An examination of predictive markers for successful sperm extraction procedures: a linear model and systematic review / 亚洲男科学杂志(英文版)

The authors performed a comprehensive review of current literature to create a model comparing commonly evaluated variables in male factor infertility, for example, follicle-stimulating hormone (FSH), testicular volume (TV), and testosterone (T), to better predict sperm retrieval rate (SRR). Twenty-nine studies were included, 9 with data on conventional testicular sperm extraction (cTESE) for a total of 1227 patients and 20 studies including data on microdissection testicular sperm extraction (mTESE) for a total of 4760 patients. A weighted-means value of SRR, FSH, T, and TV was created, and a weighted linear regression was then used to describe associations among SRR, type of procedure, FSH, T, and TV. In this study, weighted-means values demonstrated mTESE to be superior to cTESE with an SRR of 51.9% vs 40.1%. Multiple weighted linear regressions were created to describe associations among SRR, procedure type, FSH, T, and TV. The models showed that for every 1.19 mIU ml-1 increase in FSH, there would be a significant decrease in SRR by 1.0%. Seeking to create a more clinically relevant model, FSH values were then divided into normal, moderate elevation, and significant elevation categories (FSH <10 mIU ml-1, 10-19 mIU ml-1, and >20 mIU ml-1, respectively). For an index patient undergoing cTESE, the retrieval rates would be 57.1%, 44.3%, and 31.2% for values normal, moderately elevated, and significantly elevated, respectively. In conclusion, in a large meta-analysis, mTESE was shown to be more successful than cTESE for sperm retrievals. FSH has an inverse relationship to SRR in retrieval techniques and can alone be predictive of cTESE SRR.

Repeated superovulation induction after failure in previous IVF-ET cycles with the ultra-long protocol: Analysis of outcomes of clinical pregnancy / 中华男科学杂志

Objective@#To analyze the clinical outcomes of repeated superovulation induction in patients with adenomyosis or moderate to severe pelvic endometriosis after failure in previous IVF-ET cycles with the ultra-long protocol.@*METHODS@#We retrospectively analyzed the clinical data about 37 patients with adenomyosis or moderate to severe pelvic endometriosis in our center from 2009 to 2013, who underwent repeated IVF-ET after failure in the previous cycles with the ultra-long protocol, namely by injection of 2－6 ampoules of 3.75 mg gonadotropin-releasing hormone agonist (GnRH-a). All the patients met the following requirements: hCG-negative at 14 days after transfer, within 3－7 days after menstruation, and properly down-regulated serum follicle stimulating hormone (FSH) (<10 mIU/ml), luteinizing hormone (LH) (<10 mIU/ml), estradiol (E2) (<30 pg/ml), follicle diameter (<10 mm) and endometrial thickness, and received GnRH (Gonal-F, Serono) for ovulation induction. We compared the clinical and laboratory data and pregnancy outcomes between the first and repeated cycles before and after ovulation induction.@*RESULTS@#The repeated cycles, as compared with previous ones, showed significant increases in the antral follicle count (AFC) on the first day of stimulation (7.55 ± 1.86 vs 6.45 ± 2.5, P<0.05), number of follicles =≥14 mm in diameter on the hCG trigger day (7.81 ± 3.6 vs 5.56 ± 3.68, P<0.05), level of E2 (［2 362.15 ± 1 210.49］ vs ［1 749.22 ± 1 139.44］ pg/ml, P<0.05), and numbers of oocytes retrieved (7.51 ± 3.23 vs 4.78 ± 3.41, P<0.05) and embryos transferred (2.00 ± 0.33 vs 1.50 ± 0.67, P<0.05), exhibited a remarkably reduction in the dose of GnRH (［1 791.65 ± 1 889.41］ vs ［3 439.56 ± 1 836.53］ IU, P<0.05), and achieved a clinical pregnancy rate of 62.16%.@*CONCLUSIONS@#With proper reduction of the FSH, LH and E2 levels and follicle diameter, repeated superovulation induction for IVF-ET can improve the ovarian response and pregnancy outcomes of the patients with adenomyosis or moderate to severe pelvic endometriosis after failure in the previous IVF-ET cycles with the ultra-long protocol.

