ICSI outcome in patients with transient azoospermia with initially motile or immotile sperm in the ejaculate.

BACKGROUND: In patients with transient azoospermia, few sperm may be found in the ejaculate. We investigated the outcome of ICSI in patients with transient azoospermia. METHODS: Records of patients with transient azoospermia referred during a 42 month period were reviewed. If only immotile sperm were found, the sample was incubated with 30% human serum albumin (HSA) before motility re-assessment. If still immotile, mechanical assessment of sperm viability was utilized. Study groups were: (A) motile sperm; (B) motility achieved by HSA; (C) no motility, but viability assessed by a mechanical technique; and (D) control group with sperm counts from 1 to 5 x 10(6)/ml. There were 57 couples (cycles) in the study group and 43 couples (cycles) in the control group. RESULTS: Age, days of stimulation and endometrial thickness were comparable among groups. In 29.8% of the cycles, only immotile sperm were found. Fertilization and cleavage rates were higher in groups A and D than in groups B and C. Clinical pregnancy rate/cycle and live birth rate/cycle were not different among groups. No congenital malformations were found in newborns. CONCLUSION: Fertilization and cleavage rates were lower in patients with initially immotile sperm compared with those with initially motile sperm and oligoasthenoteratozoospermia patients. Clinical pregnancy and viable pregnancy rates were not statistically different among groups, although when only immotile sperm were present both clinical pregnancy and live birth rate were lower in comparison with cycles with motile sperm.

The effect of human fallopian tube epithelium on human sperm velocity motility and binding.

PURPOSE: A prospective, controlled in vitro study was conducted to evaluate the effects of human fallopian tube epithelium on the motility, velocity, and binding of human spermatozoa. METHODS: Eleven fallopian tubes from six women undergoing hysterectomy and semen samples from 14 male partners of women undergoing in vitro fertilization were collected. Human spermatozoa were cultured with monolayer of human fallopian tube epithelial cells. The motility and velocity were analyzed subsequently at 0, 2, 6, 24, and 48 hr of incubation. The sperm binding capacity was analyzed after 48 hr in the hemizona assay (HZA). RESULTS: The presence of the human fallopian tube epithelial cells did not have any beneficial effects on sperm motility and velocity. On the other hand, significant promoting effect was observed in the ability of the sperm to bind to the zona pellucida. CONCLUSIONS: The interaction of human spermatozoa with fallopian tube epithelial cells significantly increases sperm binding in the HZA.

High progesterone levels and ciliary dysfunction--a possible cause of ectopic pregnancy.

OBJECTIVES: To investigate the effects of different levels of hormones on the ciliary activity of human oviducts and, consequently, to assess their possible role in tubal implantation of the fertilized egg. DESIGN: Fallopian tube epithelial samples were incubated in media with the addition of Estradiol (E2), progesterone (P), human menopausal gonadotropin (hMG), LH, or pure FSH (Metrodin) in different concentrations. The ciliary beat frequency (CBF) was measured after 24 h of incubation. Then the media were exchanged to media without the addition of hormones and the CBF was measured again 24 h later by using the photoelectric technique. SETTING: University teaching hospital, IVF unit. RESULTS: Twenty-four hr after the addition of P to the culture medium in concentrations of 0.5 or 1 ng/ml a significant decline of the CBF down to 63% of the control level was observed (P < 0.001) and with P in concentration of 2 ng/ml or greater, 50-70% of the cilia were paralyzed. These effects of P were found to be reversible. Incubation with E2 induced a slight increase of 4% in the mean CBF (P = 0.002). Twenty-four hr incubation with Metrodin, Pergonal, or LH did not affect ciliary motility. CONCLUSIONS: Higher levels of progesterone cause ciliary dysfunction and subsequently may be a possible cause of ectopic pregnancy.

Endogenous digoxin-like immunoreactivity in follicular fluid and in vitro fertilization.

Plasma digoxin-like immunoreactive factor (DLIF) has been detected in various pathophysiological conditions associated with volume expansion. In this study, using radioimmunoassay, we confirmed the existence of high levels of DLIF in the stimulated follicular fluid, a rapidly volume-expanding biological model. The concentration of the various fractions of DLIF in follicular fluid was 2-9 times higher than in plasma, suggesting local concentration or production. No difference in concentration was observed between follicles containing fertilized oocytes and follicles with unfertilized oocytes. The role of DLIF in follicular homeostasis remains to be further investigated.

Digoxin-like immunoreactive factor(s) in human gonadotropin stimulated follicular fluid.

Plasma digoxin-like immunoreactive factor(s) (DLIF) have been reported in various pathophysiological conditions associated with volume expansion and linked to the regulation of blood volume and pressure. We hypothesized that DLIF might be present in rapidly expanding gonadotropin-stimulated ovarian follicles. The mean total and free DLIF concentrations in the follicles (n = 9) studied were 4925 nmol/L and 1885 nmol/L, respectively. These concentrations were substantially higher than the plasma total and free DLIF levels in these women: 1216 nmol/L and 158 nmol/L, respectively (p less than 0.0001). The plasma DLIF levels in the gonadotropin-treated women were comparable to those in term pregnant women, which are known to be higher than those in non-pregnant women. The ovary thus may be a source of DLIF in the plasma of gonadotropin-treated women, and DLIF may have a role in ovarian follicular fluid homeostasis.