Int. J. Gynaecol. Obstet., 1987, 25: 419428 International Federation of Gynaecology & Obstretics
Citations from the Literature This is a selection of abstracts of papers taken from the literature in the field of obstetrics and gynecology which the Journal’s Editors feel may be of general interest to our readers*.
FERTILITY AND STERILITY Mkrosnrgkal epididymovasostomy sive azoospennia
in the treatment of occlu-
Fogdestam I; Fall M; Nilsson S Sahlgrenska sjukhuset, University of Goteborg, Goteborg, Sweden FERTIL. STERIL.; 46/5 (925-929) 1986 In principle, azoospermia has two explanations: occlusion of the duct system and serious dysfunction of the testicular parenchyma. Some cases of duct occlusion are suitable for reconstructive surgery. The authors describe a reconstructive technique based on full mobilization of a single loop of the epididymal duct as caudally as possible with two-layer sideto-end anastomosis, to the vas deferens. To ensure follow-up evaluation of each anastomosis, unilateral anastomosis was done primarily. In a few cases, cross-over anastomosis was necessary. In cases of reoperation, if possible, this was performed on the same side. When the epididymal duct was found empty, the contralateral epididymis was explored. Patients with postoperative oligozoospermia were offered a supplementary contralateral operation. From 1980 to 1984, 41 patients underwent epididymovasostomy. At follow-up evaluation. 35 (85%) presented sperms in repeated tests. Fifteen of these patients (37%) have fathered children. Patients with postoperative normospermia and no antisperm antibodies had an excellent fertility prognosis. The singleloop dissection technique provides anatomic specificity and a high percentage of patent anastomoses and does not interfere with the possibilities of reoperation.
Placental-type alkaline phosphrtase plasma from fertik and infe* men
McLaughlin PJ; Lewis-Jones I; Hutchinson GE; Johnson PM Pregnancy Immunology Group, Department of Immunology, University of Liverpool, Liverpool. UK FERTIL. STERIL.; 4615 (934-937) 1986 Solid-phase enzyme immunoasssays, base-d on monoclonal antibodies reactive with different forms of human placental-type alkaline phosphatases, were applied to their detection in human seminal plasma from fertile and infertile men. The placental-like form of alkaline phosphatase (PLAP-like AP), known to occur in testicular tissue, was
found in normal seminal plasma. The incidence of detection and levels of this isoenzyme correlated significantly with the designated fertility status of the donor. Seminal plasma (PLAP-like AP) may reflect germ cell function and/or access of testicular products to the ejaculate. Comparlsoa of gouadal function between fertile and infertile men with varkocelecl Nagao RR; Plymate SR; Berger RE; et al
Department of Intemai Medicine, University of Washington. Seattle, WA, USA FERTIL. STERIL.; 46/5 (930-933) 1986 The high prevalence of men with varicoceles who by history are fertile has led some to question the suggested causal relationship between a varicocele and male infertility. However, testicular function ‘in these fertile men has not previously been studied in detail. Fifty-five normal fertile men, 42 fertile men with varicoceles, and 24 infertile men with varicoceles and normal female partners were studied. Semen analyses were done, baseline serum testosterone and gonadotropin levels tested and the gonadotropin response to luteinizlng hormone-releasing hormone (LH-RH) measured. The infertile men with varicoceles exhibited lower sperm counts, abnormal sperm morphologic features, increased baseline serum gonadotropins, and increased gonadotropin responses to LH-RH, compared with the normal fertile men. The fertile men with varicoceles showed similar abnormalities, although this was not statistically significant in all cases. That semen and hormone abnormalities were observed in both the fertile and infertile men with varicoceles suggests that the presence of a varicocele is associated with some degree of primary testicular dysfunction, regardless of present fertility status. Induction of fertility in a mao with hypogonndotropic gonadism with very low seminal volume
Tulandi T; Mclnnes RA Department of Obstetrics and Gynecology. McGill University, Montreal, Que. H3A IAI. Canada FERTIL. STERIL.; 46/4 (730-733) 1986 Pituitary function studies were performed on a 31-yearold man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing
*Generated from the Excerpta Medica Database, EMBASE. Int J Gynaecol Obstet 25
Citations from the Literature
