Neuroendocrine changes in patients with acute space occupying ischaemic stroke.

OBJECTIVE: To evaluate neuroendocrine changes in critical care patients with acute space occupying hemispheric stroke. METHODS: 22 patients with acute space occupying hemispheric stroke were studied (mean age 57.7 years; five women, 17 men). Plasma levels of prolactin, thyrotropin (TSH), total thyroxine (T4), free thyroxine (FT4), and total triiodothyronine (T3) were measured on admission and thereafter on days 3, 5, 7, and 9. Cortisol and ACTH levels were analysed at 8.00, 16.00, and 24.00 hours each day. A TRH stimulation test with measurements of TSH and prolactin was done on day 3. RESULTS: Nine patients underwent decompressive craniectomy and nine were treated with moderate hypothermia. All patients received vasopressor drugs because of arterial hypotension. Plasma ACTH and cortisol values were abnormally low despite systemic hypotension and acute systemic illness, and remained low throughout the observation period. The diurnal rhythm of cortisol was not preserved. Prolactin levels increased during the observation period, and were well above normal on day 9. Thyroid function was slightly suppressed until day 7. TRH stimulation of plasma TSH and prolactin was low. CONCLUSIONS: Patients with an acute space occupying cerebral infarct show profound neuroendocrine changes. The central regulation of adrenal and thyroid function and prolactin release is impaired, which may compromise the clinical course of affected patients and have implications for therapeutic management.

C3 in seminal plasma has no additional informative value in the diagnosis of infection/inflammation of the male genital tract.

The objective of this study was to determine the clinical significance of complement fraction C3 (C3c) in seminal plasma. Therefore 120 samples from randomly chosen subfertile males without signs of genital tract infection were screened for C3 and for seminal leucocytes as markers for subclinical infection/inflammation. A comprehensive semen evaluation included sperm analysis, sperm migration testing, immunocytochemical round cell differentiation to determine seminal leucocyte counts and the leucocyte ratio and semen cultures, in aliquots of the same ejaculates. C3 concentrations were significantly correlated with leucocyte counts per ml (P < 0.002) and per ejaculate (P < 0.001), and with the leucocyte ratio (P < 0.001). No association of C3 concentrations with semen quality or with the bacterial colonization of semen samples was found. The significant association with seminal leucocytes suggests that C3 might be used as an additional marker for silent male genital tract infection. In comparison with semen leucocytes, C3 screening does not reveal any further information about semen quality or infection/inflammation pathogenesis of the male genital tract.

Impact of obesity and leptin levels on the secretion of estradiol, inhibin A and inhibin B during ovarian stimulation with gonadotropins.

We examined the impact of high leptin levels on the secretion of estradiol, inhibin A and inhibin B in obese and lean women during ovarian stimulation. Patients undergoing long-term pituitary suppression, ovarian stimulation and in vitro fertilization for non-endocrine reasons were included in this case-control study. Obese women (body mass index (BMI) > 28 kg/m(2); n = 17) were individually matched with lean women (BMI 20-25 kg/m(2); n = 17) for age and baseline follicle stimulating hormone and luteinizing hormone concentrations. Blood samples were collected in a previous menstrual cycle and 1-3 days apart throughout ovarian stimulation. Serum levels of estradiol, leptin, inhibin A and inhibin B were measured. Obese and lean women had similar serum concentrations of estradiol, inhibin A and inhibin B in the follicular and luteal phases of the spontaneous menstrual cycle, and throughout ovarian stimulation. Serum levels of leptin were higher in obese than in lean women, and increased during stimulation in both groups. In the obese group, area-under-the-curve (AUC) leptin levels correlated with AUC inhibin A levels. In the lean group, there was no correlation between AUC leptin levels and AUC levels of ovarian hormones. The results suggest that high leptin concentrations in vivo are not associated with impaired secretion of estradiol and dimeric inhibins during ovarian stimulation.

Factors influencing the prognostic role of oestrogen and progesterone receptor levels in breast cancer--results of the analysis of 670 patients with 11 years of follow-up.

