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PubMedDate not supplied

Correlation between the hypoosmotic swelling test and various sperm function tests.

OBJECTIVE: To compare the hypoosmotic swelling test (HOST) with other sperm function assays. MATERIALS AND METHODS: The HOST was performed on 105 patients with idiopathic infertility. The results were compared with those of various other sperm function tests, including the sperm penetration assay (SPA), triple-stain technique for evaluating acrosomal reactions, and the in vitro cervical mucus penetration test (Penetrak). RESULTS: A strong positive correlation was observed between percent sperm motility and the percent swollen sperm, between the motile sperm concentration and sperm swelling, and between sperm swelling and penetration values. Only a weak correlation was detected between sperm swelling and the percent sperm penetration. However, most of the cases with a sperm swelling percentage of 50% or more had good sperm penetration into ova. CONCLUSIONS: The HOST was useful to evaluate sperm tail function and was found valuable as a screening test prior to the SPA.

Adult↗
PubMed2005

Heterogeneity, the masked part of reproductive technology success rates.

BACKGROUND: Heterogeneity in women and men's fecundity is a well-established fact. The selection process of men and women treated for infertility might bias the success rates of reproductive technology. Bias may also arise from frequency and timing of intercourse with respect to the day of ovulation. METHODS: Several datasets were collected and analysed. They concern normally fertile couples who used natural family planning methods and infertile couples treated by artificial insemination with husband or donor's spermatozoa. The effects of heterogeneity on the success rates of treatment cycles are described and solutions are proposed as to data collection and statistical analysis in this specific field. RESULTS: The decrease in the success rates along successive cycles of assisted reproduction is a consequence of heterogeneity. The probability of conception varies among women and among men. After a first success, the probability of another success is higher. After a failure, the probability of success is lower. The most specialised centres treat the less fecund couples. There is a negative correlation between men and women's fertility in case of oligo/azoospermia. The fecund window cannot be correctly located by calendar calculations, but more appropriately by assessment of cervical mucus at the vulva. The variability of this location is wide. The decrease in the success rate with men and women's age results from a complex mixture of an increase in the proportion of sterile patients and a decrease in fecund patients' fecundity. CONCLUSION: Care should be taken to limit the bias due to patient selection and specific statistical methods should be used to allow for the progressive selection of patients during fertility studies and for the variability of the frequency and the timing of intercourse or insemination relative to ovulation.

Data Interpretation, Statistical↗
PubMed1998

[Direct diagnosis of Chlamydia trachomatis genital infections: culture or PCR?].

PCR and culturing were compared for the routine diagnosis of Chlamydia trachomatis infections. Two laboratories experienced in both techniques participated in the study, which included 513 specimens. Both techniques were performed on each specimen; the portion of the specimen used for PCR was divided in two, and each half was sent to one of the two laboratories, where the tests were run in a blinded fashion. The PCR primers used by the two laboratories matched different parts of the bacterial genome. PCR inhibitors were looked for in all specimens. Overall, PCR was more sensitive than culturing; the difference was marked for sperm and endopelvic specimens and nonsignificant for urethral and cervical specimens. False-positive PCR results were few in number; there were no consistent false-positive results when each specimen was amplified twice. PCR inhibitors were rarely present in urethral and cervical specimens but were found in 7% of sperm and endopelvic specimens. PCR inhibitors should be looked for routinely during PCR testing of sperm or endopelvic specimens.

Bacteriological Techniques↗
PubMed1978

A simple method of screening for antisperm antibodies in the human male. Detection of spermatozoal surface IgG with the direct mixed antiglobulin reaction carried out on untreated fresh human semen.

A simple and rapid test for the detection of antisperm antibodies of the IgG class on freely swimming spermatozoa in fresh human semen is described. The test is based on the formation of motile mixed agglutinates between erythrocytes sensitized with incomplete anti-Rh-antibodies and freely swimming spermatozoa with surface antisperm antibodies, after mixing both cell types together with anti-IgG antiserum. Agglutination of the red blood cells serves as an internal control. The test can be applied on ejaculates with spermatozoa concentrations down to one million per ml, provided the motility is sufficient. The percentage of motile spermatozoa found to be coated with antisperm antibodies of the IgG class, and the extent of the coating, proved to be correlated with the agglutination titer of circulating antisperm antibodies and with the inhibition of sperm penetration into cervical mucus. The test can be used as a screening for the presence of antisperm autoantibodies in serum and semen.

Agglutination↗
PubMedDate not supplied

Intrauterine insemination in subfertile couples.

