Relationships of serum pro-inflammatory cytokines and vascular endothelial growth factor with liver dysfunction in severe ovarian hyperstimulation syndrome

The aims of this study were to determine if differences in serum pro-inflammatory cytokines, vascular endothelial growth factor (VEGF) and clinical pregnancy rate, could be observed in women with severe ovarian hyperstimulation syndrome (OHSS) in those who did and did not have liver dysfunction. Twenty-nine in-vitro fertilization patients with severe OHSS were included. The patients were divided into the normal liver function tests (LFT) group (n = 14) and the abnormal LFT group (n = 15) according to the LFT on day of admission. Periodic measurements of serum interleukin (IL)-6, IL-8, tumour necrosis factor-alpha (TNF-alpha), VEGF, oestradiol, progesterone concentrations, and LFT were performed during hospitalization. Concentrations of IL-6 in the active phase of OHSS were significantly higher in the abnormal LFT group than in the normal LFT group (19.7 +/- 15.7 versus 8.1 +/- 7.0 pg/ml, respectively). The severity of liver dysfunction was not correlated with concentrations of oestradiol, progesterone, haematocrit, white blood cell counts, or any studied cytokine. The clinical pregnancy rate was significantly lower in the abnormal LFT group (46.7%) than in the normal LFT group (85.7%). These results suggest that IL-6 cytokine system may play a role in the pathogenesis of liver dysfunction in severe OHSS. Abnormal LFT were associated with lower clinical pregnancy rates.

Two subgroups of lung vagal C-fibers with different vulnerabilities to blockades by perivagal capsaicin and vagal cooling in dogs

Perivagal capsaicin treatment and vagal cooling are two techniques that have been widely used to study the respiratory reflexes mediated by lung vagal C-fibers because they can block the neural conduction of unmyelinated fibers. We hypothesized that there are two subgroups of lung vagal C-fibers which have different vulnerabilities to blockades by these two techniques. To test this hypothesis, afferent activity arising from lung vagal C-fibers was recorded in 29 anesthetized, paralyzed, and artificially ventilated dogs. Afferent C-fiber activity was recorded before and after various concentrations of perivagal capsaicin treatment or before and during various temperatures of vagal cooling. Of the 89 lung vagal C-fibers studied, 73 fibers were classified as the group of "low resistance" to capsaicin, while the other 16 were classified as the group of "high resistance". The former group differed from the latter due to their afferent activity being blocked at relatively low concentrations of perivagal capsaicin and at relatively low temperatures of vagal cooling. Our results suggest that lung vagal C-fibers can be categorized into two subgroups, based upon their different blocking thresholds for perivagal capsaicin and vagal cooling. Our data may provide information for researchers to further differentiate the respiratory reflexes originating from these two subgroups of lung vagal C-fibers.

Expression of leukemia inhibitory factor and its receptor in preimplantation embryos

OBJECTIVE

To examine the expression of leukemia inhibitory factor (LIF) and its receptor (LIF-R) transcripts in human and murine preimplantation embryos.

DESIGN

Prospective study.

SETTING

University medical center.

PATIENT(S)

Human oocytes were obtained from patients undergoing IVF treatment. Two-cell murine embryos were obtained from ICR strain mice.

INTERVENTION(S)

Second-day intracytoplasmic sperm injection procedures were performed on oocytes that failed to be fertilized by IVF. Embryos were cultured to various stages and collected for study.

MAIN OUTCOME MEASURE(S)

The transcript levels of LIF and LIF-R in these embryos were examined and semiquantitated using single-cell reverse transcription-polymerase chain reaction methodology.

RESULT(S)

Leukemia inhibitory factor and LIF-R transcripts were detectable in most human preimplantation embryos (30 of 34 and 31 of 34 embryos showed LIF and LIF-R messenger RNA, respectively). There was a trend toward decreased expression of both transcripts in embryos at the four-cell stage and in embryos in which growth had been arrested for 24-48 hours. The expression of LIF and LIF-R genes in murine embryos was inconsistent.

CONCLUSION(S)

Preimplantation human embryos express LIF and LIF-R messenger RNA. It is suggested that LIF may be able to affect embryo development through its action at stages before implantation in an autocrine or paracrine manner.

Prognostic importance of serial cytokine changes in ascites and pleural effusion in women with severe ovarian hyperstimulation syndrome

OBJECTIVE

To determine the prognostic value of various cytokine levels in ascites and pleural effusion during the evolution of severe ovarian hyperstimulation syndrome (OHSS).

DESIGN

A longitudinal study.

SETTING

University teaching hospital.

PATIENT(S)

Twenty patients with severe OHSS who required either paracentesis or thoracentesis or both from whom ascites (n = 56) or pleural effusion (n = 12) samples were obtained. Control peritoneal fluid was obtained from 20 patients undergoing ovarian stimulation for IVF.

INTERVENTION(S)

Abdominal paracentesis for tense ascites and thoracentesis for massive pleural effusion. Control peritoneal fluid was obtained before oocyte retrieval.

MAIN OUTCOME MEASURE(S)

Levels of interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), E2, and progesterone concentrations in ascites and pleural effusion.

RESULT(S)

Levels of VEGF and IL-6 in ascites dropped significantly during the course of OHSS and were not correlated with E2 concentrations. Levels of VEGF were significantly correlated with levels of IL-1 beta, IL-8, and TNF-alpha, as well as progesterone concentrations, hematocrit, and white blood cell counts. None of the cytokine levels measured in pleural effusion were correlated with the course of OHSS.

CONCLUSION(S)

These results suggest that local cytokines might be involved in the evolution of severe OHSS and possibly serve as prognostic markers for this syndrome.

[The changes of GFAP, PCNA after brain contusion: an immunohistochemical study in forensic pathology]

After the model of experimental brain contusion was set up, the changes of GFAP, PCNA were studied by immunohistochemistry SP method combined with image quantity analysis. After contusion, the gray degrees and areas of GFAP-positive cells increased significantly at the 3rd hour, reached the highest level in the 4th day and kept until the 7th day. PCNA-positive cells appeared in the 12th hour, simultaneously, their gray degrees tended to increase and positive areas tended to decrease. It showed regular changes of GFAP, PCNA with various survival times, and these changes were useful in the diagnosis of brain contusion especially in the period from the second to 7th day after injury. The numbers of astrocytes increased and reached the highest level in the 3rd day after contusion while the reactive proliferation of astrocytes is only a minor phenomenon.

