BACKGROUND: The aim of this study was to evaluate the role of blastocyst culture in patients with azoospermia. METHODS: In 98 cycles embryos were cultured for 2 days and in 128 cycles for 5 days to ...reach the blastocyst stage; a maximum of two of the most developed embryos were transferred in each group. RESULTS: There was a negative correlation between a high (≥20 IU/l) male serum FSH and embryo development, manifested as embryos not reaching the morula stage on day 5 (r = 0.387; P < 0.05). After prolonged culture, 23% of embryos reached the blastocyst stage. The pregnancy rates per transfer, and the abortion rates were approximately the same in the day 2 group and the day 5 group (20 versus 20% and 19 versus 18% respectively). After blastocyst transfer, a high clinical pregnancy rate (55%) and a low abortion rate (6%) were achieved, whereas the transfer of arrested embryos provided a low pregnancy rate (2%) and a high abortion rate (100%). If only blastocysts had been transferred on day 5, the clinical pregnancy rate per started cycle would have been approximately the same in both groups (13 versus 16%). CONCLUSIONS: Blastocyst formation is a good indicator of clinical results after ICSI with testicular sperm.
Even though gender-specific differences in ventricular repolarization have gained wide recognition, the underlying mechanisms remain unknown. Because estrogen hormones may represent a causative ...factor for the changes in ventricular repolarization in women, this study evaluates a potential impact of estrogen replacement therapy on ventricular repolarization dynamics. Beat-to-beat QT and RR interval variability and QT/RR relationship during 5 minute resting high-resolution electrocardiogram recordings were measured in 30 healthy postmenopausal women (mean age 54.5 years) before and after 10 weeks of estrogen replacement therapy (ERT) with estradiol 2 mg/day. The 2 control groups included 12 healthy postmenopausal women of the similar age, who did not receive ERT, and 11 comparably healthy age-matched men. To evaluate ventricular repolarization dynamics, QT/RR linear regression slopes were calculated. After the 10-week period, the QT/RR regression slope increased by 93% in the ERT group (P lt .001), but no alterations were noted in either the male or female controls. The overall variability of RR and QT intervals did not change in any of the groups studied. Our results suggest that ERT causes alterations in ventricular repolarization dynamics without significantly affecting the autonomic nervous tone.
BACKGROUND: We investigated whether the psychological stress related to a short war (26 June–7 July, 1991) in Slovenia induced changes in fertility, sex ratio at birth and semen quality ...characteristics. METHODS: Sex ratios i.e. males/(males + females) for 4966 births in the general population of Slovenia and separately for 1565 births in the Slovenian capital, Ljubljana, from January–March 1992 were compared with the sex ratio calculated for the same time period in 1991 and 1993. Semen analyses for 38 normozoospermic men attending an outpatient infertility clinic from May to September 1991 were also evaluated. RESULTS: In the general population in Slovenia there was a significant fall in the sex ratio at birth in 1992, compared with 1991 (0.504 versus 0.518; P = 0.03). In Ljubljana, the decline in sex ratio in 1992 was even more pronounced: 0.483 versus 0.537 in 1991 (P = 0.0001) and 0.483 versus 0.516 in 1993 (P = 0.005). A decrease in the proportion of sperm that were progressively motile from 56% before the war to 52% after it (P = 0.01) and of those that were rapidly motile from 40 to 36% (P = 0.01) was observed. CONCLUSIONS: Acute psychological stress in relation to a short war in Slovenia resulted 6 to 9 months later in a decrease in the observed sex ratio at birth. Negative changes in sperm motility may be involved in the sex ratio modifications.
Summary
The aim of this retrospective study was to evaluate the efficiency of testicular biopsy and intracytoplasmic sperm injection (ICSI) in patients with aspermia or non‐obstructive azoospermia ...(NOA) after cancer treatment. From 1996 to 2003, 30 men with a history of cancer, affected by aspermia or NOA and without sperm cryopreserved before cytotoxic treatment underwent testicular sperm extraction (TESE). In these men, clinical, hormonal and histological characteristics were compared; 13 underwent 39 TESE‐ICSI cycles using frozen‐thawed testicular spermatozoa (TESE‐ICSI group). In the same period, 31 ICSI cycles were performed in 20 men with aspermia or NOA using ejaculated sperm frozen before cancer treatment (ejaculated sperm‐ICSI group). Fertilization, blastocyst development, pregnancy and miscarriage rates were compared between the groups. Testicular volume, serum follicle‐stimulating hormone level and Johnsen score indicated complete although reduced spermatogenesis in men with aspermia and abnormal spermatogenesis in men with NOA. After TESE, sperm retrieval was positive in 92% of men with aspermia and 58% of men with NOA. In TESE‐ICSI patients with NOA a significantly lower proportion of embryos developed to the blastocyst stage than in patients with aspermia and in those after ICSI with frozen‐thawed ejaculated sperm (23% vs. 43% and 47%, p = 0.03 and p < 0.01 respectively). In all groups the miscarriage rates were high; in patients with aspermia and NOA, characterized by increased age, the miscarriage rate tended to be higher in spite of similar female age and female indications of infertility. In patients affected by aspermia or NOA after cancer treatment and without sperm cryopreserved before treatment, TESE‐ICSI using testicular sperm provide a chance to father a child.
