RESUMEN

OBJECTIVE: This study aimed to evaluate the results of vasovasostomies performed in the authors' clinic over 15 years. MATERIAL AND METHODS: Between 1983 and 1998 39 vasovasostomies were performed using a macroscopic technique. The medical charts were reviewed and a postal survey was sent to 36 of these patients. The patients were invited to visit the outpatient department and to give semen for analysis and a blood sample for determination of serum antisperm antibodies and serum follicle-stimulating hormone. Twenty-five patients filled in the questionnaire and 10 patients were obtained for further semen and serum analyses. RESULTS: The overall pregnancy rate was 56% (14/25 respondents). Three of these 14 men used an assisted reproduction method with their own ejaculated sperm. The postoperative patency was recorded in the medical charts only sporadically. The age and the interval between the vasectomy and vasectomy reversal averaged 42 years and 8.6 years, respectively. Those men who could father a child had a somewhat shorter mean obstructive interval than those who failed (8.0 vs 9.3 years), although the difference was not statistically significant in this small patient sample. The serum follicle-stimulating hormone concentrations were normal, with no association with the pregnancy rate. CONCLUSION: Macroscopic vasovasostomy is an effective means of re-establishing fertility in vasectomized men.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Of 55 males, currently above 18 years of age, diagnosed with and treated for different malignancies in childhood between 1960 and 1985 at a single institution, 28 (51%) were azoospermic. The age of the patient, testicular irradiation, four different therapeutic agents (L-asparaginase, cyclophosphamide, doxorubicin, vincristine) and one combination (MOPP, nitrogen mustard, vincristine, procarbazine, prednisone) were each associated with the risk of azoospermia. However, in multivariate analysis vincristine had the statistically most significant independent effect on the risk of azoospermia, the risk being 5-fold (95% confidence limits 1.3-18.8, P = 0.02) that in patients who had not received vincristine. The risk of azoospermia in patients who had received cyclophosphamide was 3.4-fold (0.95-12.3, P = 0.06) and in those who had received testicular irradiation it was 8.2-fold (0.75-90.9, P = 0.09) that of others. Normospermia (22% of patients) was not incompatible with any of the more commonly used modes of therapy. We conclude that vincristine may have a previously unrecognised important role in causing azoospermia, possibly irreversible, when administered in childhood or adolescence.

Asunto(s)

RESUMEN

To elucidate the hypothetical role of a primary germ cell defect in the development of a germ cell tumor, with subsequent testicular dysfunction, the authors studied a series of men who had surgery performed for a benign sacrococcygeal teratoma when newborns. The mean levels of serum testosterone and gonadotropins did not differ from the control patients. However, gonadotropin-releasing hormone stimulation caused exaggerated responses of serum luteinizing hormone and follicle-stimulating hormone. Testicular size was small in three of eight patients. Semen analysis showed abnormal semen quality in five of eight patients. Only one patient had no evidence of testicular dysfunction. The results indicate that men born with benign sacrococcygeal teratoma may have Leydig cell dysfunction, abnormal spermatogenesis, or both. It was speculated that the associated abnormalities may have a common etiology: for instance, they might be due to a congenital germ cell defect.

Asunto(s)

RESUMEN

We studied by dot blot DNA hybridization semen samples of 17 regular partners of women with proven HPV infection and 16 controls, to find out whether the human papillomavirus (HPV) DNA is transmitted via semen. Although all women were positive for HPV DNA, the semen samples from their partners and controls were negative. This suggests that HPV DNA is not transmitted via semen.

Asunto(s)

RESUMEN

Direct intraperitoneal or intrauterine insemination in combination with superovulation was used randomly as the treatment of infertility that was unexplained or due to male subfertility or mild endometriosis in 124 couples during 326 cycles. The pregnancy rate per couple was 24% in the direct intraperitoneal insemination group and 31% in the IUI group. The difference was not significant. The pregnancy rates with both treatments were significantly higher than those seen during the 326 control cycles of the same couples (1.1% and 0.6%).

Asunto(s)

RESUMEN

In the infertility work-up of 98 couples, ovulatory disturbances were detected in 28 women on the basis of low progesterone values and endometrial biopsy. Of these, six were anovulatory, eight oligo-ovulatory and 14 had luteal deficiency. Their androgen status was studied by determination of androstenedione (A), dehydroepiandrosterone sulphate (DHEA-S), testosterone (T), free testosterone (free T) and sex hormone-binding globulin (SHBG). The mean level of free T was significantly higher (P less than 0.05) in anovulatory women when compared with ovulatory ones. No differences were found in the mean levels of total T, SHBG and DHEA-S between anovulatory, oligo-ovulatory, luteal deficient and ovulatory infertile women. The results show that in infertile women determination of androgen levels, and especially free T, is indicated in the absence of clinical signs of hyperandrogenism.