Human peripheral blood mononuclear cells express gonadotropin-releasing hormone (GnRH), GnRH receptor, and interleukin-2 receptor gamma-chain messenger ribonucleic acids that are regulated by GnRH in vitro

The hypothalamic decapeptide, GnRH, plays a critical role in human reproduction. In addition to the well known effects of GnRH on pituitary cells, there is evidence supporting the presence of GnRH-binding sites in tissues other than pituitary cells, including lymphocytes. In addition, a GnRH-like substance has been found to be secreted from lymphoid cells. However, the precise nature of GnRH secretion and binding in immune cells has not been fully established. In this study, we used the RT-PCR method to examine the expression and regulation of GnRH, GnRH receptor (GnRHR), and interleukin-2 receptor gamma-chain messenger ribonucleic acids (mRNAs) in human peripheral blood mononuclear cells. It was found that human mononuclear cells expressed GnRH and GnRHR mRNAs. Nucleotide sequences of these mRNAs are identical to their hypothalamic and pituitary counterparts, respectively. In addition, GnRH and GnRHR mRNA expressions in peripheral blood mononuclear cells are regulated by GnRH and its synthetic analogs in vitro. Treatment with various concentrations of GnRH (10(-5)-10(-11) mol/L) increased GnRHR mRNA expression in a dose-dependent manner (maximal level is 158% of the untreated control value at 10(-8) mol/L GnRH; P < 0.05), but reduced GnRH mRNA levels to 69% of the untreated control value at 10(-9) mol/L GnRH (P < 0.05). Cotreatment of GnRH with a GnRH antagonist blocked these regulatory effects, indicating the receptor-mediated nature of the GnRH action. Both GnRH and GnRH agonist stimulated interleukin-2 receptor gamma-chain mRNA in a dose-dependent manner, indicating that GnRH may be involved in lymphocyte activation. In summary, these observations suggest that mRNAs encoding the pituitary form of GnRHR and the hypothalamic form of GnRH are also expressed in human peripheral blood mononuclear cells. The endogenous production of GnRH by lymphocytes may act as an autocrine or paracrine factor to regulate immune functions. Because of the presence of GnRHR on lymphocytes, exogenous GnRH analog therapy may have an impact on the immune system through these receptors.

Determination of metformin in plasma by capillary electrophoresis using field-amplified sample stacking technique

A capillary electrophoresis method was described for the determination of metformin in human plasma based on the extraction of the ion-pair with bromothymol blue into chloroform. Phenformin was used as internal standard. Field-amplified sample stacking injection was employed with an electrokinetic injection voltage of 10 kV for 10 s. The running buffer was 0.1 M phosphate buffer (pH 2.5), running voltage was 20 kV and the UV absorbance detection was set at 195 nm. The limit of quantitation was 0.25 microg/ml. Linearity range of calibration curve was 0.25 to 3.5 microg/ml. Recoveries for three levels (0.25, 1 and 2 microg/ml) were 80.24%, 67.44% and 58.97% (n = 5 for each level), respectively. The intra-day precisions for the three levels were 11.9%, 3.09% and 4.33% and the inter-day precisions were 12.4%, 4.57% and 4.94%, respectively. The concentrations of metformin hydrochloride in human plasma of eight volunteers were measured after orally administrating metformin enteric-capsule and tablet.

Mechanisms underlying stimulation of rapidly adapting receptors during pulmonary air embolism in dogs

We investigated the mechanisms underlying stimulation of rapidly adapting receptors (RARs) during pulmonary air embolism (PAE). Impulses were recorded from RARs in 43 anesthetized, open-chest and artificially ventilated dogs. Forty one out of 56 RARs were stimulated by infusion of air into the right atrium (0.2 ml/kg per min for 10 min). As a group (n = 56), RAR activity increased from a baseline of 1.2 +/- 0.2 to a peak of 4.3 +/- 0.3 impulses/breath at 8-10 min after the onset of PAE induction. PAE also caused an increase in total lung resistance and a decrease in dynamic lung compliance. Studies were repeated in 33 RARs initially stimulated by PAE. In nine receptors, hyperinflation of the lungs performed at the termination of the second PAE induction largely reversed both the afferent and bronchomotor responses. Furthermore, the residual PAE-evoked activity subsequent to hyperinflation was almost eliminated by elevation in the heart position. In another 24 receptors, the responses of RARs to PAE were unaltered by pretreatment with saline (n = 8) or dimethylthiourea (a hydroxyl radical scavenger; n = 8), but was significantly attenuated by pretreatment with ibuprofen (a cyclooxygenase inhibitor: n = 8). These results suggest that: (1) the increased RAR activity following PAE is associated primarily with an increase in bronchomotor tone and secondarily with the mechanical action of the beating heart impacting on lung tissues; and (2) cyclooxygenase products may be involved in this sensory stimulation.

[Effect of puerarin on plasma endothelin, renin activity and angiotensin II in patients with acute myocardial infarction]

OBJECTIVE

To study the changes of endothelin (ET), renin activity (RA) and angiotensin II (AT-II) before and after puerarin treatment in patients with acute myocardial infarction (AMI).

METHODS

Forty-three patients with AMI were divided into two groups, and were given puerarin and glucose-insulin-kalium (GIK) treatment respectively. Plasma ET, RA and AT-II were measured by radioimmunoassay (RIA) before and after treatment in different phases.

RESULTS

It showed that plasma ET and RA, AT-II levels in AMI were higher than those in control group (P < 0.01). ET level was conversely correlated with RA and AT-II (P < 0.01). After treatment with puerarin, plasma levels of ET, RA and AT-II were recovered to normal in 3 days, but these data recovered to nearly normal until 7-14 days in group with GIK treatment.

CONCLUSION

Puerarin might play an important role in regulating the imbalance of ET, RA and AT-II of patients with AMI.

Assisted hatching increases the implantation and pregnancy rate of in vitro fertilization (IVF)-embryo transfer (ET), but not that of IVF-tubal ET in patients with repeated IVF failures

OBJECTIVE

To assess the effect of augmenting IVF with assisted hatching in the treatment of patients with repeated IVF failures.

DESIGN

Prospective randomized study.

SETTING

Division of Reproductive Endocrinology and Infertility of National Taiwan University Hospital.

PATIENT(S)

From July 1993 to February 1996, 49 patients with repeatedly failed IVF were treated with assisted hatching and were compared with 51 control subjects without assisted hatching.

INTERVENTION(S)

Assisted hatching.

MAIN OUTCOME MEASURE(S)

Pregnancy rate and implantation rate per embryo after IVF-ET or IVF-tubal ET (TET) were measured.

RESULT(S)

The pregnancy rate (PR) in the assisted hatching group was found to be 36.7% compared with 19.6% in the control group, but the difference was not significant. When only patients receiving IVF-ET were considered, it was observed that the PR was significantly higher in the assisted hatching group than the control group (42.4% versus 16.1%). With IVF-TET however, the PR was found to be similar in both assisted hatching and control groups (25.0% and 25.0%, respectively). The rate of embryonic implantation in the IVF-ET patients was 11.0%, which was significantly higher than that of control embryos (3.7%).

CONCLUSION(S)

These results implied that IVF-ET, combined with assisted hatching, may improve the PR and implantation rate in patients with repeated IVF failures, but the same was not true in the case of IVF-TET.

A simplified technique for embryo biopsy: use of the same micropipette for zona drilling and blastomere aspiration

PURPOSE

Using different micropipettes for zona drilling and blastomere aspiration for embryo biopsy is prevalent at centers of preimplantation genetic diagnosis. The purpose of our study was to simplify the technique by using only one micropipette.

