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The human sperm-hamster egg penetration assay: prognostic value.

Males from 227 infertile couples were evaluated using the human sperm-hamster egg penetration assay (SPA). Indications for the SPA were abnormal semen analyses, poor postcoital tests, documented autologous sperm antibodies, and long-term unexplained infertility. Normal results defined as greater than or equal to 11% penetration were seen in 58.6% of couples. Penetration rates of 1% to 10% were observed in 25.6%, and 15.9% failed to penetrate any of the oocytes. During the follow-up period, with a mean of 17.9 months, 26.9% conceived at least once with or without treatment. Monthly fecundity was 0.014 for normal SPA patients and 0.007 for the abnormal SPA group when calculated by the Kaplan-Meier survival curve with Cox correction for unequal follow-up. The monthly fecundity rate at any time during the 30-month interval of follow-up was twice as great for men with normal SPA values as for those with abnormal values, regardless of male or female diagnosis or therapy indicating the prognostic value of the SPA in an infertile population.

Animals↗

Therapeutic donor insemination: the impact of insemination timing with the aid of a urinary luteinizing hormone immunoassay.

The records of 120 patients undergoing therapeutic donor insemination were reviewed to determine if the use of the enzyme immunoassay of urinary luteinizing hormone (LH) to plan inseminations decreased the number of cycles required to achieve conception. All inseminations were performed with fresh semen. Patients in group 1 (n = 26) utilized urinary LH testing in addition to basal body temperature (BBT) and cervical mucus examinations to time their inseminations, while inseminations in group 2 (n = 94) were timed with only BBT and cervical mucus examinations. The monthly fecundability of patients in group 1 was 0.13, whereas the monthly fecundability of patients in group 2 was 0.11. The mean number of inseminations was 1.4 and 1.6 per cycle for groups 1 and 2, respectively. There were no significant differences between groups 1 and 2 in regard to the number of cycles required to achieve conception. The use of a urinary LH immunoassay for insemination timing offers no benefit over conventional methods of timing (BBT, cervical mucus) when fresh donor semen is used.

Adult↗

Danazol and medroxyprogesterone acetate inefficacious in the treatment of infertility in endometriosis.

Danazol (200 mg three times a day) and medroxyprogesterone acetate (MPA, 100 mg a day) were compared with placebo in the treatment of infertility of patients with endometriosis. Twenty-seven patients had medical therapy alone for 6 months, and 22 patients received it after conservative surgery. The clinical characteristics of the patients in the danazol group (n = 18), the MPA group (n = 17), and the placebo group (n = 14) were comparable to each other. The follow-up time was 30 months. The cumulative pregnancy rates, 33% in the danazol group (n = 6), 42% in the MPA group (n = 7), and 46% in the placebo group (n = 6), did not differ significantly from each other. The time to pregnancy after the start of therapy was 17.7 +/- 8.4 (standard deviation [SD]) months in the danazol group, 18.0 +/- 9.0 months in the MPA group and 10.0 +/- 5.8 months in the placebo group with no significant difference between the groups. The abortion rate was 26%, and there was no significant difference among the groups. Cox multivariant analysis did reveal ovarian endometriosis a prognostically significant negative indicator as regards fecundation in endometriosis (P less than 0.05). In summary, correction of infertility alone does not appear to be an indication for the use of danazol or MPA in the treatment of endometriosis, and ovarian endometriotic lesions but not peritoneal ones do make a worse prognosis as regards fecundation in endometriosis.

Adult↗

A prospective randomized controlled trial comparing urinary luteinizing hormone dipsticks and basal body temperature charts with time donor insemination.

Especially now with the almost exclusive use of frozen semen, accurate timing of donor inseminations is an important point to address if a successful donor insemination program is to be established. To examine whether the timing of donor inseminations using urinary luteinizing hormone (LH) dipsticks (group 2) was significantly better than using basal body temperature (BBT) charts (group 1) we performed a prospective randomized controlled trial. There was no significant difference between the cumulative pregnancy rates at 6 months (0.23 versus 0.31 for groups 1 and 2, respectively) or the monthly fecundability (0.04 versus 0.07 for groups 1 and 2, respectively). Using these monthly fecundabilities we have calculated that approximately 378 patients in each arm of the trial would be needed to demonstrate a significant difference between the two groups. We therefore conclude that timing donor inseminations using urinary LH dipsticks does not significantly improve the conception rates.

