Motility and fertilizing capacity of epididymal human spermatozoa in normal and pathological cases.

OBJECTIVE: To investigate different factors involved in the outcome of in vitro fertilization (IVF) with epididymal spermatozoa in cases of vas deferens agenesis, with particular emphasis on sperm movement parameters. DESIGN: Prospective study in which sperm movement characteristics, level of puncture, and sperm preparation technique were studied relative to the outcome of IVF. SETTING: Département de Gynécologie, Oncologie Gynécologique, Sénologie, Médecine de la Reproduction, Hôpital Edouard-Herriot, Lyon France. PATIENTS: Thirteen couples underwent 15 IVF cycles. In 14 cycles (12 patients) epididymal spermatozoa could be recovered by surgical punctures. Epididymides were taken from 10 subjects in state of cerebral death to study epididymal spermatozoa under physiological status of the epididymis. RESULTS: The cleavage rate in IVF was low (25/158: 15.8%). In seven cases, embryo transfer was possible, leading to two twin pregnancies (4 infants born). Fertilization could be achieved with spermatozoa from the epididymis caput. Motility was paradoxically higher in the proximal epididymis than in the distal epididymis. In healthy epididymides, spermatozoa collected from the caput did not exhibit any progressive motility, whereas progressive motility was always present in the epididymis corpus. CONCLUSIONS: Our study showed that forward motility could be observed in the epididymis caput in patients with congenital absence of the vas deferens and that fertilization and ongoing pregnancies could be obtained from caput spermatozoa. On the other hand, in physiological status of the epididymis, forward motility was observed only as from the corpus area, confirming observations in other species.

Poststerilization pain: a comparison of band versus clip.

PIP: The question of whether clip vs. ring tubal occlusion is more painful postoperatively was examined in this small prospective study. In cases requesting occlusion tubal sterilization, 1 tube was occluded by a Falope ring and 1 was closed by a Hulka clip in a randomized fashion. Patients graded location and degree of pain postsurgically. In 95 patients analyzed, rings were applied on the right in 45 cases and on the left in 50, and clips were applied on the left in 45 cases and on the right in 50. 48-hours postsurgery, pain was reported by 41% of patients (n=39). In 18 of these, the pain was diffused; in 21 the pain was unilateral. Pain was noted more on the right than on the left side. There was no difference between the clip and ring with respect to initiation or causation of poststerilization pain, rather, it seems that in general, regardless of occlusion or surgical method chosen, pain poststerilization is more frequent on the right than on the left side.^ieng

[The risk of cardiac arrest during laparoscopy. A study of 50,000 laparoscopies and animal experimentation]. / Le risque d'arrêt cardiaque au cours de la coelioscopies. Etude à partir de 50 000 coelioscopies et d'une experérimentation animale

In a French national enquiry into 50,000 laparoscopies it emerges that the number of cardiac arrests works out at 1 in 2,000. The percentage of reversible cardiac arrests was 1 in 2500 and of irreversible cardiac arrests 1.2 in 10,000. 25 cases were studied in great detail, both clinically and physiopathologically. This was thanks to a very full questionnaire most kindly filled up by those who had told us that this type of accident had happened in their practice. The physiopathogenesis of circulatory arrests during laparoscopy is complex. It appears however that among the different potentiating factors are changes in haemodynamics and biological changes that give rise to the greatest risks. Experimental work carried out with a long-tailed baboon was performed by the authors with the idea on the one hand of confirming that haemodynamic and biological troubles resulting from the pneumoperitoneum were important and on the other hand of analysing the changes in detail and of working out prophylactic principles for the anaesthetist and the laparoscopist.

[Choice of suture material for surgery of female and male sterility. Is there an all-purpose suture?]. / Choix du fil de suture pour la chirurgie de la stérilité féminine et masculine. Existe-t-il un fil "passe-partout"?

In the field of infertility, surgeons choose their sutures according some criteria: handling, absence of side effects and toxicity for the tissues, adequate sterilization, availability in adequate calibers with needles suitable for the structures of Fallopian tube, vas deferens and epididymis. Today, it seems that Polyglactine 910 (treated and gained Vicryl*) is perfectly adapted to all the anatomical situations and can be selected as the "unique" suture for sterility surgery (calibers 7 X 0 or 8 X 0). Our opinion is based on: Experimental findings coming from a personal work concerning 60 anastomosis on the uterine horn of the female rate. Critical analysis of previous experimentations done by other authors. The results of our personal practice in more of 1.400 salpingoplasties and 150 operations in the seminal genital ductus.