METHODS

In this animal model, ICR mouse embryos at the four-cell stage (n = 446) were randomly allocated into two groups; a biopsied group (n = 224) for blastomere aspiration and a control group (n = 222) without micromanipulation. We used a drilling/biopsy micropipette to drill a hole in the zona by expulsion of acidified Tyrode's solution and to aspirate the blastomere by gentle suction with the same micropipette and pull it out of the zona. One blastomere was biopsied from each embryo.

RESULTS

In all, 222 (99.1%) intact blastomeres were successfully biopsied from 224 embryos. Only two blastomeres were damaged during aspiration. The capacity for blastocyst development (92.4 vs 93.7%) was not different between the two groups, but the percentages of embryos hatching (51.8 vs 18.0%) and hatched (29.9 vs 8.1%) were significantly higher in the biopsied group than in the control group.

CONCLUSIONS

This simplified technique of embryo biopsy is safe and highly efficient for obtaining blastomeres for preimplantation genetic diagnosis and may also facilitate hatching of the blastocysts.

Mechanisms of stimulation of vagal pulmonary C fibers by pulmonary air embolism in dogs

We investigated the involvement of the cyclooxygenase metabolites and hydroxyl radical (.OH) in the stimulation of vagal pulmonary C fibers (PCs) by pulmonary air embolism (PAE). Impulses were recorded from PCs in 51 anesthetized, open-chest, and artificially ventilated dogs. Fifty of 59 PCs were stimulated by infusion of air into the right atrium (0.2 ml.kg-1.min-1 for 10 min). As a group (n = 59), PC activity increased from a baseline of 0.4 +/- 0.1 to a peak of 1.7 +/- 0.2 impulses/s during the period from 1 min before to 2 min after the termination of PAE induction. In PCs initially stimulated by PAE induction, PAE was repeated after the intervening treatment (iv) with saline (n = 9), ibuprofen (a cyclooxygenase inhibitor; n = 11), or dimethylthiourea (a .OH scavenger; n = 12). The responses of PCs to PAE were not altered by saline vehicle but were abolished by ibuprofen and significantly attenuated by dimethylthiourea. Although hyperinflation of the lungs reversed the PAE-induced bronchomotor responses, it did not reverse the stimulation of PCs (n = 8). These results suggest that 1) cyclooxygenase products are necessary for the stimulation of PCs by PAE, whereas changes in lung mechanics are not, and 2) the functional importance of cyclooxygenase products may be mediated in part through the formation of .OH.

Effect of peritoneal fluid on sperm motility parameters in women with endometriosis

To clarify the effect of peritoneal fluids (PF) of women with various stages of endometriosis on sperm motility, we utilized computer-aides sperm analysis (CASA) to analyze sperm movement characteristics. PF was collected in the early follicular phase (days 4-8) of the menstrual cycle from 48 women undergoing diagnostic laparoscopy. Only sperm samples having normal sperm parameters were chosen for study. Swim-up separation was performed for 1 h at 37 degrees C. Sperm suspension was mixed at a ratio of 1:1 with each of the following four groups: group 1, human tubal fluid (HTF) with 10% fetal bovine serum (control), group 2, normal PF (n = 16); group 3, minimal or mild endometriosis PF (n = 16); and group 4, moderate or severe endometriosis PF (n = 16). The mixtures were analyzed at 0, 1, 3, 6, and 24 h of co-incubation using the CASA system. At the end of the 24 h incubation, Supravital staining of sperm was done to check the viability of sperm in each group. Only time (F = 126.6, p < .001) has a significant effect on sperm motion parameters. At 6 h, sperm velocity (mean curvilinear velocity and mean straight line velocity) of the PF groups was significantly greater than that of the control, but there was no significant difference between each PF group. At 24 h, the PF groups maintained 50% of initial sperm viability, compared with 13% of initial viability in the control group (p < .001). There was no adverse effect of PF in patients with endometriosis on sperm motion parameters.

Intracytoplasmic sperm injection (ICSI) for severe semen abnormalities: dissecting the tail of spermatozoa at the tip

Recently, several investigators have emphasized that damaging the membrane of spermatozoa by compressing the mid-piece or cutting the mid-portion of the tail prior to injection yields better results than using motile spermatozoa in intracytoplasmic sperm injection (ICSI). Here we report our experience using a modified immobilization technique of dissecting the tail of the spermatozoon at the tip in 78 cycles on 60 patients. In 55 treatment cycles purely using this modified technique, 468 mature oocytes were injected. A total of 35 oocytes (7.5%) were injured. Of the intact oocytes, 282 (65.1%) were normally fertilized and 266 (94.3%) subsequently cleaved. A single pronucleus was observed in 16 (3.7%) oocytes, and three pronuclei were noted in 11 (2.5%) oocytes. Embryo transfers were performed in 54 cycles, and 18 women (32.7%) achieved clinical pregnancies. In 23 cycles, we compared the effects of these three immobilization techniques on the sibling oocytes obtained from the same patient regarding normal fertilization, abnormal fertilization, and embryo cleavage and quality. The results were comparable among them. Seven pregnancies (30.4%) were achieved in this series. Dissecting a sperm tail at the tip is easily and quickly performed and achieves permanent immobilization. Compression of the mid-piece is also easy, but usually takes several actions to achieve immobilization. Cutting the tail at the mid-portion requires more skill. Therefore, dissecting the tail of the spermatozoon at the tip may provide an alternative method to immobilize the spermatozoon permanently prior to ICSI.

Pregnancy achieved by intracytoplasmic sperm injection using cryopreserved semen from a man with testicular cancer

A successful pregnancy was achieved by intracytoplasmic sperm injection (ICSI) using cryopreserved semen from a man with testicular cancer. He was a victim of right testicular seminoma, and was azoospermic after right orchidectomy and radiotherapy. The wife had had three successive failures of intrauterine insemination (IUI) using semen that was cryopreserved before radiotherapy. The couple then underwent in-vitro fertilization (IVF) treatment. ICSI was performed because the sperm motility was extremely poor after thawing. Eight of 12 injected oocytes had normal fertilization and embryo cleavage. After replacement of four embryos, a singleton pregnancy developed. She delivered a healthy male baby at 39 weeks gestation. In addition to IUI and IVF, ICSI further provides male patients with cancer an improved chance of fathering a child. Any men diagnosed with cancer who have not yet finished their families should have their spermatozoa frozen before treatment, regardless of its quality.

Decrease in interferon gamma production and impairment of T-lymphocyte proliferation in peritoneal fluid of women with endometriosis

OBJECTIVE

Our purpose was to verify regional immune modulations and to test the effect of gonadotropin-releasing hormone agonist in women with endometriosis.

STUDY DESIGN

Concentrations of peritoneal cytokines, including interleukin-1 beta, interleukin-2, soluble interleukin-2 receptor, interleukin-6, granulocyte-monocyte colony-stimulating factor, interferon gamma, and tumor necrosis factor-alpha were compared in women with and without endometriosis. Peritoneal cytokine and interleukin-2 production were examined by adding various mitogens to peritoneal fluid mononuclear cells of women with advanced endometriosis before and after gonadotropin-releasing hormone agonist treatment.

