Correlation between peritoneal fluid and serum antiphospholipid antibodies in women with primary infertility.

OBJECTIVE: To compare the peritoneal and serum levels of antiphospholipid antibodies (aPLs) against the following phospholipids: cardiolipin, L-alpha-phosphatidic acid, L-alpha-phosphatidylethanolamine, 1-alpha-phosphatidyl-DL-glycerol, L-alpha-phosphatidyl-inositol, L-alpha-phosphatidyl-L-serine in immunoglobulin isotypes of G, M, and secretory A. PATIENTS AND METHODS: A group of 107 women with primary infertility were immunologically examined. An ELISA method was used for detection of aPLs. RESULTS: aPL-L-serine and aPL-cardiolipin predominate over peritoneal fluid in all studied Ig isotypes (G, M, secretory A). Levels of aPL-ethanolamine are much higher in peritoneal sIgA and IgM than in sera. There is a predominance of IgG-aPLs-inositol, DL-glycerol, and aPL-acid in serum, and of sIgA in peritoneal fluid. CONCLUSION: Our patients had higher levels of aPLs (IgG, IgM, sIgA) against cardiolipin, serine, and ethanolamine in peritoneal fluid than in sera. The prevalence of aPLs in IgG was against DL-glycerol, phosphatidyl-inositol, and phosphatidic acid. It is quite difficult to estimate whether the aPLs have an influence directly through phospholipid epitopes on uterine mucous membrane, on the surface of oocytes, or on the surface of the early embryo during the fertilization and/or implantation process.

Beta 2-glycoprotein I is a good indicator of certain adverse pregnancy conditions.

OBJECTIVE: To compare levels of beta2-glycoprotein I antibodies with six different antiphospholipid antibodies (aPL) in sera from patients with certain adverse pregnancy conditions. PATIENTS AND METHODS: aPL levels were examined in pregnant women with anti-phospholipid syndrome (26), pre-eclampsia (32), autoimmune disease (12), or diabetes mellitus (23) and in a group with physiological pregnancy (38). A commercial ELISA was used to determine the serum levels of anti-beta2-GPI (Immunotech) in isotypes IgG and IgA, and anti-cardiolipin levels (Milenia) in IgG and IgM. aPL screening also included L-alpha-phosphatidic acid, L-alpha-phosphatidylethanolamine, L-alpha-phosphatidyl-DL-glycerol, L-alpha-phosphatidylinositol, and L-alpha-phosphatidyl-serine (Sigma, U.S.A.) in IgG and IgM. Statistical analysis of all aPL levels was made by cut-off levels for Ig isotypes by using 3 SD or 95th percentile calculated using STATGRAPHICS. RESULTS: Positive levels of antibodies against beta2-GPI in IgA are more frequently associated with a diagnosis of anti-phospholipid syndrome, pre-eclampsia, and autoimmune disease in pregnant women than with diabetes mellitus in pregnancy. Very high interindividual differences in aPLs (against inositol, L-serine, cardiolipin, and beta2-glycoprotein in IgG and IgA) were found in serum from women with pregnancy complicated by anti-phospholipid syndrome, pre-eclampsia, and autoimmune disease. Pregnant patients with diabetes mellitus had higher serum levels in aPLs to DL-glycerol, inositol, L-serine, and beta2-glycoprotein. Positive aPL levels predominate in isotype IgG. Very low levels of aPLs to phosphatidic acid and phosphatidyl-ethanolamine were detected in all groups studied. CONCLUSION: Serum levels of anti-beta2-GPI could serve as a better prognostic marker in complicated pregnancy than the panel of seven different anti-phospholipid antibodies. Detection of anti-beta2-GPI is proposed as a first step of the screening for aPLs.

[The effect of follicular fluid pH on the quality and number of oocytes produced in the in vitro fertilization program]. / Vliv pH folikulární tekutiny na kvalitu a pocet oocytu, získaných v programu in vitro fertilizace.

