Effect of Human Gamma Interferon (Hu-IFN-gamma) on the testicular histology was studied in mice. Male mice were administered Hu-IFN-gamma intratesticularly at the doses of 2, 10 and 20 micrograms/testis in a volume of 1.0 microliter isotonic normal saline. Contralateral testis served as control and was administered same amount of vehicle. All the animals were sacrificed 7 days after drug administration. Body weight and the weights of testis and epididymis were not affected by IFN treatment nor was there any effect of the drug on the motility of the vas deferens spermatozoa. Low dose of IFN (3 mukg) did not have significant effect on the histoarchitecture of the testes and various spermatogenic elements, a progressive damage was however observed with the increasing doses of IFN. Pronounced deleterious effect of IFN on the testis leading to desquamation of the germinal epithelium, reduction in the germinal cell height and tubular diameter was observed with 20 micrograms dose. Quantitative studies on seminiferous epithelium showed a significant decrease in the number of Sertoli cells, stage-7 spermatids and stage-16 spermatozoa. The ratios of resting type spermatocyte: type A spermatogonia and stage-7 spermatids: pachytene spermatocyte was also reduced. The ratios of pachytene spermatocyte: resting spermatocyte and stage-16 spermatozoa: stage-7 spermatids were however not affected by IFN treatment. In another experiment IFN was administered (2 micrograms/day) subcutaneously to male mice for 30 days. No effect of drug treatment on body weight, organ weight, sperm motility and histology (including morphometry) of the testis was observed. Our data suggest that IFN action at testis may be associated with the antiproliferative effect of interferon.
Studies aided by transmission electron microscopy were made in order to evaluate the occurrence and efficiency of the human follicular fluid in the activation of the processes leading to the acrosome reaction; quantitative, qualitative and morphological data and relative evaluations are here presented. The effects of the human follicular fluid were compared with those determined by other types of treatment, semen untreated, Pellet-Swim-up, and Centrifugation on Discontinuous Percoll Gradient. The transmission electron microscope observations permitted to evaluate the percentage of sperm with an activation of the acrosome reaction in the different groups. The analysis of the data showed a statistically relevant difference (P < 0.001) among the first group (Control group) and the SU group, the MP group and the hFF group, regarding the sperm with AR activation. The sperm treatment with 50% diluted hFF represents an important option to the preparation protocols of the semen samples useful for ART.
The aim of this study was to analyse the experience of IVF multiple pregnancies, in relation to the maternal morbidity and the neonatal morbidity and mortality. We considered 48 multiple pregnancies: 36 twins (group A), 8 triplets (group B), 2 quadruplets (group C), and 2 quintuplets (group D). The mean maternal age was 29.72 years and the mean gestational age was 36.83 weeks. Of the 36 patients with two babies, 20 (55.60%) had cesarean section, whereas 12 were delivered vaginally. All the triplets, quadruplets and quintuplets were delivered abdominally. Twenty-three cervical cerclage were placed. In group A 7 patients had premature rupture of the membranes (PROM), 2 had pregnancy-induced hypertension (PIH) and 14 had premature labour. In group B 4 patients had premature labour, 3 hadPROM and 2 had PIH. In group C one patient had premature labour. In group D 2 patients had premature labour and one also PIH. Multiple pregnancies lead to a high incidence of antenatal complications and extensive neonatal morbidity which translate into prolonged and expensive hospitalization for the neonates.
Biological markers of ovulation, after a great in the past, have been fallen into disuse for the large diffusion of biochemical and biophysical ones. However, the real effect of hormones involved in ovulation is expressed by biological modifications on target tissues. To explore the modifications of not reproductive target tissues as ovulation markers we studied the behaviour of Albuminemia, Platelet Factor IV (as indicator of Platelet Aggregation), Type II estrogenic receptors in 42 ovulation induced women, undergoing our observation. 33 of them had ovulation and 9 developed a LUF syndrome, constituting two biological models of an opposite situation for the three markers observed. All the markers considered were sufficiently sensitive, but among them, Platelet Factor IV was the most reliable to the hormonal ovulatory situation.