Forty-three subfertile women were treated by intrauterine insemination with washed sperm. Among the couples, infertility was, in 7 cases due to cervical factor infertility, in 17 cases due to subfertile sperm quality, and 19 cases, unexplained. All women ovulated: 9 spontaneously, 26 where treated with clomiphene citrate and 8 with hMG-hCG. One hundred and sixty seven inseminations were performed in 90 ovulatory cycles. Six pregnancies were recorded (14%): three pregnancies among the cervical factor infertility group (42.8%), two among the couples with low sperm quality (11.7%) and one pregnancy in the group with unexplained infertility (5.2%). Thus, it can be concluded that IUI is effective for achieving pregnancy when unfavourable cervical factor is detected. The method is of doubtful value in cases of low sperm quality or unexplained infertility.

Adult↗
PubMed2000

Effect of corticosteroids on sperm antibody concentration in different biological fluids and on pregnancy outcome in immunologic infertility.

OBJECTIVE: In the last fourteen years, detection of free spermagglutinating antibodies has been performed by tray agglutination test (TAT) and by direct/indirect mixed antiglobulin reaction test (MAR) in 696 infertile couples aged 23-42 years (female) and 26-52 years (male) with previously undiagnosed infertility. MATERIAL AND METHODS: Oral decreasing doses of prednisone or dexamethasone for three months in the case of serum or seminal plasma spermantibodies, plasmapheresis in one patient with serum spermantibodies were used. Hydrocortisone to the ectocervix was applicated in patients with spermagglutinating antibodies in cervical ovulatory mucus. RESULTS: Serum IgG spermagglutinating antibodies totally disappeared in 3 out of 11 men, and four out of 15 women. But serum IgM sperm antibodies persisted. One female patient was treated with corticosteroids and also with plasmapheresis. Seminal plasma IgG spermagglutinating antibodies were greatly influenced in 57.8% of the patients, IgA in 38.9% and each case by oral corticosteroids. A decrease of IgG and IgA spermagglutinating antibodies in ovulatory cervical mucus during hydrocortisone local application was registered in 61.3%, IgG in 50.7% and IgA in 65.9%. Levels of IgM spermagglutinating antibodies in cervical ovulatory mucus were not influenced, spermantibodies in IgA and IgE were affected very little. CONCLUSION: The corticosteroid influence of immunocompetent cells in each case must be chosen individually with regard to the localisation of spermantibodies. We often combine the long lasting corticosteroids treatment with in vitro fertilization. The therapy seems to be very promising for the improvement of immunological causes of infertility.

Administration, Oral↗
PubMed2001

Intrauterine contraception--what now and what next?

Rising each year by around 85 million, we have started this millennium with over 6,000 million, mostly utterly destitute, human beings on a finite planet. We will never meet human needs without stabilizing human numbers. In the sexual arena, all human beings (but especially the males of the species) are very bad at using their brains and their genitalia at the same time, i.e. putting the knowledge in their head about risks of conception or of sexually transmitted infections into appropriate preventive action when sexually aroused! Therefore, a very useful criterion for choice of methods all through the various stages of reproductive life is 'forgettability'. This is a great 'plus' point for the intrauterine route, especially the levonorgestrel intrauterine system (LNG-IUS). Its main contraceptive effects are local, by endometrial suppression and changes to the cervical mucus and uterotubal fluid, which impair sperm migration. The blood levels of levonorgestrel are about one-quarter of the peak levels in users of the progestin-only pill, and so gestagenic symptoms are uncommon and ovarian function is little altered. Most women continue to ovulate and, in the remainder, sufficient estrogen for health is produced from the ovary even if they become amenorrheic, as many do; this is primarily a local end-organ effect and should be seen as a benefit. Postmenopausal estradiol levels have not been detected, even in those who have no uterine bleeding. Although usable by selected nulliparae, the LNG-IUS is a particularly good choice for the parous woman, for whom I maintain it represents the future already here, which is not recognized by many providers. It has unsurpassed efficacy; 99.5% of women have not conceived after 5 years of use. Return of fertility is rapid and appears to be complete. Combining the best features of hormonal and intrauterine contraception without most ofthe problems of either, it fundamentally 'rewrites the textbooks' about intrauterine devices. Its gynecological benefits are impressive: the LNG-IUS user can expect a dramatic reduction in amount and, after the first few months, in duration of blood loss. Dysmenorrhea is also greatly benefited, in most cases. In summary, the LNG-IUS fulfils many of the criteria for an 'ideal' contraceptive. Adverse side-effects are few and, in general, they are not in the category 'hazardous'. Regarding the inconvenience of the first weeks of light post-insertion bleeding and the early-phase low incidence ofsteroidal side-effects, forewarned is forearmed!

