Correlation between the follicular gonadotropin inhibitor and the maturity of the ovum-corona-cumulus complex**Presented in part at the Fortieth Annual Meeting of The American Fertility Society, April 2 to 7, 1984, New Orleans, Louisiana.††Supported in part by grant No. 59771130 from the Ministry of Education, Tokyo, Japan

Reduction of perifollicular arterial blood flow resistance after hCG administration is a good indicator of the recovery of mature oocytes in ART treatment

PURPOSE

To demonstrate our hypothesis that a correlation exists between oocyte maturity and a decrease in intraovarian blood flow resistance in assisted reproductive technology (ART) treatment cycles, oocyte maturity and total antioxidant status (TAOS) in follicular fluid was examined.

METHODS

A total of 59 cycles involving 51 infertile patients undergoing ART treatment in our hospital were recruited in this study. The ART cycles were divided into two groups: deeply decreased (DD) group and not-deeply decreased (NDD) group, according to the pulsatility index (PI) values for perifollicular arterial blood flow before and after hCG administration. The PI values that showed a decrease in their PI after hCG administration of 10% or more were defined "deeply decreased" and showed a decrease of less than 10% were considered "not-deeply decreased." The recovery rates of mature and immature oocytes and TAOS in follicular fluid were compared between the two groups.

RESULTS

Mature and immature oocyte recovery rates in the DD group (62.5% and 17.2%) were significantly higher and lower, respectively, than those in the NDD group (41.7% and 38.3%, p < 0.05). The TAOS (1.55 +/- 0.44 mmol/L) of the DD group was significantly lower than that in the NDD group (1.68 +/- 0.47 mmol/L, p < 0.05).

CONCLUSIONS

The decrease in intraovarian arterial blood flow resistance measured after hCG administration may be a good indicator of retrieving mature oocyte.

Utility of color Doppler indices of dominant follicular blood flow for prediction of clinical factors in in vitro fertilization-embryo transfer cycles

OBJECTIVE

To investigate the relationship between color Doppler indices of dominant follicular blood flow and clinical factors in in vitro fertilization-embryo transfer cycles.

SUBJECTS AND METHODS

This was a prospective study involving 26 patients completing a total of 33 in vitro fertilization cycles. Dominant follicular blood flow indices, peak systolic velocities, the resistance index and the pulsatility index were evaluated using transvaginal color Doppler. The indices were compared to the clinical outcomes of in vitro fertilization-embryo transfer.

RESULTS

There was a significant correlation between dominant follicular peak systolic velocities and the number of oocytes retrieved, as well as the number of mature oocytes obtained. There was no significant correlation between dominant follicular resistance index or pulsatility index and the number of follicles > 10 mm in diameter, the number of oocytes retrieved or the number of mature oocytes. There were no significant differences between dominant follicular peak systolic velocities, resistance index or pulsatility index, and fertilization rate or the ratio of good quality embryos. However, significant differences were found between the number of oocytes retrieved, as well as the number of mature oocytes for those patients in which the peak systolic velocity was below 25 cm/s.

CONCLUSIONS

Doppler assessment of dominant follicle blood flow alone is useful for predicting the number of retrievable oocytes. However, morphological quality of the embryo produced or the pregnancy rate cannot be predicted by this method.

Relatively poor oocyte quality is an indication for intracytoplasmic sperm injection

OBJECTIVE

To determine the relation between the insemination method used and the quality of oocytes and embryos.

DESIGN

Prospective study.

SETTING

Assisted reproductive centers at Yamagata University Hospital and Kuramoto Women's Clinic in Yamagata, Japan.

PATIENT(S)

Forty patients undergoing IVF and 40 patients undergoing intracytoplasmic sperm injection (ICSI).

INTERVENTION(S)

To estimate oocyte quality, the granulosa cells surrounding the oocyte were fixed and stained with a commercial dye in both groups of patients. One thousand granulosa cells were examined under a fluorescence microscope.