Relationship between the FSHR Thr307Ala-Asn680Ser gene polymorphism and male infertility: A meta-analysis / 中华男科学杂志

Objective@#To assess the association of the FSHR Thr307Ala-Asn680Ser gene polymorphism with male infertility.@*METHODS@#We searched Pubmed, EMBASE, Web of Science, CNKI, and WANFANG databases for literature on the correlation of the FSHR Thr307Ala-Asn680Ser gene polymorphism with male infertility published from 2005 to the present time. According to the inclusion criteria, we included 12 epidemiological case-control studies and subjected them to a comprehensive analysis with the Stata11.0 software.@*RESULTS@#A total of 2 893 male infertility patients and 3 312 controls were involved in the 12 studies. The Thr307Ala (rs6165) gene polymorphism was shown to be a risk factor for male infertility among the three comparison models (homozygous comparison model, hybrid comparison model and dominant comparison model), with the pooled odds ratios (OR) of 1.26 (95% CI: 1.03－1.54, P = 0.023), 1.18 (95% CI: 1.03－1.36, P = 0.018), and 1.20 (95% CI: 1.05－1.37, P = 0.006), respectively. And the Asn680Ser(rs6166) polymorphism was a risk factor for male infertility in the homozygous comparison and recessive comparison models, with the pooled ORs of 1.24, (95% CI: 1.05－1.45, P = 0.009) and 1.20 (95% CI: 1.04－1.39, P = 0.013), respectively. Layered meta-analysis showed that in the homozygous comparison model, the Thr307Ala-Asn680Ser polymorphism is a risk factor for male infertility in the white population, with the OR of 1.37 (95% CI: 1.03－1.82, P = 0.003) and 1.21 (95% CI: 1.00－1.47, P = 0.048), respectively.@*CONCLUSIONS@#In the homozygous model (GG vs AA), the FSHRThr307Ala-Asn680Ser gene polymorphism might be a protective factor against male infertility.

Controlled ovarian stimulation with r-FSH plus r-LH vs. HMG plus r-FSH in patients candidate for IVF/ICSI cycles: an RCT

Background: Different combination of gonadotropin preparation has been introduced with no definite superiority of one over others in vitro fertilization [IVF], but individualized regimens for each patient are needed

Objective: The aim of the present study was to investigate the effect of controlled ovarian stimulation with recombinant- follicle stimulating hormone [r-FSH] plus recombinant-luteinizing hormone [rLH] versus human menopausal gonadotropin [HMG] plus r-FSH on fertility outcomes in IVF patients

Materials and Methods: This is a randomized clinical trial study that was performed from October 2014-April 2016 on 140 infertile patients with a set of inclusion criteria that referred to infertility clinics in Vali- asr and Gandhi Hospital in Tehran. The women were randomly divided into two treatment groups. The first group [n=70] received rFSH from the second day of cycle and was added HMG in 6[th] day and the 2[nd] group [n=70], received rFSH from the second day of cycle and was added recombinant-LH in 6[th] day. Then ovum Pick-Up and embryo transfer were performed. In this study, we assessed the outcomes such as; chemical and clinical pregnancy rate, live birth and abortion rate

Results: Number of follicles in ovaries, total number of oocytes or M[2] oocytes and quality of fetuses has no significant differences between two groups [p>0.05]. Total number of fetuses were significantly higher in patients who received rFSH + HMG [p=0.02]. Fertility outcomes consisted of: live birth rate, chemical pregnancy and clinical pregnancy rate were higher in rFSH + HMG group in comparison to rFSH +r-LH group [p<0.05]

Conclusion: It seems that in IVF patients, HMG + rFSH used for controlled ovarian hyperstimulation have better effects on fertility outcomes, but in order to verify the results, it is recommended to implement studies on more patients

Follicle stimulating hormone and anti-mullerian hormone among fertile and infertile women in Ile-Ife, Nigeria: is there a difference?