OBJECTIVE: The aim of our study was to evaluate the role of follicular fluid pH as the marker of quality of the human oocyte in the IVF treatment efforting to predict and to enhance the effect of IVF treatment: oocyte quality, fertilization rate, cleavage rate, implantation rate. DESIGN: Prospective study. SETTING: Center of assisted reproduction, Department of Gynaecology and Obstetrics, Medical Faculty of Charles University, Pilsen. METHODS: The pH of the follicular fluid was measured in 147 IVF cycles. The oocyte quality was evaluated according to the oocyte-cumulus-cells complex morphology during the ovum pick up, according to fertilization rate, number of recovered oocytes and recovery rate. RESULTS: The lower pH of the follicular fluid correlated with significant higher occurrence of the cycles with more then half of oocyte-cumulus complexes with normal mature morphology (P = 0.026) and correlated with significant higher occurrence of cycles with fertilization rate more then 10% (P = 0.033). CONCLUSION: There was found a lower pH of the follicular fluid in the IVF cycles where the quality of oocytes was higher.

[Analysis of the zona pellucida in human oocytes and embryos in an assisted reproduction program]. / Analýza zona pellucida lidských oocytu a embryí v programu asistované reprodukce.

OBJECTIVE: Our aim was to design simple method for quantitative evaluation of oocyte and embryo morphology in in vitro fertilization (IVF) programme efforting of embryo implantation prediction to be able to set the optimal number of embryos for transfer for given specific case. This study deals with zona pellucida (ZP)--the one interesting and for oocyte unique structure. The work is the part of comprehensive research of oocyte, zygote and embryo morphology. DESIGN: Prospective study. SETTING: Center of Assisted Reproduction, Department of Gynaecology and Obstetrics, Medical Faculty of Charles University, Pilsen. METHODS: The study includes analysis of 66 microphotography pictures of oocytes, zygotes and embryos of patients who were treated by IVF on our department between September and December 2000. The microphotographs were taken by digital microphotographic system. Analysis of zona pellucida parameters was conducted by image analysis software called AnalySIS, Soft Imaging System GmbH. RESULTS: It was found out the average width of the zona pellucida 18.4 microns +/- 2.1 microns, the minimum width was 12.3 microns a maximum 23.1 microns. CONCLUSION: There was found significant narrower zona pellucida in women who conceived in this IVF cycle then in the women who did not.

[Monitoring immunity factors in serum and peritoneal fluid after laparoscopy in women. II. Sperm and zona pellucida antibodies]. / Sledování nekterých faktoru imunity v séru a v peritoneální tekutine u laparoskopovaných zen--II. Protilátky proti spermiím a proti zona pellucida.

A team of authors investigated antibody levels against spermatozoa and against the zona pellucida in sera and peritoneal fluids in infertile women where diagnostic laparoscopy was indicated. The immunological cause of infertility was diagnosed in some women with a normal laparoscopic finding on the inner genital, as well as in patients with endometriosis and in women with adhesions. A minimal antibody response to antigens of gametes was recorded in women with the diagnosis of uterus myomatosus, uterus hypoplasticus and polycystic ovary. The authors present detailed findings on antibodies in different groups of patients.

[Immunologic factors in the serum and peritoneal fluid in women after laparoscopy. I. Nonspecific factors]. / Sledování nekterých faktoru imunity v séru a v peritoneální tekutine u laparoskopovaných zen. I. Nespecifické faktory.

The authors examined by diagnostic laparoscopy and immunologically 180 patients in 1993-1995. They assessed in serum and peritoneal fluid IgG, IgA, IgM, haptoglobulin, A2-macroglobulin, A1-antitrypsin, transferrin, C4- and C3-complement, orosomucoid, A2AP-glycoprotein, albumin, prealbumin and hemopexin. The authors found that some individual pathological results as regards non-specific immunity supplement the clinical diagnosis, in particular in endomeriosis, multiple adhesions, polycystic ovaries and chronic anovulation.

[Fructose and glucose in follicular fluid and serum of women undergoing stimulation in an in vitro fertilization program]. / Fruktóza a glukóza ve folikulární tekutine a séru stimulovaných zen v programu IVF.

