Formaldehyde in cryoprotectant propanediol and effect on mouse zygotes.

Cryopreservation of human zygotes and embryos has been routinely performed by in-vitro fertilization clinics for many years. Karran and Legge (1996) first reported that formaldehyde (FA) present in the cryoprotective solutions can have a deleterious effect on mouse oocytes. FA is a cytotoxic, carcinogenic and mutagenic chemical. The effect of FA on mouse zygotes was investigated. In addition, the concentrations of FA in propanediol (PROH) obtained from various sources were determined. Pooled 1-cell embryos were dispensed into droplets of modified Ham's F10 or human tubal fluid containing various concentrations of FA. Since bovine serum albumin (BSA) may minimize toxicity additional trials were done as above in the absence of BSA. FA concentration in the standard 1.5 M PROH, from different sources in water, was measured in the same assay using a standard curve of 0-100 microM FA. FA in a complex medium had a significant deleterious effect on embryo development and hatching but only at 1 mM concentration (P < 0.000001; see Tables I-III). There was no significant effect of FA at 100 microM. However, in a simple medium even 50 microM FA decreased embryo hatching. FA was present in 1.5 M PROH from different sources (range 1.0-35.3 microM concentration). It appears that FA concentrations do not increase with storage because FA concentrations were low even after opening and storage for 3 years on the shelf. This suggests that FA is a contaminant during the manufacturing process and may vary from manufacturer to manufacturer and batch to batch. Until further studies are done to confirm the lack of toxicity to embryos during cryopreservation (with or without FA scavengers) it may be prudent to screen all batches of cryoprotectants for FA as part of quality control.

Bilateral internal jugular venous thrombosis complicating severe ovarian hyperstimulation syndrome after prophylactic albumin administration.

OBJECTIVE: To report a case of bilateral thrombosis of the internal jugular veins in a patient after controlled ovarian hyperstimulation and IVF. DESIGN: Case report. SETTING: University-based IVF program. INTERVENTION(S): Ovulation induction with gonadotropins, IVF-ET, albumin administration, and therapeutic heparinization. MAIN OUTCOME MEASURE(S): Doppler ultrasound of neck veins. RESULT(S): Severe ovarian hyperstimulation syndrome and bilateral thrombosis of the internal jugular veins occurred despite prophylactic administration of albumin. This was treated successfully with therapeutic heparinization. CONCLUSION(S): Internal jugular venous thrombosis, a rare complication of ovulation induction with gonadotropins, should be considered in patients with neck pain and swelling.

Absence of glucose decreases human fertilization and sperm movement characteristics in vitro.

The effect of glucose in a modified Ham's F10 medium (MM) without hypoxanthine, phosphate and transition metals on human fertilization and sperm survival in vitro was determined. Mature human oocytes from in-vitro fertilization (IVF) patients or Percoll-washed human spermatozoa were randomly allocated to one of the treatment groups: normal Ham's F10, MM, MM with 5 mM glucose (HGMM) and MM with 0.5 mM glucose (LGMM). Oocytes were inseminated in one of the four media for 12-20 h and checked for fertilization. Sperm were incubated likewise for 4 and 24 h, and sperm motility and sperm movement characteristics including average path velocity (VAP), curvilinear velocity (VCL), straight line velocity (VSL), amplitude of lateral head displacement (ALH), beat cross frequency (BCF), straightness (STR), and linearity (LIN) were determined using computer-assisted semen analysis. Fertilization rates were significantly lower in oocytes cultured in MM (23.8%) compared to LGMM (75.5%), HGMM (73.6%) or Ham's F10 (71.1%). Sperm characteristics after 4 h incubation in all four media were similar, except VAP, VSL, VCL and ALH were significantly lower in MM (no glucose) in comparison with the other three media. After 24 h VAP, VSL, VCL, ALH, LIN and percentage rapid spermatozoa were significantly higher in spermatozoa incubated in HGMM or Ham's F10 compared with MM or LGMM. Also after 24 h, the percentage of spermatozoa which were highly motile was greater in HGMM than in Ham's F10. Absence of glucose significantly lowered fertilization rates and sperm movement characteristics in vitro.

Improved human zygote development in a modified Ham's F10 medium in vitro.

