Preoperative and postoperative levels of interleukin-6 in patients with acute appendicitis: comparison between open and laparoscopic appendectomy.

BACKGROUND: Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study aimed to evaluate the levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures. METHODS: The levels of IL-6 were measured pre- and postoperatively in the plasma of 37 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 22 patients underwent open appendectomy, and 15 patients underwent laparoscopic appendectomy. RESULTS: The preoperative concentrations of IL-6 were 7.2 +/- 5.6 pg/ml in the open appendectomy group, as compared with 12.1 +/- 9.7 pg/ml in the laparoscopic appendectomy group (p < 0.05). The postoperative levels were 16.9 +/- 15.7 and 23.2 +/- 19.4 pg/ml, respectively. The mean postoperative to preoperative ratio of IL-6 was slightly higher for open (2.7 +/- 2.4) than for laparoscopic (2.3 +/- 1.6) appendectomy, but the difference did not reach statistical significance. CONCLUSION: The operative stress in open as compared with laparoscopic appendectomy is not reflected by circulating levels of IL-6.

Changes in semen quality in Jerusalem between 1990 and 2000: a cross-sectional and longitudinal study.

The aim of the present study was to investigate whether sperm quality has changed during the years 1990-1999 among men residing in Jerusalem, Israel, who were involved in treatment by intrauterine insemination (IUI). Both cross-sectional and longitudinal analyses were performed. A total of 2638 male partners in couples that underwent treatment by IUI participated in the cross-sectional investigation. Of them, 417 men (16%) were included in the longitudinal study. Total sperm counts and percent motility were evaluated on an annual basis to assess changes over 10 years from 1990 through 1999. A significant downward trend in sperm count and motility was demonstrated in the cross-sectional study. Sperm count decreased by 5.2 x 10(6)+/-0.9 x 10(6) (p<.0001) each year and percent motility declined by 0.50+/-0.14% (p=.0003). Similar changes were found in the longitudinal evaluation, but they were not statistically significant. These data suggest that during the last decade in Jerusalem, sperm count and motility declined significantly among men involved in infertile relationships and treated by IUI.

The use of ICSI with fresh and cryopreserved electroejaculates from psychogenic anejaculatory men.

BACKGROUND: Electroejaculation has become an accepted form of semen procurement in men suffering from anejaculation. However, sperm in these ejaculates often exhibit low motility. In such cases, ICSI is offered to improve the possibility of successful pregnancy. Here we evaluate the fertilizing potential, using ICSI, of fresh and cryopreserved sperm obtained by transrectal electroejaculation from patients with psychogenic anejaculation. METHODS: A total of 25 men suffering from psychogenic anejaculation underwent 37 sessions of electroejaculation in combination with ICSI. In 17 patients fresh sperm (29 cycles, group I) was used, and in the other eight patients cryopreserved sperm (10 cycles, group II) was used. RESULTS: A total of 155 oocytes were injected with fresh sperm with a fertilization rate of 55% (85/155). The pregnancy rate was 10% (3/29) per cycle. A total of 94 oocytes were injected with frozen-thawed sperm with a fertilization rate of 50% (47/94). The pregnancy rate was 40% (4/10) per cycle. CONCLUSIONS: The fertilization and pregnancy rates with cryopreserved sperm from electroejaculation are at least as good as those of freshly obtained sperm. Therefore, when motile sperm is found in the thawed ejaculate, additional electroejaculation can be avoided.

The development of an oocyte-containing follicle during gonadotrophin-releasing hormone agonist administration.

Administration of gonadotrophin-releasing hormone (GnRH) agonist in a 29 year old woman with infertility due to ovulatory dysfunction resulted in the development of several ovarian cysts. After human chorionic gonadotrophin (HCG) was injected, the cysts were aspirated and one mature oocyte was retrieved. Intracytoplasmic sperm injection (ICSI) was performed and the resulting embryo was transferred. A singleton pregnancy was obtained and a healthy baby was born at 36 weeks of gestation. Because GnRH agonist-derived cysts may contain oocytes, we suggest that when the growth of cysts is accompanied by high concentrations of oestradiol, the administration of HCG may be useful to achieve oocyte maturation and advance IVF treatment.

The adequacy of the MMPI-2 Harris-Lingoes subscales: a cross-cultural factor analytic study of Scales D, Hy, Pd, Pa, Sc, and Ma.

The authors investigated cross-culturally the factor structure of Scales D, Hy, Pd, Pa, Sc, and Ma of the Minnesota Multiphasic Personality Inventory--2 (S. R. Hathaway & J. C. McKinley, 1989) to examine the adequacy of the Harris-Lingoes (HL) subscales developed for these scales. A combined sample of 1,896 Israeli outpatients and inpatients and a sample of 1,020 American outpatients were used. Each scale was factor analyzed separately in the Israeli and U.S. samples and, within each sample, by gender. The results did not support the structural adequacy of the HL subscales for Scales D, Pd, Sc, and Ma but generally supported their suitability for Scales Hy and Pa. In addition, the results also suggested that all clinical scales share a common element of general distress akin to A. Tellegen's (1985) negative affectivity. These findings highlight the need for developing and validating a new set of subscales for most of the clinical scales, using external measures of relevant clinical and personality domains for which the current scales may serve as a basis.