Background: Reduced ovarian reserve predicts poor ovarian response and poor success rates in infertile women who undergo assisted reproductive technology [ART]. Ovarian reserve also decreases with age but the rate of decline varies from one woman to another. This study aims to detect differences in ovarian reserve as measured by basal serum follicle stimulating hormone [FSH] and anti-Mullerian hormone [AMH] between a matched cohort of fertile and infertile regularly menstruating women, 18-45 years of age

Materials and Methods: This case-control study involved 64 fertile and 64 subfertile women matched by age at recruitment. Peripheral blood samples were taken from the women recruited from the Gynecological and Outpatient Clinics of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Serum FSH and AMH were quantified using ELISA at the Metabolic Research Laboratory of LAUTECH Teaching Hospital, Ogbomoso, Nigeria

Results: A significant difference existed in the mean FSH of fertile [6.97 +/- 3.34] and infertile [13.34 +/- 5.24, P=0.013] women. We observed a significant difference in AMH between fertile [2.71 +/- 1.91] and infertile [1.60 +/- 2.51, P=0.029] women. There was a negative correlation between FSH and AMH in both fertile [r=-0.311, P=0.01] and infertile [r=-0.374, P=0.002] women

Conclusion: The difference in ovarian reserve observed in this study suggests that reduced ovarian reserve in regularly menstruating women may be associated with early ovarian ageing or subfertility

Age as a predictor of embryo quality regardless of the quantitative ovarian response

Background: One determining factor of a successful in vitro fertilization [IVF] cycle is embryo quality. The aim of the present study was to evaluate associations of embryo quality and reserve markers like age, FSH and AMH

Materials and Methods: In this prospective study, 120 infertile women, aged 21-44 years, undergoing routine exploration during an unstimulated cycle preceding assisted reproductive technology [ART] at our center were studied prospectively, from February 2011 to December 2014. Descriptive parameters and patient characteristics were reported as mean [SD] or median [range] depending on the distribution. Student's t test was performed for continuous variables, Wilcoxon and Pearson's Test were used for not distributed variables and Fisher's Test was performed for categorical variables. P<0.05 was considered statistically significant

Results: Overall, at the time of investigation, patients had a mean age of 33.03 +/- 4.15 years old. On cycle day three, serum anti-Mullerian hormone [AMH] level was 3.50 +/- 1.54 ng/mL, serum follicle-stimulating hormone [FSH] level was 6.29 +/- 1.53 mUI/ mL, at baseline, women had 16.57 +/- 7.0 antral follicles. The mean of collected oocytes was 11.80 +/- 5.25, embryo I+II was 2.46 +/- 2.11. A greater number of embryos I+II was observed in young patients. By evaluating 120 patients, a significant relationship was observed between age and FSH [r=0.24, P=0.01], age with AMH [r=-0.22, P=0.02], age with collected oocytes [r=-0.23, P=0.03] and age with embryo I+II [r=-0.22, P=0.03]. A significant relationship was also observed between antral follicle count [AFC] and AMH [r=0.29, P=0.01], AFC and the number of transferred embryo [r=-0.18, P=0.03], AFC and total dose of the drugs [r=-0.23, P=0.03]. Significant relationship of FSH with total dose of drugs [r=0.19, P=0.02] was also observed. In addition, we determined significant relationships between AMH and the number of collected oocytes [r=0.38, P=0.01], AMH and the number of metaphase II oocytes [r= 0.35, P=0.01], AMH and the number of embryo [r=0.19, P=0.04] as well as AMH and total dose of the drugs [r=-0.25, P=0.01]

Conclusion: Commonly used clinical markers of ovarian reserve are reflection of the ovarian reserve, while the outcome measurements of ART and age are the best predictors of embryo quality

Evaluation of central precocious puberty treatment with GnRH analogue at the Triangulo Mineiro Federal University (UFTM)

