Fawzia Al-Qattan

Seminal immune response in infertile men with leukocytospermia: effect on antioxidant activity

OBJECTIVE To investigate the incidence of leukocytospermia and relation to T helper cytokines, tumor necrosis factor alpha (TNFalpha) and interleukin-4 (IL-4), antisperm antibodies and antioxidant activity. DESIGN Semen samples from 176 infertile men and 24 fertile controls were investigated. METHODOLOGY The protocol included tubal patency test, hysterosalpingography and laparoscopy and dye test and ovulation through mid-luteal phase progesterone for the wives. The husbands had semen analysis, cytomorphology evaluation and semen culture. Seminal TNFalpha and IL-4, antisperm antibodies, total antioxidant activity, superoxide dismutase and zinc were determined. RESULTS Leukocytospermia occurred in 44.3% of the infertile men compared to 12.5% of the fertile men (P<0.01). Thirty-six (20.5%) men had pathogenic bacterial organisms which constituted 46.2% of those with leukocytospermia. Sperm parameters were worse with leukocytospermia in terms of sperm count (P<0.01), total motility progressive motility (P<0.01), morphology, asthenozoospermia, sperm membrane integrity and antisperm antibodies. TNFalpha and IL-4 had an inverse relationship; the expression of TNFalpha was higher with leukocytospermia and bacteriospermia (P<0.001), while IL-4 was higher in fertile controls (P<0.005). Incidence of antisperm antibodies was higher with leukocytospermia. Total antioxidant activity, superoxide dismutase and zinc were lower with leukocytospermia. CONCLUSION Leukocytospermia impairs sperm function through reduced antioxidant activity and enhanced T helper 1 modulation.

Differential Levels of Interleukin 6 in Maternal and Cord Sera and Placenta in Women with Pre-Eclampsia

Background: Interleukin 6 (IL-6) is a T helper 2 cytokine with a variety of properties including pro-inflammatory characteristics. It has, therefore, been implicated in the pathophysiology of abnormal pregnancies. Objective: To investigate the association between IL-6 and pre-eclampsia by estimating the differential levels of IL-6 in maternal and cord serum and supernatant of homogenized placental tissue. Methods: 50 primigravidae with pre-eclampsia and 50 matched normotensive primigravidae served as controls. At delivery, maternal and cord blood were collected and the serum extracted. Placental blocks were homogenized and sonicated in RPMI solution and the supernatant collected. The total protein concentration was determined and IL-6 levels assayed with an ELISA technique. Results: Placental IL-6 (170 and 186 pg/mg protein) was threefold that in the maternal (64 and 58 pg/mg protein) and cord serum (63 and 72 pg/mg protein; p < 0.01). There was no significant difference in the mean IL-6 levels in maternal and cord serum or placenta in both pre-eclamptic women and normotensive controls nor in pre-eclamptic patients with babies with intra-uterine growth restriction or in pre-eclamptic patients with babies with an appropriate birth weight and in normotensive controls. Conclusion: There are no differences in the maternal and cord sera and placental levels of IL-6 in pre-eclamptic and normotensive women, indicating that IL-6 may not have a role in the pathophysiology of pre-eclampsia.

Effect of low dose continuous corticosteroid therapy in men with antisperm antibodies on spermatozoal quality and conception rate

The use of steroids for treating male immunological infertility is controversial. The effect of low dose prednisolone on sperm quality in men with antisperm antibodies and the conception rate, was evaluated in 40 men and their wives. Significant circulating antisperm antibodies were detected by immunofluorescence technique. Prednisolone (5 mg) was administered orally, daily for 3-6 months in men with significant antisperm antibodies. Another group of 37 men with significant antisperm antibodies, formed the control group. Both groups had initial pre- and post therapy semen analysis and hypoosmotic swelling (HOS) test. They were followed up for 12-18 months and the pregnancy outcome documented. There were significant improvement in sperm motility and hypoosmatic swelling test with therapy (P < 0.01, P > 0.05) of 13 and 15%, respectively. The pregnancy rate of 20% was much greater than 5% in the control group (P < 0.01). There were no side effects of prednisolone. Low dose prednisolone is useful in Antisperm antibody associated infertility, by improving the sperm quality and giving rise to pregnancies.