Asunto(s)

RESUMEN

The role of sexual dysfunction was evaluated among 98 couples during infertility examination. The wife and the husband were interviewed separately and together. Sixty-six women were willing to report daily their sexual behavior in association with recording basal body temperature. Male sexual dysfunction was the primary cause of infertility in five couples (5%). Three pregnancies resulted after examination and simultaneous supportive discussion. Following a simple diary on sexual behavior, 19 of 66 women conceived (29%). Fourteen of these 19 women reported orgasm within two days preceding elevated basal body temperature. Open discussion about sex was possibly therapeutic. Infertility examinations should include an evaluation of the sexual behavior of couples, with special reference to frequency and timing of coitus.

Asunto(s)

RESUMEN

Concentrations of LH receptors in ovarian corpora lutea were measured in four women with ultrasonically monitored cycles, [in which luteinized unruptured follicles (LUF) were observed] and in one woman with an LUF observed during laparotomy. LH receptor concentrations were also measured in four control patients with proven fertility. The LH receptor concentrations in cases of LUF syndrome were on average 60% lower (P less than 0.01) than in the control patients. These results suggest that in LUF patients there is a disorder in the mechanism of LH action in the developing follicles.

Asunto(s)

RESUMEN

Modifying effects of epidural analgesia and general anesthesia on stress hormone release was studied during laparoscopy for in vitro fertilization (IVF). In 24 women follicle development was stimulated by clomiphene and gonadotropin treatment, and oocytes were collected by laparoscopy under epidural analgesia in 11 women and under fentanyl-supplemented nitrous oxide-oxygen anesthesia in 13. The plasma levels of immunoreactive beta-endorphin (ir beta-E), cortisol, and prolactin (PRL) did not change under epidural analgesia per se, but after the start of laparoscopy, increased release of all these stress hormones was observed. General anesthesia per se increased the release of PRL, whereas the release of cortisol and ir beta-E decreased, probably due to the effects of fentanyl and thiopentone. During the stress attributed to laparoscopy, significantly more ir beta-E and cortisol was released under epidural than under general anesthesia, whereas the release of PRL was more significant under general anesthesia. These results show that neither mode of anesthesia prevented the stress response to laparoscopy. In the subsequent midluteal phase, the mean plasma level of progesterone and the mean progesterone-estradiol ratio were significantly greater in the epidural than in the general anesthesia group, suggesting that the mode of anesthesia may have an effect on the luteal phase. The significance of this difference on the conception rate remained unsolved, however.

Asunto(s)

RESUMEN

Comparison of semen quality was undertaken between 60 smoking and 50 non-smoking men attending infertility investigation. As far as possible, other factors which might influence semen quality were eliminated. The men were allocated into groups according to sperm density and number of cigarettes smoked per day. The percentage of motile sperm in heavy smokers with oligozoospermia and the total sperm count were lower, the difference being significant at the 1% and 5% levels, respectively. No correlation was found in percentage of sperm with morphologically abnormal heads, midpieces or tails. Heavy smoking may have a detrimental effect on the motility of sperm. Further studies are needed to explain the mechanisms by which smoking affects spermatogenesis.

Asunto(s)

Asunto(s)

RESUMEN

The purpose of the present study was to establish the occurrence of infertility in Finnish women aged 30, 35 and 40 years. The study is based on an interview by questionnaire carried out on women participating in screening for cancer by Pap smear. The participation rate is generally about 60%. A total of 4,879 women were interviewed between May 1981 and April 1982. 149 incomplete replies were discarded and an additional 528 women not at risk of conception were excluded. The final analysis included 4,202 women. Actual infertility, i.e., failure to establish pregnancy at the time of interview, occurred in 438 women (10.4%). The overall infertility rate was 15.4%. The primary infertility rate (5%) seems to be similar in all the age groups interviewed. Secondary infertility increased among women aged 30-40 years, from 4.1 to 9.9%. Actual infertility increased highly significantly between the age groups 30 and 40 years. A limited number of women are permanently infertile, but the percentage of those who at some point in their lives are involuntarily childless is higher.

Asunto(s)

RESUMEN

Ultrasonic studies for the detection of a cumulus oophorus were carried out in 57 women taking part in an in vitro fertilization (IVF) program. When intrafollicular echoes were dissociated, clearly prominent from the follicular wall, they were considered to be a sure cumulus mass, and when they were only slightly prominent, they were suspected to be a nondissociated cumulus. All patients had at least one ultrasonically visible cumulus. A cumulus was seen in 50% of the follicles and 70% of them were dissociated. Cumuluses were also seen in follicles less than 18 mm in diameter but a significantly higher number of them were not clearly dissociated. The number of observed dissociated cumuluses correlated significantly with the number of recovered mature oocytes. However, in 18 patients there were more mature oocytes retrieved than cumuluses identified by ultrasound. When a cumulus mass is seen, it can be taken as evidence of a sign of maturity of that particular follicle and oocyte. However, mature oocytes are also found where no cumulus was seen by ultrasound. Lack of visible cumulus has little significance in predicting the maturity of the oocyte.