Objective To report our experience of treating central precocious puberty (CPP) with a GnRH analogue with respect to the final heights (FH) attained in patients who completed treatment. Subjects and methods Among 105 records of children diagnosed with precocious puberty, 62 cases (54 girls and 8 boys), who were treated with leuprolide acetate/3.75 mg/monthly, were selected, and divided into 4 groups: group 1 (G1), 25 girls who attained FH; group 2 (G2), 18 girls who completed treatment but did not reach FH; group 3 (G3), 11 girls still under treatment; and group 4 (G4), 8 boys, 5 of which attained FH. Treatment was concluded at a bone age of 12 years, and follow-up continued until FH was achieved. Results In both G1 and G2 groups, height standard deviation score (SDS), weight-SDS and percentile of body mass index (PBMI) did not show intra/intergroup differences at the beginning and at interruption of treatment, but when added, G1+G2, height-SDS and weight-SDS differed significantly (p = 0.002 and 0.0001, respectively). In G1, 19 of 25 cases attained TH, and average height gain was 16.7 cm (7.7- 27.1); there was significant difference between FH and prediction of FH at the start (PFH at start) (p = 0.0001), as well as between PFH at interruption vs TH and vs FH (p = 0.007) with FH higher than TH (p = 0.004). Significant correlation was identified between FH and height gain after treatment. Conclusion As shown by some studies, GnRH analogue treatment was effective in children with CPP reaching FH near the genetic target.

Experiencia de la Unidad de Medicina Reproductiva Clínica Monteblanco con el uso de corifollitropin alfa en ciclos de fecundación in vitro / Experience of the Monteblanco Clinical Reproductive Medicine Unit with the use of corifollitropin alfa in in vitro fertilization cycles

ANTECEDENTES: La hiperestimulación ovárica controlada (HEOC) es uno de los componentes fundamentales de los ciclos de fecundación in-vitro (FIV). HEOC se ha realizado con gonadotrofinas exógenas de uso diario, agregando un componente de estrés adicional al tratamiento. La aparición de una FSH recombinante de depósito (corifollitropin alfa) permite disminuir el estrés asociado. Los estudios publicados no han mostrados diferencias en el número de ovocitos recuperados ni en las tasas de embarazo clínico. Los estudios existentes han sido financiados en su mayoría por la industria farmacéutica. OBJETIVO: Presentar la experiencia de la Unidad de Medicina Reproductiva Monteblanco con el uso de corifollitropin alfa en ciclos de FIV autólogos en pacientes no seleccionadas. MÉTODO: Se analizaron el número de ovocitos recuperados y la proporción de ovocitos en metafase 2 en pacientes sometidas a HEOC con corifollitropin alfa, FSH recombinante diaria (rFSH), y la combinación de FSH recombinante y urinaria. RESULTADOS: Se analizaron 727 ciclos de FIV: 270 con corifollitropin alfa, 33 con rFSH y 333 con combinación de FSH. No hubo diferencias significativas en la recuperación de ovocitos ni en la proporción de ovocitos en metafase 2. Al corregir por edad de la mujer y tipo de esquema de HEOC, encontramos que la edad de la mujer se asoció negativamente con el número de ovocitos recuperados, no así el tipo de esquema de HEOC. CONCLUSION: El uso de corifollitropin alfa en ciclos de FIV autólogos, no se diferencia significativamente de los otros esquemas de HEOC en la media de ovocitos recuperados ni en la media de ovocitos en metafase 2 obtenidos.

BACKGROUND: Controlled ovarian hyperstimulation (COH) is a main component of in-vitro fertilization (IVF) cycles. COH have been performed with daily exogenous gonadotropins administered, adding to treatment an additional component of stress. The appearance of a depot recombinant FSH (corifollitropin alfa) helps to reduce stress in patients undergoing IVF. No studies have shown differences in the number of retrieved oocytes or clinical pregnancy rates; however these studies have been funded by the pharmaceutical industry. AIMS: To show the experience of Reproductive Medicine Unit Monteblanco with the use of corifollitropin alpha in autologous IVF cycles, in unselected patients. METHODS: Our main outcome was the mean number of oocytes retrieved, and the proportion of oocytes in metaphase 2 in patients undergoing COH with corifollitropin alpha, daily recombinant FSH (rFSH), and a combination of rFSH and urinary gonadotropin. RESULTS: We analyzed 727 IVF cycles: 270 cycles with corifollitropin alpha, 33 exclusive rFSH and 333 cycles with rFSH combination and urinary gonadotropins. We did not found any statistically significant difference in the mean number of oocytes recovered nor the proportion of metaphase two oocytes obtained. After adjusting for age, we did not find that the COH protocol influenced the mean number of oocytes recovered. CONCLUSION: We concluded that the use of corifollitropin alpha in autologous IVF cycles does not alter the mean number of oocytes recovered, nor the proportion of oocytes in metaphase 2.

correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women

The objective of our study was to identify the correlations between the tests currently used in ovarian reserve assessment: anti-Mullerian hormone [AMH], follicle stimulating hormone [FSH] and antral follicle count [AFC] and to distinguish the most reliable markers for ovarian reserve in order to select an adequate strategy for the initial stages of infertility treatment. In this prospective study, 112 infertile women were assessed. Subjects were divided into three age groups: group I <35 years [n=39], group II 35-40 years [n=31], and group III 41-46 years [n=42]. AMH, FSH and AFC were determined on days 2-3 of the patients' menstrual cycles. There was a significantly elevated negative correlation between age and AMH level [rs=-0.67, p<0.0001] and AFC [rs=-0.55, p<0.0001]. We observed a significantly positive correlation between age and FSH [rs=0.38, p<0.0001]. AMH negatively correlated with FSH [rs=-0.48, p<0.0001] and positively with AFC [r=- 0.71, p=0.0001]. There was a moderate negative relation between FSH and AFC [r=-0.41, p=0.0001] and moderate positive relation between age and FSH [rs=0.38, p<0.0001]. The correlation analysis performed in separate groups showed that AMH and AFC showed a statistically significant positive correlation for group I [r=0.57, p<0.0001], group II [r=0.69, p<0.0001] and group III [r=0.47, p<0.002]. A statistically significant correlation between FSH and AMH was detected only in groups I [r=-0.41, p<0.02] and II [r=-0.55, p<0.0001]. A statistically significant correlation existed between FSH and AFC only in group III [r=-0.42, p<0.006], as well as between age and AFC only in group I [r=-0.35, p<0.03]. Currently, AMH should be considered as the more reliable of the ovarian reserve assessments tests compared to FSH. There is a strong positive correlation between serum AMH level and AFC. The use of AMH combined with AFC may improve ovarian reserve evaluation

Expression of human long-acting FSH in CHO cell and its bioactivity in vivo / 生物工程学报

Follicle-stimulating hormone (FSH) is a pituitary glycoprotein hormone that is essential for the development of ovarian follicles and testicular seminiferous tubules. The relatively short half-life of FSH in vivo requires daily injections for more than 10 days that is inconvenient and possibly contribute to the stress perceived by the patients. The goal of the present study was to increase FSH glycosylation, in order to develop a long-acting recombinant FSH. The cDNA of native alpha and beta subunit of human FSH was linked by a sequence with two N-linked glycosylation sites, and the resulted DNA was inserted into pcDNA3.1 vector to generate a recombinant vector of pcDNA3.1-FSH. The pcDNA3.1-FSH was linearized and transfected into CHO-K1, positive transformants were selected by G418 and confirmed by PCR and Western blotting. A single chain recombinant FSH was expressed, with molecular weight of about 49 kDa. The recombinant FSH expression level in CHO-K1 cell strain in serum-free culture was 3 mg/L. Single injection of this recombinant FSH could induce folliculogenesis and ovulation in rats, the efficacy was similar with the commercially available FSH preparation (Folltropin-V) administrated 8 times consecutively. The results suggested a long-acting FSH was produced successfully.

[Diazinon alters sex hormones, Interferon-gamma, Interleukin-4 and 10 in male Wistar rats]

Agricultural toxins including organochlorine and organophosphorus families cause damages in the various tissues in humans. Diazinon is a non-systemic organophosphate insecticide. This study was carried out to determine the effect of Diazinon on sex hormone, interferon gamma, interleukin-4 and 10 in male rats. In this experimental study 24 adult male Wistar rats were randomly allocated into four groups. Three experimental groups were received Diazinon 5 days per week for one month at 0.3, 3 and 30 mg/kg/bw intraperitoneally, while controls received nothing. Seven days after the last injection, blood samples were obtained and the serum testosterone, FSH, LH, interferon gamma, interleukin-4 and interleukin-10 were measured. Serum level of Interleukin-10 significantly increased in experimental group [30 mg/kg/bw of Diazinon] compared to controls [P<0.05]. Serum level of Interleukin-10 significantly decreased in 0.3 mg/kg/bw and 3mg/kg/bw of Diazinon groups compared to controls [P<0.05]. Interleukin-4 level was only significant in the group receiving 30 mg/kg/bw of Diazinon [P<0.05]. Reduction in interferongamma level was not significant between control and experimental groups. FSH significantly reduced in the three experimental groups in comparison with controls [P<0.05]. Testosterone level was significantly increased in experimental groups compared to control [P<0.05]. Diazinon increases interleukin-10 and testosterone and reduces FSH hormone in the rat