MAIN OUTCOME MEASURE(S)

The incidence of apoptotic granulosa cells surrounding each oocyte.

RESULT(S)

The incidence of apoptosis in the granulosa cells enclosing the oocytes that were fertilized by IVF was significantly lower than that in the oocytes that were fertilized by ICSI. Moreover, the incidence of apoptosis in the granulosa cells enclosing the oocytes that grew into good-quality or fair-quality embryos was significantly lower after conventional IVF than after ICSI. With ICSI, the incidence of apoptosis was not significantly different among the granulosa cells surrounding the oocytes that were inseminated, were fertilized, or developed into good-quality or fair-quality embryos. With IVF, the incidence of apoptosis was highest in the granulosa cells surrounding the oocytes that were inseminated and lowest in the granulosa cells surrounding the oocytes that developed into good-quality and fair-quality embryos.

CONCLUSION(S)

A good-quality oocyte is necessary for the development of a good-quality embryo with IVF but not with ICSI. Thus, relatively poor oocyte quality is a good indication for the use of ICSI.

Ovarian fecundity in patients with endometriosis can be estimated by the incidence of apoptotic bodies

OBJECTIVE

To investigate the incidence of apoptotic bodies in membrana granulosa in patients with endometriosis.

DESIGN

Retrospective analysis.

SETTING

Yamagata University Hospital.

PATIENT(S)

Fifty-eight normoovulatory women with endometriosis and 45 patients with male factor infertility underwent ovulation induction for IVF-ET with GnRH analogues and gonadotropins.

INTERVENTION(S)

Patients underwent follicle aspiration after the administration of hCG.

MAIN OUTCOME MEASURE(S)

Recovered granulosa cells (GCs) were examined by fluorescence microscopy, and the incidence of apoptotic bodies was tabulated. These data and the other parameters associated with IVF results were analyzed on the basis of both the revised American Fertility Society (AFS) classification of endometriosis and the existence of chocolate cysts.

RESULT(S)

The incidence of apoptotic bodies in membrana granulosa of patients with endometriosis was significantly higher than that of the control (male factor infertility) group and increased as the stage of the revised AFS classification advanced. The incidence of apoptotic bodies in membrana granulosa was significantly higher in patients with chocolate cysts than in those without chocolate cysts. The patients with endometriosis had smaller numbers of developed follicles (> or = 15 mm), harvested oocytes, and mature oocytes than the male factor infertility patients. The existence of chocolate cysts corresponded with a reduced number of both harvested oocytes and mature oocytes.

CONCLUSION(S)

Through the apoptosis of GCs, the existence of endometriosis may have negatively affected the follicle development and oocyte quality.

The incidence of apoptotic bodies in membrana granulosa can predict prognosis of ova from patients participating in in vitro fertilization programs

OBJECTIVE

To investigate the relationship between the incidence of apoptotic bodies in membrana granulosa and follicular steroid concentrations in human follicles.

DESIGN

Case-controlled prospective study for 132 individual follicles.

SETTING

Procedures were performed in Yamagata University Hospital.

PATIENT(S)

Thirty-six normo-ovulatory women with tubal infertility underwent ovulation induction for IVF-ET with a conventional hyperstimulation method.

INTERVENTION(S)

Patients underwent follicle aspiration after the administration of hCG.

MAIN OUTCOME MEASURE(S)

The nuclei of recovered granulosa cells were examined by fluorescence microscopy, and the incidence of apoptotic bodies was tabulated. Intrafollicular steroids were evaluated mainly by RIA. These data were analyzed with respect to oocyte-retrieval, oocyte maturity, fertilization, and embryo quality.