Electroejaculation before chemotherapy in adolescents and young men with cancer.

OBJECTIVE: To evaluate the outcome of repeated electroejaculation for obtaining semen from adolescents and young men before initiation of anticancer therapies. DESIGN: Retrospective clinical study. SETTING: Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S): Six young male patients (average age, 18+/-3 years) with diagnosed cancer who underwent 12 procedures of electroejaculation before chemotherapy. INTERVENTION(S): Transrectal electroejaculation. Semen was cryopreserved in small aliquots. MAIN OUTCOME MEASURE(S): Semen analysis. RESULT(S): In all patients, semen was obtained by electroejaculation. Sperm count and motility were relatively low; mean values were 16 x 10(6) (range, 0--45 x 10(6)) and 14% (range, 0--53%) respectively. CONCLUSION(S): If necessary, electroejaculation can be performed in adolescents, and sperm may be obtained by repeated treatments over a short period.

Nocturnal sperm emission in men with psychogenic anejaculation.

OBJECTIVE: To evaluate sperm characteristics and fertilization potential in sperm obtained from nocturnal emission in men with psychogenic anejaculation. DESIGN: Retrospective study. SETTING: In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S): Six men with psychogenic anejaculation. INTERVENTION(S): Nocturnal emission, electroejaculation, sperm cryopreservation, and assisted reproduction technologies. MAIN OUTCOME MEASURE(S): Semen analysis, intracytoplasmic sperm injection (ICSI), fertilization rates. RESULT(S): In four patients, the concentration and motility of sperm obtained from freeze-thawed nocturnal emission were decreased compared with sperm from electroejaculation. Fertilization rates after ICSI using the nocturnal emission sperm were relatively low (45%). One clinical pregnancy was achieved after intrauterine insemination. CONCLUSION(S): The quality of sperm from nocturnal emissions is variable, but it can be used in assisted reproduction procedures to avoid aggressive procedures such as electroejaculation or testis biopsy.

Diagnostic laparoscopy in primary and secondary infertility.

PURPOSE: Our purpose was to compare the diagnostic efficacy of laparoscopy between primary and secondary infertility and to define a subgroup in which the positive findings are low. METHODS: A retrospective review of the cases of 206 infertile women who underwent laparoscopy was conducted. RESULTS: Eighty-two (39.8%) patients were found to have evidence of pelvic disease--20 (22.2%) with primary infertility and 62 (54.3%) with secondary infertility. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. In only 3 of the 20 patients with primary infertility was there no history of an abdominal operation, pelvic inflammatory disease, or an abnormal hysterosalpingography. Of the 62 women who suffered secondary infertility and had positive findings in laparoscopy, 15 had no history of suspect findings. CONCLUSIONS: The diagnostic yield of laparoscopy for primary infertility in the absence of indications of mechanical factors is low. Therefore the need for diagnostic laparoscopy in these cases should be reconsidered.

Male to female ratio in newborns of grand grand multiparous women.

The male to female ratio in newborns of grand grand multiparous women was evaluated in 569 Jewish Orthodox women and 28 Muslim women. A total of 882 babies was born on the > or = 10th delivery; 460 (52.2%) were males and 422 (47.8%) were females (sex ratio = 1.06). Newborn sex ratio did not significantly change with respect to birth order or maternal age. It is suggested that parity and increasing maternal age do not affect the sex ratio of newborns and that ethnic and environmental variables may play a role in the deviations in offspring sex ratio observed among different populations.

Antisperm antibodies in men with psychogenic anejaculation.

Antisperm autoantibodies were determined in 16 men suffering from psychogenic anejaculation who underwent assisted reproduction treatments. Blood and semen samples were collected after transrectal electroejaculation and antisperm antibodies in serum and on the surface of motile spermatozoa were measured using the direct and indirect immunobead binding test. Five men (31%) were found positive for antisperm antibodies. The majority of antibodies were directed against the sperm heads. Surface antibodies were mainly IgA isotype whereas serum antibodies were IgG isotype. These results suggest that psychogenic anejaculation might be associated with increased incidence of antisperm autoimmunity.

Electroejaculation in combination with intracytoplasmic sperm injection in patients with psychogenic anejaculation results in lower fertilization rates.

OBJECTIVE: To evaluate the outcome of intracytoplasmic sperm injection (ICSI) with sperm obtained by electroejaculation in men with psychogenic anejaculation. DESIGN: Retrospective clinical study. SETTING: In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S): Seven men with psychogenic anejaculation who underwent 16 sessions of electroejaculation in combination with ICSI. INTERVENTION(S): Electroejaculation, ICSI. MAIN OUTCOME MEASURE(S): Semen analysis, ICSI, fertilization rates. RESULT(S): All patients had poor sperm motility. One hundred forty-seven oocytes were injected, with a fertilization rate of 27% (39/142). One ongoing pregnancy was achieved. CONCLUSION(S): Sperm obtained by electroejaculation have low motility and reduced fertilization potential. Nevertheless, ICSI should be offered to improve the possibility of successful pregnancy.