Administration, Intravaginal↗
PubMedDate not supplied

Contraceptive options for the 1990s.

Estrogen-progestin combination oral contraceptives (COCs) are well tolerated, offer high reliability, convenience, and ready availability, but require strict adherence to dosing guidelines. Progesterones work by inhibiting ovulation, thickening cervical mucus, and/or suppressing endometrial growth. An FDA advisory committee has concluded that the benefits outweigh the risks of the mifepristone/misoprostol regimen for use in the United States. IUDs are a good choice for women who want to avoid the inconvenience of barrier methods and who cannot use other forms of contraception. Barrier contraceptives offer low cost and easy availability, but lower effectiveness than other methods.

Condoms↗
PubMed1985

Collagen sponge as vaginal contraceptive barrier: critical summary of seven years of research.

Extensive testing of collagen sponge as a vaginal contraceptive (mechanical and chemical) showed that the original expectations regarding the safety, convenience, and efficacy were not met. The collagen sponge was tested both as a cylinder and as a diaphragm and used as such or impregnated with spermicidal detergent or with zinc salt. The collagen sponge must be larger than 6 cm in diameter in order to serve as a mechanical barrier that will not be dislodged during physical activity. This creates problems with the ease of insertion and with the partners' awareness of the barrier. When the collagen sponge containing ejaculate is left in the vagina greater than 48 hours, it develops an offensive odor. The original acidity of the collagen sponge (pH 3.5, 0.1 mol/L) is soon neutralized by the large volume of alkaline vaginal secretions. In vitro studies showed that up to 10 mg of nonoxynol 9 per milliliter of growth medium did not inhibit the growth of Staphylococcus aureus. These effects, as well as the large surface area of the resilient sponge, present a potential risk for growing staphylococci within the collagen sponge. The capacity of the collagen sponge to absorb a large volume of cervical and vaginal fluid produced two symptoms that were annoying to the volunteers: an awareness of either vaginal dryness during intercourse or, conversely, saturation of the sponge from the vagina. Postcoital studies showed viable spermatozoa in the cervical mucus in 25% of the tests with the nonmedicated cylindrical sponge but in only 6% of tests with the sponge containing nonoxynol 9. The results of clinical trials conducted at four centers support the view that collagen sponge as a vaginal contraceptive barrier method is inconvenient to both partners, not effective enough to compete with present methods of vaginal contraception, and possibly might be unsafe because of the capacity to grow bacteria. Despite the negative end result of this goal-oriented research, we believe that our studies have contributed to a better understanding of vaginal physiologic features, the safety and effectiveness of spermicidal detergents, and the mechanisms of vaginal malodor. Although the acceptability study showed some advantages of the collagen sponge over the rubber diaphragm, the overall acceptability of the collagen sponge diaphragm was no better than that of the rubber diaphragm. For all these reasons, including the possible risk of an increased incidence of toxic shock syndrome, we have discontinued further testing of either type of collagen sponge as a vaginal barrier method.

Collagen↗
PubMed2004

[Detection of chlamydia antibodies in non-standard biological fluids in women with fertility disorders].

OBJECTIVE: Detection of IgA and IgG antibodies against Chlamydia trachomatis in various biological materials in patients with fertility disorders. DESIGN: Retrospective study. SETTING: Department of Gynecology and Obstetrics, Medical Faculty of Charles University and Faculty Hospital, Plzen. METHODS: Antichlamydial antibodies IgA and IgG were detected in 73 patients. Examination of sera was performed in all 73 women, peritoneal fluid was examined in 20 patients who underwent diagnostic laparoscopy, follicular fluid samples in 22 women from IVF programme and antibodies in cervical ovulatory mucus were examined in 31 patients of the Division of Immunology of Reproduction. Results were compared with clinical findings and data of personal histories. Blood donors sera examination were used as a control group. RESULTS: High number of chlamydial antibody positivity was found in follicular fluid--in IgA (18/22, 82%) and IgG (16/22, 73%) and also in ovulatory cervical mucus in IgA (13/31, 42%). Examinations of sera did not differ significantly from the control group. CONCLUSION: High levels of chlamydial antibodies in follicular fluid samples could display connection between chlamydia infection and infertility, mainly as its organic cause (adhesions, tubal factor). IgA positivity in cervical ovulatory mucus is caused by local antibody production. Serologic examination of chlamydial antibodies is one of the most suitable examinations of entry in infertile patients as well as in pregnant women.

Adult↗
PubMed1995

Anaerobes in ejaculates of subfertile men.