The objectives of this study was to assess the efficacy and clarify how many intrauterine insemination cycles can justifiably be proposed, in terms of cost and benefits for the patient, as alternative to other assisted reproduction procedures. Two hundred and twenty infertile couples were referred to our centre and six intra-uterine insemination cycles in combination with controlled ovarian hyperstimulation were proposed for them. A total of 650 treatment cycles were completed. The indications of intra-uterine insemination were male factor (147 couples), cervical factor (31 couples), male and cervical factor (30 couples) and unexplained infertility (12 couples). Superovulation was induced in 92 patients with human menopausal gonadotrophins, in 90 with clomiphene citrate, in 22 with FSH HP, while in 16 patients the intra-uterine inseminations were carried out during spontaneous cycles. Considering the entire population, a mean monthly pregnancy rate equal to 8.9% was obtained and a cumulative pregnancy rate equal to 39% at the end of six intra-uterine insemination cycles. In particular, in the patients treated with HMG+hCG, a mean monthly pregnancy rate equal to 10.9% and a cumulative pregnancy rate to 46% at the end of the six cycles were obtained. In conclusion, when the indications allow, we believe it is justified to propose six cycles of intra-uterine insemination in combination with controlled ovarian hyperstimulation with HMG and hCG. The theoretical probability of success at the end of six cycles has proved comparable and advantageous in terms of cost and risks for the patient, if compared with other assisted reproduction techniques.
The aim of this study was to compare results obtained using two different GnRH analogue regimens in women > or = 40 undergoing IVF cycles. Patients using GnRH-a from mid-luteal phase of the previous cycle (group A) needed more days of ovarian stimulation than patients GnRH-a in the follicular phase of the same cycle "flare-up" (group B) (11.7 +/- 1.3 vs 10.8 +/- 2 respectively). Group A patients developed more follicles and obtained more oocytes than group B (9.2 +/- 4.9 vs 6.1 +/- 4.4; And 7.6 +/- 4.7 vs 4.2 +/- 3.2, respectively). The cancellation rate was significantly higher in B than A (20 vs 8.6%, respectively). Pregnancy rates however were significantly lower in "flare-up" than in mid-luteal group (3 vs 14% per cycle, 4.7 vs 17% per patient, 3.8 vs 15.2% per oocyte retrieval and 5.4 vs 18.8% per transfer, respectively). Different results obtained in the two groups suggest that Gn-RH-a long protocol allows better ovarian stimulation and consequently improved pregnancy rate than "flare-up" in women > or = 40 years old.
OBJECTIVE:The aim of this study was to investigate whether fluoxetine given to castrated and noncastrated rats caused hyperprolactinemia and its effects with respect to adenomyosis.DESIGN:Fluoxetine, a serotonin reuptake inhibitor, was given to Wistar Albino rats for 98 days to produce hyperprolactinemia. The drug was given to two groups consisting of castrated and noncastrated rats and compared to two groups of castrated and noncastrated controls. Prolactin levels were measured and the uteri of the rats were removed for histopathological analysis at the end of 98 days.SETTING:Marmara University School of Medicine, Department of Histology and Embryology, Zeynep Kamil Women and Children's Hospital.MAIN OUTCOME MEASURES:Serum prolactin levels, uterine histopathology.RESULTS:The prolactin levels of castrated and noncastrated groups treated with fluoxetine were statistically significantly higher when compared to their respective control groups. Histological studies revealed 11 cases of adenomyosis, all within the noncastrated group receiving fluoxetine.CONCLUSION:It was suggested that high serum prolactin levels cause degeneration of myometrial cells in the presence of ovarian steroids that results in a myometrial invasion by endometrial stroma. This invasion eventually progresses to adenomyosis.
