RESUMEN
The choice of nonspermicidal sheaths for specimen collection for diagnosis and/or fertility treatment is limited. Those that are available tend to be relatively expensive and as a results, offered selectively to patients. This study describes the evaluation of three over-the-counter nonspermicidal condoms as alternatives to specialized specimen collection sheaths. Sheaths were incubated with motile sperm for up to 2 h and the percent Grade A motility, percent progressive motility and progressive velocity assessed using an 'in-house' computer-assisted semen analysis system every 30 min. Two of the sheaths tested, Pasante Naturelle (PN) and the Durex Avanti Ultima were shown to be highly toxic to sperm, leading to immobilization of most specimens within 1 h. However the loss of sperm motility when sperm were incubated with the Pasante Unique (PU) condom was no greater than with either the control (rigid 60 ml specimen container) or the Male Factor Pak (MFP), a commercially available specialized semen collection sheath. In conclusion, the PU brand of condom could be used as a cheaper alternative to the specimen collection sheaths currently available. Furthermore, some brands of condom sold as nonspermicidal are in fact toxic to sperm and will immobilize most specimens within 1 h.
Asunto(s)
Condones , Técnicas Reproductivas Asistidas , Análisis de Semen , Recolección de Tejidos y Órganos/instrumentación , Humanos , Masculino , Motilidad Espermática , EspermicidasRESUMEN
BACKGROUND: Sono-automatic volume calculation (SonoAVC) automatically identifies and measures the dimensions of hypoechogenic areas within datasets acquired using three-dimensional ultrasound. The objective of this study was to evaluate the predictive value of automated antral follicle counts according to their relative sizes in women undergoing assisted reproduction treatment (ART). METHODS: A total of 156 subjects aged < or =40 years with a baseline FSH < or =15 IU that undergo their first cycle of ART were prospectively recruited. SonoAVC was used to measure the datasets and record the number of antral follicles measuring < or =9 mm in diameter. These follicles were then grouped into subsets according to their relative sizes: < or =2.0, 2.1-4.0, 4.1-6.0, 6.1-8.0 and 8.1-9.0 mm. The primary outcome was viable pregnancy confirmed on ultrasound 5 weeks following embryo transfer. RESULTS: A total of 142 subjects were included for analysis of primary end-point. Those subjects who conceived had significantly more antral follicles measuring < or =2 (P = 0.041) and 2.1-4.0 mm (P < 0.001) than those who had unsuccessful treatment. There were no significant differences between the groups in the number of antral follicles measuring 4.1-6.0 (P = 0.191), 6.1-8.0 (P = 0.203) and 8.1-9.0 mm (P = 0.601). Multiple logistic regression showed that antral follicles measuring 2.1-4.0 mm were an independent predictor of pregnancy [Exp(B) = 1.234, 95% CI = 1.092-1.491; P = 0.004; AUC = 0.693]. CONCLUSION: SonoAVC provides automated measures of antral follicle number and size. Using this technique, the number of antral follicles measuring 2.1-4.0 mm in diameter is an independent, significant predictor of pregnancy following in vitro fertilization treatment.
Asunto(s)
Fase Folicular , Folículo Ovárico/diagnóstico por imagen , Técnicas Reproductivas Asistidas , Adulto , Transferencia de Embrión , Femenino , Humanos , Folículo Ovárico/ultraestructura , Valor Predictivo de las Pruebas , Análisis de Regresión , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: This study evaluated the effect of pituitary desensitization on the early growing follicle population through assessment of serum anti-Mullerian hormone (AMH) concentration. Other markers of ovarian reserve, basal follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin-B and three-dimensional ultrasound ovarian parameters were also assessed for comparison. METHODS: One hundred and two subjects aged <40 years with FSH levels <12 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin releasing hormone (GnRH) agonists. Serum levels of AMH and other markers of ovarian reserve measured during the early follicular phase were compared with those measured following down-regulation. RESULTS: While AMH levels increased significantly by approximately 32% (P < 0.01), there was a significant decline of approximately 40-50% (P < 0.01) in the levels of inhibin-B, FSH, LH and estradiol. Down-regulation treatment was also associated with a decrease (P < 0.01) in mean ovarian volume and in ovarian blood flow, but no difference was seen in the antral follicle count. CONCLUSIONS: Pituitary desensitization results in a significant increase in AMH levels, which implies that either the secretion of AMH by early growing follicles is enhanced or that the size of this follicle cohort is increased. The number of antral follicles visualized on ultrasound in the early follicular phase and at down-regulation appears unchanged, suggesting that any effect is restricted to the smaller selectable follicles. Our results may explain the enhanced ovarian response to conventional controlled ovarian stimulation and higher pregnancy rates when pretreatment with GnRH-agonists is employed.
