrial reflex suppressing the endometrial response to the hormonal stimuli? In 76 of 127 observations (= 59.8%) the endometrium of otherwise normal cavity failed to be synchronous with the phase, showing the characteristic hysteroscopic patterns of hypo-atrophic or proliferative mucosa. The menstrual changes and pregnancies after adhesiolysis are reported, suggesting the possible explanation for such a phenomenon, pointing out the preliminary significance of our work, and the importance of further microscopic and ultrastructural studies.

Transvaginal ultrasound or laparoscopy for oocyte retrieval (experiences in the Ljubljana IVF program).

Abstract: At present, the less invasive ultrasound-directed techniques are the methods of choice for oocyte retrieval in most in vitro fertilization and embryo transfer (FIVET) centers. Among the ultrasound-direct techniques, the transvaginal follicle aspiration guided by transvaginal ultrasound for oocyte recovery is gaining popularity in many FIVET centers. This study compare cycles outcome following transvaginal ultrasound oocyte retrieval (105 cycles) to laparoscopic oocyte retrieval (218 cycles); no statistically significant difference could be demonstrated between the groups in all parameters evaluated but better clinical results have been obtained in transvaginal ultrasound group. The Authors conclude that transvaginal oocyte recovery represents an improvement and a simplification of the FIVET procedure.

HLA sharing in Italian recurrent abortion couples.

Abstract: We performed HLA typing in 96 couples affected by recurrent abortion "sine causa". We matched these patients with 124 fertile couples and 204 individuals random paired. No significant difference in HLA sharing was demonstrated in the three study groups. The statistical analysis denoted significant differences in regard to HLA A3, A24, B12, and DR- comparing patients and normal members of fertile couples. The frequencies of HLA Cw5, Cw6 and DR2 were different in patients when compared with their partners.

Gamete intrafallopian transfer: different routes of transfer.

Abstract: The Authors report their own experience and results using different approaches to oocyte pick-up and gamete transfer for gamete intrafallopian transfer (GIFT). The overall pregnancy rate of GIFT is 35.86% (66 pregnancies on 184 cases of GIFT). The Protocol I (Laparoscopic oocyte retrieval and gamete transfer) is presently the more used and gives better clinical results (pregnancy rate of 37.7%); in the Author's opinion, the protocols III (echographic pick-up + IVF + laparoscopic delayed zygote intrafallopian transfer (ZIFT), and VII (Laparotomic pick-up and transfer) are interesting complementary techniques for GIFT.

4-hour urinary and serum immunofluorimetric assay for luteinizing hormone to detect onset of preovulatory LH surge.

Abstract: The initial surge of LH is an important preovulatory event. The validity of a time-resolved immunofluorimetric assay method for determining LH both on the samples of serum and urine are reported in our study. A good correlation exists between the serum and urinary LH with the presence of a shorter interval in the length of the LH increase in the urinary dosage in respect to the serum dosage. There emerges when comparing the RIA and IFMA techniques that a good correlation exists both in the urinary and in the serum samples. However the values found with the IFMA method are on the average inferior (ca. 50%) in respect to those obtained with the RIA technique.

Varicocele and puberty. A transversal and longitudinal survey.

Abstract: The interest for varicocele in the determination of male infertility has increased during the last decades. Most researchers consider varicocele as the primary cause of male infertility, but recently another group of authors give it a secondary role in the alteration of spermatogenesis. We think that the major part of the controversy depends on an absence of a systematic approach to the problem. We give a primary importance to an accurate epidemiological evaluation which consists in a transversal and longitudinal survey of male subjects in puberal age. Our data show that left varicocele is practically inexsistent before the onset of puberty; the percentage incidence of this alteration increases progressively with puberal maturity and the tends to decrease slightly when maturity is complete. By correlating this pathology with puberty we can obtain more precise informations than when it is correlated to the regestrated age. The young patients who result suffering from varicocele, must be controlled carefully and periodically for the evaluation of the period and the opportunity of a therapeutic treatment.

The incidence of Chlamydia trachomatis-induced infection in women suffering from cervicovaginitis.