OBJECTIVE: To find out if there is some amount of fructose in the follicular fluid of IVF stimulated patients. If so then to compare fructose and glucose levels with IVF outcome, type of stimulation and infertility factors. DESIGN: Retrospective study. SETTING: Department of Gynaecology and Obstetrics, Charles University, the Czech Republic. METHODS: 202 women undergoing IVF treatment since 11/1999 till 02/2001 were evaluated. We measured a level of fructose and glucose in a sample of serum and follicular fluid (FF) obtained at ovum pick-up. Then the results were compared with the IVF outcome, the length of stimulation and infertility factors. The control group consists of 23 women with a pure andrologic factor of infertility. RESULTS: At the day of pick-up the serum concentration of glucose and fructose taken on an empty stomach is on average 5.43 +/- 1.35 mmol/l and 25.05 +/- 9.26 micrograms/ml compared to 5.26 +/- 1.00 mmol/l and 23.69 +/- micrograms/ml in control group. The concentration of both glucose and fructose in FF correlates with their serum level. The FF concentration of glucose is on average 3.75 +/- 1.32 mmol/l (70% of serum concentration) and fructose 11.34 +/- 5.29 micrograms/ml (48% of serum concentration) by comparison with 3.78 +/- 0.91 mmol/l (73%) and 12.37 +/- 7.06 micrograms/ml (53%) in control group. CONCLUSION: There is a possible influence of follicular fluid saccharides like glucose and fructose in process of fertilization. We derived this hypothesis from studies evaluating the role of saccharides in endometrial secretion, cervical mucous and seminal plasma. We assumed that patients with a successful IVF cycle have a lower fructose concentration in FF. The clinical pregnancy is really mildly lower but this difference is not statistically significant. We confirmed FF fructose is in close correlation with its serum concentration. But we did not confirm the FF glucose and FF fructose concentration is related to the IVF outcome.

[Obesity and reproductive disorders]. / Hmotnost a poruchy reprodukce.

INTRODUCTION: Obesity and overweight correlate with endocrine disorders in women, polycystic ovary syndrome, there are more atretic follicles in the ovary of obese women, overweight affects ovulation, pregnancy rates and outcomes in natural as well as in treated cycles. Similarly starvation correlates with menstrual cycle disturbances with anovulation. MATERIAL AND METHODS: The study includes 309 IVF treatment cycles performed in our IVF centre between 1/1/97 and 30/6/99. The patients were divided into five groups according to nutrition evaluated by body mass index (BMI). The parameters of IVF treatment includes the number of follicles, the number of collected oocytes, the recovery rate, the number of fertilized oocytes, the fertilization rate, the number of cleaved embryos, the cleavage rate, the clinical pregnancy rate, the take home baby rate, the miscarriage rate. The unpaired t-test was used in statistical analysis. RESULTS: There were found statistically significant less number of cycles with more than 10% fertilized oocytes and lower recovery rate in the obese and overweight women. CONCLUSIONS: Overweight and obesity significantly affect the parameters and outcomes of IVF treatment. The fertilization of the oocytes failed more often in the obese and overweight women. The lower pregnancy rates were achieved although the high oocytes recovery and high normal cleaved embryos were found in the obese women. The cause of the bad IVF treatment outcomes in the obese women seems to be probably the affected quality of the oocytes with lower fertilization and implantation potential eventually affected endometrium quality. The overweight reduction is the important part of infertility treatment in obese women.

Effect of corticosteroids on sperm antibody concentration in different biological fluids and on pregnancy outcome in immunologic infertility.

OBJECTIVE: In the last fourteen years, detection of free spermagglutinating antibodies has been performed by tray agglutination test (TAT) and by direct/indirect mixed antiglobulin reaction test (MAR) in 696 infertile couples aged 23-42 years (female) and 26-52 years (male) with previously undiagnosed infertility. MATERIAL AND METHODS: Oral decreasing doses of prednisone or dexamethasone for three months in the case of serum or seminal plasma spermantibodies, plasmapheresis in one patient with serum spermantibodies were used. Hydrocortisone to the ectocervix was applicated in patients with spermagglutinating antibodies in cervical ovulatory mucus. RESULTS: Serum IgG spermagglutinating antibodies totally disappeared in 3 out of 11 men, and four out of 15 women. But serum IgM sperm antibodies persisted. One female patient was treated with corticosteroids and also with plasmapheresis. Seminal plasma IgG spermagglutinating antibodies were greatly influenced in 57.8% of the patients, IgA in 38.9% and each case by oral corticosteroids. A decrease of IgG and IgA spermagglutinating antibodies in ovulatory cervical mucus during hydrocortisone local application was registered in 61.3%, IgG in 50.7% and IgA in 65.9%. Levels of IgM spermagglutinating antibodies in cervical ovulatory mucus were not influenced, spermantibodies in IgA and IgE were affected very little. CONCLUSION: The corticosteroid influence of immunocompetent cells in each case must be chosen individually with regard to the localisation of spermantibodies. We often combine the long lasting corticosteroids treatment with in vitro fertilization. The therapy seems to be very promising for the improvement of immunological causes of infertility.