Human endometrial morphology around the time of implantation in natural and artificial cycles.
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Embryo Implantation↗
Biomedical subjects
I D Cooke
Publications and source records attributed to I D Cooke.
Lectin binding of endometrium in women with unexplained infertility.
OBJECTIVE: To investigate whether peri-implantation phase endometrium in women with unexplained infertility differs from the endometrium of normal fertile women. DESIGN: Assessment of the function of the endometrium by using endometrial biopsy specimens and lectin histochemistry. SETTING: Infertility Clinic, Jessop Hospital for Women, Sheffield, United Kingdom. PATIENTS: Eighteen normal fertile women (group I) and 18 women with unexplained infertility (group II). INTERVENTIONS: Endometrial biopsies were obtained from both groups at 5, 7, and 9 days after the luteinizing hormone (LH) surge. MAIN OUTCOME MEASURES: Five biotinylated lectins, concanavalin A (ConA), wheat germ agglutinin (WGA), soybean agglutinin, Peanut, and Ulex europaeus I were used as analytical probes to study endometrial glycoconjugates. Histochemical staining was performed using the avidin-biotin peroxidase method. The lectin binding by endometrial glands, surface epithelium, stromal cells, and vessels was assessed. RESULTS: In group I, ConA stained the subnuclear glandular cytoplasm, glandular lumen, stroma cells, and surface epithelium. In group II, ConA binding to glandular or surface epithelium was none or equivocal. In group I, WGA bound to glandular cytoplasm and stroma cells on days LH + 5 and LH + 7. In group II, WGA binding was absent in glands but present in stroma. CONCLUSIONS: Reproductive failure of women with unexplained infertility may be associated with defective biosynthesis and distribution of glycoconjugates that subsequently results in an unfavorable endometrial environment during the peri-implantation phase.
Adult↗
An endometrial factor in unexplained infertility.
OBJECTIVE: To study a group of women with unexplained infertility to see whether they have a defect that is intrinsic to the endometrium. DESIGN: Evaluation of the functional response of the endometrium by examining endometrial biopsy specimens using immunohistochemical methods in a group of women with unexplained infertility and in a control group of women with normal fertility. PATIENTS: 27 Women with unexplained infertility (average age 33.2); median duration of infertility five years. A control group of 44 women with normal fertility (average age 33.8) who were requesting sterilisation or reversal of sterilisation. SETTING: Infertility clinic, Jessop Hospital for Women, Sheffield. INTERVENTION: Secretory phase endometrial biopsy specimens were taken, with informed consent, as an outpatient procedure. MAIN OUTCOME MEASURES: Immunohistochemistry with monoclonal antibody D9B1, was used to assess the production and secretion of an oligosaccharide epitope produced by endometrial gland cells between two and seven days after the luteinising hormone surge. A reflected light measuring system was used to assess the amount of epitope within the gland cells, and in the gland lumen. RESULTS: In the control group of women, mean reflected light measurements at the cell base and cell apex peaked at three and five days after the luteinising hormone surge respectively, and in the gland lumen the epitope accumulated rapidly from three days, reaching a peak at seven days. In the women with infertility the peaks of epitope at the cell base and cell apex were lower, broader, and delayed in onset, and the build up of epitope in the gland lumen was retarded. The synthesis and secretion of the epitope in the women with infertility was therefore significantly reduced and delayed, even in the presence of normal concentrations of circulating progesterone. CONCLUSIONS: The results suggest that a primary dysfunction of the endometrium might be associated with hitherto unexplained infertility.
Adult↗
Is analgesia required for transvaginal single-follicle aspiration in in vitro fertilization? A double-blind study.
High oocyte retrieval rates using transvaginal follicular aspiration for single follicles and improved laboratory techniques have engendered renewed interest in natural-cycle in vitro fertilization (IVF). To assess analgesia requirements during single-follicle aspiration, a double-blind study was set up in 30 patients comparing intraprocedure intravenous fentanyl with normal saline as a placebo. Analysis of pain perception using visual analogue scoring showed a similar pain tolerance in both groups for the procedures of vaginal ultrasound scanning, needle insertion, and follicular aspiration. A correlation between each patient's tolerance of common pain-producing experiences with that for the procedure was not well defined (r = 0.5). We conclude that one of the benefits of natural-cycle IVF using transvaginal single-follicle aspiration is that it can be performed without analgesia.
Analgesia↗
Outpatient endometrial biopsy: clinical, endocrinologic and histologic consequences.
