Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position.

OBJECTIVES: To determine the prevalence of clinical symptoms associated with Cesarean scar defects, and to determine the association between the size of these defects, clinical complaints, uterine position, and a history of multiple Cesarean sections. METHODS: In this cross-sectional study, Cesarean scar defects in women with a history of transverse lower-segment Cesarean section were measured by transvaginal ultrasound while being assessed for other gynecological conditions. The relationships between the size of the Cesarean scar defect and the clinical symptoms, uterine position and number of previous Cesarean sections were evaluated. Patients with other uterine pathologies, including endometrial hyperplasia, polyps, malignancy and submucosal myomas, were excluded from the study. RESULTS: During a 3-year period, 4250 women were assessed by transvaginal sonography, of whom 293 (6.9%) were diagnosed with Cesarean scar defects. Eighty-six patients were excluded due to other uterine pathologies. Altogether, 207 patients with Cesarean scar defects were included in this study. Women who had undergone multiple Cesarean sections tended to have larger scar defects (in width and depth) than did those who had undergone a single Cesarean section. Women with retroflexed uteri also tended to have wider defects than those with anteflexed uteri. Defect width was significantly greater in women with postmenstrual spotting, dysmenorrhea and chronic pelvic pain. CONCLUSIONS: Multiple Cesarean sections and retroflexed uteri are risk factors for larger Cesarean scar defects. The size of the Cesarean scar defect is associated with clinical symptoms such as postmenstrual spotting, dysmenorrhea and chronic pelvic pain.

SPRASA, a novel sperm protein involved in immune-mediated infertility.

BACKGROUND: Antisperm antibodies (ASA) may be an important cause of infertility, but current tests for the detection of ASA have poor prognostic value. Identification of the sperm proteins that ASA bind to may aid the development of more useful diagnostic tests. METHODS: One- and two-dimensional PAGE and western blotting analyses, as well as amino acid sequencing, were used to identify a novel sperm protein reactive with ASA (SPRASA) from infertile men. An antiserum reactive with SPRASA was produced by immunizing a rabbit with SPRASA excised from two-dimensional gels. This antiserum was used to demonstrate the localization of SPRASA on the sperm. RESULTS: Amino acid sequences derived from SPRASA matched those of a theoretical protein, XP-085564. This protein is derived from the C-type lysozyme/alpha-lactalbumin gene family. Immunohisto chemistry indicates that SPRASA is localized to the acrosome. Western blot analysis revealed that 50 unselected individuals did not have antibodies that reacted with SPRASA. CONCLUSION: Only ASA from infertile men react with SPRASA, suggesting that this novel protein may be important in the processes of fertility. The identification of SPRASA as the antigen for infertility-associated ASA raises the possibility of developing first, antigen-specific tests for ASA, and secondly, more targeted treatment for immune-mediated infertility.

Human seminal plasma antibody-binding proteins.

PROBLEM: The physiological role of antibody-binding proteins in human seminal plasma and the potential role of these proteins in infertility is relatively unknown. METHOD OF STUDY: Literature on antibody-binding proteins. RESULTS: Human seminal plasma has a diverse effect on immune function of the reproductive tracts. This review describes (1) the presence of receptors like proteins that can react with monoclonal antibodies against Fcgamma receptors III (Fcgamma RIII) but are distinctly different from Fcgamma RIII; (2) IgG binding factors (IgGBF), a group of low molecular weight proteins that are capable of binding human IgG; (3) other proteins that can bind antibodies, such as prolactin-inducible protein and three other novel proteins that we have discovered. These proteins potentially all have the ability to reduce the interactions between antisperm antibodies and effector components of the immune system, such as phagocytic cells. CONCLUSIONS: Human seminal plasma contains proteins that can bind antibodies. However, to date our knowledge of these proteins especially, whether they have a physiological role in either the male and female reproductive tracts is limited.

Use of antisperm antibodies in differential display Western blotting to identify sperm proteins important in fertility.

BACKGROUND: Antisperm antibodies (ASA) may be an important cause of infertility but current tests for the detection of ASA have poor prognostic value. The inadequacy of current tests may reflect the inability of these tests to define the antigenic specificity of the sperm proteins with which the ASA react. Identification of the sperm proteins that ASA bind to is a necessary preliminary step to the development of more useful diagnostic tests for ASA. METHODS: A sensitive Western blotting technique was used to compare the antigenic specificities of ASA from men who were infertile (n = 6) with those who were fertile following vasectomy reversal (n = 3). Normal fertile men (n = 3) and infertile men with known ASA (n = 4) were also included in the analysis. RESULTS: All men, including the normal fertile controls, had ASA detectable in our system. Several sperm proteins were identified that react with ASA from infertile but not fertile men. Quantitative differences in the binding of ASA to some proteins were also demonstrated. Additionally, we demonstrated that normal motile sperm are coated with an antibody that appears to be bound to sperm by a non-antigenic mechanism. CONCLUSION: Sera from all men contained ASA, but clearly some of these did not cause infertility. Characterization of the proteins that are antigens for ASA from infertile but not fertile men may allow the development of more accurate tests for infertility-inducing ASA. The significance of immunoglobulin G coated on normal sperm remains to be determined.

Antibody-binding proteins in human seminal plasma.

PROBLEM: The significance of antibody-mediated infertility is unclear and complicated by the finding of that antisperm antibodies are found both in fertile and infertile couples. Seminal plasma contains immunosuppressive factors, one such factor may be antibody-binding proteins (ABP's). METHOD OF STUDY: Antibody-binding-proteins were purified using human IgG or IgG-Fc affinity chromatography columns. The purified antibody-binding proteins were characterized by their molecular weights, partial amino acid sequences, and immunoreactivities. RESULTS: Three proteins of molecular weight 74, 70 and 55 kDa and other low molecular weight proteins specifically bound to the IgG or IgG-Fc affinity columns demonstrating Fc-binding specificities. These proteins were not FcgammaRIII, IgG, or fragments of these proteins by their behaviors under reducing conditions, Western blot, and partial amino acid sequence analyses. Amino acid sequence data demonstrated some of these proteins to be novel. CONCLUSIONS: We have isolated and partially characterized several ABP's from seminal plasma. The IgG-binding proteins we have identified may protect spermatozoa against antibody-mediated damage by conferring protection to antibody-coated spermatozoa. If this hypothesis holds true, differences in the level or function of these ABP's may alter the status of fertility.