RESULT(S)

Membrana granulosa cells in the follicles from which oocytes were subsequently fertilized showed a significantly lower incidence of apoptotic bodies than those in follicles from which the oocytes did not fertilize. Membrana granulosa cells in the follicles from which oocytes were developed into good quality showed a significantly lower incidence of apoptotic bodies than those in the follicles from which oocytes developed into fair and poor quality. The incidence of apoptotic bodies was significantly higher in the mural granulosa cell region than in the cumulus cell region in most cases. Intrafollicular E2, P, and free T levels were not different between the oocyte groups.

CONCLUSION(S)

These results indicate that lower incidence of apoptotic bodies in individual follicles is associated with better outcomes for oocytes. Also, mural granulosa cells and cumulus cell in each follicle may show differentiation during follicular maturation.

Incidence of apoptotic bodies in membrana granulosa of the patients participating in an in vitro fertilization program

OBJECTIVE

To investigate the incidence of apoptotic bodies in mural granulosa cell masses and cumulus cell masses.

DESIGN

Nonrandomized, prospective study.

SETTING

Department of Obstetrics and Gynecology, Yamagata University School of Medicine, Yamagata, Japan.

PATIENT(S)

One hundred twenty-nine normally ovulating women underwent ovulation induction for IVF-ET with GnRH analogue (GnRH-a) and gonadotropins.

INTERVENTION(S)

Patients underwent follicle aspiration after the administration of hCG.

MAIN OUTCOME MEASURE(S)

The nuclei of recovered granulosa cells were examined by fluorescence microscopy and the incidence of apoptotic bodies was tabulated.

RESULT(S)

The incidence of apoptotic bodies was significantly higher in mural granulosa cell masses than in cumulus cell masses in the entire group of 129 patients. Both incidence of apoptotic bodies of mural granulosa cell masses and cumulus cell masses were significantly higher in patients with less than six follicular oocytes compared with patients with six or more oocytes. Nonpregnant patients showed significantly higher incidence of apoptotic bodies in mural granulosa cell masses compared with pregnant patients.

CONCLUSION(S)

These results indicate that mural granulosa cell masses and cumulus cell masses may have different functions in follicular maturation. The incidence of apoptotic bodies in mural granulosa cell masses can be used as an indicator of success of IVF.

The role of follicle-stimulating hormone in the selection of follicles in human ovaries: a survey of the literature and a proposed model

A review of the literature resulted in a model consisting of three follicle-stimulating hormone (FSH)-related mechanisms of follicle selection in the human ovarian cycle. The FSH-dependent selection of dominant follicles is the result of varying FSH serum levels on the one hand, and a varying follicular sensitivity to FSH on the other hand. The first FSH-related mechanism of follicle selection is the intercycle rise of FSH which induces the ongoing development of a reasonable number of follicles during the early follicular phase. The intercycle FSH level should surpass the FSH threshold of the follicles with the highest FSH sensitivity, but the FSH level should not be too high because many other less sensitive follicles might also be stimulated to develop. The second and third mechanisms act together during the mid- to late follicular phase. During the mid- and late follicular phases, the number of dominant follicles is reduced by the synergistic actions of a decreasing FSH level and the differentiation of the follicular sensitivity to FSH. Follicles destined to become dominant gain sensitivity to FSH, whereas follicles destined to become atretic lose their sensitivity to FSH. This differentiation of follicular sensitivity to FSH is the result of several endo-, para- and autocrine factors which modulate the effect of FSH on the growing follicle. The differentiation of follicular sensitivity to FSH supports the effect of the decreasing FSH level. Only the most sensitive follicle will become dominant. The other follicles will become atretic. The presented model may be of use not only for interpretation of the results of ovarian stimulation, but also to put the growing amount of data on growth factors and other substances which modulate the effects of FSH in the dynamic context of follicle selection.