RESULTS

A significant increase in peritoneal interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha and a decrease in interferon gamma were noted in women with endometriosis. After gonadotropin-releasing hormone agonist treatment interleukin-6 decreased and interferon gamma increased. A significant impairment of interleukin-2 production of peritoneal fluid mononuclear cells by phytohemagglutinin and pokeweed mitogen stimulation was demonstrated in endometriosis, and production could be restored after gonadotropin-releasing hormone agonist treatment.

CONCLUSION

These results indicate that regional immunologic dysfunction might be invoked in the disease process of endometriosis.

Positive charge at position 549 is essential for phosphatidylinositol 4,5-bisphosphate-hydrolyzing but not phosphatidylinositol-hydrolyzing activities of human phospholipase C delta1

Point mutagenesis, phosphatidylinositol (PI), and phosphatidylinositol 4,5-bisphosphate (PIP2) hydrolysis assays and equilibrium centrifugation PIP2 assays were used to study the functional roles of four highly conserved arginine residues in the Y region of human phospholipase C delta1 (PLCdelta1) (Arg-527, -549, -556, -701). Most of the mutant enzymes were either partially defective or fully active in their abilities to catalyze the hydrolysis of PI or PIP2. However, upon substitution of Arg-549 by glycine or histidine, the mutant enzyme was defective in its ability to catalyze the hydrolysis of PIP2, but it is still able to hydrolyze PI. Replacing Arg-549 with lysine had little effect on the level of PI and PIP2 hydrolytic activities of the mutant enzyme. The residual PIP2 hydrolyzing activity of R549H is highly dependent on pH. R549H showed 5-10% of the PIP2-hydrolyzing activity of the native enzyme between pH 5 and 7 and nondetectable PIP2-hydrolyzing activity at pH 8. The PIP2-hydrolyzing activity of R549G was not detectable at all pH values. Kinetic analysis of PLCdelta1-catalyzed PIP2 hydrolysis revealed that the micellar dissociation constant Ks and interfacial Michaelis constant Km were similar in the native, R549K, and R549H enzymes; but the specific activity at the saturated substrate mole fraction and infinite level of substrate (Vmax) of the R549H mutant were reduced by a factor of 15. PIP2 competitively inhibits the native enzyme to hydrolyze PI at both pH 7 and 8. However, PIP2 inhibits R549H only at pH 7.0 and does not inhibit R549G at either pH. Taken together, these results suggest that positive charge at position 549 of PLCdelta1 protein is essential for the enzyme to recognize and catalyze the hydrolysis of PIP2 but not PI.

The value of human growth hormone as an adjuvant for ovarian stimulation in a human in vitro fertilization program

The purpose of this study was to evaluate whether the combined treatment of growth hormone (GH) and gonadotropins can improve ovulation stimulation in previously poor responders. Twelve patients who, had suboptimal responses in previous in vitro fertilization cycle were enrolled. They underwent 1 cycle with gonadotropin-releasing hormone analogue (GnRH-a) and gonadotropins and another cycle with GnRH-a, gonadotropins, and GH. Serum gonadotropins, insulin-like growth factor-1 (IGF-1), and sex steroids, including estradiol (E2), progesterone (P4), testosterone, and androstenedione were measured on Day 2 and during ovulation induction. The serum IGF-1 level was higher in the GH cycle. There were no significant differences in the levels of the serum luteinizing hormone, E2, P4, testosterone, and androstenedione between the 2 cycles, so was IGF-1, E2 and P4 in follicular fluid. Co-treatment with GH did not improve the ovarian response. However, the GH cycles had better performance in terms of the number of oocytes fertilized and the pregnancy rate.

Combination of direct swim-up technique and discontinuous Percoll gradient centrifugation for sperm preparation of oligoasthenozoospermic samples

Sperm recovery for assisted reproduction in oligoasthenozoospermic patients is not satisfying either by the swim-up technique or by Percoll gradient centrifugation, and no single technique is constantly preferred. The design of this study was to evaluate the effects of combining the two methods on improving the efficacy of sperm preparation in these poor samples. For each semen sample, 1 mL was treated with a combination method, which used direct swim-up technique to recover motile sperm swimming to the supernatant, and then the residual semen was subjected to two-layer discontinuous Percoll gradient procedure for further recovery of motile sperm. Another 1 mL was prepared with two-layer discontinuous Percoll gradient centrifugation alone for comparison. Parameters measured included sperm concentration, number of progressively motile sperm, percentage of progressive motility, percentage of motile sperm recovery, amount of debris, percentage of normal forms according to Kruger's strict criteria, and motion characteristics of sperm using computer-aided motility analysis. The results of 30 oligoasthenozoospermic samples demonstrated that the combination method achieved a significantly greater recovery of motile sperm than the two-layer discontinuous Percoll gradient centrifugation did (43.2 +/- 19.7% vs. 32.2 +/- 14.3%, p < .05). The percentage of progressive motility was higher in the samples of the combination method than in those of Percoll gradient centrifugation alone, but the difference was not significant (63.7 +/- 21.8% vs. 58.7 +/- 20.1%). The debris of semen was removed equally well by both methods. The percentage of normal forms as well as motion characteristics, including curvilinear velocity, straight-line velocity, mean amplitude of lateral head displacement, and linearity, were similar in the samples treated by these two procedures. The combination of the direct swim-up technique and discontinuous Percoll gradient centrifugation combines the advantages of each procedure and results in greater recovery of motile sperm in oligoasthenozoospermic samples.

How many embryos should be transferred in in vitro fertilization and tubal embryo transfer?

In order to achieve higher pregnancy rates, more than one embryo is usually transferred in in vitro fertilization (IVF) programs. Tubal embryo transfer (TET) produces an even higher pregnancy rate. However, the number of embryos that should be transferred in TET programs remains to be clarified. We studied a series of 241 consecutive TET cycles and analyzed their clinical characteristics, embryo numbers, cumulative embryo score (CES), and pregnancy outcomes. The results demonstrated that 1) four embryos was an adequate number to obtain a satisfactory pregnancy rate and fewer multiple pregnancies, 2) older patients and cases with male factor had less chance of pregnancy and more than four embryos could be transferred, and 3) CES values > 40 were preferred, but for young patients with unusually high anxiety about multiple pregnancies, a CES of 21 to 40 was optimal. A policy of transfer that limits transfer to a maximum of two, three or four embryos is not suitable in all cases and other factors (eg, repeated IVF failure or older age) should be individually considered. Therefore, two equations utilizing CES, age and failure of previous TET as the factors were developed to help practitioners to evaluate how many embryos should be transferred on an individual basis.

Fertilization and embryo cleavage after intracytoplasmic spermatid injection in an obstructive azoospermic patient with defective spermiogenesis

OBJECTIVE

To achieve fertilization and cleavage by spermatids without tails from testicular biopsy.

DESIGN

Clinical trial.

SETTING

Reproductive unit of a university teaching hospital.

PATIENT

A patient of obstructive azoospermia with defective spermiogenesis.

INTERVENTION

Testicular biopsy after scrotal exploration and spermatid injection into the cytoplasm of oocyte.

MAIN OUTCOME MEASURES

Fertilization and cleavage.

