A comparison of ICSI outcomes with fresh and cryopreserved epididymal spermatozoa from the same couples.

The published experience with frozen-thawed epididymal spermatozoa and intracytoplasmic sperm injection (ICSI) suggests that fertilization and pregnancy success rates are comparable to those achieved with freshly retrieved spermatozoa. However, no study has exactly compared clinical outcomes between the two IVF/ICSI cycles in the same couples. To formally address this issue, we assessed ICSI outcomes in couples each of whom had had two IVF/ICSI cycles: one using fresh and the second using frozen-thawed epididymal spermatozoa obtained from a single aspiration procedure. From a pool of 101 consecutive patients undergoing IVF/ICSI with epididymal spermatozoa, 19 couples initially used fresh epididymal spermatozoa and subsequently underwent a second IVF/ICSI procedure with frozen-thawed spermatozoa from the same aspiration. Normal (2PN) oocyte fertilization rates, embryo quality and pregnancy rates were compared between the two IVF/ICSI cycles for each couple. In the fresh epididymal sperm group, 58.4% of the injected oocytes fertilized normally compared with 62.0% of the injected oocytes in the frozen-thawed epididymal sperm group, revealing no statistically significant difference. Graded embryo quality also did not differ significantly between the paired IVF/ICSI cycles. The clinical pregnancy rates were 31.6% (6/19) and 36.8% (7/19) in the first and second cycles respectively. All but one pregnancy were singletons. In summary, this study provides strong evidence to support the notion that motile, cryopreserved and thawed epididymal spermatozoa are equal to freshly retrieved spermatozoa for ICSI in couples with obstructive azoospermia.

Pupillary responses in recognizing awareness in persons with profound mental retardation.

Pupil-size changes have been shown to indicate positive or negative reactions to several sensory and psychologic stimuli in normal persons. Whether this could be extended to mentally retarded patients who lack ability for verbal or motor behavior was tested by pupillary responses to several visual, tactile, and auditory stimuli. 24 institutionalized severely and profoundly retarded patients were examined by video camera in their usual environments rather than in a controlled laboratory setting. The videotapes were later projected onto a screen for pupil-size measurements. Pupils dilated with pleasant stimuli, including visualizing a familiar person, soft touch to the arm, music, and soft compliments. There was constriction with presenting an unfamiliar person, rough grasp of the arm, and abrasive noise and harsh commands. The findings demonstrate the existence of pupil reactivity in profoundly retarded persons and suggest such testing as a means of determining which elements of their environment are pleasing or aversive to them.

Birth injury as the cause of mental retardation.

Mental retardation, on initial impression, may appear to be caused by the birth process, but may be disproved by later clinical or autopsy examination. However, information often is lacking as to the basic pathology that may have been responsible for attributing the cause of the mental retardation to traumatic birth. From a 39-year period (1944 to 1983) 1146 records were evaluated at a state hospital for mentally retarded persons to determine how the intake impression compared with the final clinical and autopsy diagnoses of perinatal damage. Clinical evaluations provided some corrections of the intake diagnoses; autopsies provided more, but a combination provided the most reliable final diagnoses. Of 258 patients diagnosed as birth injury on intake, only 49.2% were confirmed by the best clinical and/or autopsy diagnoses. Although the cause of mental retardation was not ascertainable by either clinical or autopsy studies in 14.8% of cases, 31.4% were corrected to prenatal influences, and 4.6% to postnatal brain damage. Patients with perinatal cause of mental retardation usually were institutionalized at a young age and died young. If they do not require institutionalization until they are older, their life expectancy is longer, although still much less than that of normal persons.

Inability to cope with environmental stress: peptic ulcers in mentally retarded persons.

Mentally retarded persons in the protective environment of an institution developed more peptic ulcers than the general population. We sought to determine whether their physical and mental handicaps may have a relationship to this disease. Thirty seven mentally retarded institutionalized ulcer patients were compared to 37 non-ulcer controls matched for age and sex, who were also similar in IQ and mental retardation diagnoses. A stepwise discriminant analysis demonstrated that the ulcer group was more limited by chronic diseases and inability to ambulate. Also differentiating the groups were ulcer patients having more cerebral palsy, more visual deficit, and more limited motor and sphincter control than non-ulcer subjects. We conclude that helplessness in responding to environmental demands produces stress sufficient to induce peptic ulcers, even in severely mentally retarded persons.