hormone (LH) response to luteinixing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotgropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMCi)hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMGhCG treatment. Cryopreservation of human spermatozoa correlations of ultrastractural sperm bead configuratioa with sperm motility and ability to penetrate zoaa-free hamster ova Serafini PC; Hauser D; Moyer D; Marrs RP University of Southern Corifornia School of Medicine, Los Angeles, CA, USA FERTIL. STERIL.; 46/4 (691-695) 1986 Freezing and storage of human male gametes is associated with a reduction in the overall semen quality and establishment of pregnancy. This study was done to evaluate the integrity of sperm head ultrastructure (SHU) with computerized and vapor freezing. Comparisons were made between the effect of cryopreservatives glycerol (G) and dimethylsulfoxide (DMSO) on SHU. Twelve ejaculates from five proven fertile donors were studied with the use of routine semen analysis, xona-free hamster ova, and SHU. Both cooling processes, regardless of the preservative used, significantly reduced sperm function and the number of SH with intact plasma membranes. The staged cooling technique was substantially superior to vapor freezing in all parameters analyzed (P < 0.01). G was less detrimental to the postthaw SHU than 1 M DMSO. A significant positive correlation (r = 0.98; P < 0.01) was noted between the total number of intact SH and motile sperm. Computerized freezing in a Gdiluted semen rendered a sperm environment that allowed the highest number of forms with intact SH membranes and with the best chances to penetrate zona-free hamster ova. Enhancement of human sperm motility and velocity in vitro: effects of cah4om and creatine phosphate Fakih H; MacLusky N; DeCherney A; et al The Sperm Physiology Laboratory, Department of Obstetrics incubated with 1 mm01 of calcium, 5 mmol magnesium, Haven, CT 06510-8063, USA FERTIL. STERIL.; 46/5 (938-944) 1986 Because of their roles in motility regulation and energy transport, calcium and creatine phosphate were examined for their effects on sperm motility and velocity in specimens of normal donors. Semen or migrated sperm fractions were incubated with 1 mmol of calcium, 5 mmol magnesium, and 10 mmol of creatine phosphate (n = 28) or in the presence of 4 gmol of Verapamil, calcium, and creatine phosphate (n = 10). The samples were subjected to multiple exposure photography (four picture frames of two different
Int J Gynaecol Obstet 25
drops) at 0, 1. 4, or 5 and at 10 hours and sperm motility and velocity were analyzed. In both calcium and calciumcreatine phosphate conditions, sperm motility and velocity were significantly increased, compared with control values (P = between < 0.001 and 0.05). Sperm motility declined following Verapamil exposure, but the motility values remained at the level of the control in the presence of additional calcium or creatine phosphate. The effects of calcium and creatine phosphate take place rapidly; within 1 minute all improvements in sperm velocity and motility are fully achieved. There is no loading effect of calcium, and when the sperm is transferred into media without the additional calcium, the velocity decreased to that of the initial control value. Magnesium alone had no effect on motility or velocity. These experiments indicate that calcium or creatine phosphate can support sperm motility and velocity at a significantly increased level. Thus the addition of calcium or creatine phosphate to the insemination media may enhance the fertilizing capacity of sperm during in vitro fertilization or gamete intrafollopian transfer procedures. Luteal phase defect and premenstrual syndrome in an infertile population Ying Y-K; Soto-Albors CE; Randolph JF; et al Divirion of Reproductive Endocrinology and Idertility, Department of Obstetrics and Gynecolo~, University of Connecticut Health Center, Farmington, CT, USA OBSTET. GYNECOL.; 69/l (96-98) 1987 To test the hypothesis that an abnormal luteal phase is associated with significant symptoms of premenstrual syndrome, psychologic and somatic premenstrual syndrome symptoms were evaluated in a group of 83 infertile patients undergoing timed endometrial biopsy for the assesssment of luteal phase adequacy. The severity of psychologic and somatic symptoms was evaluated separately. It was found that luteal phase defect, defined by endometrial biopsy, was associated with less severe pyschologic and no more severe somatic symptoms of premenstrual syndrome in comparison with normal luteal phase controls. The data suggest that the hormonal milieu associated with luteal phase defects does not correlate with premenstrual syndrome symptoms and do not support the hypothesis that suboptimal ovarian function causes premenstrual syndrome. Experimental evidence for failure to implant as a mechanism of infertility associated with endometriosis Hahn DW; Carraher RP; Foldesy RG; McGuire JL Research Laboratories, Ortho Pharmaceutical Corporation, P.O. Box 300, Raritan, NJ 08869-0602, USA AM. J. OBSTET. GYNECOL.; 155/5 (1109-1113) 1986 The effect of endometriosis on pregnancy. from ovulation through day 14 of pregnancy, was studied in an animal model previously developed and validated with the use of the rabbit. Endometrial tissue was implanted surgically in rabbits and allowed to grow for 11 weeks without hormonal supplementation.The animals were artificially inseminated with semen from bucks with established fertility and human cho-