RESULTS

Four of 13 spermatid injections achieved normal fertilization and 2 of them cleaved.

CONCLUSION

Intracytoplasmic spermatid injection may be a possible treatment for patients of defective spermiogenesis who have no viable spermatozoa available.

The suppression of peritoneal cellular immunity in women with endometriosis could be restored after gonadotropin releasing hormone agonist treatment

PROBLEM

Our previous study reported that peritoneal natural killer (NK) cytotoxicity and CD3+CD25+ lymphocyte subpopulation were suppressed in women with advanced endometriosis. Whether these phenomena are general for all stages of endometriosis and whether these alterations could be restored by long-term use of gonadotropin releasing hormone agonist (GnRHa) are further tested in this study.

METHOD

Lymphocyte subpopulations (B cells, NK cells, T cells, and T-cell activation markers such as CD69, HLA-DR, and CD25) and NK cell cytotoxicity of peripheral blood and peritoneal fluid by dual-color flow cytometry and 51Cr release assay in 30 cases of endometriosis were compared with those in 26 controls. We also compared these changes before and after 6-month treatment with GnRHa for advanced endometriosis.

RESULTS

Compared with the controls, only those women with advanced endometriosis showed lower NK cytotoxicity in peritoneal fluid mononuclear cells (PFMC). The CD3+CD69+ lymphocyte subpopulation decreased in peripheral blood mononuclear cells (PBMC) of advanced endometriosis, while the CD3+CD25+ lymphocyte subpopulation decreased in both PBMC and PFMC of mild and advanced endometriosis. After GnRHa treatment, the CD3+CD69+ lymphocyte subpopulation increased in both PBMC and PFMC and the CD3+CD25+ lymphocyte subpopulation increased in PFMC, but not in PBMC.

CONCLUSION

Impaired local immunological function in the PF of endometriosis was confirmed by this study and the impairments could be restored after long-term GnRHa therapy.

Interleukin-1 beta (IL-1 beta) is increased in the follicular fluids of patients with premature luteinization

PROBLEM

Most, but not all, studies indicate that premature luteinization correlates with poor pregnancy outcome in in-vitro fertilization (IVF) programs. It remains unclear whether cytokines (IL-1 beta, TNF alpha), the established immune mediators, play a role in regulation or initiation of an abnormal follicular or embryo development in patients with premature luteinization.

METHODS

Levels of cytokines (IL-1 beta, TNF alpha), estradiol (E2) progesterone (P4), and androstenedione (A'ione) were examined in 18 preovulatory follicular fluid (FF) samples from patients with premature luteinization (group 1) and 3 FF samples from patients without premature luteinization (group 2). The number of oocytes recovered, fertilization rate, and pregnancy outcome were evaluated in these two groups.

RESULT

IL-1 beta (25.4 +/ 11.9 pg/ml, mean +/ SD) and TNF alpha (13.4 +/ 10.7 pg/ml) were present in these FF samples. The mean level of IL-1 beta in group 1 was significantly higher than that in group 2 (37.3 +/ 12.3 vs. 20.0 +/ 7.6 pg/ml; P < 0.00001) and the mean level of E2 was significantly lower in group 1 than that in group 2 (1064 +/ 686 vs. 1570 +/ 641 ng/ml; P = 0.02). The levels of TNF alpha, P4, and A'ione showed no distinction between these two groups. There was no correlation between the levels of either IL-1 beta or TNF alpha and P4, E2 or A'ione. The fertilization rate in group 1 (62/77; 80%) was similar to that in group 2 (124/160; 78%). Five of 7 patients in group 1 and seven of 20 patients in group 2 achieved pregnancy following embryo transfer. One of five pregnancies in group 1 aborted.

CONCLUSION

The exaggerated levels of IL-1 beta in patients with premature luteinization may arise from accumulation of this cytokine owing to sustained high LH stimulation, and this may be a protective response to the abnormal LH surge and function to inhibit prematurely increased secretion of P4. These data indicate the important role of LH in the induction of IL-1 beta secretion and the possible regulatory action of IL-1 beta in luteinization. According to the diminution of E2 in group 1, there may be a subtle atretic process progressing in follicles primed with prematurely elevated LH. However, the detrimental effect of premature luteinization, if it exists, may work at the stage ¿during or after implantation.

Comparison between a two-layer discontinuous Percoll gradient and swim-up for sperm preparation on normal and abnormal semen samples

PURPOSE

This work was to compare the effects of Percoll gradient and swim-up treatments for sperm preparation on the percentage of progressive motility, recovery of motile sperm, removal of debris, percentage of normal forms according to strict criteria, and movement characteristics of sperm using computer-assisted velocity analysis.

RESULTS

In total, 50 semen samples from 50 patients were tested and divided into two groups: a normal group (n = 27) with normal parameters and an abnormal group (n = 23) with abnormal parameters. The results in both the normal and abnormal groups revealed that the sperm concentration in the Percoll samples was significantly greater than that in the swim-up samples. Although the percentage of progressive motility was greater in the swim-up samples than in the Percoll samples, the number of motile sperm, reflecting the percentage of motile sperm recovery, was till greater in the Percoll samples. The debris of semen was equally removed by both methods and the percentage of normal forms was also similar in the samples treated according to these two procedures. Both curvilinear velocity (VCL) and straight-line velocity (VSL) of sperm were significantly greater in the swim-up samples than in the Percoll samples. Sperm from the swim-up procedure also showed a greater mean amplitude of lateral head displacement than that from the Percoll gradient procedure, but the distinction was insignificant.

CONCLUSION

The Percoll gradient technique, by recovering more motile sperm, may be applied to prepare oligospermic samples. The swim-up method may become the standard choice to prepare normal semen which could obtain sufficiently motile sperm, due to its simplicity and recovered sperm with superior motility.

Decidual natural killer cytotoxicity decreased in normal pregnancy but not in anembryonic pregnancy and recurrent spontaneous abortion

PROBLEM

The natural killer (NK) cell activity is depressed in the decidua of early normal pregnancy. Recently Morii et al. (Am J Reprod Immunol 1993;29:1-4) found that all early intradecidual CD3+ T cells expressed either T cell receptor (TCR) alpha/beta or gamma/delta but that the expression of the CD3+/TCR complex was down-regulated.

METHOD

To test whether these changes in decidual cellular immunity are different among normal pregnancy, anembryonic pregnancy and recurrent spontaneous abortion, we examined the immune cell subpopulations in the decidua from these three types of pregnancy using flow cytometry and an NK cytotoxicity assay.

RESULTS

Intradecidual CD3+ T cells expressed either TCR alpha/beta or gamma/delta, and the level of expression of the CD3/TCR complex was down-regulated in normal pregnancy, anembryonic pregnancy, and recurrent spontaneous abortion. Although the relative proportion of decidual NK cells was increased to approximately the same extent in all three types of pregnancy, decidual NK activity was higher in anembryonic pregnancies and in recurrent spontaneous abortions than it was in normal pregnancies.

CONCLUSION

Decidual NK cell responses are different in anembryonic pregnancies and in recurrent spontaneous abortions than in normal pregnancies. Whether this difference is pathogenic or is the response to a dead embryo remains to be elucidated.