OBJECTIVE:to investigate the effects of treatment with low dose of cyproterone acetate and ethynyl-estradiol on chemical and hormonal parameters in female hyperandrogenism.DESIGN:twenty patients, affected by clinical manifestations of hyperandrogenism, were studied basally and during treatment with 10 mg of cyproterone acetate associated with ethynyl-estradiol (20 m g) in an inversal sequential scheme for six months. Safety parameters were assessed throughout the study. Hirsutism was graded by Ferriman and Gallway score, and hormonal parameters were evaluated basally and after six months of therapy.RESULTS:after six months of therapy all patients showed a significant decrease of clinical and biochemical signs of hyperandrogenism, and normalization of ovarian parameters in seventeen women affected by PCOS.CONCLUSIONS:this treatment is an effective and well tolerated therapy. It is reasonable to consider this treatment as a safe procedure especially in view of a long-term administration.
The aim of this study is to compare retrospectively the outcome of patients that underwent tubal surgery by laparotomy or laparoscopy by the same surgeon Thirty two women that presented with distal tubal obstruction were treated by laparoscopic tubal surgery and 38 by laparotomy and microsurgery. Patients were equally matched for age, duration of infertility and severity of disease. In all cases there were no injuries to adjacent groups and no additional surgery was needed. The duration of surgery was 35-60 min for laparoscopy and 70-120 min for laparotomy and mean duration of hospital stay was 2 and 7 days respectively. Of the 32 cases that underwent laparoscopic surgery 10 had intrauterine pregnancies (31.25%) and 2 ectopic (6.2%). Conversely 11 (28.9%) of the 38 cases with tubal microsurgery resulted in intrauterine pregnancy and 4 (10.5%) in ectopic. Our results suggest that laparoscopic tubal surgery is the method of choice for the treatment of distal tubal obstruction.
The performance of two different methods of embryo transfer for IVF has been evaluated in 132 consecutive embryo transfers. Thirty Eight pregnancies were achieved, corresponding to a pregnancy rate of 28.7% of all embryos transfers. The embryo transfer under ultrasound control was used in 61 cases of our study whereas 71 cases were performed with the "clinical feel" method without ultrasound control. The echoguide embryo transfer procedure yielded a significantly higher pregnancy rate than the blind method (36.06% versus 22.6%). The mean number of embryos transferred per attempt was similar in the two groups (3.1 +/- 0.1 and 3.0 +/- 0.1) as was the quality. The randomized comparative study will continue in order to get more data.
OBJECTIVE:To evaluate whether the number of follicles and ovarian volume have any significance in evaluating the response to clomiphene citrate treatment in Polycystic ovarian syndrome (PCOS).DESIGN:A prospective study of 70 infertile women, 44 of which were diagnosed with PCOS.SETTING:Zeynep Kamil Women and Children's Hospital Infertility Polyclinic.MAIN OUTCOME MEASURES:Follicle numbers and volumes in both ovaries, hormonal profile, response to Clomiphene Citrate (CC). Ovarian volume was significantly greater in PCOS cases than controls. However ovarian volume in the CC nonresponders was significantly greater than in CC responders in the PCOS group. The number of small follicles was significantly higher in PCOS cases than controls, and in the CC nonresponder group this number was also significantly higher than in CC responders. Endocrine features of patients with PCOS revealed that FSH, LH/FSH, DHEAS and Androstenedion do not discriminate between patients who respond to CC and those who do not respond. However, Testosterone (T) and LH levels differ significantly in responders and nonresponders. Small multiple follicles (> 9) and enlarged ovarian volume (> 6.8 ml) were the most prominent transvaginal ultrasonographic features of ovaries in CC nonresponsive patients with PCOS. Higher levels of T, LH, and significantly higher number of small follicles were associated with lack of CC response. These ultrasonographic features and laboratory assays could be clinically useful for distinguishing better the CC nonresponders from responders.
The present report covers the results of a 38-month period in which 2853 consecutive intracytoplasmic sperm injection (ICSI) cycles were performed in 1953 couples. These couples were afflicted with male factor infertility and had at least one previous failed conventional in vitro fertilization (IVF) treatment cycle. In other couples, the husband had semen parameters incompatible with conventional IVF or suffered from excretory or secretory azoospermia where it was possible to recover spermatozoa by microsurgical epididymal sperm aspiration (mesa) or by testicular sperm extraction (tese) procedure. Overall, the 2-PN fertilization rate was 62% per retrieved metaphase II oocyte and 70% per successfully injected metaphase II oocyte. Embryo transfer was performed in 91% of started cycles. The cumulative pregnancy rate (positive HCG) was 34% per started ICSI treatment and 37% per embryo transfer.