PURPOSE: Our purpose was to determine the effect of modified Ham's F10 media with and without glucose, hypoxanthine, phosphate, and transition metals (MM) on human embryo development. METHODS: Patients with at least one zygote were randomized by alternate assignment to one of the treatment groups. The treatment groups were as follows: normal Hams F10, MM, and MM with 0.5 mM glucose (LGMM). Patients were undergoing in vitro fertilization and embryo transfer or frozen-thawed embryo transfer. Zygotes (fresh and frozen-thawed) were incubated in one of three media for 24 hr before transfer. The groups were compared with respect to embryo quality, number of embryos transferred, age of the patients, clinical pregnancy rate, and implantation rate. RESULTS: The clinical pregnancy rate and the implantation rate were significantly higher in the group of patients whose zygotes were cultured in MM. LGMM did not appear to improve the pregnancy outcome compared to normal Ham's F10. However, the quality of the embryos cultured in MM or LGMM appears to be superior to the normal Ham's F10 with respect to the number of excellent and good-quality embryos and embryos without fragments. CONCLUSION: A modified Ham's F10 medium (MM) without added glucose appears to be superior to normal Ham's F10 for culture of human zygotes for embryo transfer.

Yeast infection of sperm, oocytes and embryos after intravaginal culture for embryo transfer.

OBJECTIVE: To report a case of an embryo culture infected with Candida albicans after intravaginal culture. DESIGN: Case report. SETTING: Private infertility practice and university medical center. PATIENT: A couple with tubal and male factor infertility. INTERVENTIONS: Superovulation, oocyte recovery, Percoll sperm preparation, and intravaginal culture of sperm and oocytes in a tissue culture tube. MAIN OUTCOME MEASURES: Yeast infection of sperm, oocyte, and embryo culture. RESULTS: Candida albicans infection occurred in the sperm, oocyte, and embryo culture when cultured in a sealed tube in the vagina. Candida albicans also was found in the prepared sperm suspension culture in a separate tube kept in a 37 degrees C incubator. CONCLUSIONS: Infection of the embryo culture with C. albicans probably occurred when contaminated sperm was added at the time of insemination. Sperm preparation by the Percoll gradient centrifugation failed to eliminate C. albicans in the semen.

Lipoprotein alterations from a triphasic oral contraceptive containing ethinyl estradiol and gestodene. A 12-month trial.

To evaluate the lipid and lipoprotein changes induced by a triphasic oral contraceptive (OC) containing ethinyl estradiol and gestodene, 25 healthy women from the Baltimore metropolitan area were enrolled in an open-label, noncomparative study. Serum lipids were measured prior to starting the OCs and again during the 3rd, 6th and 12th treatment cycles. Mean lipid concentrations in each treatment cycle were compared to baseline levels using the t test for paired samples. Small but statistically significant (P < or = .05) increases in the mean concentrations of total cholesterol, total triglycerides, total high density lipoprotein (HDL) cholesterol, HDL3 cholesterol, apolipoprotein A1 and apolipoprotein B were noted. Although the increases were statistically significant, the mean lipid concentrations were still within the normal range. The mean HDL2 and low density lipoprotein cholesterol concentrations were unchanged, as was the mean total cholesterol/HDL ratio. Healthy women taking a triphasic OC containing ethinyl estradiol and gestodene have minimal changes in lipids and should not be at increased risk of atherosclerosis due to OC-induced lipid alterations.

A comparison of the reproductive outcome between women with a unicornuate uterus and women with a didelphic uterus.

OBJECTIVE: To compare the reproductive performance of women with a unicornuate uterus with the reproductive performance of women with a didelphic uterus. DESIGN: Retrospective. SETTING: Reproductive endocrinology service of a tertiary referral hospital. MAIN OUTCOME MEASURES: The proportion of pregnancies resulting in spontaneous abortion, preterm delivery, term delivery, and living children was determined for each group. RESULTS: Twenty-nine women with a unicornuate uterus and 25 women with a didelphic uterus were identified. Twenty women with a unicornuate uterus produced a total of 40 pregnancies, whereas 13 women with a didelphic uterus produced a total of 28 pregnancies. The 33% spontaneous abortion rate in the unicornuate group was not significantly different from the 23% rate in the didelphic group. The proportion of pregnancies resulting in preterm delivery, term delivery, and living children was similar in both groups. CONCLUSIONS: The reproductive performance of women with a unicornuate uterus is similar to the performance of women with a didelphic uterus.

Vaginal and bladder angiosarcoma after therapeutic irradiation.

Angiosarcoma involving the female genitourinary tract is a rare soft tissue malignancy of vascular origin. We have described probably the first reported case of postirradiation angiosarcoma involving the vagina and bladder, and have reviewed the existing literature on the subject of angiosarcoma resulting from previous therapeutic irradiation for gynecologic malignancy.