Jørgen Grinsted

Prediction of ovulation

The purpose of this investigation was to evaluate all available ovulatory diagnostics with respect to sensitivity, specificity, diagnostic specificity (predictive value of a positive test, PVP) and diagnostic sensitivity (predictive value of a negative test, PVN). Twentyone ovulatory women with more than 3 years of infertility problems were included in the study. PVP and PVN were highest for detection of urinary luteinizing hormone (LH) peak at ovulation (PVP=90%, PVN=95%) and for serum-estradiol peak 1 day before ovulation (PVP=83%, PVN=97%). The predictive values were lower for all other tests. The PVP (54%) and PVN (90%) were rather low for detection of ovulation with vaginal electric impedance. However, all ovulations were predicted when urinary LH peak and vaginal impedance were combined. Two women were stimulated with human chorionic gonadotropin to investigate a possible connection between the LH peak and the preovulatory vaginal electric impedance. No close connection between them could be demonstrated. Basal body temperature should not be used for the prediction of ovulation (PVP=25%). We suggest that ovulation should primarily be predicted from the identification of the urinary LH peak and that other methods be supplementary.

A New Method for the Purification of Human Motile Spermatozoa Applying Density-Gradient Centrifugation: Polysucrose Media Compared to Percoll Media

AbstractPurpose: A newly developed method for the Isolation of human motile spermatozoa using density-gradient centrifugation was compared with the traditionally used Percoll technique. Method: Sperm samples were divided into two equal aliquots, which were purified with either the traditionally performed Percoll technique or a new alternative based on polysucrose/Optiprep media. For each sample the isolation was performed during the same run of the centrifuge. Results: The average recovery of progressively motile spermatozoa with the polysucrose/Optiprep method was significantly higher (48 ± 7%) than with the Percoll method (38 ± 6%) (n = 18). The average percentage of motile spermatozoa and the motility score were similar in the purified preparations. Conclusions: The new polysucrose/Optiprep-based density-gradient centrifugation technique for the isolation of motile human spermatozoa is as good as the traditionally used Percoll method and may replace it in connection with assisted reproduction techniques.

Interruption of early pregnancy with mifepristone in combination with gemeprost

BACKGROUND Mifepristone in combination with prostaglandin has been used since 1988 for induction of early abortion. The aim of the present investigation was to assess the tolerance and efficacy of 600 mg. mifepristone orally followed by gemeprost 1 mg. vaginally either 24 hours (group one) or 48 hours (group two) later. METHODS Sixty-four healthy women applying for abortion within the first 8 weeks of pregnancy were randomly allocated to one of the two treatment groups. Intrauterine pregnancy and gestational age were verified by ultrasonography. Symptoms after administration of mifepristone and gemeprost were recorded, and the patients observed at the hospital for at least three hours after prostaglandin-insertion. Blood samples for blood group, hemoglobin, beta-chorion-gonadotrophin, aspartate-aminotransferase and creatinine were drawn. RESULTS Outcome was established by gynecological examination, the level of beta-hCG and ultrasonography, at visits one, two and if necessary three to four weeks later. Surgical curettage was performed in case of incomplete abortion, of which there were four in the 24-hour interval group and five in the 48-hour interval group with a success rate (complete abortion) of 55 out of 64 patients (86%). CONCLUSIONS There was no difference in efficacy or side effects whether the prostaglandin was administered 24 or 48 hours after mifepristone intake, which suggests that the treatment period can be reduced from the conventional 48 hours.

Obstetrical complications in dichorionic twin pregnancies in women with polycystic ovary syndrome

Both women with polycystic ovary syndrome (PCOS) and women with twin pregnancies have increased risk of adverse pregnancy outcome. The aim of this study was to investigate the impact of PCOS and maternal androgen levels on the outcome of dichorionic twin pregnancy.

Progesterone-Activated Spermatozoa Used for In Vitro Fertilization

Recent studies have shown that progesterone from follicular fluid or progesterone produced locally by the cumulus cells stimulates the spermatozoa in the female reproductive tract and enhances the fertilizing potential (reviewed in Refs. 1-3). Through specific membrane receptors progesterone induces intracellular calcium release, which results in hyperactivation and primes the spermatozoa rapidly to undergo the acrosome reaction on making contact with the zona pellucida (4-6). In most assisted reproduction programs enhancement of the fertilizing capacity of spermatozoa by natural inducers such as progesterone is usually not undertaken. The aim of the present study was to evaluate whether progesterone-activated spermatozoa from men with normal semen resulted in an increased cleavage rate and/or preembryo quality in connection with IVF treatment.

Is resumption of meiosis in the human preovulatory oocyte triggered by a meiosis-inducing substance (MIS) in the follicular fluid?**Supported by Nordisk Insulinfond (A. G. B).

Aspirates from 31 ovarian follicles and 2 corpora lutea of 26 women at different stages of the menstrual cycle were investigated for activity of meiosis-inducing substance (MIS) and meiosis-preventing substance (MPS). The aspirated follicles were classified as dominant (i.e., preovulatory), healthy, or atretic according to their size, steroid hormone content, and stage of the menstrual cycle. To test for MIS and MPS activity, gonads of sexually undifferentiated fetal mice were cultured in media containing either 15% follicular fluid aspirate (test gonads) or 15% human blood serum (control gonads). MIS activity is present in follicular fluid if the test testes contain more meiotic germ cells than the control testes. MPS activity is present if the test ovaries have less meiotic germ cells than their controls. MIS activity was present only in healthy follicles of the late follicular phase (12 of 15 follicles). No MIS activity was seen in healthy or atretic follicles from other phases of the menstrual cycle. The MIS activity is apparently unrelated to the composition of steroids in the follicular fluid. MPS activity was not found in any of the follicles. It is proposed that the preovulatory resumption of meiosis may be triggered by a MIS in the follicular fluid.

Meiosis-Inducing and Meiosis-Preventing Substances in Human Male Reproductive Organs**Supported by Grants 512-10639 and 512-20059 from the Danish Medical Research Council, by EURATOM Contract 120-73-1 BIO-DK, and by the Nordic Insulin Foundation.

The initiation of meiosis is controlled by two substances, a meiosis-inducing substance (MIS) and a meiosis-preventing substance (MPS). These have been shown to be present in reproductive organs of both sexes of different mammals. In this investigation MIS and MPS were also shown to be present in man. MIS was found in fetal and adult epididymides and testes. MPS was obtained from the tests of one fetus, which was delivered by laparotomy. MPS could not be found in the testes of another fetus, which was aborted by prostaglandin F2 alpha and oxytocin. No or only weak MPS activity was detectable in the adult testis. This report indicates that continued spermatogenesis might be influenced by the MIS:MPS ratio. MPS was shown not to be species-specific. MIS and MPS activity have been evaluated by qualitative scoring of the different germ cell stages present in fetal gonads after culture in used media containing MIS or MPS.