[Transplacental administration of diethylstilbestrol in the rat. I. Apropos of the fertility of its offspring]. / Administration transplacentaire de diéthylstilboestrol chez le rat. I. A propos de la fertilité des descendants.

To determine the effects of transplacental exposure to diethylstilboestrol (DES) on the fertility of the offsprings, timed pregnant Sprague Dawley OFA rats were treated with DES (10, 20, 50 and 100 micrograms/kg/d, subcutaneous) on days 10 to 18 of gestation (long time) or days 13 to 18 of gestation (short time). Only the lowest dosed groups (10 micrograms/kg/d, short and long times, and 20 micrograms/kg/d, short time) gave birth to living offsprings. The fertility of the male and female offsprings was determined postnatally by a breeding technique and appeared to be strongly decreased among females of all groups (70 to 100% of sterility) and moderately among males (11 to 18% of pathological fecundity). Fertility of offspring of these rats with pathological fecundity appeared to be normal.

[Transplacental administration of diethylstilbestrol in the rat. II. Effect on the hormonal receptors of the endometrium]. / Administration transplacentaire de diéthylstilboestrol chez le rat. II. Effets sur les récepteurs hormonaux de l'endomètre.

Transplacental exposure to diethylstilboestrol (DES) strongly decreases the fertility of the offsprings. Progesterone receptors concentrations are significantly decreased for treated group (0.40 and 0.44 pmol/mg cytosol proteins) versus control group (0.74 pmol/mg cytosol proteins) Estradiol receptor concentrations are significantly higher for long time treated groups (0.26 pmol/mg cytosol proteins) versus control or short time treated groups (0.15 and 0.13 pmol/mg cytosol proteins).

[Personal experience with salpingoplasty. Apropos of 285 cases]. / Notre expérience de la salpingoplastie. A propos de 285 cas.

285 cases of salpingoplasty are reported and studied. Only 172 patients could be followed up recently. The percentage of pregnancies was 27-7, 20 per cent were intra-uterine pregnancies. The percentage of successful pregnancies was 45-93 if only those patients who were seen again were reviewed. The results are best when the operation is carried out in the most conservative and most anatomically restorative fashion. This fine surgery, which must be carried out so delicately and with such detail, which will appeal more and more to modern technicians using micro-surgery, should stay in the hands of specialists because there is no doubt that the level of success rises with the experience of the operator.

[Therapeutic hopes in excretory azoospermia and genetic risks in congenital aplasia of the vas deferens]. / Espoirs thérapeutiques dans les azoospermies excrétoires et risques génétiques dans l'asplasie congénitale des canaux déférents.

Therapeutical solutions now can be proposed to some excretory azoospermia, using in vitro-fertilization with epididymal sperm. The encouraging results obtained with this new approach should be analyzed with the genetic risk, sometimes encountered in the specific form of azoospermia due to the congenital absence of the vas deferens. This abnormality is to day supposed to represent a moderate form of cystic fibrosis (CF), corresponding to a genital phenotype of this disease. This suggestion has been firstly induced by similar anatomical findings in the male individuals presenting a classical form of CF. The hypothesis has mainly been confirmed by the real progress in the genetic analysis of this disease. So an abnormally high percentage of known mutations of CF has been demonstrated in the patients with congenital absence of vas deferens. Other arguments such as positive sweat chloride tests, high percentage of sinusitis or presence of anti-pseudomonas antibodies, reinforce this hypothesis. It is the reason why a clinical and biological check-up, prior to any decision of therapy for infertility, in this specific indication should be done in order to propose a genetic counselling to the couple.

[Distal tubal surgery]. / Chirurgie tubaire distale.

The author summarizes his extensive experience of surgical treatment of tubal sterility. He shows by analysis of statistics of 1968 to 1980, that microsurgery does not significantly improve the total of intrauterine pregnancies, but seems to reduce the number of extrauterine gestations. He states that the results of tubal surgery seem to have attained a plateau, whilst one can anticipate a considerable development of in vitro fertilisation in the coming years.