In the last two decades, the prognostic role of the steroid hormone receptors has been the subject of a myriad of publications. Nevertheless, its relevance after long-term follow-up is still not clear. The confusion about the prognostic value is mainly due to the difficulty in comparing analyses. Despite different study-designs and statistical approaches, oestrogen (ER) and progesterone (PR) receptors are widely accepted as prognostic factors. Data from 670 breast cancer patients with a median follow-up of 11.4 years were analysed retrospectively. ER and PR were measured by the dextran-coated charcoal (DCC) assay. To investigate the time dependence of the prognostic relevance of ER and PR, separate analyses were done for follow-up shorter and longer than 5 years. Special focus was directed at patients < or =50 and >50 years, node-negative women, in particular those without adjuvant therapy. Univariate and multivariate analyses were performed. In univariate analysis, ER and PR were associated with a significantly longer overall survival at the cut-off levels 10, 20 or 100 fmol/mg protein. The significant survival benefit occurred in the first 5 years of follow-up and remained unchanged in the following period. In the multivariate analyses, only the PR was of significant prognostic value (for PR> or =20 fmol/mg P=0.036, for PR> or =100 P=0.01, Cox analysis). In patients younger than 51 years, only PR was an independent prognosticator at the cut-off level of 100 fmol/mg protein, while in patients >50 years both hormone receptors were not significant. In N0 patients, only the PR reached long-term prognostic independence at a cut-off point of > or =100 fmol/mg (P=0.018). In addition, in the group of node-negative women < or =50 years without adjuvant therapy the PR level reached prognostic significance. The hormone receptor status was a prognostic factor only during the first 5 years of follow-up. Our data suggest that age, lymph node status, length of follow-up and probably the ER/PR assay are important for the evaluation of ER and PR as prognostic variables. In most analyses, PR appeared to be superior to ER in predicting the prognosis of primary breast cancer patients.

Reduced cerebrospinal fluid estradiol levels are associated with increased beta-amyloid levels in female patients with Alzheimer's disease.

Recent in-vitro studies indicate that estrogens such as 17beta-estradiol (E2) may decrease the production of beta-amyloid 1-42 (Abeta42), a peptide central for the formation of senile plaques in Alzheimer's disease (AD). To test this hypothesis in a clinical study, cerebrospinal fluid levels of E2 were compared between 30 female AD patients and 11 female patients with non-dementing diseases such as major depression and investigated with respect to beta-amyloid 1-40 and Abeta42 levels. E2 levels were significantly (P<0.05) lower in the AD group than in controls; within the AD group E2 levels were inversely correlated with Abeta42 concentrations (r=-0.36, P=0.05). This is the first clinical study providing evidence for an influence of E2 on Abeta42 metabolism in vivo. This observation corresponds to the putative beneficial effects of estrogen replacement therapy on the development and course of AD.

Dehydroepiandrosterone stimulates proliferation and gene expression in MCF-7 cells after conversion to estradiol.

Dehydroepiandrosterone (DHEA) is a mitogen for estrogen-dependent MCF-7 breast cancer cells. Our aims were to determine whether DHEA required conversion to estrogens in order to stimulate cell proliferation and estrogen-dependent gene expression. After incubation of cells with 100 nM DHEA for 4 days, estradiol was present in the medium at a concentration of approximately 200 pM. Other compounds identified were testosterone ( approximately 300 pM) and estrone. Significant stimulation of cell proliferation by 1 nM estradiol and 100 nM DHEA was observed after 38 h and 4 days of incubation, respectively, indicating the necessity of DHEA conversion. DHEA doses > or = 10 nM induced estrogen-dependent reporter gene expression in MCF-7 cells transfected with a luciferase reporter gene under the control of the estrogen response element. DHEA-dependent stimulation of proliferation and luciferase induction could be inhibited by the anti-estrogens ICI182,780 and tamoxifen, respectively, and by the aromatase inhibitor 4-hydroxyandrostenedione. An androgenic effect of DHEA on proliferation and gene expression of MCF-7 cells was not observed. We conclude that conversion of DHEA to estrogens, particularly estradiol, is required to exert a mitogenic response.

[The effects of hormone replacement therapy on ovarian function in premenopausal women after hysterectomy]. / Auswirkungen einer hormonellen Substitutionstherapie bei hysterektomierten prämenopausalen Frauen auf die ovarielle Funktion.

