Elevated serum progesterone values at the time of ovulation induction in luteal leuprolide acetate-down-regulated GIFT cycles are associated with decreased clinical pregnancy rates.

PURPOSE: The effects of premature luteinization of ovarian follicles as detected by elevated progesterone values on the day of human chorionic gonadotropin induction of ovulation were evaluated in 38 consecutive gamete intrafallopian transfer (GIFT) retrieval cycles. MATERIALS AND METHODS: All patients received leuprolide acetate beginning in the midluteal phase of their prior menstrual cycle, followed by gonadotropin stimulation of folliculogenesis. At least four oocytes were transferred in each cycle. RESULTS: No significant differences in gonadotropin dosage, total number of days of gonadotropins, age, number of prior pregnancies, years of infertility since last pregnancy, total number of eggs retrieved, mature residual oocytes, fertilization of mature residual oocytes, or primary etiology of infertility were observed between groups; however, estradiol concentrations were significantly higher in the group with elevated progesterone values (2573 +/- 216 pg/ml) compared to the lower progesterone group (1925 +/- 202 pg/ml, P = 0.035) and the total number of oocytes transferred was greater in the high progesterone group (7.5 +/- 0.5) vs the low progesterone group (6.3 +/- 0.3, P < 0.038). P4 concentrations < or = 0.8 ng/ml were associated with significantly higher pregnancy rates (11/19; 57.9%) compared to progesterone concentrations > 0.8 ng/ml (5/19, 26.3%; P = 0.050). CONCLUSIONS: Premature luteinization may occur in luteal leuprolide acetate-down-regulated patients and progesterone values > 0.8 ng/ml are associated with significantly lower pregnancy rates in GIFT cycles.

Synergy between tumor necrosis factor and endotoxin decreases early embryo development in vitro.

The purpose of the present study was to investigate the individual and combined effects of low levels of endotoxin and physiological levels of tumor necrosis factor on in vitro fertilization and preimplantation embryo development. B6D2F1 mice were superovulated by utilizing pregnant mare serum gonadotropin and human chorionic gonadotropin. Oocyte-cumulus complexes (3221 oocytes) were collected, pooled, and randomized into control and treatment groups. Sperm were collected from the caudae epididymides of mature male mice and allowed to capacitate. Treatments included culture media supplemented with increasing amounts of endotoxin (0.5, 1.0, and 2.0 ng/ml; sp act, 3000 IU/ng) and/or tumor necrosis factor (1, 10, and 50 pg/ml; sp act, 0.01 IU/pg) throughout the fertilization and preimplantation development process. Percentage cleavage and percentage expanded blastocyst formation were evaluated. No significant effects were observed for percentage cleavage or percentage expanded blastocyst formation in either the endotoxin (E) or the tumor necrosis factor (TNF) groups. The combination of endotoxin and tumor necrosis factor at any of the levels tested did not significantly decrease cleavage; however, percentage blastocyst formation was decreased with any combination of TNF and E (P less than 0.05-P less than 0.001). We conclude that TNF and E exert significant synergistic effects which are detrimental to in vitro preimplantation embryonic development.

Preimplantation murine embryos are more resistant than human embryos to bacterial endotoxins.

Bacterial endotoxins have been correlated with increased fragmentation of early cleavage-stage human embryos and decreased pregnancy rates in human in vitro fertilization programs. The purpose of the present study was to test the direct effects of increasing concentrations of endotoxins on in vitro fertilization and development of mouse embryos to the blastocyst stage. Sexually mature B6D2F1 female mice were superovulated and oocytecumulus complexes were collected from the oviducts and randomized into control and treatment groups. Oocytes (n = 867) were inseminated with capacitated sperm. Treatments included Ham's F-10 supplemented with 3 mg/ml bovine serum albumin and increasing amounts of endotoxin (0.35, 0.64, 0.92, 1.5, 2.08, 3.21, 6.07, and 11.79 ng/ml). Percentage cleavage, percentage fragmentation at the four-cell stage, and percentage expanded blastocyst formation (of cleaved embryos) were evaluated. Statistically significant decreases in cleavage at 6.07 ng/ml (P less than 0.05) and blastocyst formation at 11.79 ng/ml (P less than 0.05) of endotoxin were observed. Fragmentation at the four-cell stage was significantly increased at 3.21 ng/ml (P less than 0.05) of endotoxin. We conclude that the levels of endotoxin necessary to decrease murine preimplantation development significantly is higher than that reported for human embryos.