Body Temperature↗

The effect of therapy initiation day on clomiphene citrate therapy.

Eighty-seven anovulatory patients were treated with clomiphene citrate (CC) to induce ovulation in 414 cycles. Clomiphene citrate was initiated randomly on the 2nd, 3rd, 4th, or 5th day of the menstrual cycle to evaluate the effectiveness of therapy. The results of therapy were assessed in terms of ovarian response and pregnancy outcome. Ovarian response was evaluated employing basal body temperature (BBT) to define follicular, luteal, and cycle lengths, and a midluteal serum progesterone (P) level and the integrated luteal P to define luteal adequacy. Pregnancy outcome was evaluated in the categories of total pregnancy, live birth, first trimester abortion, and fecundity rates. There were no significant differences noted between the groups who started CC on the 2nd, 3rd, 4th, or 5th day of cycle in terms of anovulation rates (12% to 21%), luteal dysfunction (28% to 39%), and normal ovulation rates (42% to 57%). Pregnancy was achieved in 31% (n = 27/87) of patients with a spontaneous abortion rate of 19% (n = 5/27). The fecundity rates ranged between 5.7% and 9.4%. Pregnancy outcomes also were not significantly different between the groups. Significantly shorter luteal phase length and longer follicular phase length were observed in the cycles with luteal dysfunction. The luteal progesterone parameters, including midluteal serum P concentration, the integrated luteal P, and the luteal P amplitude were significantly lower in the cycles with luteal dysfunction.

Abortion, Spontaneous↗

The effectiveness of intrauterine insemination in couples with sterility due to male infertility with and without a woman's hormone factor.

OBJECTIVE: To examine the efficacy of IUI on fecundity and baby-take-home rates in cases of infertility attributable to a male factor with and without a woman's hormone factor. DESIGN: Retrospective analysis. SETTING: Department of Gynecology and Obstetrics at the General Public Hospital, Horn, Austria. PATIENT(S): Seventy-eight long-standing involuntarily childless couples. INTERVENTION(S): After a follicular phase GnRH analog (buserelin) protocol with hMG stimulation of the woman and a Percoll gradient preparation and capacitation of the man's semen, an IUI was performed. MAIN OUTCOME MEASURE(S): Fecundity and baby-take-home rates. RESULT(S): One hundred nine inseminations were followed by 53 pregnancies (48.6%; 95% confidence intervals (CI) 38.9%-58.4%) and 38 deliveries (34.9%; 95% CI 26.0%-44.6%). Forty-nine children were born and 47 are alive (43.1%). CONCLUSION(S): Intrauterine insemination combined with buserelin gonadotropin stimulation, Percoll semen preparation, and sperm capacitation is a feasible solution to the problem of sterility attributable to a male factor with and without a woman's hormone factor.

Adolescent↗

Pregnancy outcome after laparoscopic fimbrioplasty in nonocclusive distal tubal disease.