Peritoneal natural killer cytotoxicity and CD25+ CD3+ lymphocyte subpopulation are decreased in women with stage III-IV endometriosis

We examined the lymphocytes of peripheral blood (PB) and peritoneal fluid (PF) of women with or without endometriosis to investigate the alteration of cytotoxic activity of natural killer (NK) cells and activation of T cells in the peritoneal cavity of women with endometriosis. A total of 16 control women and 14 patients with stage III-IV endometriosis were selected on the basis of laparoscopic examination in National Taiwan University Hospital. The lymphocyte subpopulations (B cell, NK cell and T cell), including T-cell activation markers (CD69, CD25, HLA-DR), in PB and PF were analysed by dual-colour flow cytometry. The NK cytotoxicity of PB and PF mononuclear cells was evaluated by 51Cr release assay. There was a significant decrease of NK cytotoxicity and CD25+ CD3+ lymphocyte subpopulation in PF of women with endometriosis compared with those without endometriosis. However, there was no difference in the proportion of NK cells in both PB and PF between women with and without endometriosis. Therefore, the decreased NK cytotoxicity in PF of women with endometriosis was due to the functional defect, but not quantitative defect, of NK cells. The concomitant reduction of activated T cells in women with endometriosis might suggest its possible role in the defect of NK cytotoxicity.

Heterotopic pregnancies after controlled ovarian hyperstimulation and assisted reproductive techniques

Eight cases of heterotopic pregnancy following assisted reproductive techniques (ART) were reviewed. One cervical, three cornual and four tubal pregnancies were combined with intrauterine pregnancies. The cervical ectopy was successfully treated with a local injection of potassium chloride (KCl) into the gestational sac. A viable baby was produced from the intrauterine gestation. Cornual metroplasties were performed on two ruptured and one unruptured cornual heterotopic pregnancies. One of these three cases was maintained till term. All four tubal heterotopic pregnancies were aborted. Widespread application of ART in recent years has meant that heterotopic pregnancies are no longer a rarity. Both physicians and patients should be made aware that the existence of an intrauterine gestation does not preclude the risk of nidation of other fetuses in ectopic sites. The authors recommend that detailed ultrasound studies, preferably via the vaginal route, should be performed on patients in ART programs. During the examination, the adnexae should be carefully evaluated, even if an intrauterine gestational sac is already present. If a heterotopic pregnancy is diagnosed, the appropriate treatment depends on the location of ectopic pregnancy. Local injection with KCl or methotrexate is effective in certain types of cervical or cornual ectopic pregnancy, as it may allow the conservation of the intrauterine pregnancy.

Effect of assisted hatching by partial zona pellucida dissection on mouse embryos in vitro

The zonae pellucida of mouse embryos were dissected to examine the effect of partial zona dissection (PZD) at the four-cell stage on embryonic development and the hatching process in vitro. Micropipettes were used to create a gap of one-sixth the zona circumference, to avoid damage to the blastomere. A total of 484 embryos at the four-cell stage (defined as day 2 embryos) were randomly divided into two groups, the PZD group (n = 238) and the control group (n = 246). Embryos of both groups were cultured in vitro under identical conditions and examined on the following day. The hatching rates were as follows: day 3, 11/238 (4.6%) in the PZD group and 0/246 (0%) in the control group; day 4, 105/238 (44.1%) in the PZD group and 54/246 (22.0%) in the control group; day 5, 71/238 (29.8%) in the PZD group and 36/245 (14.5%) in the control group. On day 4 the rates of complete hatching were 7/238 (2.9%) in the PZD group and 2/246 (0.8%) in the control group. On day 6 they were 88/238 (37.0%) in the PZD group and 66/246 (26.8%) in the control group. A significantly higher percentage of PZD embryos than controls initiated and completed hatching in similar culture conditions. The present study indicates that the creation of an opening in the zona pellucida is not harmful to embryonic development and may facilitate hatching. Whether the enhanced hatching ability of embryos in vitro caused by PZD can improve the implantation rate requires further study.

Gonadotropin releasing hormone (GnRH) agonist induces down-regulation of the CD3+CD25+ lymphocyte subpopulation in peripheral blood

PROBLEM

To test whether GnRH agonist could alter in vivo human immune cells and whether the alteration is related to the success of pregnancy in an in vitro fertilization-embryo transfer (IVF-ET) program.

METHODS

Thirty-six infertile patients were enrolled under the long protocol of GnRH agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells, and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry.

RESULTS

B cells, NK cells, CD8+ T cells, and CD71+ T lymphocyte subpopulations were not changed throughout the whole course of treatment. CD4+ T cell and CD25+ T cell subpopulations were significantly down-regulated when the GnRH agonist was used for approximately 2 wk. CD3+CD69+, CD3+CD25+, and CD3+DR+ lymphocyte subpopulations were increased at 7 days (during implantation) and at 14 days after embryo transfer in pregnant patients, but not in patients who failed to get pregnant.

CONCLUSIONS

The GnRH agonist had a transiently immunosuppressive effect on CD4+ and CD25+ T cells, but CD69+, CD25+, and HLA-DR+ T cells were activated during and after successful implantation.

Biliary excretion of furosemide glucuronide in rabbits

Furosemide (F) was administered to rabbits intravenously and intraduodenaly and the biliary excretion was studied. The major metabolite excreted in bile was furosemide glucuronide (FG). F and acyl migration isomers of FG (FG-iso) were also excreted in bile. The biliary excretion rates of total F (F+FG+FG-iso) following intraduodenal administration of F were much smaller than those following intravenous administration. The fraction of (F+FG-iso) in bile following intraduodenal administration of F were larger than those following intravenous administration. Stability of FG or FG-iso in bile and supernatant solution of the duodenum homogenate of rabbits was studied. FG was unstable in both media and its degradation followed apparent first-order kinetics in both media. In bile, FG degraded to produce several FG-iso and F, while in the supernatant solution of the duodenum homogenate, it hydrolyzed immediately to F. FG-iso were hardly detected in the supernatant solution. These results indicated that FG excreted in bile degraded easily to FG-iso and F. FG might easily hydrolyze to F enzymatically in the duodenum, and the resultant F might be reabsorbed from the intestinal tract. Unabsorbed FG-iso and F might be excreted in the feces.

Correlation between sperm morphology using strict criteria in original semen and swim-up inseminate and human in vitro fertilization

To study the value of sperm morphology using strict criteria in raw semen and in swim-up inseminate of human in vitro fertilization (IVF), 135 cycles of IVF with normal sperm concentration and motility were recruited. At least two mature oocytes were recovered in each cycle. The correlation between the percentages of normal forms and fertilization rates of mature oocytes was analyzed. The results demonstrate that the percentage of normal forms in both the raw semen and swim-up sample of patients with poor fertilization was significantly lower than in those with acceptable fertilization. The percentages of normal forms both in raw semen and in swim-up sample were significantly correlated with fertilization rates in vitro, however, the former seemed to have a better correlation (r = .51 and .19, respectively). Regarding the percentages of normal forms in raw semen, the fertilization rate in patients with normal forms < 4% was 6 +/- 11%, for 4-14% it was 58 +/- 36%, and for > 14% it was 88 +/- 20%. The fertilization rates were significantly different among these three groups of patients. The evaluation of sperm morphology using strict criteria in raw semen before IVF is predictive of fertilization outcome and may also help doctors to choose an optimal method of treatment for patients.