The clinical significance of micro-organisms in semen samples of asymptomatic subfertile patients is a matter of constant debate. Usually little attention is paid to anaerobic bacteria as they are sensitive to transportation and culturing, and differentiation is difficult, costly and time-consuming. In the present study, special screening was carried out for anaerobes in ejaculates in addition to the routine microbial cultures of genital secretions of both partners. In addition to standard semen analysis and evaluation of sperm ability to penetrate cervical mucus (CM) in vivo (post-coital testing) and in vitro using a standardized test system, semen samples from 126 randomly chosen males of couples with a median duration of infertility of 4 years were examined for colonization with anaerobic bacteria. All couples were without clinical signs or symptoms of genital tract infection. The special care taken for anaerobic growth in semen samples gave a high rate of positive cultures and showed that nearly all ejaculates (99%) were colonized with anaerobic micro-organisms, and potentially pathogenic species were found in 71% of men. This rate was more than four times higher than that obtained with routine cultures and standard transportation (16%). Anaerobic bacterial growth of > or = 10(6) colony forming units (CFU)/ml was seen in 42% (total range 10(3)-10(8) CFU/ ml). In addition, aerobic growth was found in 96% (> or = 10(6) CFU/ml in 21%), potentially pathogenic species in 61% of semen specimens. There were no marked differences in the prevalence of anaerobic micro-organisms in patients with reduced or normal sperm count, motility or morphology. Nor was there any significant difference in anaerobic colonization between samples with impaired or good ability to penetrate CM of female partners (in vivo or in vitro), or the CM of fertile donors in the in-vitro sperm-cervical mucus penetration test (SCMPT) in this asymptomatic group of patients. There was no clear association between microbial colonization and subsequent fertility in vivo within an observation period of 6 months. The results of this study suggest that anaerobic bacteria are often not detected when routine methods for microbial evaluation are used. This should be considered during assisted reproduction and in patients with symptoms of genital tract infection and should lead to further studies in infertile patients where subclinical infection or inflammation is indicated by specific markers in semen samples.

Adult↗
PubMed1984

Human sperm penetration in bovine cervical mucus clinical studies. II. Use of split ejaculates.

Sperm penetration through bovine cervical mucus was determined and correlated with the sperm characteristics in three fractions of the split ejaculate and in the whole ejaculate from 40 men of infertile couples in which a female cause of infertility had been ruled out. Sperm concentration and motility were found to be significantly higher in the first fraction (n = 40) as compared with the rest of the fractions and the whole ejaculate, whereas normal sperm morphology was not significantly different among the various fractions and the whole ejaculate. The bovine mucus penetration (BCMP) test was found to be normal in a significantly high percentage (58%) of samples of the first fraction as compared with the other two fractions (32% and 17%, respectively) and the whole ejaculate (35%) (n = 17). Moreover, in the first fraction of the split ejaculate, the results of the BCMP test were correlated significantly with sperm concentration (P less than 0.01), motility (P less than 0.0001), and morphology (P less than 0.02). The data demonstrate the superiority of the first fraction of the split ejaculate in terms of cervical mucus penetrability and sperm characteristics.

Adult↗
PubMed1995

Lea's Shield: a phase I postcoital study of a new contraceptive barrier device.

Lea's Shield is a new vaginal barrier contraceptive that may offer advantages over existing methods. It is made of silicone which is resistant to petroleum-based lubricants, does not absorb odors, and does not cause allergic reactions in users with latex sensitivity. It has an anterior loop for ease of insertion and removal and a one-way flutter valve. Its novel design has sufficient volume to fill the posterior fornix, which helps keep it in place and prevent sperm from entering the cervical os. This study evaluated with a standard postcoital test (PCT) the ability of the Lea's Shield used with spermicide or non-spermicidal lubricant to prevent sperm from entering midcycle cervical mucus. Ten sterilized women underwent four PCT cycles: one cycle in which no contraceptive barrier was used (a baseline cycle) and 3 cycles in which one of the following was used: Lea's Shield with spermicide, or with non-spermicidal lubricant, or the contraceptive diaphragm used with spermicide. All volunteers demonstrated more than 5 progressively motile sperm per high power field in the cervical mucus after intercourse in the baseline cycle. No motile sperm were found in the cervical mucus in any cycle in which Lea's Shield or the diaphragm was used with spermicide. No motile sperm were found in cervical mucus in 9 of 10 cycles in which Lea's Shield was used without spermicide. Only two progressively motile sperm were present in the cervical mucus of one volunteer who used the shield with non-spermicidal lubricant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Delayed first injection of the once-a-month injectable contraceptive containing 25 mg medroxyprogesterone acetate and 5 mg estradiol-cypionate: effects on cervical mucus.

