Aarne I. Koskimies

Diagnosis of luteinized unruptured follicle (LUF) syndrome by ultrasound

To evaluate the role of ultrasound in diagnosing luteinized unruptured follicle (LUF), 37 women with unexplained infertility were examined for two to three menstrual cycles. Laparoscopy or laparotomy was performed on days 16 to 18 of the third study cycle in 25 patients. The LUF syndrome was suspected at ultrasound examination in 57 of 100 cycles observed. In the remaining 43 cycles, follicular collapse was observed in 33, and 10 were diagnosed as anovulatory. At laparoscopy or laparotomy on 25 patients, 18 of the 21 patients diagnosed as having LUF by ultrasound had a corpus luteum without a stigma. The other three cases diagnosed as LUF by ultrasound had ovulation stigmata. Additional findings in the 25 patients who underwent laparotomy or laparoscopy were endometriosis in 7 (5 of whom had LUF as well), ovulation in 5, bilateral hydrosalpinx in 1, and inability to visualize the ovaries because of adhesions in 1. The LUF syndrome was not a consistent change in the ovulatory pattern of most of the patients. It occurred by ultrasound diagnosis in three consecutive cycles in only 34% of patients.

Pregnancy proteins in seminal plasma, seminal vesicles, preovulatory follicular fluid, and ovary.

A number of proteins previously thought to be specific for the placenta or pregnancy have been identified in the fluids bathing both the oocyte and the sperm. In many cases their concentrations in follicular fluid and seminal plasma greatly exceeded those in the serum of nonpregnant women or men, and sometimes they even exceeded the levels in pregnancy sera. We report here the occurrence of PP5, PP12, PP14 and PAPP-A in follicular fluid and seminal plasma. In follicular fluid, the levels of PP5, PP12, and PAPP-A correlate with the estrogen concentration of the same fluid, and the PP12 and PAPP-A levels also bear a positive correlation to the progesterone concentration. The levels of PP12 and PAPP-A increase as the follicle grows, as do the levels of many steroid hormones. Therefore, the apparent correlations observed may be merely coincidental. However, circumstantial evidence from other reproductive organs indicates that the synthesis of PP12 and PAPP-A is stimulated by progesterone. Results of immunohistochemical staining show that PP12 and PAPP-A are localized in the luteinized granulosa cells and the corpus luteum. Previous studies indicate that PP5 and PAPP-A inhibit the action of proteolytic enzymes plasmin and elastase, which are believed to be involved in the mechanisms of ovulation. The study of the significance of these various placental proteins for human reproduction is only at its beginning. Clearly, elucidation of their function is the key to a more fundamental understanding of their role in the events governing ovulation and implantation.

Direct intraperitoneal or intrauterine insemination and superovulation in infertility treatment : a randomized study

Direct intraperitoneal or intrauterine insemination in combination with superovulation was used randomly as the treatment of infertility that was unexplained or due to male subfertility or mild endometriosis in 124 couples during 326 cycles. The pregnancy rate per couple was 24% in the direct intraperitoneal insemination group and 31% in the IUI group. The difference was not significant. The pregnancy rates with both treatments were significantly higher than those seen during the 326 control cycles of the same couples (1.1% and 0.6%).

Testicular function after chemotherapy for osteosarcoma

Testicular volume, sperm count and four hormones were measured in 18 patients 1-13 years after chemotherapy for osteosarcoma. The testicles were small in 13 patients. 17 patients gave semen samples: 10 were azoospermic and 2 were oligozoospermic. Testicular volume and sperm count were possibly associated with the type of chemotherapy. Of the 7 patients who had received cisplatin-containing chemotherapy, 6 had small testes and azoospermia; 1 was oligozoospermic with normal-sized testes. In 3 of the 11 patients whose chemotherapy had not included cisplatin, testicular size and sperm count were normal.

Immunoglobulin e-mediated severe allergy to human seminal plasma.

Two women with allergy to human seminal plasma are described. Both patients had generalized and local allergic symptoms, i.e., hypotension, asthmatic dyspnea, urticaria, and vaginal swelling, beginning within a few minutes of intercourse. The antigen causing the reaction in these patients was common to all seminal plasmas examined. Most of the antigenic activity was shown to be present in one protein band detected by acrylamide gel electrophoresis. The seminal plasma reaction was mediated through an immunoglobulin E (IgE) antibody. Passive transfer of the hypersensitivity with the serum of both patients was successful, and the radioallergosorbent test showed that the serum of the first patient contained IgE specific to seminal plasma.