OBJECTIVE: To determine pregnancy rates (PR) after fimbrioplasty and salpingostomy in nonocclusive distal tubal disease. To evaluate the relative impact of various factors using contemporary statistical analysis. DESIGN: Prospective cohort. SETTING: Tertiary institutional infertility clinic. PATIENTS(S): Infertility patients. INTERVENTION(S): Fimbrioplasty and salpingostomy. MAIN OUTCOME MEASURE(S): Cumulative PR, monthly fecundity rates, monthly probability of pregnancy, crude PR, and cure rates. RESULTS(S): Thirty-five percent of patients conceived with a cure rate of 72.2%, monthly probability of pregnancy of 3.9%, and monthly fecundity rate of 3.9%. Cumulative PRs were 22%, 35%, and 58% at 6, 12, and 24 months, respectively. Pairwise comparisons (unilateral, bilateral, or either) failed to detect any statistical difference between the salpingostomy and fimbrioplasty groups. Salpingostomy patients initially may have a higher tendency to become pregnant but appear to lose that advantage after the first few months. When patients with tubo-ovarian adhesions are excluded from the analysis, patients who underwent a bilateral salpingostomy as their sole procedure had better outcome compared with those who only underwent bilateral fimbrioplasty. There was no significant association between pregnancy outcome and the presence of endometriosis, other infertility factors, or tubo-ovarian adhesions. The staging of adnexal adhesions and endometriosis did not predict pregnancy outcome. CONCLUSION(S): Laparoscopic fimbrioplasty and salpingostomy are clinically efficacious for the treatment of nonocclusive distal tubal disease. After accounting for statistical interactions of various factors among them, no particular association with pregnancy outcome could be identified. This illustrates the need for a revision of the classification of patients with distal tubal disease.

Abortion, Spontaneous↗

Is hysterosalpingography an important tool in predicting fertility outcome?

OBJECTIVE: To determine the prognostic significance of hysterosalpingography (HSG) for fertility outcome. DESIGN: Retrospective cohort study. SETTING: Infertility department of an academic hospital. PATIENT(S): Consecutive patients undergoing HSG for subfertility between May 1985 and November 1987. INTERVENTION(S): Hysterosalpingography. MAIN OUTCOME MEASURE(S): Follow-up ended when pregnancy or tubal surgery occurred or at the day of last contact. Kaplan-Meier curves for the occurrence of spontaneous intrauterine pregnancy (IUP) were constructed for a normal HSG, a HSG with a one-sided abnormality, and a HSG with a two-sided abnormality. Fecundity rate ratios were calculated to express the association between HSG findings and the occurrence of spontaneous IUP. RESULT(S): Of 359 patients that were analyzed, 231 (64%) showed no tubal pathology on HSG, 67 (19%) had a one-sided tubal pathology, and 61 (17%) had a two-sided tubal pathology. The adjusted fecundity rate ratios were 0.81 (95% confidence interval 0.47 to 1.4) for a one-sided pathology and 0.30 (95% confidence interval 0.13 to 0.71) for a two-sided pathology. Correction for informative censoring and sensitivity analysis did not alter these results. CONCLUSION(S): One-sided tubal pathology detected on HSG has limited prognostic significance, whereas two-sided tubal pathology detected on HSG reduces fertility prospects considerably.

Adult↗

Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm.

OBJECTIVE: To compare World Health Organization threshold values for normal sperm with the initial sperm quality necessary for successful IUI. DESIGN: Retrospective study. SETTING: Private fertility clinic. PATIENT(S): One thousand eight hundred forty-one couples undergoing 4,056 cycles of IUI. INTERVENTION(S): Intrauterine insemination. MAIN OUTCOME MEASURE(S): Relation of initial sperm quality to fecundity. RESULT(S): Progressive motility and total motile sperm count were the initial sperm characteristics most closely related to pregnancy on discriminant analysis. The per-cycle pregnancy rate averaged 11.1% during the first three IUI cycles. Pregnancy rates were > or = 8.2% per cycle when the initial sperm values were a concentration of > or = 5 X 10(6)/mL, a total count of > or = 10 X 10(6), progressive motility of > or = 30%, or a total motile sperm count of > or = 5 x 10(6). Minimal increases in fecundity occurred when initial values were greater than these threshold levels. The lowest initial values that resulted in pregnancy were a concentration of 2 x 10(6)/mL, a total count of 5 x 10(6). motility of 17%, and a total motile sperm count of 1.6 X 10(6). Pregnancy rates were <3.6% when initial values were between the threshold levels and the lowest levels. CONCLUSION(S): The sperm quality that is necessary for successful IUI is lower than World Health Organization threshold values for normal sperm. Intrauterine insemination is effective therapy for male factor infertility when initial sperm motility is > or = 30% and the total motile sperm count is > or = 5 X 10(6). When initial values are lower, IUI has little chance of success.

