Programming in vitro fertilization retrievals during working days after a gonadotropin-releasing hormone antagonist protocol with estrogen pretreatment: does the length of exposure to estradiol impact on controlled ovarian hyperstimulation outcomes?

OBJECTIVE: To verify whether a variable number of days beyond the menses of estrogen (E) pretreatment may impact on controlled ovarian hyperstimulation (COH) outcomes and birth rate using a GnRH antagonist protocol. DESIGN: Single center, prospective, nonrandomized study. SETTING: Nonacademic fertility unit. PATIENT(S): A total of 1,080 women, aged 25-38 years, consecutively included (1,603 cycles). INTERVENTION(S): Given 4 mg/d E(2) valerate, started 3 days before the theoretical date of the next menses up to the first day of stimulation (S1). MAIN OUTCOME MEASURE(S): Hormone serum levels, drug exposure, and main IVF outcomes. RESULT(S): The cancellation rate was similar in the six similarly sized groups according to the number of days with E(2) pretreatment beyond the menses (1-8 days). The mean serum E(2) and LH levels at S1 gradually increased along with E(2) exposure, whereas the mean serum P level decreased. The mean serum E(2) level on the day of hCG administration gradually increased along with E(2) exposure. Serum LH level at S1 correlated significantly and positively to the length of E(2) exposure and to E(2) level on the day of hCG administration. No significant difference was observed for the number of oocytes retrieved and the number of embryos obtained. Women exposed the longest to exogenous E(2) tended to have higher pregnancy rates (PR). CONCLUSION(S): Extending E(2) pretreatment beyond the menses had no deleterious effect on the main COH outcomes and proved to be slightly beneficial.

Study of aneuploidy in large-headed, multiple-tailed spermatozoa: case report and review of the literature.

OBJECTIVE: To determine the meiotic segregation in large-headed, multiple-tailed spermatozoa. DESIGN: Analysis of sperm nuclei by fluorescence in situ hybridization (FISH). SETTING: University hospital. PATIENT(S): A 34-year-old man with 100% morphologically abnormal spermatozoa. INTERVENTION(S): Dual-color FISH for chromosomes 13 and 21 and triple-color FISH for chromosomes X, Y, and 18 were performed. MAIN OUTCOME MEASURE(S): Aneuploidy rates. RESULT(S): More than 99% of the spermatozoa had abnormal content for chromosomes X, Y, 13, 18, and 21. Diploidy, triploidy, and tetraploidy rates were found to be 18.42%, 6.14%, and 33.99% in triple-color FISH and to be 16.09%, 16.28%, and 38.95% in dual-color FISH. CONCLUSION(S): Our results and those from other investigators show that large-headed, multiple-tailed spermatozoa are associated with a high rate of polyploidy and aneuploidy. Intracytoplasmic sperm injection should not be recommended to those patients, not only because of its low success rate but also because of its high genetic risk.

Involvement of semenogelin-derived peptides in the antibacterial activity of human seminal plasma.

Mechanisms for protecting spermatozoa, and the testes that produce them, from infection are essential, given the importance of these cells and organs for the fertility of the individual and perpetuation of the species. This is borne out by the publication of numerous papers on this subject over the last 50 years. We extended our work and that of others on the anti-infectious defense system of the male genital tract, using a new strategy for the direct identification of antibacterial molecules in human seminal plasma. We subjected a liquefied seminal plasma cationic fraction to reversed-phase HPLC, monitored microbicidal activity by gel overlay and radial diffusion assays, and identified the proteins and/or peptides present in each active fraction by mass spectrometry. In addition to proteins with known potent microbicidal activity--phospholipase A2, lactoferrin, and lysozyme--we also found that peptides produced by cleavage of semenogelin I, the predominant human semen coagulum protein, had high levels of antibacterial activity.

Expression of antimicrobial defensins in the male reproductive tract of rats, mice, and humans.

Defensins are antimicrobial peptides that play a major role in innate immunity. Using reverse transcriptase-polymerase chain reaction, immunochemistry, or both, we performed a search of all presently known defensins in rat testis, epididymis, and isolated testicular cells; in mouse testis and epididymis; and in human testis and ejaculates. In the rat, all alpha- and beta-defensins except RNP-4 were expressed within the testis, whereas alpha-defensins RNP1-2, RNP-4, and beta-defensins RBD-1 and RBD-2 were present within the epididymis. In the mouse, the cryptdin transcripts CRS1C, mBD-1, and mBD-2 were detected in the testis and epididymis, whereas mBD-3 and mBD-4 were expressed only in the epididymis, and CRS4C was absent in both organs. In the human testis, transcripts for four known defensins were expressed with the consistent exception of HBD-2 and HBD-3. In rat interstitial tissue, resident macrophages expressed most of the defensins studied, whereas Leydig cells produced only RBD-2. In contrast, all studied defensins except RNP-4 were present in the seminiferous tubules. Within these tubules, peritubular and Sertoli cells expressed most of the studied alpha- and beta-defensins, whereas spermatogonia displayed only alpha-defensins, but at relatively high levels. Meiotic pachytene spermatocytes expressed only beta-defensins, whereas postmeiotic spermatids and their cytoplasmic lobes displayed both types. In humans, the HBD-1 peptide was expressed mainly in the germ line from pachytene spermatocytes to late spermatids. The peptide was also present in ejaculated spermatozoa and seminal plasma, where multiple soluble forms were present. Finally, high salt concentration or dithiothreitol-sensitive cationic extracts from human seminal plasma were indeed found to display antimicrobial activity. We conclude that the male reproductive tract produces defensins that most probably assume an important, innate organ defense system against pathogens.