Biomedical subjects
Publications and source records attributed to J H Check.
Attempts at in vitro fertilization-embryo transfer (IVF-ET) for women with hypergonadotropic hypogonadism and bilateral tubal disease demonstrated a very low fertilization rate and no clinical pregnancies.
The human endometrium synthesizes a specific protein known as the progestagen-dependent endometrium protein (PEP) which rises from early to late luteal phase. The PEP levels follow the pattern of the endometrial biopsy more than the serum progesterone (P) levels (4). Late luteal-phase serum PEP levels were evaluated as well as serum P in mid-luteal phase in patients undergoing IVF-ET. Comparisons were made between conceivers and nonconceivers and between aborters and nonaborters. Both serum PEP and late luteal P levels were significantly higher in pregnant patients but no differences in mid luteal P levels were seen. No difference was seen in aborters vs nonaborters. It is still inconclusive whether the higher late luteal PEP levels contribute to the greater likelihood of pregnancy or are a result of the pregnancy.
Explore the source record for details and available documents.
Three women with very elevated, early-first-trimester CA 125 levels spontaneously aborted but not until later in the first trimester or early in the second trimester. All three products of conception showed chromosomal abnormalities. Further investigation is warranted to see if high CA 125 levels might be predictive of abnormal karyotypes.
A 38-year-old woman ovulated and conceived after administration of human menopausal gonadotropins despite a previous diagnosis of ovarian failure at age 18. Possible explanations include restoration of down-regulated gonadotropin receptors by development of a prolactinoma, spontaneous remission of autoimmune oophoritis, or prior tumor secretion of biologically inert gonadotropins.
The efficacy of a technique of gonadotropin suppression and human menopausal gonadotropins (hMG) to induce ovulation in women with hypergonadotropic amenorrhea was evaluated in 100 consecutive women. Ovulation was achieved in 19% of cycles (68/361), the pregnancy rate per cycle was 5.2% (19/361), and the viable pregnancy rate was 2.2% (8/361). In the majority of the successful cases, estrogen was used to decrease the elevated luteinizing hormone and follicle-stimulating hormone levels, especially where the ethinyl estradiol therapy alone induced a rise in endogenous 17 beta-estradiol levels with hMG used to boost the follicle to maturation. Although the success rate is low, this technique can result in some successes in otherwise almost hopeless cases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Ultrasonographic monitoring of ovum release was performed in two consecutive cycles in each of 220 patients treated with gonadotrophin. Definite release occurred in 69% of cycles, indeterminate in 24% and non-release in 7%. Support for the accuracy of sonography in diagnosing the luteinized unruptured follicle (LUF) was demonstrated by a much higher pregnancy rate in those patients showing ovum release. There was a definite tendency for non-release to recur in the next cycle. Thus, the data support the routine use of sonography 2-3 days after human chorionic gonadotrophin (HCG) injection to monitor ovum release in gonadotrophin-treated patients (HMG).
Sixty-nine couples enrolled in 123 in vitro fertilization-embryo transfer cycles were categorized by percentage fertilization; the results of categorization were compared with those of computerized semen analysis carried out with the CellSoft semen analyzer. Four groups were established: group 1 had 75% fertilization or greater; group 2 had 34% to 74% fertilization; group 3 had 1% to 33% fertilization; and group 4 had 0% fertilization. Statistical differences in certain semen parameters (motility, linearity, and straight-line velocity) were found comparing groups 1 and 3 using the initial ejaculate. A significant number of patients in group 1 had all normal semen parameters, but no statistical difference could be found in group 3 or 4 because of variations in specific abnormal parameters in the groups. When the straight-line velocity-motile density (SLVMD) calculation was used, a significant difference was seen between group 1 and group 3 and between group 1 and group 4 (p less than 0.01); 65% of group 3 and 76% of group 4 had an abnormal SLVMD. SLVMD is a useful calculation to predict fertilization rates in vitro from the initial ejaculate.
The ability of the semen analysis either by routine methods (RSA) or computer-assisted means (CSA) to predict male infertility was evaluated by determining the pregnancy rates during an 8-month span in a large group of infertile couples where a female fertility factor was identified and presumably corrected. The males were untreated. Not only was CSA less effective than RSA in predicting a male infertility factor, but also neither CSA or RSA seemed capable of identifying infertility unless severely abnormal. It would appear that there is definite need to find more accurate methods of evaluating the spermiogram.
Poor quality sperm motility might, in some instances, be related to a defect in the seminal fluid rather than in an intrinsic sperm defect. Three men with sperm lacking progressive forward motion (PFM), 40 min after suspension of their small antegrade fraction of a retrograde ejaculation in Ham's F-10 medium, did demonstrate sperm with PFM after suspension of the sperm in donor seminal plasma (DSP). All three achieved pregnancies following the intracervical insemination of their wives within a total of nine ovulatory cycles. Further investigation is needed to determine if the use of DSP can be applied to improve sperm motility in infertile males with a asthenozoospermia but without the complications of retrograde ejaculation. Suspension of sperm in donor seminal plasma had an enhanced effect on asthenozoospermia compared to Ham's F-10 medium in three infertile males with retrograde ejaculation and enabled them to impregnate their wives.
Therapeutic insemination by donor (TDI) was just as successful in achieving pregnancies in couples in whom the male counterparts had subnormal motile densities as in those with normal levels. All wives in this study had an infertility factor that was corrected and remained so for at least 8 months. Thus, motile density may not be a particularly good predictor of male fertility potential.
The standard semen analysis frequently fails to identify subfertile males even when findings are normal and conversely often fails to identify fertile males with subnormal semen analyses. This has created the need to produce other tests of sperm physiology that will better distinguish a fertile from a subfertile specimen. Understanding more about the nature of the sperm defect should lead to the establishment of more specific and effective therapies. Until that time, it would still be reasonable to try some of the available empirical therapies even though they may work merely by a placebo mechanism.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
CA 125 has been found in high concentrations in human amniotic fluid throughout gestation, with significant quantities seen in the decidua and chorion. Because disruption of the epithelial basement membrane of the fetal membrane or the decidua could theoretically lead to a rise in maternal CA 125 levels, this increase may be a predictor of subsequent spontaneous abortion of the fetus. A study was initiated to investigate whether a sudden rise in the serum CA 125 level might predict spontaneous first-trimester abortions. CA 125 levels of 101 pregnant women were evaluated 18-22 days from conception and 6 weeks from conception (a frequent time for spontaneous abortion) to determine whether there is a sudden increase (from baseline or early trimester levels) during the middle or late first trimester immediately before or at the time of abortion. The results indicated that although there was a definite correlation found between elevation of CA 125 and spontaneous abortion, the higher levels occurred early in the first trimester whereas the majority of abortions did not occur until much later, after fetal viability was established. Six of ten women with CA 125 levels of 150 U/mL or greater aborted, compared with four of 92 women with CA 125 levels less than 150 U/mL. One of 11 women pregnant after in vitro fertilization had a CA 125 level above 150 U/mL, and she aborted.
Explore the source record for details and available documents.