In this prospective study involving 152 outpatient endometrial biopsies (EBs), it was found that 89% had post-EB spotting which ranged from 1 to 5 days with a median of 2 days. Premenstrual spotting which could not be accounted for by post-EB spotting was present in 14% of the subjects, but less than half of them considered such spotting unusual. Outpatient EB resulted in earlier onset of menstruation in 43% of the subjects, but no overall change in the amount of menstrual flow or discomfort. When compared to control cycles in which an EB was not performed, cycles in which an EB was performed, had significant shortening of the luteal phase by an average of 1.0 day (P less than 0.01). However, there was no change in the corpus luteum function as assessed by the measurement of progesterone concentration in saliva samples collected daily throughout the luteal phase. EB did not appear to have any significant effect on histologic development (dating) of the endometrium, although leucocytic infiltration could be increased.
Adult↗
Delayed abdominal pain after outpatient endometrial biopsy in the luteal phase.
Outpatient endometrial biopsy was followed by delayed abdominal discomfort in 50% of cases. The pain started 2-3 h after the procedure, lasted for about 2 h and was described in most cases as similar to dysmenorrhoea of a moderate degree. Appropriate explanation and the use of a simple analgesic may reduce the discomfort and the anxiety with which it is associated.
Abdominal Pain↗
Peritoneal sperm recovery can be consistently demonstrated in women with unexplained infertility.
Diligent analysis of PF 10 to 20 hours after midcycle intracervical insemination with husband's semen in couples with unexplained infertility showed that sperm are consistently able to transverse the reproductive tract in this group of patients. However, this finding does not necessarily imply that the sperm were retained at the site of fertilization or that they were competent to achieve oocyte fertilization. Therefore, further experiments obtaining sperm from the tubal isthmus to assess the effects of their sequestration there on their ability to fertilize human oocytes are needed.
Adolescent↗
Donor insemination--a look to the future.
In this article we have reviewed many aspects of donor insemination. The deficiencies in the screening of semen donors especially for sexually-transmitted diseases has been discussed and importance of a rational protocol for recruitment and screening of potential donors has been emphasized. Factors influencing the success and outcome of donor insemination have been reviewed with particular emphasis on providing prognostic guidelines to potential donor insemination couples as to the success and outcome of the treatment. The importance of accurate timing of inseminations in determining the success of donor insemination has also been discussed. However, as has been highlighted throughout this review, there is a lack of specific prospective controlled trials, which are clearly necessary to answer specific important questions. Also emphasized has been the need of these trials to answer such basic questions as the influence of accurate timing on conception rates in specific groups of insemination recipients.
Female↗
Are factors that influence oocyte fertilization also predictive? An assessment of 148 cycles of in vitro fertilization without gonadotropin stimulation.
Fertilization characteristics of 152 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occurred significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases of secondary infertility. Grade I sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progesterone (P), estradiol (E2), E2:P ratio, and luteinizing hormone (LH), as well as baseline plasma LH and the magnitude of the LH surge did not correlate with fertilization. However, when the identified factors were used to predict fertilization (discriminant analysis), only 58.3% of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right.
Adult↗
The placebo response of subfertile couples to attending a tertiary referral centre.
The objective of this study was to determine whether there was a placebo response to clinic attendance in couples with prolonged (greater than 4 years) subfertility. From 4 to 18 years of subfertility we observed a treatment independent cumulative conception rate of 22%, which was independent of the length of subfertility. Twenty-seven women conceived after 1 to 4 years' subfertility, and 30 conceived after greater than 4 years' subfertility. The fecundity of the latter group was significantly greater than that of women with 1 to 4 years' subfertility, being similar to "normal" subjects who had stopped contraception. This study demonstrates that a subgroup of apparently normal women with greater than 4 years' subfertility responded positively to clinic attendance independent of any investigation(s) or therapy.
Adult↗
Using a donor insemination management system.
A computerized database management system has been developed for an expanding donor insemination service. The programs have been written in dBASEIV language and they will run on a single personal computer (IBM or compatible, with a hard disc) or on a network. The central database enables access to stock, donor and couple details and routine statistics e.g. pregnancy rates, although levels of access to the system are restricted by password control. The central database provides an archival component, with data recorded on a daily basis, a service management component assisting in the routine administration of a donor insemination service, a financial component and a statistical component providing for both local and national statistics. Data may be converted for use in other software packages, e.g. SPSSX, SAS (statistical packages), encouraging data manipulation and enabling specific research questions to be addressed more readily.
Database Management Systems↗
A morphometric study of the human endometrial stroma during the peri-implantation period.
In this study we have examined the human endometrial stromal cell population in well-timed biopsies during the peri-implantation period, using traditional stereological techniques. This paper reports data obtained from 16 women of known fertility who underwent endometrial biopsies at known times after the luteinizing hormone (LH) surge (four each at LH + 2, LH + 4, LH + 6 and LH + 8). The average stromal cell nuclear diameter increased in size throughout the period of study (P less than 0.01), with a significant decrease (P less than 0.05) in the nuclear profile axial ratio. This suggests that the nuclei were increasing in size and becoming more rounded. There was a dramatic increase (P less than 0.01) in the packing density between LH + 2 and LH + 6; this is likely to be due, at least in part, to the glands filling up with secretory products and so compressing the intervening stroma. A substantial decrease (P less than 0.01) was seen in the packing density between LH + 6 and LH + 8. This corresponds to the time when stromal oedema is thought to be maximal.