Summary
High seminal reactive oxygen species (ROS) are related to poor semen quality and impaired fertilization. We aimed at finding whether there is an association between ROS and fertilization, ...embryo quality and pregnancy rates after conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In prepared semen of 147 male partners of infertile couples, ROS were assessed with luminol chemiluminescence. Spermiogram was assessed in native semen. ROS were negatively correlated with standard sperm characteristics and testicular volume, and positively with abnormal sperm head morphology. Fertilization rate and embryo morphology on day 2 and on day 4 were assessed in 41 IVF and 106 ICSI cycles. The influence of maternal (female age and number of oocytes) and paternal (sperm motility, morphology and ROS) factors on fertilization and embryo quality were assessed by means of regression analyses. After IVF, fertilization and pregnancy rates were negatively associated with ROS level (p = 0.031 and 0.041, respectively). In case of higher ROS, significantly fewer ICSI‐derived embryos (p = 0.036) reached the morula‐blastocyst stage on day 4. High seminal ROS levels are associated with impaired sperm fertilizing ability and lower pregnancy rates after IVF. In ICSI, a negative association of ROS with embryo development to the blastocyst stage has been observed.
Utero-ovarian arterial blood flow and hormonal profile were evaluated in 20 patients with polycystic ovary syndrome (PCOS) and in 22 patients with normal menstrual cycle (NMC) undergoing in-vitro ...fertilization (IVF) treatment. In this controlled prospective clinical study the vascular impedance in the utero-ovarian arteries was measured in both groups on days 4, 13, 22 introduction of gonadotrophin releasing hormone agonist (GnRHa) administration, 36 (after the 14 day GnRHa administration) and on the day of human chorionic gonadotrophin (HCG) administration. Simultaneously, serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), oestradiol, androstendione and sex hormone-binding globulin (SHBG) were determined. In the PCOS group significantly (P < 0.05) higher concentrations of FSH and LH were found on day 22, whereas the excess of androstendione production and lower SHBG values were registered throughout the studied cycles. Also, no effect of the 14 day GnRHa administration on the androstendione discharge was registered. In both groups the serum LH concentration decreased significantly (P < 0.05); however, the value remained significantly (P < 0.05) higher in the PCOS group. In the PCOS group no changes regarding the vascular impedance in the uterine artery were registered in the phase of the cycle preceding the GnRHa administration. The resistance index (RI) on day 22 of the cycle was 0.86 in the PCOS and 0.82 in the NMC group. In the NMC group the active ovary showed dramatic changes during the cycle, with vascular impedance almost constant throughout the cycle in the inactive ovary. In the PCOS group the vascular impedance to ovarian arterial blood flow in both ovaries was similar to that in inactive ovaries in the NMC group. After the 14 day GnRHa administration the utero-ovarian vascular impedance was high in both groups with changes registered only in the NMC group, as the PCOS patients exhibited maximal vascular impedance throughout the cycle. On the day of HCG administration strong negative correlation between the vascular impedance in the uterine artery and the serum oestradiol concentration in stimulated cycles was found in both groups, but not in anovulatory PCOS patients. As in PCOS patients the utero-ovarian vascular impedance was raised throughout the cycle we concluded that the 14 day GnRHa administration neither affected the utero-ovarian arterial blood flow nor suppressed the androstendione discharge.
BACKGROUND: Fragile X premutation carriers are at increased risk of premature ovarian failure (POF), which is usually defined as menopause before the age of 40 years. METHODS: We evaluated 83 women ...with sporadic premature ovarian failure, treated at the Department of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, between 1991 and 2001. There was no family history of mental retardation in any of the patients. They were phenotypically normal and had normal female karyotype (46,XX), without a past history of pelvic surgery, chemotherapy or autoimmune diseases. RESULTS: The premutation in the FRAXA locus was found in four of the women screened (4.8%; 95% confidence interval 1.9–11.7). This prevalence (1 in 21) was statistically significantly higher than expected in the female Caucasian population. CONCLUSION: In this study we have confirmed an important association between FRAXA premutation and the pathogenesis of POF. This result has practical implications for genetic counselling and fertility treatment.
To establish whether LPA determination improves the differentiation of benign from malignant ovarian tumors.
Total LPA and LPA species in the serum were determined using a novel method in 142 ...patients with ultrasound (US) suspecious ovarian tumors and in 78 healthy women. All women underwent determination of CA125 in the serum, a vaginal US examination and morphology scoring of the tumor.
The levels of total LPA and its species in women with ovarian tumors were significantly higher from those in healthy women (p < 0.001). No significant difference was found in the levels of total LPA or any of its species between the women with benign and those with malignant ovarian tumors.
Determination of serum LPA would be an appropriate test for ovarian tumor presence, especially in women of reproductive age. The method however does not differentiate benign from malignant ovarian tumors.
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