Connection between human leucocyte antigens D region and T helper cytokines in preeclampsia

Abstract. Preeclampsia is a common and major cause of maternal and perinatal morbidity and mortality. Human leucocyte antigen (HLA) susceptibility and impaired adaptation of the T lymphocyte sub-population and a bi-directional effect of T helper cytokines on the outcome of pregnancy have been reported in patients with preeclampsia. The association between maternal HLA class II and T helper cytokines in women with preeclampsia was investigated in seventy-six preeclamptic women and normotensive controls using Terasaki microlymphocytotoxicity test. T helper cytokines interleukin (IL)-8, IL-6, IL-4, tumour necrosis factor (TNF)-α and interferon (IFN)-γ were estimated in the maternal blood and placenta by enzyme-linked immunosorbent assay (ELISA). Histopathological evaluation of the placenta was also carried out. HLA class II DR2, DR4, DR5, DRw8, DRw10, DRw11, DRw18, and DQw2 had significant relative risk ratios for preeclampsia, while DQw3 was more common in the controls. DR4-DRw11-DQw2 haplotype was more common in preeclamptic women with intrauterine growth restriction, low birth weight and placental weight, increased expression of T helper cytokines IL-8, TNF-α and IFN-γ and abnormal uteroplacental vasculature. These findings suggest that HLA class II DR4-DRw11 -DQw2 haplotypes may be associated with preeclampsia with intrauterine growth restriction through low placental weight from impaired placental development, as a result of increased expression of T helper 1 cytokines IL-8, TNF-α and IFN-γ.

A Prospective Randomized Study Comparing Nifedipine versus Ritodrine for the Suppression of Preterm Labour

Nifedipine is a dihydropyridine and a calcium channel blocker during the second phase of the action potential of uterine smooth muscle cells, and ritodrine is a β-sympathomimetic. Objective of Study: To compare the efficacy and side-effects of oral nifedipine to ritodrine in the inhibition of preterm labour. Methodology: Sixty parturients admitted to the Maternity Hospital with preterm labour who fulfilled the inclusion criteria were randomized into two equal therapy groups: (a) oral nifedipine (n = 30) and (b) intravenous ritodrine (n = 30). During the period, the parturients were under continuous monitoring of fetal well-being, maternal uterine contractions, blood pressure, and pulse and respiratory rates. Both groups were given dexamethasone and followed up through delivery and the early neonatal period. Results: The incidence of preterm deliveries during the study period was 6.5%. Ritodrine had a quicker onset of inhibition of uterine contractions, especially between 20 and 40 min after initiation of tocolytic therapy (p < 0.04). Labour was delayed on the average for 40 h in the nifedipine group compared to 24 h in the ritodrine group (p < 0.05). Eighteen patients (60%) in the nifedipine group had cessation for more than 48 h compared to 7 (30.4%) in the ritodrine group (p < 0.05). Nifedipine inhibited uterine contractions for more than 7 days in more patients than ritodrine (13 versus 5, p < 0.05). Ten patients in the nifedipine group went beyond 36 weeks of gestation compared to 4 in the ritodrine group (p < 0.03). In 5 (17.9%) of the ritodrine group compared to none in the nifedipine group, treatment was abandoned because of severe side-effects of nausea (11 versus 2, p < 0.01) and palpitations (16 versus 3, p < 0.004). There were no significant differences in the Apgar scores and neonatal morbidity. More infants in the ritodrine group (17, 73.9%) than in the nifedipine group (14, 46.1%, p < 0.05) were admitted to the neonatal unit. Conclusion: Nifedipine is recommended for aborting preterm contractions because it has fewer side-effects, superior efficacy and greater ease of administration than intravenous ritodrine.

Human leucocyte antigens in pregnant women with pre-eclampsia associated with intrauterine growth retardation and in normal controls