Ketone EC50 values in the Microtox test

The Microtox EC50 values for the following ketones are reported in the following homologous series: straight chain methyl ketones (acetone, 2-butanone, 2-pentanone, 2-hepatonone, 2-octanone, 2-decanone, and 2-tridecanone); methyl ketones substituted at one alpha carbon (3-methyl-2-butanone; 3,3-dimethyl-2-butanone); methyl substituted at two alpha carbons (2,4-dimethyl-3-pentanone; 2,2,4,4-tetramethyl-3-pentanone); phenyl groups replacing methyl in acetone (acetophenone; benzophenone); methyl groups substituted at the alpha carbons of cyclohexanone; and 2,3- 2,4-, and 2,5-hexanediones, most for the first time. While there were linear relationships between log EC50 and MW for the straight chain methyl ketones, and for methyl substitution at the alpha carbon for methyl ketones, there were no other linear relationships. As molecular weight increased, the EC50 values of soluble ketones decreased; as distance between two carbonyl groups decreased so too did EC50 values. Thus, for the ketones the geometry around the carbonyl group is an important determinant of toxicity as well as MW, water solubility, and octanol/water coefficient.

Cytomegalovirus infection and viral shedding in the genital tract of infertile couples

The prevalence of cytomegalovirus (CMV) infection and viral shedding in infertile couples in Taiwan and its role in infertility were studied. Two hundred fifty couples were enrolled in this study. Anti-CMV IgG was measured in serum samples from these infertile couples. Viral shedding examined by DNA hybridization was detected in semen from the husband and cervical mucus from the wife. Anti-CMV IgG was detected in 249 (99.6%) of the 250 male serum samples and in 247 (98.9%) of the 250 female serum samples. Viral shedding was detectable in 83 (33.5%) of 248 semen samples and 83 (33.7%) of 246 cervical mucus samples by dot-blot DNA hybridization assay. Semen quality was not apparently affected by the existence of viral shedding. The co-shedding rate in semen and cervical mucus was high (15.9%). It is concluded that the seroprevalence and genital tract viral shedding were relatively high in infertile couples in Taiwan. Viral shedding did not affect the semen quality. Nevertheless, screening of donor semen is recommended.

In vivo CD3+CD25+ lymphocyte subpopulation is down-regulated without increased serum-soluble interleukin-2 receptor (sIL-2R) by gonadotropin releasing hormone agonist (GnRH-a)

PROBLEM

To test further whether the suppression of the CD3+CD25+ lymphocyte subpopulation by gonadotropin-releasing hormone agonist (GnRH-a) is related to the change in levels of cytokines and soluble interleukin-2 receptor (sIL-2R).

METHOD

Twenty-seven infertile patients were enrolled under the long protocol of GnRH-a agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry. Serum levels of cytokines and sIL-2R were measured.

RESULTS

The B cells, NK cells, T cells, CD4+, CD8+ T cells, CD3+DR+, and CD3+CD71+ lymphocyte subpopulations were not changed after the use of GnRH-a. The CD25+ T cell subpopulation was significantly down-regulated, but the CD69+ T cell subpopulation was increased when the GnRH-a was used for approximately 2 wk. The serum levels of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma), and sIL-2R were not changed.

CONCLUSION

The GnRH-a had a transiently suppressive effect on CD25+ T cells, but a stimulatory effect on CD69+ T cells. However, the serum level of cytokines or sIL-2R did not change. These immunological modulations seems to be the result of interaction between GnRH-a and estrogen.

Hormonal studies and Doppler flow imaging of ovarian lipoid cell tumors: report of two cases

Ovarian lipoid cell tumors are very rare. We report two cases with abnormal menstruation, hirsutism, clitoromegaly and marked elevations of serum testosterone. Sonography revealed unilateral adnexal solid tumors. Flow velocity wave form study showed apparent flow within the tumor with the resistance index ranging from 0.42 to 0.49 in both cases. Unilateral oophorectomy and contralateral ovarian biopsy were performed. Frozen sections showed lipoid cell tumors without malignant change. During surgery, direct ovarian venipuncture showed a discrepancy in testosterone level in the bilateral ovaries of both patients and large ovarian-peripheral venous gradients in case 2. The testosterone concentration returned to normal postoperatively in both cases. Flow velocity wave form study and direct ovarian venipuncture are useful tools for evaluation of androgen-secreting tumors preoperatively and intraoperatively.

Delayed maternal death after perimortem cesarean section

We report a case of perimortem cesarean section performed on a multigravida with congestive heart failure. This patient had a past history of repeated episodes of acute myocarditis and this time, congestive heart failure attacked her at the 36th week of gestation. The maternal condition deteriorated rapidly with frequent attacks of ventricular fibrillation and cardiac arrest, which gradually became unresponsive to active cardio-pulmonary resuscitation (CPR). The fetal condition also worsened accordingly. Cesarean section was therefore performed and a 2590 gm depressed female baby was delivered in less than one minute after skin incision and about twenty-seven minutes after the maternal condition became extremely unstable. The Apgar scores were 1 at one min, 4 at five min and 6 at ten min. The mother improved soon after delivery of the fetus and her consciousness returned. However, her condition deteriorated again and she died four hours after operation. The fetus survived and follow-up 21 months after delivery was normal.

Co-culture with Vero cell monolayer maintains the motility of asthenozoospermic semen samples

The clinical effectiveness of co-culture with Vero (Green monkey kidney) cell monolayer in maintaining the motility and viability of fresh asthenozoospermic semen (18 samples) and frozen-thawed semen with poor motility (motility fraction < 50%) (15 samples) in a 24-h period was evaluated. Co-culture with Vero cell monolayer in human tubal fluid (HTF) medium for 24 h resulted in a statistically better maintenance of motility percentage (P < 0.005), mean amplitude of lateral head displacement (ALH) (P < 0.005), and mean track speed (VCL) (P < 0.05) than culture in HTF medium alone. However, these motility parameters (motility percentage, ALH, VCL) declined soon after removal of spermatozoa from the monolayer. Co-culture with Vero cell monolayer also maintained the viability percentage of these sperm samples (52% of the original value) after the 24-h period compared with culture in HTF medium alone (22% of the original) (52% versus 22%, P < 0.05). It is concluded that Vero cell monolayer is effective in the maintenance of motility and viability of asthenozoospermic semen or frozen-thawed semen with poor motility. This co-culture system may be beneficial in enhancing the in-vitro performance of asthenozoospermic semen samples in the practice of assisted reproductive technology. However, its safety needs further evaluation.

Peptides extracted from Vero cell cultures overcome the blastocyst block of mouse embryos in a serum-free medium

PURPOSE

The aim of this work was to evaluate the effect of a Vero cell coculture system on the development of mouse embryos.

