Polycystic kidney disease and infertility: case report and literature review.

Adult polycystic kidney disease (APKD) is a frequent disease (1/1000) responsible for about 10% of chronic renal failure. It is an autosomic dominant disease due to mutation of one out of three genes: PKD1 (on the 16th chromosome), PKD2 (on the 4th chromosome) and PKD3 (still unmapped). In the past APKD diagnosis was normally done in fourteen-fifteen years old subjects who have completed their reproductive program. However frequently today, after renal ultrasound introduction, the APKD diagnosis is made during reproductive life. There are several reports of APKD-related infertility in male subjects. The frequency of this association appeared significantly higher than expected by chance alone in a recent observation. So a possible causal relation between APKD and male infertility may exists. Several pathogenetic mechanisms may be responsible of such an association. We recently observed an infertile couple with long standing infertility due to criptozoospermia (<1 x 10(6) spermatozoa/ml) and necrospermia (100% of died spermatozoa at eosin test) in an APKD affected patient. Endocrine tests showed normal testosterone and FSH levels. A TESA-ICSI was done with two embryos development after fertilization of two oocytes (fertilization rate: 25%). At the 14th day after pick up beta-HCG determination showed 72 mUI/ml. A male baby was born at 40th week of pregnancy. Prenatal morphological ultrasound excluded polycystic kidney.

Greater implantation and pregnancy rates with vaginal progesterone in intracytoplasmic sperm injection but not in in vitro fertilization cycles: a retrospective study.

OBJECTIVE: To compare the effectiveness of vaginal progesterone supplementation with intramuscular supplementation in assisted reproduction cycles. DESIGN: Retrospective study. SETTING: Physiopathology of Human Reproduction Unit, Pordenone, Italy, from July 2000 to June 2004. PATIENT(S): Three hundred and eight-five intracytoplasmic sperm injection (ICSI) procedures (188 with vaginal gel and 197 with intramuscular progesterone) and 373 in vitro fertilization (IVF) cycles (227 with vaginal and 146 with intramuscular progesterone). INTERVENTION(S): Progesterone luteal supplementation: vaginal gel (Crinone 8% 90 mg/day) or intramuscular (Prontogest 50 mg/day). MAIN OUTCOME MEASURE(S): Implantation rates, and total and clinical pregnancy rates. RESULT(S): Higher rates of implantation and total and clinical pregnancies were observed in the vaginal supplemented ICSI subgroup than in the intramuscular one. This difference was observed for all transfers (13.3% vs. 8.8%, 39.8% vs. 23.3%, and 28.7% vs. 18.6%) and for ultrasound-guided transfers (17.2% vs. 9.3%, 49% vs. 27%, and 36.9% vs. 21.1%, respectively). CONCLUSION(S): The vaginal route of luteal supplementation may be better than the intramuscular one, yielding higher implantation rates as well as total and clinical pregnancy rates in ICSI cycles but not in classic IVF treatments.