Seminal hyperviscosity is not associated with semenogelin degradation or sperm deoxyribonucleic acid damage: a prospective study of infertile couples.

OBJECTIVE: To investigate the association between seminal hyperviscosity, the extent of semenogelin degradation, and sperm DNA integrity (DNA fragmentation index [DFI] and high DNA stainability [HDS]) in semen from infertile couples. DESIGN: Prospective study. SETTING: University-affiliated fertility center. PATIENT(S): Twenty-four consecutive infertile couples with moderate or high seminal viscosity (hyperviscosity group) and 25 consecutive infertile couples with normal semen viscosity (control group) undergoing standard IVF. INTERVENTION(S): Semen volume and seminal hyperviscosity, sperm concentration, motility, and morphology, level of semenogelin degradation (by immunoblotting), and sperm chromatin damage (by sperm chromatin structure assay and expressed as %DFI and %HDS) were evaluated. MAIN OUTCOME MEASURES(S): Sperm %DFI and %HDS in the hyperviscosity group and the control group and the relationship between the extent of semenogelin degradation and seminal viscosity. RESULT(S): Semen volume in couples with moderate and high seminal viscosity was significantly lower as compared with the control group. In addition, total motility and normal morphology were significantly lower in the couples with high seminal viscosity as compared with the control group; however, there were no significant differences in sperm %DFI and %HDS between the hyperviscosity group and the control group. In addition, there was no relationship between the extent of semenogelin degradation and seminal viscosity. CONCLUSION(S): Our data suggest that seminal hyperviscosity (a posttesticular factor) is not an important cause of sperm DNA damage. Moreover, seminal hyperviscosity is not related to the degree of semenogelin degradation.

Effect of long-term combined oral contraceptive pill use on endometrial thickness.

OBJECTIVE: To estimate whether there is any association of long-term use of combined oral contraceptive pills (OCP) with adverse endometrial growth. METHODS: We reviewed the charts of 137 patients with history of OCP use undergoing endometrial preparation with estrogen for frozen embryo transfer. Endometrial thickness was measured by transvaginal ultrasonography on day 10 after menses and patients were divided into two groups (less than 7 mm and 7 mm or more). RESULTS: Thirty patients had endometrial thickness less than 7 mm and 107 had thickness of 7 mm or more. Mean years of combined OCP use in each group were 9.8±4.54 and 5.8±4.52, respectively (P<.001). With 10 years of combined OCP use as the threshold, the difference between the two groups (63.35% users in less than 7 mm group compared with 28.04% in the 7 mm or more thickness group) was highly significant (P<.001 by Fisher exact test), with an odds ratio of 4.43 (95% confidence interval 1.89-10.41). Past use of 5 years of OCPs was also associated with a significant (P=.002) difference in endometrial thickness. The mean endometrial thicknesses on cycle day 10 in patients using combined OCP for less than 10 years and 10 years or more were 9.54±1.88 mm and 8.48±2.33 mm, respectively, with P=.007. The mean endometrial thickness was 9.72±1.69 mm in less than 5 years and 8.81±2.23 mm in 5 or more years of use, respectively (P=.008). Cycle cancellation rates in the less than 7 mm group and 7 mm or greater endometrial thickness group were 23% and 4%, respectively (P=.002), but there was no difference in the clinical pregnancy rates between the two groups (13% compared with 27%, respectively; P=.15). CONCLUSION: Long-term combined OCP use (5 years or more) can potentially affect optimal endometrial growth, leading to a higher cancellation rate and longer stimulation in frozen embryo transfer cycles. These findings suggest a previously unidentified adverse effect of long-term combined OCP use in women who are anticipating future fertility. LEVEL OF EVIDENCE: II.

New method to remove a broken guide pin in the hip joint.

Removing a broken guide wire is difficult and challenging. This article reports a method that was used to successfully remove a broken guide wire in 3 patients who underwent operative treatment for intertrochanteric fractures of the femur. Under general anesthesia, the first patient was placed on the orthopedic fracture table, and closed reduction of the hip fracture was performed under the image intensifier. A 2-mm non-threaded pin was used in the center of the femoral neck, and the amount of reaming required was determined. The reaming proceeded without any difficulty until the reamer failed to progress, which was attributed to the presence of a sclerotic or calcar region. Under fluoroscopy, on an anteroposterior view, the pin was parallel with the reamer; however, the authors failed to check the lateral image. After reaming through the hard tissue, the reamer suddenly passed through easily. On checking under the scope, it was noted that the pin was broken. The tip of the pin passed the acetabulum but did not enter the pelvis. Efforts to remove the broken pin failed. An attempt to reach the pin using a dynamic hip screw reamer also failed. Ultimately, the broken pin was removed using a 2-mm cannulated drill bit under fluoroscopy. After the experience with the first patient, in the other 2 cases, the authors used a cannulated drill bit to avoid any extensive reaming and trauma to the tissues. With this method, the authors were able to remove the broken pin easily in a few minutes.

Clavicular fracture and upper-extremity deep venous thrombosis.