Adult↗

Comparison of intrauterine and intracervical insemination with frozen donor sperm: a meta-analysis.

OBJECTIVE: To determine whether artificial insemination with frozen donor sperm yielded a higher pregnancy rate per cycle by intracervical (ICI) or intrauterine (IUI) techniques. A meta-analysis was performed. DATA IDENTIFICATION: A computerized MEDLINE search of the English-language literature on artificial insemination with donor sperm was performed and augmented by a review of meeting abstract books and references in published papers. STUDY SELECTION: Only prospective randomized studies that reported monthly fecundity rates for IUI and ICI with frozen donor sperm were included. DATA ANALYSIS: Seven studies were identified. The odds ratios (OR) and 95% confidence intervals (CI) were determined with use of the general estimating equation method for the three studies for which raw data could be obtained. For the remaining four studies, the OR and CI were assessed with use of the published summary data. A random-effects meta-analysis was then performed. RESULT: Intrauterine insemination resulted in a significantly higher monthly fecundity rate with a common OR of 2.4 (CI 1.5-3.8). CONCLUSION: On the basis of this meta-analysis of the seven prospective studies, IUI results in higher pregnancy rates than ICI for frozen donor insemination.

Cervix Uteri↗

Initial experience with a modification of the follicle aspiration, sperm injection, and assisted rupture technique.

OBJECTIVE: To establish cycle fecundity with a modification of the follicle aspiration, sperm injection, and assisted rupture (FASIAR) technique. DESIGN: Prospective, observational study. SETTING: University and health maintenance organization-based infertility centers. PATIENT(S): Infertile couples were enrolled from our professional practices. All patients were </=41 years of age and had documentation of at least one patent tube. INTERVENTION(S): After administration of clomiphene citrate, patients were given an intramuscular injection of hCG when the lead ovarian follicle was >16-18 mm in diameter by transvaginal ultrasonography. A modified FASIAR procedure was performed 22 to 28 hours after hCG injection. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): No clinical pregnancies were observed with the modified FASIAR technique. CONCLUSION(S): The FASIAR technique is still an attractive and economical technique. Our modification of the FASIAR technique, however, resulted in a suboptimal cycle fecundity.

Adult↗

Modelling host cell availability and the crowding effect in Eimeria infections.

Within-host mathematical models of Eimeria maxima and Eimeria praecox infections of the chicken are presented and used to investigate the role of host cell availability as a possible determinant of the so-called 'crowding effect'; whereby the fecundity of the parasites decreases as infectious dose increases. Assumptions about the number of available host cells, the average lifespan of these cells and the age structure within the host-cell population were made and mathematical models were constructed and combined with experimental data to test whether these conditions could reproduce the crowding effect in the two species. Experimental data demonstrated that crowding during in vivo infections was apparent following very low infectious doses, but none of the models could adequately reproduce crowding at the same doses while maintaining realistic estimates of the dynamics of the enterocyte pool. However, both the size and lifespan of the enterocyte pool were demonstrated to have substantial effects on the fecundity of the infections, particularly at higher doses. These data indicate that host cell availability cannot be solely responsible for the crowding effect. Alternative factors such as the influence of the primary immune response to the parasite may also be explored using within-host models and other applications of these models are discussed.

Animals↗

The effect of fasting on Ascaris suum and Oesophagostomum spp. in growing pigs.

Experiments were conducted to study the possible influence of fasting on Ascaris suum and Oesophagostomum spp. In growing pigs. Forty young crossbred pigs naturally infected with A. suum and Oesophagostomum spp. were used. In one experiment 10 pigs were fasted and offered water ad libitum for 6 days, in another experiment for 10 days. Subsequently, these pigs, together with 10 non-fasted control pigs per experiment were slaughtered, and worm numbers, worm location, sex, developmental stage and female worm fecundity were determined. Pigs fasted for 10 but not for 6 days had decreased numbers of A. suum and Oesophagostomum spp. at slaughter vs controls, and worms were found in more distal locations in the gastrointestinal tract. Fasting for both 6 and 10 days significantly lowered the fecundity of both worm species.

