RESUMEN
Microsurgical or percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection (ICSI) are proposed to overcome male infertility due to congenital bilateral absence of vas deferens (CBAVD). CBAVD has been associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and consequently, genetic counselling has to be addressed before beginning ICSI procedure. However, management of male infertility due to CBAVD should not ignore a mild form of cystic fibrosis. We describe the case of cystic fibrosis late diagnosis performed in a 49-year-old infertile men with CBAVD. CFTR molecular testing detected two mutations F508del and A455E corresponding to a cystic fibrosis genotype. Pneumological evaluation revealed a severe obstructive respiratory disease, bronchiectasis and high sweat chloride levels. Symptoms consistent with a cystic fibrosis have to be identified in infertile men with CBAVD before beginning assisted reproductive procedures.
Asunto(s)
Fibrosis Quística/diagnóstico , Infertilidad Masculina/terapia , Enfermedades Urogenitales Masculinas/complicaciones , Adulto , Fibrosis Quística/complicaciones , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Femenino , Asesoramiento Genético , Humanos , Infertilidad Masculina/etiología , Masculino , Persona de Mediana Edad , Embarazo , Inyecciones de Esperma Intracitoplasmáticas , Recuperación de la Esperma , Conducto Deferente/anomalíasRESUMEN
OBJECTIVES: To evaluate the results of the initial in vitro fertilization (IVF) procedure after intrauterine insemination (IUI) failure where half of the oocytes were inseminated as for conventional IVF and half of the oocytes where treated for intra cytoplasmic sperm injection (ICSI). PATIENTS AND METHODS: From the first of January 2001 to the 31st of December 2008, 75 couples failing to conceive with ovarian stimulation and IUI were included in this retrospective study. RESULTS: Among the 75 couples, 53 had IVF and ICSI in sibling oocytes and 22 had just ICSI because of an insufficient oocyte cohort. No significant difference was observed in fertilization, implantation and pregnancy rates between the different groups; however, a total fertilization failure was observed more frequently when conventional IVF was used compared to ICSI (11.3% vs 3.8%). These patients with fertilization failure on conventional IVF had a lower sperm count than those who obtained embryos but sperm parameters were normal according to World Health Organisation (WHO) criteria and our study did not find any predictive factor of fertilization failure. DISCUSSION AND CONCLUSION: Couples failing to conceive after controlled ovarian hyperstimulation and IUI may be proposed a mixed in vitro fertilization procedure (with conventional IVF and ICSI) in order to avoid a total fertilization failure. Moreover, this procedure will indicate the better IVF technology (conventional or ICSI) for the subsequent attempt.
Asunto(s)
Inseminación Artificial/métodos , Oocitos , Inyecciones de Esperma Intracitoplasmáticas/métodos , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 30-year-old woman undergoing an In Vitro Fertilization (IVF) treatment for tubal infertility and for whom no oocyte was retrieved at the puncture ("white puncture") presented an ectopic pregnancy. The patient was asymptomatic except some bleeding events reported for several days prior to the puncture. The ovulation monitoring was normal throughout the stimulation by gonadotrophin and hCG was administered for the final oocyte maturation on the twelfth day of stimulation at a rate of 2771 pg/ml of estradiol with a perfect ultrasound follicular growth. This case demonstrates that we have to beware of a "white puncture" and that the hCG measurement the day of the oocyte retrieval is necessary because of the possibility of an ectopic pregnancy.
Asunto(s)
Fertilización In Vitro/efectos adversos , Infertilidad Femenina/terapia , Recuperación del Oocito/métodos , Oocitos , Embarazo Ectópico/etiología , Adulto , Gonadotropina Coriónica/sangre , Gonadotropina Coriónica/uso terapéutico , Estradiol/sangre , Femenino , Humanos , Inducción de la Ovulación/efectos adversos , Inducción de la Ovulación/métodos , Embarazo , Embarazo Ectópico/diagnóstico , Embarazo Ectópico/diagnóstico por imagen , Ultrasonografía PrenatalRESUMEN
Pregnancy in a rudimentary uterine horn is a rare event which can be revealed by uterine rupture. Following the fetal extraction, some authors recommend the ablation of the rudimentary horn, in order to limit the risk of uterine rupture in case of subsequent pregnancy in the same horn. We report the obstetrical outcome of a patient with a history of rudimentary uterine horn rupture the treatment of which was conservative.
Asunto(s)
Embarazo Ectópico/diagnóstico , Rotura Uterina/etiología , Útero/anomalías , Adulto , Femenino , Muerte Fetal , Humanos , Embarazo , Embarazo Ectópico/patología , Embarazo Ectópico/cirugía , Recurrencia , Rotura Espontánea , Útero/cirugíaRESUMEN
Native human renin, produced from the culture of human chorionic trophoblasts, has been purified to homogeneity on a milligram scale using a five-step purification scheme. The chorion cells secrete 50-200 milliGoldblatt Units of trypsin-activatable prorenin per ml into the medium. The pro-enzyme is partially purified by ammonium sulfate fractionation and chromatographies on QAE-Sephadex and cibracon blue-agarose. Following conversion of prorenin to the active enzyme by porcine trypsin, the renin is purified to homogeneity by affinity chromatography and gel filtration. Chorionic prorenin has a molecular weight of 43,000; the active enzyme 40,000. Both proteins exist as a single polypeptide chain as determined by SDS-polyacrylamide gel electrophoresis under reducing conditions. The average specific activity of six different preparations was found to be 1072 Goldblatt Units/mg. The amino acid composition and N-terminal sequence of the active enzyme has been determined and is identical to the human kidney enzyme. Microheterogeneity of chorionic renin was demonstrated by isoelectrofocusing analysis. The physical characterization of chorionic renin is compared with that reported for the human kidney enzyme.