Abstract.Objective: To investigate the association between maternal HLA class II and intrauterine growth retardation with associated birthweight of the newborn, in women with preeclampsia. Methodology: Thirty preeclamptics and 30 normotensive matched for age, parity and gestation were investigated for HLA class II profile using Terasaki microlymphocytotoxicity test as the typing technique. The outcome of the pregnancy in terms of intrauterine growth retardation, birthweight and placental weight, were investigated to elucidate a susceptibility factor in the HLA Class II profile of the preeclamptic women. Results: HLA class II DR2, DR4, DRw11, DRw14 and DQw2 were more common in the preeclamptic women (p<0.04, 0.03, 0.05, 0.03, 0.05), while DQw3 was more common in the controls (p<0.05). Mean birthweight was 2.71±0.73 kg with preeclampsia compared to 3.4±0.4 kg for controls (p<0.01). Low birthweight was 56.7% versus 6./% (p<0.001) and mean placental weight was 474.8±100.8 gm versus 692.1±107.3 gm (p<0.01). DR4 and DQW2 were significantly associated with intrauterine growth retardation with associated low birthweight and placental weight (p<0.01). Conclusion: HLA class II hyaplotypes DR4, and DQw2 are associated with intrauterine growth retardation with associated low birthweight and placental weight through preeclampsia. The association between intrauterine growth retardation and HLA may be a direct susceptibility factor. This needs further elucidation.

A comparative study of obstetric outcome of patients with pregnancy induced hypertension: economic considerations

Background. Hypertension in pregnancy is associated with increased maternal and fetal morbidity and mortality. The aim of this prospective study was to evaluate the obstetric outcome of patients with pregnancy induced hypertension (PIH) that delivered at the Maternity Hospital Kuwait within a period of six months and evaluate the economic implications of present management strategies.

Effect of antihypertensive therapy in preeclampsia on levels of serum interleukin-4

We investigated the effects of antihypertensive therapy on serum levels of interleukin-4 using InterTest-4 ELISA in 25 preeclamptic women; 14 were placed on treatment, while 11 were not. Comparison was made with 14 non-preeclamptic pregnant controls. Interleukin-4 levels were significantly lower in the controls than in the treated preeclamptic women (p < 0.001): 68.6 +/- 10.9 versus 106.1 +/- 13.2, 64.7 +/- 9.6 versus 119.8 +/- 11.4, 90.2 +/- 9.1 versus 124.3 +/- 15.7, and 65.6 +/- 3.6 versus 109.7 +/- 11.4 pg/ml, during antepartum, early intrapartum, late intrapartum and postpartum periods, respectively. No significant differences were detected between the therapy and no therapy subgroups (p > 0.05). This shows that antihypertensive therapy has no effect on interleukin-4 levels.

ABO Blood Group and Expression of Antisperm Antibodies in Infertile Couples in Kuwait

Two hundred and fifty infertile couples and 102 fertile controls were evaluated to determine the association between ABO blood group status and seminal blood group substances among infertile couples and expression of circulating antisperm antibodies. Antisperm antibodies occurred in 18.8 and 17.7% of the infertile men and women, compared to 3.9% in the fertile women (p < 0.01). The 23 ABO blood group combinations in the infertile and fertile couples revealed no significant association with infertility except the predominance of B+/O+ spouses in the fertile group (p < 0.03). Although 76.8% of the men were secretors of seminal blood group substances, there was no significant association with development of antisperm antibodies. This shows that ABO blood group is not directly associated with infertility nor antisperm antibody formation.

Causal Factors and Management Options of Infertility in Kuwait

Objective: To determine the main causes and management options of infertility in Kuwait. Methodology: Clinical evaluation, hormone profile of LH, FSH, prolactin and testosterone and midluteal phase progesterone, tubal patency tests, semen analysis and antisperm antibodies were assessed. Treatment included medical and surgical induction of ovulation. Male factor infertility was treated with antibiotics and immunosuppression when indicated, and empirically with antioxidants. Results: The main cause of female infertility was ovarian dysfunction (40.7%) with predominance of polycystic ovarian syndrome (52.9%), anovulatory regular cycles (25%) and hyperprolactinaemia (14.3%). Male factor accounted for infertility in 40.2% of the couples, with asthenozoospermia in 34.3%, oligozoospermia in 29.2% and azoospermia in 8.2%. Immuological tubal factors and endometriosis occurred in 9.8, 5.9 and 5.6%, respectively, and unexplained infertility in 8.5%. Both spouses were involved in 36.5% of the couples. Clomiphene citrate was the commonest agent for induction of ovulation with an 80% success rate. Bromocriptine, gonadotropins and laparoscopic ovarian cautery had success rates of 71, 69, and 80%, respectively. Treatment outcome in male factor infertility was variable. Conclusion: Ovarian dysfunction and male factor infertility are the dominant factors responsible for infertility in Kuwait. Induction of ovulation has a good prognosis of 40–80% success rate. Tubal factor infertility is uncommon in Kuwait.