Immunocytochemical localization of follicle regulatory-protein (FRP) in testis

Follicle regulatory protein (FRP) can exert paracrine control over follicular development. It is synthesized by the granulosa cells of the developing follicles and was localized in the cytoplasm of the mural cells by immunocytochemistry. When administered to male dogs and rats, FRP causes impairment of spermatogenesis. In the intact male rat, it has been postulated that FRP manifests its effects at a stage prior to the conversion of testosterone to dihydrotestosterone. Sertoli cells of the seminiferous tubules are implicated in testosterone metabolism. Furthermore, Sertoli cells in male gonads are regarded as the counterpart of granulosa cells in ovaries. The exact source of FRP in the male is not known. Therefore, it was of interest to study the localization of FRP in the male gonads. Testicular sections of the pig, dog, cat, rat, mouse, monkey, and man were immunocytochemically stained with monoclonal antibody to porcine FRP of ovarian origin. Sections of pig ovaries were used as controls throughout the study. Specificity of immunocytochemical localization was established by preabsorption. FRP antibody predominantly localized to the interstitial compartment of the pig testis. In the seminiferous tubules, FRP localization was limited to basal spermatogonia and Sertoli cells of tubules at few specific stages of spermatogenesis. The study also showed that the monoclonal antibody against porcine FRP is species-specific. Antibody binding was found only in pig testis, whereas tissues from the cat, dog, mouse, rat, monkey, and man did not display any immunocytochemical reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

The measurement of hyaluronidase activity in human spermatozoa by substrate slide assay and its clinical application

Acrosomal hyaluronidase activity of individual sperm can be detected by a halo formation around the sperm head on hyaluronic acid substrate slides. The following results were obtained by this method in clinical practice. A significant correlation was found between hyaluronidase activity and sperm concentration in male infertility. Hyaluronidase activity increased as the concentration of sperm increased, and the least hyaluronidase activity was determined at less than 10 X 10(6)/ml. The group with more than 40% motility had a higher hyaluronidase activity than other groups with poor motility. Although there was no significant correlation between hyaluronidase and cumulus dispersion and fertilization rates in immature oocytes, there was an excellent correlation in mature oocytes in human in vitro fertilization. These findings suggest that a newly developed assay will be useful for evaluating sperm fertilizing capacity.

Reduction of fertility in the male rat by systemic treatment with follicle regulatory protein

Forty-five-day-old rats received daily injections of follicle regulatory protein (FRP). After 15, 30, 45, and 70 days of therapy, serum was measured for testosterone, androstenedione, estradiol, and follicle-stimulating hormone levels. Testes were evaluated for sperm head counts, plasminogen activator activity, weight, and length of seminiferous epithelial stages. In no case was serum follicle-stimulating hormone concentration reduced in FRP-treated rats. After 75 days of treatment, there was a significant decrease in the number of the sperm head counts. After 60 days of treatment, the length of the dark zone of the tubule was longer than that of control. Pregnancy rates for FRP-treated rats were reduced after 45 and 60 days of treatment. In conclusion, systemic injection of FRP alters seminiferous epithelial function by reducing development of mature sperm.

A postulated role for naturally occurring aromatase inhibitors in follicle selection

The studies reviewed here indicate that follicle regulatory protein (FRP) alters aromatase and 3B-hydroxysteroid dehydrogenase activity in porcine, human, and rat granulosa cells. The inhibitory effect of FRP on granulosal aromatase activity depend upon the response of the cell to FSH: large amounts of FSH can partially overcome FRP inhibition while relatively small amounts of FSH sensitize the granulosal aromatase system to FRP. Although androgens potentiate FSH-mediated granulosal functions, they also sensitize granulosa cell steroidogenic enzymes to inhibition by FRP. The demonstration that FRP acts primarily on granulosa cells of less mature antral follicles to inhibit aromatase supports the hypothesis that FRP may facilitate follicle selection and suggests a role for FRP in atresia. Most of the effects of FRP on granulosal activities reflect an interplay between the systemic endocrine and local paracrine systems. That FRP functions, at least in part, by modulating follicular response to FSH is consistent with the hypothesis that paracrine effectors are important mediators of folliculogenesis in the presence of gonadotropins.