The objectives of this study were to assess whether women who were administered the first injection of the once-a-month contraceptive containing estradiol cypionate and 25 mg depot-medroxyprogesterone acetate (MPA+E(2)C) on Day 7 of their menstrual cycle (delayed injection) exhibit the same degree of cervical mucus changes as women who receive it on Day 5 of their menstrual cycle. This was a multicenter, randomized, controlled clinical trial. A total of 158 women, aged between 18 and 38 years (inclusive), who, were willing to use MPA+E(2)C as their contraceptive method participated in the trial. Participants received a MPA+E(2)C injection on Day 5 (control group, n = 41) or Day 7 (delayed-injection group, n = 117) of their menstrual cycle. Participants who received MPA+E(2)C on Day 5 of their menstrual cycle (control group) exhibited fair or poor mucus quality and poor sperm penetration. Of those women who received MPA+E(2)C on Day 7 of their menstrual cycle (delayed-injection group), 3 (3%) showed good mucus or good sperm penetration at some time point during follow-up. It is possible to conclude that the first injection of MPA+E(2)C given on Day 7 of a menstrual cycle does not provide the same degree of inhibition of mucus quality and sperm penetration as that observed if it is administered on Day 5. However, the theoretical risk of pregnancy after receiving MPA+E(2)C on Day 7 would be expected to be low.

Adult↗
PubMed1987

Placental-type alkaline phosphatase in cervical neoplasia.

Monoclonal antibodies reactive with placental-type alkaline phosphatase have formed the basis of methods for detection of this oncodevelopmental antigen in patients with pre-invasive and invasive cervical neoplasia, with or without evidence of papilloma virus infection. Disease-related elevations of placental-type alkaline phosphatase were not observed in patients' sera. Solubilised cervical smears or biopsy material, and cervical mucus swabs, often contained substantial amounts of this isoenzyme; however, there was no significant difference between any of the patient and control groups. Thus, serological and smear test assays for placental-type alkaline phosphatase were not useful in differential diagnosis of cervical lesions. However, its presence in most biopsy specimens, often at high levels, indicated possible application for in vivo radioimmunoimaging studies of invasive or metastatic cervical cancer.

Alkaline Phosphatase↗
PubMed2002

The expression of secretory leukocyte protease inhibitor (SLPI) in the fallopian tube: SLPI protects the acrosome reaction of sperm from inhibitory effects of elastase.

BACKGROUND: Secretory leukocyte protease inhibitor (SLPI) is a protein found in various fluids, including parotid secretions, cervical mucus, seminal plasma and ascites, and is a potent inhibitor of human leukocyte elastase activity. The objective of the study was 2-fold, to evaluate (i) the presence of SLPI in the Fallopian tube, and (ii) the effect of SLPI on the acrosome reaction of sperm. METHODS AND RESULTS: Western blot analysis revealed that SLPI protein was detected as a 12 kDa band in the isthmus, ampulla and infundibulum of the Fallopian tube. Immunohistochemistry using an anti-SLPI polyclonal antibody revealed positive staining of epithelial cells in the Fallopian tube. RT-PCR demonstrated that SLPI transcripts were expressed in the Fallopian tube. To determine the function of SLPI in the Fallopian tube, the effects of SLPI and elastase on the sperm acrosome reaction were examined. SLPI prevented the reduction of the acrosome reaction by elastase in a dose-dependent manner. CONCLUSION: The present findings suggest that SLPI in the Fallopian tube contributes to sperm-oocyte interaction.

Acrosome Reaction↗
PubMed2006

Induction of labour at the start of the new millennium.

Around 20% of all deliveries are preceded by labour induction, a proportion that has not varied dramatically over recent years. Fetal death was the only indication for labour induction centuries ago, while this is now a very rare indication, with prolonged pregnancy and maternal hypertensive disorders being the major indications for the last 50-60 years. Techniques for inducing labour have also changed from dietary delicacies and verbal threats giving way to physical stimulation mainly achieved by cervical stretching and amniotomy and more recently to sophisticated pharmacological manipulation using oxytocin and prostaglandins, based on our expanding knowledge of the physiological processes involved in spontaneous parturition. Relaxin, antiprogestins, nitric oxide as well as complementary medicines have also been explored in recent years. Successful induction is, however, still not guaranteed and there has been increasing emphasis during the past decade on exploring strategies for identifying the probability of success. Measurement of fetal fibronectin in cervical mucus, maternal serum nitrite/nitrate concentrations, ultrasound delineation of cervical form and electrical impedance measurements across the cervix are all being investigated. Safety, success, and patient satisfaction continue to be the major objectives with economic evaluations now becoming a significant factor in the search for the ideal induction method.

Amnion↗