OBJECTIVE: Examining the consequences of temporary postoperative hormone replacement therapy following hysterectomy for the function of the ovaries and the subjective well-being of women. MATERIAL AND METHODS: Hormone profiles (Estradiol, FSH, LH, Testosterone, DHEA) and typical estradiol deficiency phenomena were investigated prospectively in premenopausal hysterectomized women with intact ovaries. Group 1 (n = 21) was replaced transdermally following surgery for 3 weeks with estradiol patch 0.05 mg daily. Group 2 (n = 21) got no hormones. RESULTS: Group 1 had a remarkable decrease of estradiol after 10 days to 59% and after 6 weeks to 71% of the starting point. Gonadotropins showed an increase in this group. In group 2 without replacement there was only a small decrease of estradiol after 10 days and after 6 weeks the level was higher than before hysterectomy. Testosterone also decreased in group 1 to 64% of the level before surgery after 6 weeks, whereas in the comparing group it was 87%. On the other hand in group 1 only 2 of 21 women, but 10 of 21 in group 2 showed climacteric-like symptoms. CONCLUSIONS: HRT over 3 weeks induces ovarian suppression, which is still seen 6 weeks after hysterectomy. But hormonally treated women have clearly less subjective complaints.

The Acridine Orange test: a clinically relevant screening method for sperm quality during infertility investigation?

To determine the clinical usefulness of Acridine Orange (AO) staining of spermatozoa as a screening test for the evaluation of semen quality during basic infertility investigation, semen smears from 103 randomly chosen males of subfertile couples were examined. The median duration of infertility was 4.5 years (range 1-15) and the median age was 33 years (range 21-43). The outcome of AO staining ranged from 5 to 81%, with a median of 24%, green fluorescent spermatozoa. Results were not significantly related to the parameters of semen analysis (sperm count, motility, standard morphology, viability, pH and volume, as well as fructose concentration and number of found cells) or to local sperm antibody testing and semen cultures. Fluorescence after AO staining was also not related to sperm functional capacity (evaluated using sperm-mucus interaction tests in vitro and in vivo), or the medical history of the patient. No significant differences in the AO test outcome were seen in patients with explained and unexplained infertility, or with regard to subsequent fertility [with a median value of 21% (range 5-46) green fluorescence in the fertile group, compared with a median value of 28% (range 9-81) green fluorescence in the other men]. The results of this prospective study indicate that under the usual conditions of conception, the AO test is not clinically useful as a screening procedure to determine semen quality during basic infertility investigation.

Role of leukotriene C4 in follicle-stimulating hormone (FSH) secretion in female rat pituitary.

Leukotriene C4, at doses of 0.01 and 0.1 nmol/l added to superfused cells in pulse of 4-min duration, evoked follicle-stimulating hormone (FSH) release up to 12- to 26-fold of basal secretion. Higher and lower concentrations of leukotriene C4 were not able to induce FSH secretion. Gonadotropin-releasing hormone (GnRH)-induced FSH release was reduced by 38-57% by the leukotriene receptor antagonist FPL 55712 (10 mumol/l). Moreover, we have shown that FSH release occurs parallel to leukotriene C4 synthesis in rat anterior pituitary cells. Mellitin (100 nmol/l), an activator of phospholipase A2, induced FSH and radioactivity secretion in rat anterior pituitary cells previously preincubated for 24 h with [3H]arachidonic acid (AA).

[Hormone profile of elderly women and potential modifiers]. / Hormonprofile bei hochbetagten Frauen und potentielle Einflussfaktoren.

In 136 women with a median age of 78 (60-98) years the serum concentrations of FSH, LH, prolactin, estradiol-17 beta, testosterone and DHEA-S were determined completed by GnRH and ACTH stimulation tests in a subgroup. This resulted in median values for FSH of 15.8 ng/ml, LH 6.4 ng/ml, prolactin 6.9 ng/ml, estradiol 16 pg/ml, testosterone 270 pg/ml and 306 ng/ml for DHEA-S. No correlation with age in this population was found for gonadotropins as well as the other hormones for an age level of up to 98 years. Determination of multiple general clinical and laboratory parameters demonstrate the significance particularly in a geriatric group of patients to consider these patient characteristics when interpreting the serum hormone levels. In summary, the results of this prospective study underline the importance for health, of the secretion of gonadotropic and sexual hormones even at a very advanced age.

Evaluation of polyacrylamide gel as substitute for human cervical mucus in the sperm penetration test.