Effect of ethanol-containing liquid diet upon gonadotropin receptor depletion in rat testis.

By using pair-feeding technique, the number of gonadotropin binding sites per unit mass of testicular homogenate was measured 15, 30, 45 and 60 days after ethanol administration to 60-day-old male rats. The ingestion of ethanol (5%, v/v) as a part of a nutritionally adequate liquid diet resulted in 30, 35 and 40% reduction in gonadotropin receptors by 15, 30 and 45 days, respectively. The body weights in the alcohol-fed rats were comparable to pair-fed controls. These findings suggest that the presence of ethanol in the liquid diet depresses the level of gonadotropin receptors in the rat testis.

Ultrasound diagnosis of multiple anomalies associated with prenatal oral contraceptives.

PIP: The case of a 22-year old woman with 1 child who became pregnant soon after initiating use of Ortho-Novum 1 + 50 pills is described. The patient had smoked 20-30 cigarettes/day for 2 years. There was no history of exposure to other potential teratogens or of maternal illnesses, and the family history was noncontributory. At 26 weeks gestation, real-time and B-scan ultrasound examination revealed the absence of a cranium and other anomalies. Labor was induced with prostaglandin E2 suppositories, and the patient spontaneously delivered a female fetus with severe anomalies, which autopsy revealed to include encephalocele containing residual brain tissue, cleft lip and palate, gastroschisis, thoracoschisis, and agenesis of the left upper extremity. A 2-vessel umbilical cord was noted. Maternal serum and amniotic fluid alpha fetoprotein were more than 2 standard deviations from the normal mean for the gestational age. The case appears to support the finding in previous studies of an association between smoking more than 20 cigarettes/day, oral contraceptive use during pregnancy, and congenital malformations. Ultrasound should be offered as a fetal malformation screening technique during the 2nd trimester of pregnancy to women with a history of prenatal hormone exposure.^ieng

Reversal of female sterilization.

Sterilization reversal is performed more frequently since the innovation of microscopic technics in tubal surgery. We analyzed 40 consecutive cases of reversal of female sterilization performed at the Medical College of Georgia from 1973 through 1980. We used a temporary intraluminal 2-0 nylon splint. Microsurgical technic was used in 17 cases (43%) and macrosurgical, in 15 (37%). Other technics included unilateral microsurgical (2), unilateral macrosurgical (1), unilateral microsurgical and contralateral implantation (1), salpingostomy (1), Peterson implantation (2), and cornual implantation (1). Pregnancy rates (longer than three months follow-up) for the microsurgery group and macrosurgery group were 80% and 33%, respectively. The ectopic pregnancy rate was 15% for the entire group.

Progestin reversal of ureteral endometriosis.

Successful medical therapy of ureteral obstruction secondary to pelvic endometriosis has not previously been documented by roentgenography. Reversal of ureteral obstruction by progestin therapy is reported in a patient with laparotomy-proved pelvic endometriosis.

A clinical and cytogenetic study of fifteen patients with 45,X/46XY gonadal dysgenesis.

The cytogenetic and phenotypic findings in 15 patients with 45,X/46,XY mosaicism are described. Six patients presented with delayed sexual development without masculinization. The remaining nine patients had varying degrees of masculinization, ranging from clitoromegaly to hypospadic male phenotypes. Cardiovascular/renal anomalies were detected in 2 of the 15 patients. Gonadoblastomas were present in two patients and did not appear to correlate with the degree of masculinization or percentage of 46,XY cells present. Structural Y chromosome abnormalities were seen in three of the 45,X/46,XY probands. MZ twinning occurred in one of the 45,X/46,XY sibships.