Luther M. Talbert

Biosocial foundations for adolescent female sexuality.

Despite the widespread assumption that hormones stimulate motivation for sexual behavior in adolescence, no published empirical studies have demonstrated this link. In a cross-sectional study of 78 females in the eighth, ninth, and tenth grades in public schools, we show that hormones have effects on sexual motivation and behavior. Comparison with previous results from a parallel sample of males indicates that for both sexes these effects are primarily androgenic in origin and for the most part exert their effects directly rather than through the social interpretation of age and hormone-induced pubertal development.

Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors

OBJECTIVE To determine if metformin therapy improves in vitro fertilization (IVF) outcomes in patients with clomiphene-resistant polycystic ovarian syndrome (PCOS). DESIGN Retrospective data analysis of selective groups of patients. SETTING A private IVF unit. PATIENT(S) Forty-six women with clomiphene citrate-resistant PCOS underwent 60 cycles of IVF embryo transfer with intracytoplasmic sperm injection. INTERVENTION(S) In half of the cycles, patients received metformin (1000 to 1500 mg) daily, starting the cycle prior to gonadotropin treatment. MAIN OUTCOME MEASURE(S) Total number of follicles; serum estradiol (E2) on the day of hCG administration and the cycles E2 maximum; total number of oocytes, mature oocytes, embryos, fertilization, and pregnancy rates; and follicular fluid levels of insulin-like growth factors (IGF-I, IGF-II) and IGF-binding proteins (IGFBP-1, IGFBP-3). RESULT(S) In patients treated with metformin, the total number of follicles on the day of hCG treatment was decreased (23 +/- 1.2 vs. 33 +/- 2.6) with no change in follicles > or = 14 mm in diameter (21 +/- 1.2 vs. 25 +/- 1.7). Metformin treatment did not affect the mean number of oocytes retrieved (22 +/- 1.9 vs. 20.3 +/- 1.5). However, the mean number of mature oocytes (18.4 +/- 1.5 vs. 13 +/- 1.5) and embryos cleaved (12.5 +/- 1.5 vs. 5.9 +/- 0.9) were increased after metformin treatment. Fertilization rates (64% vs. 43%) and clinical pregnancy rates (70% vs.30%) were also increased. Metformin led to modulation of preovulatory of follicular fluid IGF levels with increases of IGF-I (140 +/- 8 vs. 109 +/- 7ng/mL) and decreased of IGFBP-1 (133 +/- 8 vs.153 +/- 9ng/mL). CONCLUSION(S) Metformin use appears to improve IVF outcomes in patients with clomiphene citrate-resistant PCOS.

Semen parameters and fertilization of human oocytes in vitro: a multivariable analysis

Semen parameters in 195 couples undergoing in vitro fertilization and embryo transfer were studied using multivariable analysis. Semen parameters that correlated most closely with reduced ability to fertilize apparently mature oocytes were a slow rate of foreward progression of sperm and the presence of excess numbers of white cells in semen. In men with semen parameters within the normal range, the hamster egg penetration assay (HEPA) test did not add additional predictive power. In men with suspected semen abnormalities, however, a low attachment rating added some, but minimal, predictive value. None of the predictive methods reported thus far in this or other studies offers sufficient accuracy to reliably identify the men who will prove infertile for in vitro fertilization treatment.

Sex hormone effects on personality at puberty.

In this study we use serum steroid hormone assays and Adjective Check List responses from a representative sample of 102 male and 99 female adolescents to examine the relations between hormones, personality, and sexual behavior. We address two questions: (a) Does pubertal testosterone (T) cause sex dimorphism in personality? (b) Do pubertal hormones affect sexual behavior indirectly through effects on personality? Exploratory factor analysis of the Adjective Check List generated a factor common to male and female adolescents that correlated highly with T. However, male and female subjects did not differ in their mean level on this factor or in the correlation of this factor with T. In spite of the large sex difference in T, the girls were much more sensitive than the boys on the extracted factor to differences in T. We conclude that the answer to both questions is probably no.

Reproductive History of Women Exposed to Diethylstilbestrol in Utero

The menstrual and reproductive histories of 276 female offspring of women who had received diethylstilbestrol (DES) during pregnancy were evaluated. Mean age was 24.6 years, and mean age at menarche was 12.6 ± 0.3 years. Reported menstrual abnormalities included increased menstrual flow and cycle irregularities, primarily anovulation and oligomenorrhea. An apparent increased incidence of urinary tract manipulation was detected, and cervical stenosis was noted to follow cryosurgery in 75% of women treated. Of 106 women attempting pregnancy, there were 129 conceptions and 58 live births. The fetal wastage rates were 43% for the first pregnancy and 37% for all pregnancies. The losses were due to spontaneous abortions (25%), ectopic pregnancies (5%), molar pregnancies (2 of 129), and in utero fetal death (4%). In the subgroup of women with vaginal adenosis or cervical hoods, the fetal wastage rate was 53%. Of 35 women unable to conceive for more than 1 year, only three pregnancies have resulted after infertility evaluations. Although abnormalities of the uterine cavity were identified, tubal and/or ovulatory defects were also present. DES, given to mothers in hope of maintaining threatened pregnancies, appears to have a deleterious effect on the reproductive ability of female offspring. Menstrual and structural abnormalities identified in this study may be associated with the reported reproductive difficulties.