OBJECTIVE: To compare polyacrylamide gel as synthetic medium with human cervical mucus (CM) for the in vitro sperm-penetration test during infertility investigation. PATIENTS: One hundred sixty-nine randomly chosen couples with a median duration of infertility of 4 (range, 1 to 16) years presenting at the infertility unit of the Women's University Hospital of Heidelberg, Germany. MAIN OUTCOME MEASURES: Evaluation of sperm migration in polyacrylamide gel used in four different concentrations (1.5%, 1.6%, 1.7%, 1.8%) in the capillary tube test in parallel with CM of patients' female partners and CM of fertile donors, obtained under standardized conditions. Correlation of migration test results with outcome of semen analysis including microbial cultures and testing for local antisperm antibodies by means of the mixed antiglobulin reaction, postcoital testing, and the subsequent pregnancy rate after control for female infertility factors in a prospective study. RESULTS: Sperm ability to penetrate the synthetic medium (concerning all concentrations) correlated significantly with the penetration of human CM, although polyacrylamide proved to be a stronger barrier. Sperm velocity and duration of progressive motility were markedly reduced in polyacrylamide. Polyacrylamide results correlated with the outcome of standard sperm analyses but not with sperm antibody testing. No clear differentiation was obtained with regard to subsequent fertility (19% after 6 months), although adequate sperm migration in polyacrylamide 1.8% was significantly more frequent in the fertile group. CONCLUSIONS: In analyzing the intrinsic motility, penetration testing with polyacrylamide gel provides important information not obtained by routine sperm analysis. However, particularly with regard to immunological factors and fertility prognosis, human CM should be preferred whenever possible.

Serum inhibin levels in gonadotrophin stimulated in-vitro fertilization/gamete intra-fallopian transfer cycles.

Serum inhibin concentrations of 64 cycles of in-vitro fertilization--embryo transfer (IVF-ET) or gamete intra-Fallopian transfer (GIFT) have been analysed retrospectively. No significant difference was observed in serum inhibin levels of cycles stimulated with buserelin and human menopausal gonadotrophin (HMG) or HMG alone. During the late follicular phase, serum inhibin was higher in cycles resulting in pregnancy than in cycles without a pregnancy (peak values on day +1: 8.3 versus 6.4 IU/ml, respectively). The same difference was found between stimulation cycles resulting in a viable or a non-viable pregnancy (peak values on day +1: 8.3 versus 7.5 IU/ml). However, these differences were not significant. During the early luteal phase, serum inhibin values were similar in these groups of patients. Our results indicate that the use of the gonadotrophin-releasing hormone (GnRH) analogue buserelin, in combination with HMG, for ovarian stimulation does not affect inhibin production by granulosa cells in vivo. The late follicular and early luteal concentrations of serum inhibin have to be considered unsuitable as predictors in IVF/GIFT cycles with respect to pregnancy and pregnancy outcome.

Influence of reducing luxury calories in the treatment of experimental mammary carcinoma.

The aim of this study was to investigate the influence of dietary calorie intake at three different fat levels on (a) the growth of established methylnitrosourea (MNU)-induced mammary carcinoma, (b) the reappearance of mammary carcinomas after surgical removal, and (c) the growth of manifest lesions in animals treated with the cytostatic agent hexadecylphosphocholine (HPC). A reduction of calories by 30% significantly inhibited tumour growth of manifest mammary carcinomas in rats, without having a negative influence on body weight gain. After chemotherapeutic treatment no significant dietary influence was observed besides the high antineoplastic efficacy of HPC, but when feeding calorically restricted diets to surgically treated animals the number of reappearing tumours was considerably smaller (P = 0.06) than after feeding the diets ad libitum. The fat content of the diets did not influence the growth of manifest mammary carcinomas. No significant dietary effects were exerted on oestradiol or testosterone levels in untreated tumour bearing animals. An elevation of oestradiol levels was observed when animals were subjected to HPC and fed a high calorie diet. An elevation of testosterone levels was assessed after surgical treatment of the rats, irrespective of fat content and calorie level. Our results suggest that a reduction of calories can inhibit growth of manifest mammary carcinomas and has impeding effects on tumour development after surgical removal. After effective chemotherapeutic treatment the additional influence of dietary changes was of less relevance. Furthermore, our data do not establish any association between growth inhibition of mammary tumours, caused by the mild caloric restriction, and altered oestradiol or testosterone production.