Prediction of age at menopause in women of suburban areas in Chennai using a model of FSH over age - a pilot study

The human ovary is characterized by early senescence and the end stage of ovarian activity is termed menopause. The age at which menopause occur is between 45 and 55 years world wide. The objective of this pilot study is to determine the age at menopause by using a model of FSH over age in women of sub urban region around Chennai, India. The subjects include 500 patients of age between 30 and 36 yrs with BMI ranging from 24-28. After recording their general profile and history, blood samples were obtained by venipuncture and hormone FSH was estimated on the day 3 of the menstrual cycle. Based on functional dependence of FSH in the form of exponential relation with age, a model was proposed. Using least square approximation the beta values were calculated. With the help of beta values and using the cut off value of 40 IU/ml for FSH, this predicted model determined the age of menopause as 44.6 yrs in women of sub urban region around Chennai. The age of menopause is different in various region worlds wide. According to this pilot study the suburban women of Chennai, attain menopause at an age of 44.6 years. Further exploration should be done to alleviate the role of diet, life style and ethnic variation on menopausal age and the impact of chronic disease like osteoporosis during the period of menopause

The effect of aromatase inhibitor letrozole incorporated in gonadotrophin-releasing hormone antagonist multiple dose protocol in poor responders undergoing in vitro fertilization

OBJECTIVE: To evaluate whether letrozole incorporated in a gonadotrophin-releasing hormone (GnRH) antagonist multiple dose protocol (MDP) improved controlled ovarian stimulation (COS) and in vitro fertilization (IVF) results in poor responders who underwent IVF treatment. METHODS: In this retrospective cohort study, a total of 103 consecutive IVF cycles that were performed during either the letrozole/GnRH antagonist MDP cycles (letrozole group, n=46) or the standard GnRH antagonist MDP cycles (control group, n=57) were included in 103 poor responders. COS results and IVF outcomes were compared between the two groups. RESULTS: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the letrozole group than in the control group. Duration of GnRH antagonist administered was also shorter in the letrozole group. The number of oocytes retrieved was significantly higher in the letrozole group. However, clinical pregnancy rate per cycle initiated, clinical pregnancy rate per embryo transfer, embryo implantation rate and miscarriage rate were similar in the two groups. CONCLUSION: The letrozole incorporated in GnRH antagonist MDP may be more effective because it results comparable pregnancy outcomes with shorter duration and smaller dose of rhFSH, when compared with the standard GnRH antagonist MDP.

Correlation of the day 3 FSH/LH ratio and LH concentration in predicting IVF outcome

This study was undertaken to evaluate the role of day 3 FSH/LH ratio and day 3 LH level as predictors of IVF cycle outcomes. This prospective observational study was undertaken in the IVF and Reproductive Biology Centre and Lok Nayak Hospital, affiliated to Maulana Azad Medical College, in New Delhi, India. The study included 105 women who underwent controlled ovarian hyperstimulation for in vitro fertilization. Characteristics of IVF cycles and outcomes were studied in patient subgroups based on day 3 FSH/LH ratio [<2 and >/= 2] and day 3 LH levels [>3 and /= 2 [n=31] required higher doses of gonadotrophins [3019.34 vs. 2482.43 IU]. The outcome of IVF was poor in these patients and they had fewer number of mature follicles [>16 mm] [5.44 vs. 6.09], less E2/mature follicle ratio [4.65 vs. 6.36], fewer retrieved oocytes [6.67 vs. 9.09] and fewer pregnancy rates [11.1% vs. 33.8%]. On the other hand, patients with low basal LH levels [3 mIU/ml. Elevated day 3 FSH/LH ratio is associated with inferior outcome in IVF treatment cycles and it could be used as an additional predictor of decreased ovarian reserve

