George E. Tagatz

Pregnancy and systemic lupus erythematosus

Eleven patients with 18 pregnancies occurring during the course of systemic lupus erythematosus (SLE) were reviewed. Ten had long-standing lupus glomerulonephritis and a single patient developed glomerulonephritis during pregnancy. Patients were divided into those without (Group A) and those with (Group B) clinical evidence of renal disease or active SLE at conception. In Group A there were 10 pregnancies in five patients; all pregnancies were uncomplicated, except for mild superimposed pre-eclampsia in two, and all resulted in term delivery. Eight pregnancies in six patients occurred in Group B; four pregnancies were complicated by severe (2) or mild (1) superimposed pre-eclampsia and the onset of glomerulonephritis (1), resulting in three premature deliveries and a spontaneous abortion. The remaining four pregnancies were uncomplicated but resulted in one term delivery, one elective abortion, and two spontaneous abortions. None of the patients developed either renal failure or a rapidly progressive course following pregnancy.

Epidermal growth factor in human follicular fluid stimulates mouse oocyte maturation in vitro

OBJECTIVE To study the effect of human follicular fluid (FF) and the specific contribution of its epidermal growth factor (EGF) component on the in vitro maturation of cumulus-enclosed mouse oocytes. DESIGN A previously described mouse oocyte model system was used to study the effect of FF on oocyte maturation before and after extraction of EGF by immunoprecipitation. Follicular fluid specimens enclosing both mature and immature human oocytes were tested. MAIN OUTCOME MEASURES The endpoints assessed were the percentage of oocytes undergoing germinal vesicle breakdown (GVBD) and polar body one formation at different intervals over a 24-hour period and the final degree of cumulus expansion achieved. RESULTS A concentration-related stimulatory effect of mature FF was noted when compared with the spontaneous increase of GVBD and polar body one formation observed for the EGF-free control medium. Overall, the effect of immature FF was inhibitory. After extraction of EGF from FF by immunoprecipitation from both immature and mature FF, the rates of GVBD and polar body one formation were decreased in both groups. The addition of 5 ng/mL of EGF to the extracted groups reversed this effect on polar body one formation. Cumulus expansion was maximal for oocytes incubated with mature FF and minimal for those incubated with EGF-free media. CONCLUSIONS The positive effect of mature human FF on mouse oocyte maturation and cumulus expansion is to a large extent because of the presence of EGF.

The effect of vaginal lubricants on sperm motility and viability in vitro

2 surgical lubricants commonly available in the U.S. were demonstrated to have a spermicidal effect in vitro on human spermatozoa obtained from the male partners of infertile couples. After incubation with either KY or Surgilube for 15 minutes, no motile or viable sperm were present in 80% of the semen specimens, and less than 5% of the spermatozoa were either motile or viable in the remaining 20% of the specimens. After 30 minutes of incubation no motile or viable spermatozoa were found. The lubricants had a similar effect on both the 8 normal and 12 abnormal semen specimens. Unpublished studies at Wellcome Foundations Veterinary Research Laboratories showed that a third lubricant, Lubafax, has a spermicidal effect in cattle, attributed by the Wellcome investigators to the spermicidal effect of the bactericide in Lubafax. The findings suggest that these products should not be used for vaginal lubrication by the infertile couple.

Intrauterine insemination: the University of Minnesota experience

Forty-five patients initiated intrauterine insemination between October 1981 and August 1983. Indications for insemination included poor semen (count less than 20 X 10(6)/ml and/or motility less than 40%), poor cervical mucus, presence of sperm antibodies, unexplained poor postcoital tests, or various combinations of the above. During this time period, 374 inseminations were performed in 163 cycles and resulted in eight pregnancies in the 45 patients receiving artificial insemination by homologous donor, for an overall pregnancy rate of 17.4%. The fact that five of the pregnancies occurred in the first insemination cycle and two in the second cycle was felt to indicate a cause-and-effect relationship. A trial of intrauterine insemination in selected patients would appear to be warranted.

Hypothalamic pituitary gonadal axis dysregulation in depressed women.

In order to examine HPG axis regulation in women with major depression, luteinizing hormone (LH) pulsativity was studied in 26 depressed and 24 normal women. Blood was sampled every 10 min for an 8-h period during the first week of their menstrual cycle. LH pulsatile release was analyzed using the computerized cluster analysis algorithm of Veldhuis and Johnson and spectral analysis. Compared to control women, depressed women had slower frequency dysrhythmic LH pulsatility. These results are consistent with a previously published pilot study which reported results of the first 23 subjects [Am. J. Psychiat. 154 (1997) 1454].