OBJECTIVE:To determine in a prospective study if the use of two low-dose estrogen oral contraceptives is associated with changes in weight or body composition.DESIGN:80 outpatients referring to the family planning service, aged 18-43 years were randomly assigned to a treatment with the EE/desogestrel or EE/gestodene association, 20 patients with IUD, aged 26-40 years, were selected as a control group. Anthropometric data and body composition were taken at enrollment and after 6 and 12 months.MAIN OUTCOME MEASURES:Anthropometric measurements included body mass index (BMI), body composition estimated by mean of Bioelectrical Impendance Analysis (BIA).RESULTS:In the three groups weight, BMI, and total body water (TBW), and body cellular mass (BCM) remained unchanged during the study period.CONCLUSIONS:The use of EE/desogestrel and EE/gestodene is not associated with significant variations of body weight and body composition during one year treatment.
Clinical treatment of recurrent spontaneous abortion (RSA) is still a matter of debate due to the absence of an univocal definition of the term. As a consequence of the reproductive history of the couple, there is still uncertainty regarding the moment when the problem of recurrent abortion arises and this prevents the start of diagnostic evaluation and therapy. In addition to a critical review of the literature, the aim of this study was to evaluate whether two successive abortions with the same partner are sufficient to suggest that the couple should undergo diagnostic test, or if it would be more sensible to wait for other reproductive failures. The study was performed in 50 couples suffering from recurrent abortion who attended the Laboratory of Cytogenetics in the Department of Animal Biology at Turin University for caryotyping in order to exclude the presence of chromosomal aberrations. Interviewed by telephone, out of 50 couples 41 presented the necessary requisites for being included in the study. Follow-up ranged between a maximum of 8.5 years and a minimum of 1 year (mean of 4.7 years). From the data collected it emerged that the probable cause of RSA was identified in 21 out of 41 couples enrolled in the study group (51.2 per cent). In the remaining 20 couples tests were within normal ranges. In all diagnosed cases the reproductive problem was identified with one or more alterations present in women. Among the hypothesized cause of RSA, uterine abnormalities were the most frequent (19.5 per cent), followed by immunological problems (17.1 per cent), etiologic factors of hormonal origin (12.2 per cent), one single case of genital infection (2.4 per cent), one balanced chromosomal translocation (2.4 per cent) and at last only one case of cervical incompetence of (2.4 per cent). The diagnosis was determined effectively in 85.7 per cent of couples. Of 20 couples who had not shown any abnormalities, 80 per cent had had a healthy child without any abortions and with the same partner. In conclusion, diagnostic tests performed finally identified the cause of RSA in 43.9 per cent of the couples who completed the procedure; vice versa, 39.0 per cent of couples solved the problem without the need for diagnostic tests; finally, the remaining 18.1 per cent were unable to carry pregnancy to term. By comparing our results to those reported by other authors, we believe that the probability of identifying the cause of RSA and curing it is sufficiently high to justify the start of the diagnostic evaluation of the problem as early as the second abortion in view of the stress on the couple produced by repeated reproductive failures.
We present a case of microprolactinoma (3 mm) grown into macroprolactinoma (21 mm) during pregnancy. This patient was admitted in our hospital for left hemianopsia 13 days after delivery. Through Magnetic Resonance Imaging (MRI) a macroprolactinoma (21 mm in diameter) was diagnosed. The Prolactin (PRL) serum levels were 152 ng/ml. The patient started Cabergoline treatment with good results: normalization of PRL levels after 5 days, of the visual field after 58 days and complete disappearance of prolactinoma within 180 days from the beginning of treatment.