Asunto(s)
Hormona Antimülleriana/metabolismo , Folículo Ovárico/metabolismo , Hipófisis/metabolismo , Adulto , Estudios de Cohortes , Estradiol/metabolismo , Femenino , Hormona Folículo Estimulante/metabolismo , Regulación de la Expresión Génica , Hormona Liberadora de Gonadotropina/metabolismo , Humanos , Inhibinas/metabolismo , Hormona Luteinizante/metabolismo , Estudios Prospectivos , Ultrasonografía/métodosRESUMEN
BACKGROUND: This study evaluated the effect of pituitary desensitization on ovarian volume, antral follicle count (AFC), and ovarian blood flow indices and their value as predictors of ovarian response during assisted reproduction treatment. METHODS: A total of 115 subjects aged <40 years with follicle-stimulating hormone (FSH) levels <12 IU/l underwent transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin-releasing hormone agonists. 3D power Doppler was used to quantify ovarian volume, AFC and ovarian blood flow. The relationship between these ultrasound variables and treatment outcome was evaluated using multiple regression analysis. RESULTS: Although a significant decrease in the ovarian volume (P < 0.05) and flow index (FI; P < 0.01) was demonstrated after pituitary desensitization, no differences were seen in the AFC. The total AFC, regardless of whether this was measured before or after down-regulation, was a significantly better predictor of the number of oocytes retrieved (P < 0.001) and poor ovarian response (P < 0.05) than age, FSH, ovarian volume and vascular indices although pre-treatment ovarian volume (P < 0.05) and FI (P < 0.05) were also predictive of the number of oocytes retrieved. CONCLUSIONS: Pituitary desensitization results in a significant reduction in ovarian volume and vascularity, but has no effect on the AFC. AFC is the single best predictor of ovarian response regardless of whether the assessment is performed before or after down-regulation.
Asunto(s)
Ovario/diagnóstico por imagen , Ovario/fisiología , Hipófisis/efectos de los fármacos , Técnicas Reproductivas Asistidas , Adulto , Regulación hacia Abajo , Femenino , Humanos , Imagenología Tridimensional/métodos , Folículo Ovárico/citología , Ovario/anatomía & histología , Pruebas de Función Hipofisaria , Estudios Prospectivos , Análisis de Regresión , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: This study compared the predictive value of the antral follicle count (AFC) measured from stored 3D data by three methods including a '2D equivalent technique' and two 3D techniques, the 'multiplanar view' and 'rendered inversion mode', as a test of ovarian reserve and treatment outcome. METHODS: One hundred consecutive subjects aged<40 years with basal FSH levels<12 IU/l underwent transvaginal ultrasound in the early follicular phase prior to their first cycle of assisted reproduction treatment. The relationship between the AFC made with each method and outcome was evaluated. RESULTS: The AFC as measured by the 'inversion mode' method (r=0.777) showed a higher, but statistically insignificant, correlation with the number of retrieved oocytes than did comparable measurements made with the '2D equivalent' (r=0.665) and '3D multiplanar' (r=0.687) techniques. Multiple regression analysis showed the AFC measured using any of the three methods was a significantly better predictor of the number of oocytes retrieved (P<0.001) than age, FSH or ovarian volume. AFC was not predictive of non-conception regardless of the measurement technique. CONCLUSIONS: For predicting ovarian respone and outcome, the AFC measured using techniques based on 3D ultrasound offers no statistically significant advantage over a measurement which is limited to information available with conventional 2D imaging.
Asunto(s)
Imagenología Tridimensional/métodos , Ovario/anatomía & histología , Ovario/patología , Técnicas Reproductivas Asistidas , Adulto , Femenino , Fertilización In Vitro , Hormona Folículo Estimulante/metabolismo , Humanos , Folículo Ovárico/diagnóstico por imagen , Folículo Ovárico/patología , Pruebas de Función Ovárica , Ovario/diagnóstico por imagen , Inducción de la Ovulación , Análisis de Regresión , Resultado del Tratamiento , UltrasonografíaRESUMEN
Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a member of the epidermal growth factor family. In rodents HB-EGF has been found to mediate the mitogenic effects of oestrogen on the endometrial glandular cells and those of progesterone on the stromal cells. HB-EGF has also been found to be expressed at the site of implantation before any other discernible sign of blastocyst attachment in rodents. Our aim was to determine whether HB-EGF mRNA was expressed in the human pregnant and non-pregnant endometrial tissues. Normal endometrial tissues at different stages of the menstrual cycle, first trimester chorionic villi and decidua, second trimester chorionic villi and term placental tissues were snap frozen and stored at -80 degrees C. Reverse transcription-polymerase chain reaction (RT-PCR) was used to analyse the expression of HB-EGF mRNA in these tissues. HB-EGF mRNA was found to be expressed in human endometrium throughout the menstrual cycle. It was also present in first trimester chorionic villi and decidua, second trimester villi and term placenta. These findings suggest that HB-EGF may have a role in the growth or function of the human uterus, and that it may be important at the feto-maternal interface throughout pregnancy.