[Subjective complaints and hormonal reactions in the first 6 weeks after hysterectomy]. / Subjektive Beschwerden und hormonelle Reaktionen in den ersten 6 Wochen nach Hysterektomie.

Hormone profiles (estradiol, testosterone, FSH, LH) and typical estradiol deficiency phenomena were investigated prospectively in the first 6 weeks after hysterectomy (n = 50) and after additional bilateral adnexectomy (n = 17). In the second group estradiol was replaced transdermally from the 2nd postoperative day (estradiol patch, 0.05 mg daily). In the 1st group 34% of patients showed a significant decrease in estradiol, 28% of patients a significant decrease in testosterone on the 3rd postoperative day which was no longer demonstrable after 6 weeks. In the second group no decrease in hormone levels was found. So the estradiol patch can replace estradiol to a sufficient degree and in particular physiologically even after bilateral oophorectomy Subjective complaints improved in both groups. Psychosomatic influence also seems to be of importance.

Multicenter evaluation of new enzyme-linked immunoassays of follitropin and lutropin in serum or plasma.

Results from a multicenter evaluation of two new enzyme-linked immunosorbent assays [Enzymun-Test for follitropin (FSH) and lutropin (LH)] are presented and compared with results from 11 other commercial immunoassays, radioactive as well as nonradioactive. Enzymun-Test FSH and LH assays are suitable for automated systems and manual applications. The tests were reproducible (CV less than 5%), highly specific, and sensitive enough (less than 0.5 int. unit/L) to measure the hormones directly in almost all patients' samples, except for LH measurements in prepubertal children. We did not find interference by heterophilic antibodies or other factors. A comparison of assays for FSH found very good agreement among all modern two-site assays; competitive immunoassays almost invariably yielded systematically lower results for FSH, probably because of the heterogeneity of the International Reference Preparation (2nd IRP FSH, 78/549). For LH also we found good agreement, with no systematic differences among the various reagents. Guidelines for reference values with the new reagents are given.

The gene map of the Norway rat (Rattus norvegicus) and comparative mapping with mouse and man.

The current status of the rat gene map is presented. Mapping information is now available for a total of 214 loci and the number of mapped genes is increasing steadily. The corresponding number of loci quoted at HGM10 was 128. Genes have been assigned to 20 of the 22 chromosomes in the rat. Some aspects of comparative mapping with mouse and man are also discussed. It was found that there is a good correlation between the morphological homologies detectable in rat and mouse chromosomes, on the one hand, and homology at the gene level on the other. For 10 rat synteny groups all the genes so far mapped are syntenic also in the mouse. For the remaining rat synteny groups it appears that the majority of the genes will be syntenic on specific (homologous) mouse chromosomes, with only a few genes dispersed to other members of the mouse karyotype. Furthermore, the data indicate that mouse chromosome 1 genetically corresponds to two rat chromosomes, viz., 9 and 13, equalizing the difference in chromosome number between the two species. Further mappings will show whether the genetic homology will prove to be as extensive as these preliminary results indicate. As might be expected from evolutionary considerations, rat synteny groups are much more dispersed in the human genome. It is clear, however, that many groups of genes have remained syntenic during the period since man and rat shared a common ancestor. One further point was noted. In two cases groups of genes were syntenic in the mouse but dispersed to two chromosomes in rat and man, whereas in a third case a group of genes was syntenic in the rat but dispersed to two chromosomes in mouse and man. This finding argues in favor of the notion that the original gene groups were on separate ancestral chromosomes, which have fused in one rodent species but remained separate in the other and in man.

Thyroid and ovarian function in infertile women.

The aim of this study was to examine more closely the interaction between thyroid function and pituitary--ovarian axis in infertile women. In 185 infertile women without clinical signs of thyroid dysfunction, TRH-tests (TSH basal and 30 min after 200 micrograms TRH i.v.) were performed in the early follicular phase in addition to routine hormonal checks (gonadotrophins, oestradiol, DHEAS, testosterone, prolactin). The women were classified as euthyroid (n = 74; TSH stim 5-20 mU/l), latent hyperthyroid (n = 31; TSH stim less than 5 mU/l), and preclinical hypothyroid (n = 80; TSH stim greater than 20 mU/l). From frozen serum, the following determinations were performed: TSH IRMA, laevothyroxine (T4), thyroxine binding globulin (TBG), microsomal (Mab) and thyroglobulin (Tab) antibodies. Various correlations between the thyroid parameters and the pituitary--ovarian axis were demonstrated. With increasing TBG concentrations, the interval between menses decreased. Overall and spontaneous pregnancy rates were highest in women with normal (less than 75th perc.) basal and stimulated TSH, high (greater than 75th perc.) T4 and low (less than 25th perc.) Mab. Women with normal Tab or high TBG experienced the highest delivery rate (77 versus 30%), while in women with low Tab or high Mab abortion and tubal pregnancies were most frequent. As only 25 women exhibited elevated Mab (greater than 500 U/ml) or Tab (greater than 200 U/ml) which correlated with elevated TSH and normal T4, the routine determination of thyroid antibodies was not necessary. The TRH-test, however, should be included in infertility work-up.