METHODS

Mouse embryos were randomly divided and cultured in human tubal fluid (HTF) medium with/without Vero cell monolayers, conditioned medium (CM) obtained from Vero cell cultures, and HTF medium supplemented with peptides extracted from CM. The concentrated CM was examined by SDS/PAGE.

RESULTS

The development of mouse embryos was blocked at the blastocyst stage in pure HTF medium (1.4% hatching at day 5). This "blastocyst block" was overcome by coculture with Vero cell monolayers (48.1% hatching at day 5; 1.4 vs 48.1%; P < 0.001). CM and the addition of 5% fetal bovine serum (24.1 and 34.9% hatching, respectively, at day 5) were also able to enhance the process of hatching. In the other experiment, the addition of peptides extracted from Vero cell cultures also overcame the blastocyst block (12.5%) compared with pure HTF medium (2.1%) (P < 0.05). Electrophoretic separation revealed several classes of polypeptides consistently secreted into CM obtained from Vero cell cultures. Most peptides occurred in the M(r) range between 6.5 kd and 35.9 kd.

CONCLUSION

A developmental block (blastocyst block) of mouse embryos in a serum- and protein-free medium (HTF) was discovered in this study. This block was effectively overcome by HTF plus serum and coculture with Vero cell monolayers and also by the peptides extracted from Vero cell-conditioned medium. We speculate that certain factors secreted or converted by Vero cells may be critical in hatching of mouse embryos. Further study of these factors may be helpful in delineating its mechanism.

Effects of pulmonary air embolism on discharge of slowly adapting pulmonary stretch receptors

Pulmonary air embolism (PAE) usually causes small-airway collapse. Local transpulmonary pressure (Ptr) is thought to be closely associated with the activity of slowly adapting pulmonary stretch receptors (SAPSRs). To test whether discharge of SAPSRs located distal to collapsed airways is closely related to the overall Ptr, we studied 65 SAPSRs in anesthetized paralyzed open-chest dogs that were ventilated at constant tidal volume and frequency. PAE increased both Ptr and total pulmonary resistance but decreased dynamic lung compliance. Three groups of SAPSRs were identified on the basis of their locations in intrapulmonary airways. Group I had 29 SAPSRs located in airways < 1 mm in diameter. Group II had 10 SAPSRs that were found in intrapulmonary airways between 1 and 2 mm in diameter. PAE decreased the activity of 31 of the 39 SAPSRs in these two groups. Their activity during PAE was not related to Ptr. The 26 SAPSRs in group III were in airways > 2 mm in diameter. PAE increased the peak firing rate of 18 of these receptors, and there was a close relationship between the discharge frequency of these SAPSRs and the Ptr during PAE. In groups I and II, the dissociation between Ptr and SAPSR activity during PAE may have been caused by peripheral airway collapse. Activity of central fibers was blocked at higher temperatures than activity of peripheral fibers. We suggest that the response of a SAPSR to PAE depends on the location of the receptor within the lungs, and we speculate that threshold and fiber type are also related to location.

Acrosin activity of human sperm did not correlate with IVF

To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (AAI) was measured in 95 semen samples from patients participating in an IVF program. All patients had at least two mature oocytes. Of 95 patients, 84 had successful fertilization and 11 failed to fertilize all oocytes in vitro. The numbers of mature oocytes were similar between fertilization and nonfertilization groups. The mean AAI, measured using a commercially available (Accu-Sperm) acrosin activity assay, was greater in the fertilization group than in the nonfertilization group, but the difference was not significant. There was no correlation between AAI and the in vitro fertilization rate of mature oocytes. The relation between AAI and semen parameters also showed no significant difference. It would appear that measurement of AAI inaccurately reflects in vitro fertilizability of human sperm.

Sharing of human leukocyte antigens in couples with unexplained infertility affects the success of in vitro fertilization and tubal embryo transfer

OBJECTIVE

The purpose was to test further our hypothesis that genes, or genetic defects, linked to the major histocompatibility complex affect reproduction by correlating human leukocyte antigen sharing with the success or failure of in vitro fertilization and tubal embryo transfer in couples having unexplained infertility.

STUDY DESIGN

Seventy-six couples with unexplained infertility who failed superovulation and intrauterine insemination at least three times were typed for human leukocyte antigens and treated by in vitro fertilization and tubal embryo transfer. The results were correlated with the sharing of human leukocyte antigens in the couples.

RESULTS

Thirty-four of the women had successful pregnancies, 36 did not become pregnant, and six became pregnant but aborted shortly thereafter. There was a highly significant excess of human leukocyte antigen sharing in the couples who failed treatment: three of the A, B, DR, and DQ antigens (p = 0.015) or two of the B, DR, and DQ antigens (p = 0.015). No specific human leukocyte antigen alleles were present in excess.

CONCLUSIONS

Genes, or genetic defects, linked to the major histocompatibility complex significantly affect the success of in vitro fertilization and tubal embryo transfer just as they affect the prevalence of recurrent spontaneous abortion, cancer, and congenital anomalies. It appears as if the critical genes, or genetic defects, are located in the B-DR-DQ region of the major histocompatibility complex.

Antihypertensive principles from the leaves of Melastoma candidum

Three active principles were isolated from the leaf of Melastoma candidum using the screening of hypotensive effects on spontaneously hypertensive rats (SHR). Intravenous injection of castalagin, procyanidin B-2, or helichrysoside into SHR lowered the mean blood pressure in a dose-dependent manner, with helichrysoside being the most potent compound. Plasma noradrenaline (NA) levels, both basal in SHR and elevated in normal rats through cold-stress stimulation, were attenuated by these compounds in a way which was not influenced by adrenalectomy. Decrease of NA release from sympathetic nerves was assumed to be responsible. Moreover, the hypertensive effect of various vasoconstrictors in anesthetized rats was reduced by helichrysoside. The same results were also observed in castalagin or procyanidin B-2 treated animals. The results indicate that the three principles possess the ability to lower blood pressure through a decrease of sympathetic tone as well as due to direct vasodilatation in SHRs.

Expression of the Epstein-Barr virus latent membrane protein (LMP) in insect cells and detection of antibodies in human sera against this protein

Recombinant baculoviruses containing the complete LMP and truncated LMP genes were generated and high levels of the LMP proteins were expressed in Spadoptera Frugiperda insect cells. A specific rabbit antiserum directed against the N-terminal part of LMP was obtained by immunizing the rabbits with Escherichia coli-expressed trpE-N-terminal part of LMP fusion protein. A total of 127 human sera were studied for their immune response to the recombinant full-length LMP. In immunofluorescence analysis, all sera tested showed no detectable reaction with the recombinant full-length LMP. In immunoprecipitation-immunoblotting analysis, however, sera from patients with nasopharyngeal carcinoma (5/22), patients with Hodgkin's disease (16/27), patients with other diseases exhibiting high EA-IgG titers (3/52), and VCA-IgG-positive healthy individuals (2/26) were shown to contain antibodies against this recombinant LMP. The expressed LMP proteins provided a sufficient and economic source of the proteins for further serological and biological studies.