Conservative treatment of ectopic pregnancy.

As a conservative nonsurgical treatment of an early ectopic pregnancy, local prostaglandin, parenteral or local methotrexate, local hyperosmolar glucose, and also expectant management have been used successfully in selected cases. The success rate of conservative treatment has been 71%-100% and that of tubal patency after different kinds of conservative treatment 72-93% of patients. In the present study of expectant management in early ectopic pregnancy in patients with decreasing serum hCG levels, spontaneous resolution was observed in 64.6% of patients and in the total series of 207 ectopic pregnancies in 15.0% of patients. Expectant management of early ectopic pregnancy is recommended when emergency surgery is not needed on admission and the serum hCG level is decreasing as noted in two consecutive estimations with an interval of 1-2 days.

Regression of endometriosis following shorter treatment with, or lower dose of danazol: Comparison of pre‐ and post‐treatment laparoscopic findings in the Scandinavian multi‐center study

Abstract. One hundred and sixteen patients with laparosco‐pically confirmed primary or recurrent endometriosis were treated with danazol, either 600 mg daily for 4 months (group A, n = 76) or 600 mg daily for the first 2 months, followed by 400 mg daily for an additional 4 months (group B, n = 40). The only surgery performed before treatment was biopsies, resection of endometriomas 23 cm and/or adhe‐siolysis. The extent of endometriosis before and after treatment was established laparoscopically and recorded by means of a modified AFS record as mean additive diameter of implants (mean ADI) in millimeters. This provided a uniform and reproducible quantitative registration for each type and location of endometriotic implant.

Vincristine is associated with the risk of azoospermia in adult male survivors of childhood malignancies

Of 55 males, currently above 18 years of age, diagnosed with and treated for different malignancies in childhood between 1960 and 1985 at a single institution, 28 (51%) were azoospermic. The age of the patient, testicular irradiation, four different therapeutic agents (L-asparaginase, cyclophosphamide, doxorubicin, vincristine) and one combination (MOPP, nitrogen mustard, vincristine, procarbazine, prednisone) were each associated with the risk of azoospermia. However, in multivariate analysis vincristine had the statistically most significant independent effect on the risk of azoospermia, the risk being 5-fold (95% confidence limits 1.3-18.8, P = 0.02) that in patients who had not received vincristine. The risk of azoospermia in patients who had received cyclophosphamide was 3.4-fold (0.95-12.3, P = 0.06) and in those who had received testicular irradiation it was 8.2-fold (0.75-90.9, P = 0.09) that of others. Normospermia (22% of patients) was not incompatible with any of the more commonly used modes of therapy. We conclude that vincristine may have a previously unrecognised important role in causing azoospermia, possibly irreversible, when administered in childhood or adolescence.

Peritoneal fluid 6-keto-prostaglandin FLα, thromboxane B2 in endometriosis and unexplained infertility

Abstract. To study peritoneal fluid (PF) prostaglandin (PG) in infertile women, 6‐keto‐PGFla (a breakdown product of prostacyclin) and thromboxane B2 (T × B2) (a metabolite of T × A2) were assayed with radio‐immunoassays from PF samples collected at laparascopy from patients with endo‐metriosis (n = 29), unexplained infertility (n = 13) and from women with normal pelvic organs (n = 25). The concentrations of 6‐keto‐PGFla and T×82 in PF were increased (p<0.05) in endometriosis and unexplained infertility, as compared with the corresponding levels in the controls. In patients with endometriosis, both 6‐keto‐PGFla and T × B2 increases were related to the severity of the disease. There was no relationship between 6‐keto‐PGF1α × B2 in PF, and day of menstrual cycle. It is suggested that endometriotic tissue and peritoneal macrophages may contribute to these prostanoids in PF. The smooth muscle activities of PF prostacyclin and T × A2 may be involved in infertility by interfering with tuba1 function.

The occurrence of relaxin in hyperstimulated human preovulatory follicles collected in an in vitro fertilization program

The avidin-biotin immunoperoxidase method and antisera against highly purified porcine relaxin were utilized to localize relaxin-like immunoreactivity in biopsied specimens from six preovulatory follicles from four women undergoing laparoscopy for oocyte retrieval in an in vitro fertilization program. By histological criteria, three of the follicles were luteinized and three were not. Relaxin was found in the granulosa cells of those cells which showed histological luteinization, whereas no relaxin was found in the nonluteinized preovulatory follicles. Our results show, for the first time, the occurrence of relaxin in the human ovary before ovulation and they suggest that the appearance of relaxin is related to the luteinization process.