[Effect of sodium azide on sperm parameters and the serum levels of testosterone, LH and FSH in adult male mice]

Sodium azide is a chemical and toxic compound. The aim of this study was to evaluate the effects of sodium azide on the viability of sperms and the serum levels of testosterone, LH and FSH in mature male laboratory small mice. In this experimental study, 50 Balb/C male mice weighing 20-25g were divided into five groups [10 mice in each group]. The animals were prescribed sodium azide for 60 days. Alternatively 5, 10 and 20 milligrams per kilogram of body weight of sodium azide were fed to the animals in the experimental groups 1, 2 and 3. After the completion of treatment, serum values of testosterone, LH and FSH were measured. The viability of sperms was also studied. The number of sperms in three experimental groups showed significant decrease compared to the control and sham groups [p<0.001]. Serum value of testostrone hormone showed dose- dependently significant decrease compared to the control and sham groups. The serum level of FSH in the experimental groups did not show any significant change compared to the control and sham groups. But, the serum level of LH in experimental groups receiving sodium azide 10, 20 mg/kg increased significantly compared to the control and sham groups [p<0.01]. It seems sodium azide reduces serum level of testosterone and the number of sperms under the process of spermatogenesis in the animals

Luteal estradiol supplementation in gonadotropin-releasing hormone antagonist cycles for infertile patients in vitro fertilization / 대한생식의학회지

OBJECTIVE: To evaluate the effect of the addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles for infertile patients undergoing IVF/ICSI. METHODS: One hundred and ten infertile patients, aged 28 to 39 years, were recruited for this prospective randomized study. They were randomly assigned to receive vaginal progesterone gel (Crinone) along with 4 mg estradiol valerate (group 1, n=55) or only Crinone (group 2, n=55) for luteal support. A GnRH antagonist multiple dose protocol using recombinant human FSH was used for controlled ovarian stimulation (COS) in all of the subjects. The COS results and pregnancy outcomes of the two groups were compared. RESULTS: Group 1 and 2 were comparable with respect to the patient characteristics. The COS and IVF results were also comparable between the two groups. There were no differences in the clinical pregnancy rate (PR) and multiple PR between the two groups. However, the embryo implantation rate were significantly higher in group 1 than that in group 2 (22.2% vs. 13.3%, p=0.035). The incidence of luteal vaginal bleeding (LVB) was significantly lower in group 1 (7.4% vs. 27.8%, p=0.010). CONCLUSION: The addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles reduces the incidence of LVB and increases the embryo implantation rate in infertile patients undergoing IVF/ICSI.

The molecular design and drug development of recombinant long-acting follicle stimulating hormone / 药学学报

Follicle-stimulating hormone (FSH) is a glycoprotein which regulates the development, growth, pubertal maturation and reproductive processes of the body. Exogenous FSH has been used to promote ovarian follicular growth and maturation in female and spermatogenesis in male. The relative short elimination half life and rapid metabolic clearance of current versions of FSH require a daily or twice-daily scheduled subcutaneous injection to maintain stable FSH level being not below the threshold during ovarian stimulation. The development of recombinant long-acting FSH with enhanced biological activities may be helpful for less injection therefore to improve patient compliance, while reducing patient stress and error rates. A number of technological strategies have been explored to develop recombinant longer-acting FSH. For examples, attachment of the C-terminal peptide (CTP) of the human chorionic gonadotropin beta subunit or a sequence containing potential glycosylation sites to either subunit of FSH, creation of a single chain containing the alpha and beta subunits of FSH combined with CTP or N-linked glycosylation signal sequence as a linker, or fusion of the Fc domain of IgGi to FSH. Based on the modifiable molecular structure and pharmacokinetic and pharmacodynamic properties of recombinant FSH, it is hopeful that more FSH drugs with prolonged half-life and increased bioactivity will be developed to meet the modern clinical demands.

Effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase compared with GnRH agonist long protocol in non-obese and obese patients with polycystic ovary syndrome undergoing IVF/ICSI / 대한생식의학회지

OBJECTIVE: To evaluate the effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase (MDP-EL) in comparison with standard GnRH agonist luteal long protocol (LP) in each non-obese and obese polycystic ovary syndrome (PCOS) women undergoing IVF. METHODS: Two hundred eleven infertile women with PCOS were recruited and randomized to undergo either GnRH antagonist MDP-EL (antagonist group) or standard GnRH agonist luteal LP (agonist group). IVF cycle outcomes were compared between the two groups. RESULTS: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the antagonist group than in the agonist group. Incidence of severe ovarian hyperstimulation syndrome was significantly lower in the antagonist group. However, IVF and pregnancy outcomes were similar in the two groups. When all subjects were divided into non-obese and obese subgroups, in non-obese PCOS subgroup, IVF and pregnancy outcomes were comparable in the antagonist and agonist groups but total dose and days of rhFSH were also significantly fewer in the antagonist group. Similar findings were also observed in obese PCOS subgroup. CONCLUSION: GnRH antagonist MDP-EL is at least as effective as GnRH agonist LP and may be a more patient-friendly alternative in controlled ovarian stimulation for PCOS patients undergoing IVF, independent of body mass index.

Etiology of primary amenorrhoea: a study of 50 cases

Amenorrhoea is one of the commonest reasons for referral of female patients to a gynaecology clinic. It is subdivided into primary and secondary. The etiology of primary amenorrhoea is complex. The aim of this study was to determine the etiological factors of primary amenorrhoea and to find out the mean age at first presentation. Descriptive Study. This Study was conducted in the department of Obstetrics and Gynaecology Foundation University Medical College Fauji Foundation Hospital Rawalpindi, from 1[st] January 2005 to 31[st] December 2007. 50 girls who reported to gynae outpatient department with the complaint of primary amenorrhoea were included in the study after informed consent. Detailed history, clinical examination and investigations [transabdominal ultrasonography, hormonal profile including serum FSH, LH and prolactin, karyotyping] were recorded in proformas for analysis. A total of 50 girls reported to gynae OPD with complaints of primary amenorrhoea over a period of 24 months with the mean age of 18.5 years at initial presentation. Almost half of the girls [48%] with normal secondary sexual characteristics had anatomical defects, rokitansky;s syndrome being the commonest, while those with absent secondary sexual characteristics had constitutional delay as the commonest cause. Mean age at first presentation is late. Anatomical causes are the commonest. Turner's syndrome is relatively uncommon in our patients

[Effects of cefixime on the testis structure and pituitary-gonadal hormones in adult Balb/C mice]

Cefixime is an antimicrobial agent which has a widespread ability against various pathogens, especially gram-negative organisms. Today, physicians apply cephalosporins especially cefixime in a wide scale. Regarding the side effects of some of these antibiotics on reproductive system, this study was conducted to determine the effect of cefixime on pituitary-gonadal hormones, gonadotrophins and testes morphology in adult male mice. Eighteen male mice [age: 12-16 weeks, weight: 35 +/- 5 gr] were divided into three groups; control, sham and experimental [6 mice in each group]. Experimental group received cefixime [0.5 gr/kg/day] as a solution in dimethyl solfoxide [DMSO] for 10 days; the sham group received only drug solvent [DMSO] via IP injection and the control group remained intact. The animals were weighed and sacrificed. Level of hormones was measured by Radioi Immuno Assay [RIA] method. Then, tissues were fixed in Buin's fixative. Sections were cut into 5 micro m thicknesses and stained with Hematoxylin and Eosin [H and E]. Data were analyzed using T-test and SPSS software. Count of spermatogenic, Sertoli and leydig cells and titer of FSH significantly decreased in the experimental group in comparison with the control and sham groups [P<0.01 and P<0.05]. In the experimental group, DHEA hormone decreased significantly [P<0.05] in comparison with sham. No significant differences were seen in other factors between the groups. Regarding physiological role of Sertoli cells during spermatogenesis, reduction of FSH hormone may lead to negative effects on the sperm production and reproductive potential of male mice