Claude Humeau

Ovarian stimulation by a combination of a gonadotropin-releasing hormone agonist and gonadotropins for in vitro fertilization

In the first of two studies, 20 patients were selected on the basis of tubal infertility and were randomly assigned to two groups receiving different ovarian stimulation protocols. In group A, 10 patients were given follicle-stimulating hormone (FSH), FSH was continued until the criteria for human chorionic gonadotropin (hCG) administration were satisfied. In group B, 10 patients received Buserelin (0.3 ml twice a day subcutaneously) for 14 days to induce pituitary desensitization. Stimulation with FSH was then started, and Buserelin treatment was continued until hCG administration. In the second study, patients were included if they had had at least two previous attempts at ovarian stimulation that failed to reach the stage of follicular aspiration. Ovarian stimulation was conducted with a combination of Buserelin and human menopausal gonadotropin. Use of the gonadotropin-releasing hormone (GnRH) agonist in in vitro fertilization increased the number of oocytes collected, the fertilization rate, the length of the luteal phase and the pregnancy rate. The GnRH agonist also contributed to a generally better ovarian response in patients whose estradiol production had previously responded poorly to conventional ovarian stimulation protocols.

Does previous salpingectomy improve implantation and pregnancy rates in patients with severe tubal factor infertility who are undergoing in vitro fertilization? A pilot prospective randomized study

OBJECTIVE To evaluate the implantation rate and pregnancy rate (PR) in patients with severe tubal factor infertility who were undergoing IVF. Patients who had undergone salpingectomy were compared with those who had not. DESIGN A prospective randomized study. SETTING A department of obstetrics and gynecology at a university hospital. PATIENT(S) Thirty patients who previously had undergone salpingectomy and 30 patients who had not undergone salpingectomy before IVF treatment. INTERVENTION(S) Laparoscopy with or without salpingectomy followed by IVF with the use of combined GnRH agonist and hMG therapy in a long stimulation protocol. MAIN OUTCOME MEASURE(S) Embryo implantation rate and ongoing PR per transfer. The cumulative PRs were compared for the two groups of patients. RESULT(S) After the first IVF attempt, the implantation rate was 10.4% in the group with salpingectomy and 4.6% in the group without salpingectomy. For all IVF attempts, the respective embryo implantation rates in the two groups were 13.4% and 8.6%. The ongoing PR per transfer was 34.2% in the group with salpingectomy compared with 18.7% in the group without salpingectomy. After four IVF attempts, the probability of becoming pregnant was greater in the group of patients with salpingectomy (75%) than in the group without salpingectomy (63%). CONCLUSION(S) Previous salpingectomy in patients with severe tubal factor infertility who are undergoing IVF seems to increase the embryo implantation rate and the PR per cycle of IVF. This monocentric study must be followed by other similar studies to allow for a metaanalysis and confirm this clear trend with definitive evidence.

Early effect of estrogen on chromatin ultrastructure in endometrial nuclei

The effect of estradiol on chromatin ultrastructure in interphase nuclei was studied in immature rat and lamb endometrium. Physiological doses of estradiol within the first hour transformed the condensed chromatin into dispersed chromatin both in vivo and in vitro. These ultrastructural modifications were specifically induced by hormones translocating the estrogen receptor to the nucleus of estrogen-responsive tissues. Conversely, the antiestrogen tamoxifen gave a hypercondensation of chromatin. The addition of actinomycin D, cordycepin or alpha-amanitin, but not of cycloheximide, prevented the effect of estradiol both on the ultrastructural change and on [3H]uridine incorporation, suggesting that chromatin decondensation was closely related to transcriptional activity. These results indicate that in endometrium, estrogen rapidly provokes a large and extended modification of chromatin ultrastructure, which suggest a general effect on chromatin function rather than a selective activation of a limited number of genes.

The fine structure of meningiomas: An attempted classification

We examined 23 meningiomas by electron microscopy. In each case it was possible to distinguish certain cells with epithelial features (desmosomes, microfilaments, interdigitating extensions) and others with fibroblastic features (collagen fibers). Others cells of transitional form were also seen. The proportion of these cellular types is variable, making it possible to classify meningiomas into seven types progressing gradually from a purely epithelial type to a purely fibroblastic one. We found no important ultrastructural abnormalities in the cells. These case reports confirm the uniqueness of meningiomas, which are composed of variously shaped cells but have their origin from a single cellular type. This has double potentiality for fibroblastic and epithelial differentiation.

Nuclear translocation of the estradiol receptor: partial inhibition by ethidium bromide

Ethidium bromide (EB), an intercalating drug, has been shown to prevent the in vitro interaction of the estrogen receptor (R) with DNA (André et al., 1976). We have now studied the effect of this drug on the nuclear translocation of R in order to determine whether DNA integrity is needed for this translocation. In a cell-free reconstituted system made of purified nuclei and cytosol, the pretreatment of nuclei by EB prevented approximately half of the R nuclear translocation, but was unable to extract more than 17% of the E2-R previously translocated. A series of indirect evidences suggests that EB inhibits the nuclear translocation of R by interacting with nuclear DNA. The degree of the inhibition was related to the amount of drug bound to nuclei and was in agreement with the degree of ultrastructural modifications of chromatin. R was not irreversibly altered by the drug. The EB inhibition was only observed with DNA-containing particles and with estrogen receptor able to bind to DNA. In surviving uteri the drug also inhibited the R nuclear translocation. These resuts indicate two types of nuclear translocation of R, one sensitive and the other resistant to EB, and suggest that DNA is required for the EB-sensitive translocation.

Tissue-type plasminogen activator level is decreased in human seminal plasma with abnormal liquefaction.

OBJECTIVE To determine plasminogen activators (PAs) and PA inhibitor levels in seminal plasma of patients attending an infertility clinic. DESIGN Quantification by immunologic method of PAs in seminal plasma. SETTING Patients of Department of Urology and Andrology, University Hospital, Nimes, France. PATIENTS Ninety-two men attending for assessment because of infertility. INTERVENTIONS Semen were collected by masturbation. Usual sperm parameters were determined; immediately after liquefaction, samples were snap-frozen at -85 degrees C until used for immunologic determination. MAIN OUTCOME MEASURES Tissue-type PA antigen, urokinase-type PA antigen, and type 1 PA inhibitor antigen levels in seminal plasma. RESULTS Median values of PA were 270 ng/mL (tissue-type PA) and 5.4 ng/mL (urokinase-type PA) in normozoospermia; 290 ng/mL (tissue-type PA) and 5.7 ng/mL (urokinase-type PA) in oligozoospermia; 325 ng/mL (tissue-type PA) and 3.5 ng/mL (urokinase-type PA) in oligoasthenozoospermia. Type 1 PA inhibitor antigen levels were often under detection limit. Tissue-type PA was 173.5 ng/mL in semen with abnormal liquefaction and 290 ng/mL in semen with normal liquefaction. CONCLUSION The study confirmed the presence of both types of PAs in seminal plasma, tissue-type PA being largely predominant. No difference was found in tissue-type PA, urokinase-type PA, or type 1 PA inhibitor antigen levels between normal and oligozoospermic semen nor between normal and asthenozoospermic semen. On the other hand, semen with abnormal liquefaction had significantly lower tissue-type PA level than normal semen.