Dioxin concentrations in women with endometriosis.

The concentrations of the enviromental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin were measured in the blood of 44 infertile women with endometriosis (study group), and in 35 age-matched women with tubal infertility (control group). Eight women with endometriosis (18%) were dioxin positive as compared to one woman (3%) in the controls (P = 0.04). Although the concentrations of dioxin did not seem to be directly correlated with the severity of endometriosis, these observations contribute to the accumulating data linking dioxin to endometriosis in humans.

Expression of glucose transporter and glucose uptake in human oocytes and preimplantation embryos.

The expression of glucose transporters 1, 2, 3 and 4 was evaluated in human oocytes and polyploid preimplantation embryos. Only glucose transporter 1 (GLUT-1) isoform was detected in oocytes and in 2-12-cell stage embryos. Glucose uptake was markedly increased in embryos as compared to oocytes (19.7 +/- 3.4 pmol/min/embryo and 2.3 +/- 0.3 pmol/min/oocyte), and GLUT-1 was inhibited by cytochalasin B. These results suggest that, although GLUT-1 is expressed in human oocytes and throughout preimplantation development, its function in mediating the rise in glucose uptake is triggered following fertilization.

Electroejaculation and assisted fertility in men with psychogenic anejaculation.

OBJECTIVES: To evaluate sperm characteristics and fertility potential in ejaculates obtained after electroejaculation in men with psychogenic anejaculation. DESIGN: Retrospective clinical study. SETTING: In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS: Twenty men with psychogenic anejaculation who underwent 55 sessions of electroejaculation and their spouses. INTERVENTIONS: Electroejaculation, assisted reproduction technologies. MAIN OUTCOME MEASURES: Semen analysis, IVF, intracytoplasmic injection (ICSI), fertilization rates, and pregnancy rates. RESULTS: In all patients, sperm density and motility rates were unsatisfactory (98 +/- 127 x 10(6) with 14.6% +/- 15% motility in the antegrade portions and 42 +/- 42 x 10(6) with 9.7% +/- 15.6% motility in the retrograde samples). Intrauterine inseminations performed in eight couples did not result in a pregnancy. Four couples underwent IVF-ET treatments. Two pregnancies were achieved with overall success rates of 22% per cycle. Five couples were treated using the ICSI procedure. Although good quality embryos were transferred, none of the treatments resulted in a pregnancy. CONCLUSIONS: Psychogenic failure to ejaculate may be treated by electroejaculation. However, the average motility of the sperm obtained is diminished. The combination of electroejaculation with IVF, including the ICSI procedure, should improve chances of fertilization and pregnancy in these cases.

Pregnancy rates after communal growth of preimplantation human embryos in vitro.

OBJECTIVE: To evaluate the effect of communal growth of preimplantation human embryos on pregnancy rates in IVF-ET. DESIGN: Prospective randomized study. SETTING: In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS: Ninety-one women undergoing 91 cycles of IVF-ET. INTERVENTION: In 42 cycles (control) embryos were grown singly, in 49 cycles (study) embryos were grown in groups until transfer. MAIN OUTCOME MEASURES: Proportion of women achieving pregnancy in study and control groups. RESULTS: Communal growth of embryos resulted in significantly improved pregnancy rates. Intrauterine transfer of embryos grown in groups produced 43% pregnancy rates per transfer, whereas, with embryos grown individually, 24% pregnancy rates were obtained (odds ratio = 2.4). CONCLUSIONS: Our study suggests that, in IVF, the potential of preimplantation human embryos to produce pregnancy tends to increase when embryos are grown in groups.

Immunity to zona pellucida in women with low response to ovarian stimulation, in unexplained infertility and after multiple IVF attempts.

A retrospective study was designed to assess the presence of antizona pellucida autoantibodies in in-vitro fertilization (IVF) patients in relation to low ovarian response, multiple IVF attempts and unexplained infertility. Antizona pellucida and antisperm antibodies were determined in serum samples obtained from 37 women undergoing IVF-embryo transfer and 20 fertile women. Antizona pellucida antibodies were measured using enzyme immunoabsorbent assay. Antisperm antibodies were evaluated by the immunobead binding method. Three of 10 patients with low response to ovarian stimulation had antizona pellucida antibodies in serum and one patient had antisperm antibodies. None of the other participants in the study and the control groups demonstrated measurable levels of serum antigamete antibodies. The results in this small group suggest an association between antizona pellucida antibodies and suboptimal response to gonadotrophins. It is indicated that repeated stimulation and puncture of ovaries in IVF procedures do not elicit autoimmunity to gametes.