Jerome H. Check

EFFECT OF AN ABNORMAL SPERM CHROMATIN STRUCTURAL ASSAY (SCSA) ON PREGNANCY OUTCOME FOLLOWING (IVF) WITH ICSI IN PREVIOUS IVF FAILURES

A high DNA fragmentation index (DFI) when performing the sperm chromatin structural (SCSAr) assay was claimed to be so specific for male subfertility that even IVF with ICSI did not result in live pregnancies. The present study was designed to corroborate or refute these findings. The SCSA test was performed on the male partner from couples failing to have a successful pregnancy despite at least 2 previous IVF attempts. In contrast to the aforementioned studies, ongoing pregnancies were found despite working with a group of recalcitrant patients. Nevertheless, a high DFI score was associated with a trend for lower ongoing pregnancy rates especially related to a high miscarriage rate. Other more recent studies seem to support our conclusions. A high DFI score should influence a patient to choose IVF as a therapeutic modality sooner, especially with ICSI.

The hypoosmotic swelling test as a useful adjunct to the semen analysis to predict fertility potential

The sperm HOS test was highly predictive of eventual achievement of pregnancy in women in whom other infertility factors had been corrected. No woman conceived whose partners HOS was less than 50%. The results of spermiograms did not correlate with conception rate.

Evaluation of sperm morphology using Kruger's strict criteria.

Prospective and retrospective studies were conducted to evaluate sperm morphology using strict criteria for predicting fertilization capacity in males. Severely impaired male fertility potential was measured by a result of less than or equal to 4% (denotes percentage sperm having normal morphology) and scores of greater than 14% indicated normal fertilization potential. There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of less than or equal to 4% vs. those with 14% or greater (chi 2 analysis): the prospective study showed a 41% pregnancy rate in less than or equal to 4% group vs. 29% rate in greater than 14% group (p = 0.44 NS); the retrospective analysis showed a 50% pregnancy rate in the group with less than or equal to 4% morphology scores vs. 67% in greater than 14% group (p = 0.45 NS). When only the men with normal motile density (greater than 10 x 10(6)/ml) were evaluated, a statistical difference was found in the retrospective study between the group with morphology results greater than 14% (93%) vs. the group less than or equal to 4% (40%). However, the 56% success rate in the men with less than 10 x 10(6)/ml sperm and normal morphology less than or equal to 4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria.

The risk of fetal anomalies as a result of progesterone therapy during pregnancy.

The incidence of congenital anomalies in infants born to 382 women treated with P was noted. Only five anomalies occurred in the infants born to women who had taken P. This study supports the data of Rock et al. by demonstrating a similar low incidence of birth defects in a much larger series of patients who also took a much higher dosage of P. Similarly, because only 1 of 189 patients treated with both P and 17-OHP developed anomalies, the data supports the study by Katz et al., suggesting no increase in anomalies related to 17-OHP therapy.

Correlation of semen analysis and hypoosmotic swelling test with subsequent pregnancies

The hypoosmotic swelling (HOS) test was evaluated in 40 men whose wives had no apparent fertility factors. Only one of 29 men with normal semen parameters had a surbnormal HOS test, and that couple failed to conceive compared to 27 of 28 with normal HOS test who did conceive. All five couples with husbands with subnormal semen parameters but with normal HOS tests achieved a pregnancy, but none of the three with abnormal HOS tests achieved a pregnancy. The results suggest that the HOS test might be of value in predicting which couples should be more patient despite low semen parameters.

Semen Characteristics and Infertility in Aging

A study was initiated to compare the spermiograms according to age in 570 consecutive men with a history of infertility. The semen was evaluated by computer-assisted semen analysis (CSA) and by the hyposmotic swelling test (HOS). A statistical difference was seen between men over 50 years of age compared with younger men, but only for the HOS scores and velocity. No statistical differences were found on any of the other parameters. Since most semen parameters were similar even in the men over age 50, a definite decline in fertility potential with increasing age could not be determined by this study.

Male Sex Preselection: Swim-Up Technique and Insemination of Women After Ovulation Induction

Insemination of women with sperm treated by the swim-up technique resulted in 81% male offspring. This was achieved even in women taking ovulation-inducing drugs, in whom the albumin gradient separation technique not only is not effective in male preselection but in which the female sex is favored. Confirmation of these initial data is needed as well as an investigation of the swim-ups efficacy of producing male offspring in women not taking ovulation-inducing drugs.

Improved semen quality after a short-interval second ejaculation

Les auteurs montrent que chez les oligospermiques plus que chez les sujets normaux, une 2eme ejaculation 30 a 60 minutes apres la 1ere fournit un specimen plus riche en spermatozoides. Ceci peut etre le fait de la reduction du volume seminal. Il semble que ceux qui ameliorent leur score dans le 2e ejaculat obtiennent des grossesses plus facilement

Ovulation induction and pregnancy with an estrogen-gonadotropin stimulation technique in a menopausal woman with marked hypoplastic ovaries

A case is described of a woman with ovarian failure and documented atrophic ovaries in whom ovulation was achieved with the use of high-dose estrogen and human menopausal gonadotropins. The proposed mechanism involves a reduction in the elevated gonadotropins, which restored an adequate number of receptors. Thus sensitivity to exogenous menotropins was reestablished.

False-positive human chorionic gonadotropin levels caused by a heterophile antibody with the immunoradiometric assay

A case of a false-positive test for the beta-subunit of human chorionic gonadotropin as performed by the immunoradiometric assay is described. Further studies revealed that this problem was secondary to a cross-reacting heterophile antibody.