Gonadoblastoma. Ultrastructural evidence for testicular origin

A gonadoblastoma arising in the dysgenetic gonad of a virilized 17‐year‐old Caucasian with a female phenotype and with a 45,X0/46,X‐ring‐Y genotype was studied by light microscopic histochemistry, electron microscopy, and ultrastructural histochemistry. The gonadoblastoma was composed of nests of cells containing large germ cells and small “granulosa‐Sertoli‐like cells,” and stromal tissue containing “Leydig‐like cells.” The germ cells were identical to those found in normal fetal gonads and in germ cell tumors. Charcot‐Böttcher crystaloids present in the “granulosa‐Sertoli‐like cells” strongly suggest that they are, in fact, Sertoli cells. Multilayered basal laminae located in the periphery of the tumor nests and in “hyaline bodies” were identical to those surrounding the seminiferous tubules of the adult testis. The “Leydig‐like cells” present in the stroma contained occasional dense bodies and crystalloids which characterize the Leydig cells of the fetal testis. Delta 5‐3 beta hydroxysteroid dehydrogenase activity was demonstrated in the periphery of lipid droplets and lysosome‐like dense bodies of the Leydig cells, and in some Sertoli cells. The findings support the theory that gonadoblastoma arises in a dysgenetic testis rather than in a dysgenetic ovary.

A comparison of 17β-hydroxysteroid oxidoreductase type 1 and type 2 activity of cytosol and microsomes from human term placenta, ovarian stroma and granulosa-luteal cells

A large body of evidence suggests multiple forms of 17 beta-hydroxysteroid oxidoreductase (17-HOR) regulate estrogen and androgen levels within gonadal and peripheral tissues. Two kinetically-differing 17-HOR activities have been detected in placental homogenates. 17-HOR type 1, found mainly in the cytosol, is highly reactive with estradiol-17 beta (E2) and estrone (E1) but not testosterone (T) (high E2/T activity ratio). Microsomal 17-HOR type 2 is reactive with both E2 and T (low E2/T activity ratio). In this study, 17-HOR activity of cytosol and microsomes from term placenta, ovarian stroma and granulosa-luteal cells was assayed under conditions which specifically differentiate between the two forms of the enzyme. Placenta had the highest activity with either E2 or T in both cytosol and microsomes and stroma the lowest. The highest specific activity with E2 and E1 was cytosolic in all samples. The highest specific activity with T was microsomal in placenta and ovarian stroma. E2/E1 activity ratios were comparable for cytosol and microsomes while E2/T activity ratios were comparable for placenta and stroma, but markedly elevated in granulosa-luteal (G-L) cell cytosol and microsomes. The results indicate trophoblast and ovarian stroma have more 17-HOR type 2 relative to type 1. G-L cells, in contrast, are relatively enriched in 17-HOR type 1 and thus have a greater capacity for net conversion of E1 to E2 under physiologic conditions. These differences may contribute to increasing serum and follicular fluid E2/E1 ratios during development of the dominant follicle.

Pregnancy in a Juvenile Diabetic After Renal Transplantation (Class T Diabetes Mellitus)

The successful outcome of a pregnancy in a juvenile diabetic after renal transplantation is reported. It is proposed that class T be added to the classification of pregnancies complicated by diabetes mellitus. Pregnancy prevention should be considered until significant longevity can be demonstrated in diabetics receiving renal transplants.

Lipid cell tumor of the ovary: an ultrastructural study.

An ovarian lipid cell tumor without Reinkes crystalloids in a woman with secondary amenorrhea, minimal hirsutism, and elevated 17‐ketosteroid excretion was studied by light and electron microscopy. Tumor cells were found in small clumps or scattered singly within a collagenous matrix. The cytoplasm of the tumor cells contained abundant smooth endoplasmic reticula, numerous mitochondria with tubular cristae, lipid droplets, lysosomal dense bodies, and concentric membranous whorls, characteristic of steroidogenic cells. In addition, “peripheral canalicular systems” were found at the outer margins of the nests of the tumor cells. These “peripheral canalicular systems” were bordered by the cell membranes and the surrounding collagenous stroma into which microvilli projected. Since the intercellular canalicular system present between the tumor cells was continuous with the “peripheral canalicular system,” both systems probably have a common function related to steroid metabolism. The intercellular and “peripheral” canalicular systems and cytoplasmic microfilaments found in this tumor suggest that this ovarian lipid cell tumor was derived from the ovarian stroma. Cancer 40:234–243, 1977.

Unconjugated estriol and 15α-hydroxyestriol in complicated pregnancies

Abstract Simultaneous determinations of unconjugated estriol and 15α-hydroxyestriol (E 4 ) levels in maternal serum were studied serially to ascertain the relative usefulness of these estrogens as indicators of fetal welfare. Complicated pregnancies included 16 patients with pre-eclampsia and/or hypertension, six patients with severe Rh-isoimmunization, 12 patients with diabetes mellitus, of which four had vascular disease, three patients with fetal death in utero, and three twin pregnancies. Retrospective analysis failed to indicate a clinically useful role for serum E 4 determinations in the evaluation of fetal welfare during high-risk pregnancies.