Adult↗
A morphometric study of the human endometrial stroma during the peri-implantation period.
In this study we have examined the human endometrial stromal cell population in well-timed biopsies during the peri-implantation period, using traditional stereological techniques. This paper reports data obtained from 16 women of known fertility who underwent endometrial biopsies at known times after the luteinizing hormone (LH) surge (four each at LH + 2, LH + 4, LH + 6 and LH + 8). The average stromal cell nuclear diameter increased in size throughout the period of study (P less than 0.01), with a significant decrease (P less than 0.05) in the nuclear profile axial ratio. This suggests that the nuclei were increasing in size and becoming more rounded. There was a dramatic increase (P less than 0.01) in the rounded. There was a dramatic increase (P less than 0.01) in the packing density between LH + 2 and LH + 6; this is likely to be due, at least in part, to the glands filling up with secretory products and so compressing the intervening stroma. A substantial decrease (P less than 0.01) was seen in the packing density between LH + 6 and LH + 8. This corresponds to the time when stromal oedema is thought to be maximal.
Adult↗
Functional significance of white blood cells in the male and female reproductive tract.
The functional significance of white blood cells in the modulation of an anti-sperm antibody response, prevention of infection (including HIV) sperm transport/storage and sperm function is extensively discussed. A critical review of the existing literature is presented with future experimental lines of investigation outlined. A lack of controlled clinical studies in the human to validate data from animal species--for example--the involvement of white blood cells in the transport and storage of sperm in the female tract and the possible adverse effect of pathology (i.e. endometriosis) on these functions are presented. In conclusion, with the advent of modern techniques, e.g. monoclonal antibodies and sophisticated sperm function tests, many of the questions raised should be answered in the near future.
Female↗
A comparison of some clinical and endocrinological features between cycles with normal and defective luteal phases in women with unexplained infertility.
The luteal phase in a group of women (n = 49) with unexplained infertility was evaluated by improved methods, including the use of the LH surge for precise timing of measurements, quantitative techniques for histological dating of endometrial biopsy and determination of the integrated progesterone concentration in the luteal phase. Overall, 10 out of 49 (20%) women were considered to have a retarded endometrium. The prevalence of retarded endometrium in women with primary infertility (10/37, 27%) was found to be significantly higher (P less than 0.05) than in women with secondary infertility (0/12, 0%). Women with retarded endometrial development had a significantly (P less than 0.01) lower integrated P concentration than those with normal endometrial development; however, of the 10 cases with retarded endometrium, only four were associated with an integrated P concentration below the normal range, whereas the remaining six were associated with an integrated P concentration within the normal reference range, suggesting that an abnormal response of the endometrium is a likely cause of abnormality in these latter cases. There was no difference in age, duration of infertility, follicular phase length, magnitude of the oestrogen surge, magnitude of the LH surge, maximum follicular diameter and luteal phase length between women with a normal or defective luteal phase, defined either by endometrial morphology or integrated progesterone concentration.
Endometrium↗
Antisperm antibodies and lymphocyte subsets in semen--not a simple relationship.
The significance of white blood cells in the ejaculate remains a matter of controversy. Several authors have suggested that such cells are important in the modulation of an antisperm antibody response, i.e. a predominance of suppressor/cytotoxic to helper/inducer T cells may prevent the development of antisperm antibodies. In order to examine this relationship further we have documented the white blood cell types, with emphasis on the T-lymphocyte populations, in the ejaculates of men from infertile couples with and without antisperm antibodies; the latter group was divided further into two groups--vasovasostomized men and idiopathic men. All seven of the men without antisperm antibodies had a predominance of suppressor/cytotoxic T cells to helper/inducer T cells in the ejaculate. However, only in some of the men with antibodies was there a predominance of T-helper/inducer cells. It is clear that the relationship between antisperm antibodies and seminal leucocytes is therefore not as straightforward as has been proposed.
Antibodies↗
Seminal peroxidase positive cells are not an adequate indicator of asymptomatic urethral genital infection.
The relationship between asymptomatic urethral infection and seminal white blood cells, as detected using the peroxidase enzyme system, was examined. Eighty-four semen donors were tested. Twenty-four (29%) were diagnosed as having an active urethral genital infection. There was no statistical relationship between the total number of concentrations of peroxidase-positive cells and a urethral genital infection. Further studies should concentrate on the subtypes of seminal leucocytes and their surface receptors using monoclonal antibodies.
Humans↗