A controlled study for gender selection using swim-up separation.

OBJECTIVE: To evaluate the success for gender selection using a sample of semen separated by a modified swim-up technique. DESIGN: We retrospectively compared the gender outcome of two treatments (A and B) for either a male or female offspring with those who conceived spontaneously. SETTING: Private practice of one author (M. A.K.). PATIENTS, PARTICIPANTS: The treatment groups consisted of 52 total pregnancies for couples who conceived by the separation technique. Of these 52 participants, 15 desired a female offspring and were placed into treatment A and 37 desired a male offspring and were placed into treatment B. The control groups consisted of 162 women who were presented with initial consultation for gender selection and conceived spontaneously. Control group A consisted of 80 women who initially chose a female offspring, and control group B consisted of 82 participants who initially chose a male. INTERVENTIONS: In treatment group A, one timed intrauterine insemination (IUI) was carried out with the bottom 0.5 ml of the separated semen on cycle days 12-14, when the follicle was 18-22 mm. Patients in this group were also administered clomiphene citrate and human chorionic gonadotropin. In treatment group B, one timed IUI was done with the top 0.5 ml of the separated semen, when the follicle was 18-22 mm. MAIN OUTCOME MEASURE: The gender outcome of the pregnancies of two treatment and control groups was evaluated based on the known desired gender. RESULTS: The success rate for conceiving a female child after intervention (treatment group A) was 86.7% effective (p = 0.002) as compared to the control group A. Couples seeking a male child (treatment group B) were 89.2% effective (p = 0.0002) as compared to the control group B. CONCLUSIONS: This study reveals that the modified swim-up method with additional monitoring results in statistically significant gender preselection.

Effect of opioid antagonism on beta-endorphin processing and proopiomelanocortin-peptide release in the hypothalamus.

Previous studies have shown that chronic opioid receptor blockade has significant effects on POMC gene expression and peptide levels in the hypothalamus. We have now examined the effects of the opioid antagonist naltrexone on beta-EP processing in the hypothalamus and on the release of 2 POMC-derived peptides, beta-EP and gamma 3-MSH, from the perifused hypothalamus in vitro. The beta-EP immunoactivity in the medial basal hypothalamus (MBH) of 7 rats infused for 1 week with naltrexone by osmotic minipump, was individually analyzed by HPLC and compared to 7 control rats. The mean ratio of beta-EP1-31 compared to beta-EP1-27 plus beta-EP1-26 was 2.34 +/- 0.41 in the naltrexone treated rats, significantly higher than the ratio of 1.26 +/- 0.09 in the control rats (P < 0.02). Thus in the setting of chronic opioid antagonism although beta-EP content decreases, there is relatively more beta-EP1-31, the biologically active opioid form of the peptide, compared to the C-terminally cleaved forms of beta-EP which have reduced biological activity. To study the effects of naltrexone on beta-EP and gamma 3-MSH release, hypothalami were perifused in vitro with 10(-6) M naltrexone. Basal release of gamma 3-MSH was significantly higher from the naltrexone treated brains compared to the controls (221 +/- 20 pg/60 min vs. 161 +/- 6.7 pg/60 min) (P < 0.01); KCl stimulated gamma 3-MSH was also significantly higher in the naltrexone group (951 +/- 94 vs. 543 +/- 85 pg/60 min) (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of severe ovarian hyperstimulation syndrome with extremely elevated serum estrogen levels.

The incidence of ovarian hyperstimulation syndrome (OHSS) is directly correlated with the pre-human chorionic gonadotropin blood estrogen (E) levels. The higher the E content, the greater the chances of OHSS. However, even when the E levels are very high, only 2.96% of the patients developed severe OHSS. Younger women with primary ovarian dysfunction are more at risk than older women. Human chorionic gonadotropin should be withheld when the estradiol levels are over 4,000 pg/ml; however, the patients should be individualized, since some patients--particularly older women--may require higher blood estradiol levels for successful ovulation induction.

Cytogenetics of müllerian agenesis. A case report.