Upper-extremity deep venous thrombosis (DVT) is considered an uncommon clinical event with considerable potential for morbidity. This article presents a case of upper-extremity DVT following a clavicular fracture. A 25-year-old man presented with pain and distortion of the left midclavicular area after falling on his left shoulder during martial arts practice. Following physical examination and radiography, he was diagnosed with a simple displaced clavicle fracture at the middle third. The patient had no previous surgery or medical problem, and did not smoke. No family history of blood clotting disorders were present and neurovascular examination appeared normal on the symmetric contralateral side. A figure-of-8 bandage was applied to support the arm and the patient was discharged. One week later, he returned with swelling and severe pain in his left arm. On examination, a DVT was suspected and the figure-of-8 brace was removed. A Doppler ultrasonography was performed and the presence of a thrombus extending from the brachial axillary veins to the distal subclavian vein with no flow in that segment was revealed. The patient was placed in a sling instead of a figure-of-8 bandage to immobilize the arm, while anticoagulation therapy with enoxaparin was started (1 mg/kg every 12 hours, 80 mg subcutaneous daily for 3 months). The swelling was reduced after 5 days. At 2-week follow-up, the patient had no pain and the swelling had completely disappeared.

The effect of age on in vitro fertilization outcome: is too young possible?

PURPOSE: The negative correlation between fecundity and age in women has been extensively documented although data on reproductive performance in very young women is sparse. The objective of this study was to determine whether age ≤25 years has an impact on reproductive outcome in women undergoing IVF-ET. METHODS: IVF outcome in 85 infertility patients aged 19-25 years was compared to that in 69 infertility patients aged 30-35 years. Primary outcomes included fertilization rates and embryo quality. Secondary outcomes were clinical pregnancy and miscarriage rates. RESULTS: The young patients (≤25 years) demonstrated a lower fertilization rate, and reduced number of top quality embryos. Although clinical pregnancy, and implantation rates were similar to their older counterparts (30-35 years), the young women had a significantly higher miscarriage rate. CONCLUSION: Our results demonstrating poorer reproductive performance in very young patients were surprising and need further investigation.

Three-dimensional culture of endometrial cells: an in vitro model of endometriosis.

Endometriosis is the presence of endometrial tissue outside of the uterine cavity and is the most common gynecologic disorder in women of reproductive age. Although the quality of life for women with endometriosis is severely compromised, very little is known about the pathophysiology of endometriosis and current therapeutic strategies provide temporary symptomatic relief but not a cure. Endometriosis remains poorly understood primarily because of an inability to identify patients with early stage disease. Animal models have been developed to study early endometriosis but all have some problems that limit their usefulness in determination of the pathophysiology of endometriosis as it occurs in the human. We have preliminary evidence that in the presence of a three-dimensional fibrin matrix, human endometrial glands, stroma, and neovascularization can develop in vitro, mimicking the earliest stages of endometriosis. We believe this model system reflects the situation in the peritoneal cavity of women following retrograde menstruation when endometrial fragments, fibrin, leucocytes and cytokines are trapped in pockets in the dependent parts of the pelvis, allowing endometrial cell proliferation, invasion and angiogenesis to occur. In the present review article, we will further discuss this in vitro model of early endometriosis and discuss possible anti-angiogenic drugs that are already commercially available in an attempt to find an effective and specific treatment for endometriosis.

Expression of glycodelin and cyclooxygenase-2 in human endometrial tissue following three-dimensional culture.

PROBLEM: Our previous study showed that in vitro culture of human endometrial tissue in a three-dimensional (3D) fibrin matrix could mimic the early stages of endometriosis with invasion, gland and stroma formation and sprouting of new vessels. The objective of the present study was to evaluate the expression of glycodelin (Gd) and cyclooxygenase-2 (COX-2), two angiogenic factors, to further validate the 3D culture model of endometriosis. METHOD OF STUDY: Human endometrial fragments were obtained from endometrial biopsies and placed in a 3D fibrin matrix culture. Immunohistochemistry with specific antibodies to Gd and COX-2 was used to examine endometrial epithelium and blood vessels, and 4, 6-diamidino-2-phenylindole staining was used for nuclear identification. RESULTS: Three-dimensional culture of human endometrial tissue in the fibrin matrix resulted in the proliferation of endometrial stromal cells, glandular epithelium and angiogenesis. Gd positive glandular epithelium was seen in 85% of wells with developing endometrial glands and COX-2 positive new vessels were seen in 80% of wells with angiogenesis-like structures after 4 weeks of culture. CONCLUSION: Our findings confirm that angiogenesis occurs following the culture of endometrial tissue in the 3D fibrin matrix, and suggests that Gd and COX-2 might play important roles in promoting neovascularization and cell proliferation in the establishment of endometriosis.

Positive bacterial culture of semen from infertile men with asymptomatic leukocytospermia.

OBJECTIVE: To examine results of semen culture in a population of infertile men with asymptomatic leukocytospermia, and to determine the correlation between culture results and sperm characteristics in these patients. METHODS: Semen samples were collected from a group of infertile men (n = 80) after 2-3 days of sexual abstinence. Standard semen analysis was performed according to World Health Organization (WHO) guidelines. Seminal leukocyte concentrations were determined by a myeloperoxidase staining technique. Culture of semen was performed on enriched and specific culture media. RESULTS: Based on the results of semen culture, the samples were classified into three groups: group 1 (enteric gram-negative bacilli [Enterobacteriaceae], n = 13), group 2 (bacteria other than Enterobacteriaceae, n = 15), and group 3 (negative cultures, n = 52). No correlation was found between positive semen culture and sperm characteristics (concentration, motility, and morphology). However, seminal leukocyte concentrations were negatively correlated with percentages of motile sperm and normal sperm morphology. CONCLUSION: Our data indicate that semen samples from infertile men with asymptomatic leukocytospermia may have bacterial contamination, evidenced by positive bacterial cultures. Lack of correlation between positive semen cultures and sperm characteristics may be indicative of early or mild (subclinical) infection.