Animals↗

Nutritional and respiratory pathways to parasitism exemplified in the Turbellaria.

Symbiosis is a dominant trait in the Platyhelminthes. The Neodermata (Aspidogastrea, Monogenea, Digenea, Udonellidea, Cestoda) are wholly parasitic and even the predominantly free-living Turbellaria have almost 200 species from 35 families living in permanent associations with other animals. In the simplest turbellarian symbioses, ectosymbiotes such as the Temnocephalida, some other Rhabdocoela and a few Tricladida live on the body surfaces or in the branchial chambers of their mainly arthropodan or chelonian hosts. They feed on the same types of prey as their free-living relatives but supplement their diet by opportunistic commensalism. Their digestive physiology and food reserves are the same as in free-living species. The entosymbiotic Umagillidae, Graffillidae, Pterastericolidae, Fecamplidae and Acholadidae live in internal body cavities or body wall derivatives of echinoderms, molluscs or arthropods and show increasing metabolic dependence on their hosts. Patterns of digestive physiology and food storage generally differ markedly from those of ectosymbiotic and free-living species. Some umagillids, in echinoids, feed as entozoic predators on co-symbiotic protozoa, supplemented by opportunistic ingestion of the hosts' ingesta, gut cells or coelomocytes. Others, in holothurians, feed mainly on gut cells, which also provide some digestive enzymes, and to a lesser extent on host ingesta and co-symbiotes. Graffillids, in molluscs, lack endogenous digestive enzymes and rely entirely on those taken in with host ingesta and gut tissues. Pterastericolids, in asteroids, similarly utilise gut tissues both as food and enzyme sources. The climax to metabolic dependence occurs in the Fecamplidae and Acholadidae. The former, in crustacean haemocoels and myzostomid tissues, lack conventional alimentary systems and absorb soluble nutrients through the epidermis. In the latter the only known species lives in the tube feet of its asteroid host, lacks a normal endodermal gut, but has a modified epidermis performing both digestive and absorptive functions. Most of these entosymbiotes show a shift from the lipid storage characteristic of free-living and ectosymbiotic species to the glycogen storage predominating in the Neodermata. In both groups this emphasis on carbohydrate metabolism is often independent of the PO2 of their environment. Both groups also show high fecundity and it is suggested that there is a direct relationship between this and glycogen storage. High fecundity, while clearly of adaptive value in entosymbiotes, is arguably primarily related to the assured food supply conferred by the entosymbiotic habit and thus can be viewed as a consequence of the latter rather than a prerequisite for it. Some entosymbiotic Turbellaria have evolved physiologically active haemoglobins, allowing them to abstract oxygen preferentially from host tissues; some have also evolved facultative glycolytic mechanisms comparable to those of the Cestoda. All these adaptations to ecto- and entosymbiotic life in the Turbellaria exemplify possible pathways to wholly parasitic lifestyles, with total metabolic dependence on the hosts, which may have been followed during the evolution of the Neodermata.

Animal Nutritional Physiological Phenomena↗

The origins of parasitism in the platyhelminthes: a summary interpreted on the basis of recent literature.

A summary is given of the 4 contributions on the origins of parasitism in the Platyhelminthes. Recent ecological literature is used to interpret some of the findings. In particular, recent findings on rugged fitness landscapes, the increasing difficulty of long-jump adaptations, complexity catastrophes, and empty phenotypic space are discussed in order to find an explanation for the large number of Neodermata and the scarcity of parasitic turbellarians; it is concluded that evolutionary stasis of symbiotic turbellarians that are "trapped" in their particular niches is responsible for the small number of symbiotic species of turbellarians, rather than competitive exclusion by the numerous neodermatans. The earliest neodermatans were probably already dependent on the production of many offspring; hence the protoneodermatan was probably a species preadapted to parasitism by high fecundity. Monogenea produce few offspring in spite of their rich and secure food supply; the protomonogenean was either a species with a complex behaviour pattern for habitat selection or, alternatively, a species with high fecundity subsequently reduced to permit the evolution of more complex behaviour patterns (switch from r- to K-strategy). The finding that embryonic replacement of the epidermis is shared by several turbellarian groups, a developmental pattern possibly used and modified in the formation of the neodermis in the Neodermata, can be interpreted as supporting the views that Neodermata and turbellarians with epidermal replacement are all monophyletic, or alternatively, that a similar developmental pattern has arisen several times due to similar selection pressures. However, the possibility of horizontal character transfer should also be considered for explaining similar characters, including similar developmental patterns, in apparently not closely related groups. Horizontal gene transfer and principles for demonstrating horizontal character transfer are discussed.