Serum testosterone levels in the polycystic ovary syndrome. Effect of an estrogen-progestin on protein binding of testosterone.

Abstract Total and unbound testosterone and the molar concentration of testosterone binding protein (TBP, expressed as molar concentration of testosterone binding sites) were determined in 25 normal women and 15 with polycystic ovary syndrome (PCOS) on no drug and after a combination oral contraceptive. The 10 treated normal women showed an increase in total testosterone (82 ± 26 to 170 ± 43 ng. per cent) and TBP (30.64 ± 5.98 to 63.89 ± 22.69 × 10 −8 ) but no significant change in unbound testosterone. Pretreatment, the PCOS patients showed a significantly low TBP (17.40 ± 4.66), high total (120 ± 26 ng. per cent) and unbound (1.28 ± 0.16 ng. per cent) testosterone. After treatment these patients had levels of TBP (61.81 ± 21.95 × 10 −8 ) and unbound testosterone (0.54 ± 0.17 ng. per cent), similar to the treated normal women. The significance of these findings is discussed.

Maternal and fetal plasma levels of adrenal corticoids in spontaneous vaginal delivery and cesarean section

Abstract Plasma levels of cortisol, cortisone, and corticosterone were determined in 13 normal mothers and newborn infants undergoing spontaneous delivery at term. These values were compared with values from 7 normal patients undergoing elective cesarean section and 6 patients undergoing cesarean section for cephalopelvic disproportion following a period of spontaneous labor. Maternal levels of cortisol and corticosterone were consistently higher than fetal levels, and fetal levels of cortisone were significantly higher than maternal cortisone levels. While plasma levels of cortisol, cortisone, and corticosterone were slightly higher in infants born following spontaneous labor, the differences were not statistically significant.

The role of aerobic and anaerobic semen cultures in asymptomatic couples undergoing in vitro fertilization : effects on fertilization and pregnancy rates

OBJECTIVE To determine if routine semen culture is useful in asymptomatic couples undergoing in vitro fertilization and embryo transfer (IVF-ET). DESIGN Prospective data collection. SETTING All cultures and IVF cycles were performed at the University of North Carolina in Chapel Hill, North Carolina. PARTICIPANTS All asymptomatic couples undergoing IVF-ET from January 1989 through January 1990. INTERVENTIONS Aerobic and anaerobic cultures were performed on semen samples obtained before IVF. MAIN OUTCOME MEASURES Quantitative semen cultures were evaluated for both aerobic and anaerobic bacterial isolates. Fertilization and pregnancy rates (PRs) were compared in patients with positive and negative semen cultures. RESULTS Eighty percent of cultures contained at least one bacterial isolate. Three of the four most commonly isolated bacteria were normal skin flora. Positive culture results had no effect on either fertilization or PRs. CONCLUSIONS Bacterial contamination is common with semen collection, yet routine semen cultures are not beneficial in asymptomatic couples undergoing IVF-ET.

Diffusion chamber for exposing spermatozoa to human uterine secretions

Abstract An intrauterine chamber has been designed for sampling human uterine secretions and for exposing spermatozoa to uterine secretions in utero. The chamber is made of nylon tubing, with windows covered by cellulose ester membranes of specific pore size, and it can be inserted and removed cleanly and simply. Chambers loaded with saline and then left in utero for 12 hours contained fluids with an ionic balance differing from that of serum and with many proteins similar to those found in serum. Many spermatozoa were motile after being loaded into the chambers, left in utero for periods up to 14 hours, and then maintained in vitro for a further 24 hours.

Positive correlation between body weight, length of human menopausal gonadotropin stimulation, and oocyte fertilization rate *

One hundred four normally cycling women were treated with fixed low-dose human menopausal gonadotropin (hMG) (2 ampules/day) in preparation for oocyte aspiration for in vitro fertilization. The response rate was related to age, weight, and the ratios weight/height2 and weight/height. The required dose of hMG was related to total body weight, but not to age or either of the weight/height ratios. In patients who required fewer than 5 days of hMG (rapid responders), a significantly higher number (P less than 0.02) of oocytes were harvested, compared with slow responders. However, a smaller percentage of the oocytes from rapid responders fertilized (P less than 0.003) and resulted in a reduced rate of embryo transfer. The difference in pregnancy rates was not statistically significant. The results of the study suggest that patients undergoing in vitro fertilization who weigh less than 55 kg may benefit from treatment with a lower dose of hMG to prolong the stimulation cycle.