A 38-year-old woman presented with primary infertility and primary amenorrhea. The evaluation revealed müllerian agenesis and mosaicism, 45,X/46,XX/47,XXX.

Effect of opioid receptor antagonism on proopiomelanocortin peptide levels and gene expression in the hypothalamus.

In order to determine how brain beta-endorphin (beta-EP) and its precursor proopiomelanocortin (POMC) adapt to chronic opioid blockade we have examined the effects of treatment with the opioid receptor antagonist naltrexone (NTX) on POMC gene expression and peptide levels in the hypothalamus. Male rats were treated with NTX by daily injection or constant minipump infusion. RNA was isolated from the medial basal hypothalamus (MBH) after an aliquot was removed for peptide RIA and the amount of POMC mRNA was measured by solution hybridization SI nuclease protection assay. beta-EP and several other POMC-derived peptides including alpha-melanocyte-stimulating hormone (alpha-MSH) and corticotropin-like intermediate lobe peptide (CLIP) or gamma(3)-MSH were measured in the MBH and anterior hypothalamus (AH) by RIA. In an initial experiment POMC peptide levels were measured after 7 days of NTX (4.8 mg/day) infusion. There was a marked fall in the concentrations of beta-EP, alpha-MSH, and CLIP; levels in the MBH declined by more than 60% (P < 0.001). In the next experiment NTX (1 mg) was injected daily and POMC peptides and mRNA were measured after 2 and 5 days of treatment. (beta-EP) and alpha-MSH levels fell progressively in the MBH and AH and were significantly less than those of the controls by 5 days of treatment (P < 0.02). POMC mRNA levels, however, did not change after 2 or 5 days. When NTX was infused for 3 weeks there was a decrease in the concentrations of beta-EP, alpha-MSH, and gamma(3)-MSH in the MBH (P < 0.001). The concentration of POMC mRNA in the MBH, however, was significantly higher in the NTX-treated animals, 0.99 +/- 0.06 pg/mug RNA vs 0.81 +/- 0.05 pg/mug RNA (P < 0.05). Since NTX can affect LH and testosterone release, the study was repeated in castrated rats. POMC peptide levels again fell after 3 weeks of NTX. POMC mRNA levels were higher in the castrated rats than in the intact rats, 1.14 +/- 0.06 pg/mug RNA vs 0.85 +/- 0.09 pg/mug RNA (P < 0.05), consistent with our previous findings in longterm castrated rats. However POMC mRNA increased further to 1.40 +/- 0.09 pg/mug RNA in the castrated animals treated with NTX (P < 0.05). We conclude that opioid receptor blockade has significant effects on POMC peptide levels and gene expression in the MBH. The increase in POMC gene expression associated with a fall in peptide levels is consistent with a compensatory increase in brain beta-EP synthesis and release in the setting of chronic opioid receptor blockade.

A controlled study for gender selection.

OBJECTIVE: To evaluate the success for gender selection of insemination with a sample of semen separated by a serum albumin density separation gradient. DESIGN: We retrospectively compared the gender outcome of conceptions of couples who conceived spontaneously with those who conceived secondary to an insemination with separated semen. SETTING: Private practice of one author (M.A.K.). PATIENTS, PARTICIPANTS: The study group consisted of 48 pregnancies of couples who conceived by the separation technique. The control group consisted of 46 pregnancies of couples who initially presented for consultation for gender selection but conceived spontaneously. INTERVENTIONS: In the study group, one timed intrauterine insemination with separated semen was performed per cycle, with a mean of 2.3 cycles per couple. Patients desiring a female were also treated with clomiphene citrate and human chorionic gonadotropin. MAIN OUTCOME MEASURE: The gender outcome of the pregnancies of the two groups was evaluated based on the known desired gender. RESULTS: The success rate for conceiving a desired male was 56.5% in the study group and 60.9% in the control group (P = 1.000). Of couples seeking females, 78.6% of the procedure group versus 35.3% of the control group were successful (P = 0.019). CONCLUSIONS: This study debates the albumin gradient as definitively enriching the proportion of Y-bearing sperm after in vitro separation.