Animals↗

Effects of reduced salinity on survival, growth, reproductive success, and energetics of the euryhaline polychaete Capitella sp. I.

Physiological adjustment to water of reduced salinity requires energy expenditure. In this study we sought to determine the fitness costs associated with such adjustment in the euryhaline polychaete Capitella sp. I, and the extent to which such costs could be explained by increased rates of energy expenditure. In a series of experiments conducted at 20 degrees C, salinity was reduced from 30 per thousand to either 25, 20, 15, 12, or 10 per thousand within 72 h after the larvae had been induced to metamorphose. Juveniles were reared on fine, organic-rich sediment. Over the next 15-30 days, we determined survival, growth, fecundity, and rates of respiration and feeding (via fecal pellet production). Larval salinity tolerance was also determined. Juvenile survival at salinities as low as 12-15 per thousand was comparable to that at 30 per thousand. The lower limit of salinity tolerance was 10-12 per thousand at 20 degrees C for both larvae and juveniles. Juveniles grew significantly more slowly at 12-15 per thousand in six of the seven experiments. Fecundity, however, was generally highest at intermediate salinities of 20-25 per thousand, and comparable at 30 and 15 per thousand. No individuals released embryos at 12 per thousand over the approximately 30-day observation periods in any of the three experiments in which the worms were reared at this low salinity. Reduced growth rates were not explained by differences in rates of respiration at different salinities: at reduced salinity, respiration rates were either statistically equivalent to (P>0.10) or significantly below (P<0.05) those recorded for animals maintained at 30 per thousand. Lower growth rates at lower salinities were best explained by reduced feeding rates. Further studies are required to determine whether digestive efficiency, growth hormone concentrations, or reproductive hormone concentrations are also altered by low salinity in this species.

Journal Article↗

The effects of reproduction on longevity and fertility in male Drosophila melanogaster.

We examined the effect of reproduction on subsequent survival and fecundity of male Drosophila melanogaster by reversing the reproductive status of individuals part-way through life. Reproduction had a much more marked effect on fertility than survival: males with a history of reproduction showed complete sterility at a time when upwards of 80% of their cohort were still alive. Analyses of survival rates alone gave a misleading measure of the impact of ageing. Sterility appeared to be attributable mainly to a reduction in sperm count. Early reproduction caused permanent, irreversible damage to both survival and fecundity, with risk playing an apparently minor role. Individual differences in frailty appeared to be of little consequence for the interpretation of these reversal experiments, although its possible occurrence made definite detection of risk difficult.

Journal Article↗

Adaptation of Aedes aegypti (Diptera: Culicidae) oviposition behavior in response to humidity and diet.

Effects of humidity and sugar concentration on the fecundity, temporal oviposition patterns and survival of a tropical strain of Aedes aegypti (L.) were investigated. Fecundity was significantly reduced by low humidity, but was not affected by sugar concentration. Low humidity caused a significant decrease in percentage survival after 19 days as compared to high humidity. Oviposition was inhibited by host availability for eight successive days. When access to a host was no longer provided, oviposition continued for 10 days in three to four distinct cycles without additional bloodmeals. Humidity stress and high sugar concentration caused oviposition to be delayed for one to four days, which is the typical duration of extreme low humidity periods in nature. These responses are hypothesized to protect the eggs of ovipositing females against the environmental hardships of periodic humidity stress and lack of hosts, thus enabling the perpetuation of the vector and the diseases it transmits in hot and dry seasons.

Journal Article↗