Thyrotropin-releasing hormone (TRH) and metoclopramide testing in infertile women.

Thyroid stimulating hormone (TSH) determinations before and after thyrotropin-releasing hormone (TRH) stimulation were obtained in 834 infertile women, from 1982 until 1985. Thyroid function disturbances were seen in 20% of the women, in accordance with the prevalence in South Germany. Postcoital tests were significantly poorer in women with subclinical hypothyroidism than in euthyroid patients. Spontaneous conception was more frequent in euthyroid (16%) than in hypothyroid (6%) women. During the same period, prolactin was determined after TRH stimulation in the early follicular phase and after metoclopramide stimulation in the luteal phase, in 759 women. The pregnancy rate was not improved by administration of dopamine agonists in women with an exaggerated response to TRH or metoclopramide. Our results suggest that subclinical hypothyroidism as well as disorders of prolactin secretion may play a role in infertility. The TRH test is proposed to rule out thyroid dysfunction. Neither the TRH nor the metoclopramide test was useful for the prognostic differentiation of prolactin secretion disorders.

Characterization of leukotriene C4 binding in anterior pituitary membrane preparations.

Pituitary cells produce leukotrienes (LTs) and respond to exogenous administration of LTs by releasing gonadotropins. Specific high affinity leukotriene C4 (LTC4) binding has been found in membrane preparations of bovine anterior pituitaries. Unlabelled LTC4 displaced specific [3H]LTC4 binding. Other leukotrienes (LTB4, LTD4, LTE4, LTF4) did not compete with [3H]LTC4 for binding sites when administered at increasing concentrations together with a constant amount of radioligand indicating that the binding is highly specific for LTC4. Scatchard analysis of binding data obtained from saturation studies revealed a single binding site for [3H]LTC4 with a Kd of 8.95 +/- 5.53 nM and a B max of 15.44 +/- 6.93 pmol per mg of membrane protein. Glutathione S-transferase, a possible LTC4 binding site, did not display activity in the membrane fraction although the two glutathione derivates S-octylglutathione and S-decylglutathione competed with LTC4 in binding experiments. As leukotrienes are potent stimulators of gonadotropin secretion and modulators of gonadotropin-releasing hormone (GnRH)-induced gonadotropin release it is concluded that leukotrienes may be involved in the signal transduction pathway of GnRH and that they may act via a specific and high affinity receptor.

Circulating antisperm antibodies and fertility prognosis: a prospective study.

In a prospective study performed on 235 couples with long-standing infertility (median 5 years), circulating antisperm antibodies (ASA) were determined with both a standard trayagglutination test (TAT) and a radioimmunoassay (RIA). Serum levels were correlated with results of sperm analysis (SA), postcoital testing (PCT) and in-vitro sperm--cervical mucus penetration testing (SCMPT), performed with cervical mucus and spermatozoa of patients and in parallel with material of fertile donors. A simultaneous microbial screening included Chlamydia trachomatis, mycoplasmas, Herpes simplex virus, gonococci, other potentially pathogenic aerobic and anaerobic bacteria and yeasts. The pregnancy rate 12 months after determination of ASA in the serum samples was 27% (64/235). Between ASA-positive and -negative male and/or female patients (TAT as well as RIA), no significant difference was found for any of the tested variables of SA, PCT, crossed SCMPT and colonization of genital secretions with microorganisms. Patients who later achieved pregnancy and those who did not did not differ with regard to serum antibody status (TAT as well as RIA). The findings suggest that the clinical significance of circulating ASA determined with the currently available methods is low. ASA in serum samples of infertile female and/or male patients do not influence the fertility prognosis.