Asunto(s)

RESUMEN

Radioimmunoassay, gel filtration, isoelectric focusing, and immunoperoxidase methods were used to study the levels, properties, and localization of pregnancy-associated plasma protein A (PAPP-A) in the human seminal plasma and male genital tract. Seminal plasma specimens from 20 normospermic and 20 oligospermic men were studied. PAPP-A was found in 30 of 40 samples, the levels ranging from undetectable to 135 micrograms/liter (median 35 micrograms/liter) in the normospermic group and from undetectable to 111 micrograms/liter (median 21 micrograms/liter) in the oligospermic group. There was no significant difference in the PAPP-A levels between the two groups, and no correlation was observed between the seminal plasma PAPP-A levels and the volume of seminal plasma or the sperm count or the viability of spermatozoa. Serial dilutions of seminal plasma and PAPP-A standard yielded parallel dose-response curves, and incubation with seminal plasma did not result in any change in the elution pattern of [125I]PAPP-A in gel filtration. PAPP-A-immunoreactive material from seminal plasma eluted as two peaks, the major one corresponding to the elution volume of purified PAPP-A and the minor eluting more slowly. The isoelectric point of seminal plasma PAPP-A was 4.3-4.7 and that of term pregnancy serum was 4.2-4.6. In the immunoperoxidase staining, PAPP-A was seen in the epithelium of the prostate, seminal vesicle, and the ampullar part of the vas deferens but not in the testis, epididymis, proximal parts of vas deferens or urethra. The results confirm the occurrence of PAPP-A in the seminal plasma but do not suggest any clinical utility for seminal plasma PAPP-A measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

RESUMEN

A number of proteins previously thought to be specific for the placenta or pregnancy have been identified in the fluids bathing both the oocyte and the sperm. In many cases their concentrations in follicular fluid and seminal plasma greatly exceeded those in the serum of nonpregnant women or men, and sometimes they even exceeded the levels in pregnancy sera. We report here the occurrence of PP5, PP12, PP14 and PAPP-A in follicular fluid and seminal plasma. In follicular fluid, the levels of PP5, PP12, and PAPP-A correlate with the estrogen concentration of the same fluid, and the PP12 and PAPP-A levels also bear a positive correlation to the progesterone concentration. The levels of PP12 and PAPP-A increase as the follicle grows, as do the levels of many steroid hormones. Therefore, the apparent correlations observed may be merely coincidental. However, circumstantial evidence from other reproductive organs indicates that the synthesis of PP12 and PAPP-A is stimulated by progesterone. Results of immunohistochemical staining show that PP12 and PAPP-A are localized in the luteinized granulosa cells and the corpus luteum. Previous studies indicate that PP5 and PAPP-A inhibit the action of proteolytic enzymes plasmin and elastase, which are believed to be involved in the mechanisms of ovulation. The study of the significance of these various placental proteins for human reproduction is only at its beginning. Clearly, elucidation of their function is the key to a more fundamental understanding of their role in the events governing ovulation and implantation.

Asunto(s)

RESUMEN

Placental proteins PP10, PP12, and PP14 and pregnancy-associated plasma protein A (PAPP-A) and relaxin (RX) were studied by the immunoperoxidase method in the uterine mucosa at the time of embryo replacement in 18 women for whom no embryo was available to be replaced. All subjects had received 17 alpha-hydroxyprogesterone caproate at the time of follicle aspiration, which had been performed 36 hours after preovulatory administration of hCG. The time between follicle aspiration and endometrial biopsy varied from 26 to 216 hours. PP10 was not detected in any specimen. RX was found in 17 of 18, PP12 in 15 of 18, PAPP-A in 14 of 18, and PP14 in 6 of 18 specimens. In a normal cycle, PP12, PAPP-A and RX appear in the endometrium on the fourth day post ovulation. In the conditions described above the same proteins could be seen in the endometrium sooner after oocyte retrieval. This may be due to a strong progesterone effect after multiple follicle aspirations and treatment with 17 alpha-hydroxyprogesterone. The significance of the occurrence of these pregnancy proteins as well as that of the morphologic and biochemical maturity of the endometrium at the time of embryo transfer are discussed.

Asunto(s)

Asunto(s)

RESUMEN

The avidin-biotin immunoperoxidase method and antisera against highly purified porcine relaxin were utilized to localize relaxin-like immunoreactivity in biopsied specimens from six preovulatory follicles from four women undergoing laparoscopy for oocyte retrieval in an in vitro fertilization program. By histological criteria, three of the follicles were luteinized and three were not. Relaxin was found in the granulosa cells of those cells which showed histological luteinization, whereas no relaxin was found in the nonluteinized preovulatory follicles. Our results show, for the first time, the occurrence of relaxin in the human ovary before ovulation and they suggest that the appearance of relaxin is related to the luteinization process.

Asunto(s)