The article reports on a case of functioning adrenal carcinoma in a woman of 40 with concomitant in situ carcinoma of the portio (CIN 3). She had had amenorrhoea for 14 months and early menopause was suspected. Hirsutism and other signs of virilization such as clitoromegaly and voice changes were detected upon hospitalization.. The characteristic of the clinical case is given by hormone production involving not only androgens of prevalently adrenal genesis (dehydroepiandrosterone, dehydroepiandrosterone sulphate and androstenedione), but also testosterone, more suggestive of a gonadal neoplasm. The adrenal carcinoma only produced androgens, as plasma cortisol and aldosterone concentrations were normal. Diagnosis of adrenal carcinoma was first made with hormone assays and then with the adrenal block test using dexamethasone, with adrenal ecography and abdomino-pelvic computed tomography (CT). When amenorrhoea is present and hirsutism and other signs of virilization occur ex-novo in a short period, in a woman of fertile age, a thorough endocrine study must be carried out. According to the hormone profile, the next diagnostic step should be aimed at detecting a prospective ovarian or adrenal neoplasm.
Obviously, medical therapy of secretory azoospermia or microsurgical therapy of excretory azoospermia are not always successful. The unsolvable cases therefore can be grouped as residual azoospermias. Both the medical and microsurgical approaches are reviewed and their success rates analyzed. Some problems are unsolvable after work-up of the diagnosis. Till the early nineties, such patients were discouraged to undergo further medical therapeutic approaches and were advised to consider either adoption or donor insemination. At the present time, new possibilities have risen since the use of epididymal spermatozoa for performing assisted fertilization has considerably altered the picture. Furthermore, the last breakthrough of using testicular spermatozoa combined with the ICSI procedures have offered solutions that were unthinkable only a few years ago. The impact of these new approaches is discussed and the future development of microsurgery versus assisted reproduction techniques is also considered.
Laparoscopic chromoperturbation in superior to hysterosalpingography in the evaluation of infertile women. Referring women to both investigations is therefore cost ineffective and unacceptable for the patient. To estimate the magnitude of this problem, the records of all women referred to hysterosalpingography in our department during 1989-92 were reviewed. We registered the result of the hysterosalpingography, whether or not she later had laparoscopic chromoperturbation and the results of this procedure if done. One hundred and eighteen women were included. Fifty eighty had a laparoscopic chromoperturbation (49%). The fertility prognosis obtained at hysterosalpingography was different from the fertility prognosis found by laparoscopic chromoperturbation in 34 percent of the women. Women with an abnormal hysterosalpingography had significantly more often a complicated gynecologic history. It is suggested that testing for tubal patency as a primary infertility investigation should be reserved for women with an adverse gynecologic history. Laparoscopic chromoperturbation is the method of choice.
The pelvic inflammatory disease (PID) can be caused by various germs. Of the two thousand seven hundred thirty one women screened for different microbiological agents in the genitourinary tract and for PID, three hundred sixty nine patients were Chlamydia trachomatis (Ct) positive; one hundred and three patients were affected by PID. Seventy out of them were resulted to be Ct positive. One hundred twenty two women were Ct positive but not affected by PID. The antibiotic treatment resulted to be less effective in women Ct positive but affected by PID. Results of the present study demonstrate that Ct is the primary cause of PID.
The aim of this work was to establish whether cryopreservation procedure can trigger the production of Reactive Oxygen Species (ROS) in selected sperm populations. Semen samples were obtained from 45 subjects attending our Department of Medical Pathophysiology. Motile sperm suspensions were obtained by swim-up in Tyrode's salt solution. After dilution with TEST yolk buffer freezing medium, they were cryopreserved in liquid nitrogen. In addition to motility assessment, in basal and freeze/thaw conditions ROS detection and the Hypoosmotic Viability Test were also carried out. In 19 subjects (42.2%) there was already evidence of ROS production prior to cryopreservation, which increased after thawing. In 9 subjects (20.0%) there was no ROS production prior to cryopreservation, however, after freezing/thawing we detected evidence of the presence of ROS. It seems, therefore, that cryoprocedure can indeed provoke or increase ROS production in some semen samples. In ROS producing subjects, the post-show recovery of sperm motility and vitality was significantly lower compared to ROS-free subjects. This was probably due to damage by oxidative stress leading to lipid peroxidation of the sperm membrane. Moreover, in some ejaculates, ROS overproduction or scavenger system failure can be regarded as a cryopathogenetic factor affecting "sperm quality" recovery.