Abstract: The results of a research on Chlamydia T. (direct survey of both the antigen in the uterine cervix and plasmatic antibodies) in a group of subjects suffering for cervico-vaginitis are provided. The incidence of the Chlamydia infection (proved by either the presence of this bacterium or antibody positivity) is not different from the values reported in literature. Conversely, the presence of neither specific cytological or colposcopic patterns nor of priviledged comites at vaginal level could be demonstrated. Our data, however, confirm a greater incidence of this infection in women reporting early sexual life and a high number of partners. As for the relationship between Chlamydia and contraceptives a slightly higher incidence of positivity in the cervix of patients using oestro-progestinics was registered, whereas no significant difference was noted in the use of other contraceptives IUD included.

Ovulation monitored by serum 17 beta-estradiol and ultrasound: differential ovarian response to human gonadotropins in various anovulatory states.

Abstract: Ovulation induction with human gonadotropins (hMG or pFSH and hCG) was simultaneously monitored with daily serum 17 beta-estradiol measurements and ultrasound in 38 infertile women. They were subgrouped as follows: A, hypogonadotropic hypogonadism (n. 7); B, polycystic ovary syndrome (n. 13); C, non-PCO chronic anovulation (n. 6); D, unexplained infertility (n. 12). The dose of hMG and the duration of therapy were assessed individually depending on the results of the monitoring when serum estradiol concentration was 500-1500 pg/ml and/or ultrasound showed of a follicle of at least 18 mm, hMG was stopped and hCG was administered 36 hours later. Ovulation was obtained in 61 cases and pregnancy occurred in 12 women out of 64 monitored cycles. The highest pregnancy rate was observed in hypogonadotropic hypogonadism; this group also required the greatest total dose of hMG to obtain ovulation. We confirm that women with PCOS are at increased risk with this therapy, since 5 subjects in our series showed signs of ovarian hyperstimulation in spite of the lowest total dose of FSH administered to this group. We conclude that anovulatory states of various origin are associated with different ovarian sensitivity.

Prediction and detection of ovulation relationship between woman's observations of cervical mucus changes, thermic and echographic parameters of ovulation.

Abstract: Every woman can perceive and interpret her fertility signs such as cyclic changes of cervical mucus, sensation of wetness and lubrification of the vulva and thermal shift. 18 cycles were studied in 6 volunteers but one cycle was eliminated because ovulation did not occur. Each of the 6 women perceived the day in which cervical mucus was more abundant, clear, lubrificative and elastic and noted the "Peak" mucus day. These two data were correlated with the thermic nadir day and the day or the period of echographic ovulation showing an accurate relationship with ovulation.

Ultrastructural changes in the principal cells of epididymis of adult rhesus monkey (Macaca mulatta) after castration and androgen replacement therapy.

Abstract: The epididymal epithelium from adult castrated and androgen supplemented, castrated rhesus monkeys was examined with transmission electron microscope. Ninety days after bilateral castration the tubular diameter of all the regions of the epididymis, viz. the initial segment, caput, corpus and cauda portions of epididymis was reduced and was accompanied by a drop in cell size. There was a marked decrease in the number and size of microvilli on the luminal surface. The invaginations of apical membrane into the cell cytoplasm became less prominent. There was a reduction in the amount of smooth and rough endoplasmic reticulum, and Golgi complex. Mitochondria accumulated in the apical cytoplasm. Several vacuoles often associated with lipofuscin pigment granules were common in the cytoplasm. These findings suggest a reduction in both the absorptive and secretory functions of the principal cells. Following androgen replacement therapy for 30 days in monkeys that were castrated 60 days earlier there was a recovery of structural features in the epithelium to near normal state.

Ultrastructural changes in the rabbit epididymis following vasectomy and clip occlusion.

Abstract: Adult male rabbits were subjected to vasectomy, tantalum clip occlusion and sham operations. Caput and cauda regions of epididymis were studied with electron microscope at intervals of 15 days and 15 months after operation. Vasectomized and clip occluded subjects revealed similar changes when compared with sham operated animals. The epithelium remained functionally active even after vasectomy and clip occlusion as indicated by the presence of all characteristic complements of cellular organelles. Increased number of vacuoles and electron dense bodies indicated enhanced absorptive and digestive mechanisms at 15 months of vasectomy and clip occlusion. Disposal of continuously producing spermatozoa following vas occlusion may take place by intraluminal disintegration of sperm and subsequent phagocytosis by epididymal epithelium as evidenced by presence of identifiable parts of spermatozoa and flocculent material in caput and cauda regions.