Elizabeth A. Kennard

Activin a stimulates meiotic maturation of human oocytes and modulates granulosa cell steroidogenesis in vitro

OBJECTIVE To test the hypothesis that activin A promotes in vitro human oocyte meiotic maturation while inhibiting steroid secretion by nonluteinized antral granulosa cells. DESIGN Prospective randomized controlled study. SETTING A university medical center. PATIENT(S) Nine women ranging in age from 31-44 years who were undergoing oophorectomy for nonovarian pathology. INTERVENTION(S) Analysis of meiotic maturation of oocytes and steroid secretion by granulosa cells cultured in the presence or absence of activin A. MAIN OUTCOME MEASURE(S) Germinal vesicle breakdown (GVBD) and attainment of metaphase II (MII) in oocytes, and progesterone and E2 secretion by granulosa cells. RESULT(S) Activin A significantly enhanced GVBD (91% vs. 65%) for control and maturation to MII (56% vs. 35% for control) of immature oocytes. Activin A significantly suppressed basal, and inhibin A-and FSH-stimulated progesterone and E2 secretion by nonluteinized granulosa cells. CONCLUSION(S) Activin A is a promoter of oocyte maturation in vitro and a modulator of granulosa cell steroidogenesis in culture.

Elevated level of follicular fluid vascular endothelial growth factor is a marker of diminished pregnancy potential

OBJECTIVE To evaluate whether differences in follicular fluid vascular endothelial growth factor (FF VEGF) concentrations are observed between women achieving a clinical pregnancy and those failing to conceive. DESIGN Retrospective chart review and analysis of FF VEGF concentrations. SETTING University teaching center. PATIENT(S) Fifty-seven women < or =42 years of age undergoing follicular aspiration in preparation for IVF or GIFT. INTERVENTION(S) Analysis of FF VEGF concentrations and chart review of a single IVF or GIFT cycle. MAIN OUTCOME MEASURE(S) Follicular fluid VEGF concentrations, clinical pregnancy rate, age, ampules of gonadotropins used, oocytes retrieved, peak estradiol serum concentrations, day 3 FSH levels, and fertilization rate. RESULT(S) Women who did not conceive had higher FF VEGF concentrations than women achieving a clinical pregnancy (4.409 + 2,387 versus 2.793 +/- 1,180 pg/mL: P < .001). A negative correlation was observed between FF VEGF concentrations and peak estradiol levels and number of oocytes retrieved. A positive correlation was found for FF VEGF and patients age and ampules of gonadotropins used. CONCLUSION(S) Elevated FF VEGF concentrations are associated with poor conception rates after IVF or GIFT.

Interleukin-1β induces cyclooxygenase-2 in cultured human decidual cells

PROBLEM: The purpose of this study was to examine the hypothesis that interleukin‐1β (IL‐1β)‐elicited increases in decidual prostaglandin E2and F2α (PGE2 and PGF2α) biosynthesis are due to the de novo expression of the inducible isoform of cyclooxygenase (i.e., COX‐2).

Effects of ovarian source, patient age, and menstrual cycle phase on in vitro maturation of immature human oocytes.

OBJECTIVE To determine the efficiency of in vitro maturation, expressed by nuclear maturation, of oocytes aspirated during gynecologic surgeries or collected from excised ovaries. To assess the effect of patient age and cycle phase at collection on the oocytes ability to mature in vitro. To examine the time course of oocyte maturation in vitro. DESIGN Nuclear maturation based on patient criteria compared. SETTING University-based IVF program and research center. PATIENT(S) Consented patients undergoing gynecologic surgeries or patients undergoing oophorectomy. INTERVENTION(S) Oocytes were maintained in culture for 48 hours and evaluated for maturation. MAIN OUTCOME MEASURE(S) Nuclear maturation evaluated as germinal vesicle breakdown (GVBD) or progression to the metaphase II (MII) stage. RESULT(S) A significantly higher percentage of oocytes collected during the follicular phase of the menstrual cycle underwent GVBD than did oocytes collected during the luteal phase (60% versus 48%, respectively). The percentage of oocytes reaching the MII stage, from these two groups, was not different. No statistically significant differences in maturation were observed in oocytes from different ovarian sources or from patients >40 or <40 years of age. CONCLUSION(S) These data suggest that oocytes collected during the follicular phase are more likely to undergo GVBD than oocytes collected during the luteal phase. In this study, ovarian source, age, or cycle phase did not influence the final meiotic maturation of oocytes to metaphase II.

Juxtaposition of contralateral ovary and fallopian tube to allow pregnancy in unicornuate uterine anomaly

Infertile patients who have undergone unilateral oophorectomies or salpingectomies or those with uterine anomalies may require juxtaposition of a remaining fallopian tube and contralateral ovary. A 28-year-old woman with previous left oophorectomy for endometriosis was found to have a left unicornuate uterus during subsequent infertility evaluation. Laparotomy and resection of a right rudimentary horn and juxtaposition of the left fallopian tube and the right ovary was performed. A large endometrioma was also resected from the right ovary. The patient conceived during the second month postoperatively. A simple procedure for juxtaposing a contralateral fallopian tube and ovary is described. Careful evaluation of the pelvic organs should be performed before removal of an ovary in a young woman.