M.N. Cauchi

Treatment of Recurrent Aborters by Immunization With Paternal Cells—Controlled Trial

ABSTRACT: A paired sequential trial was undertaken to establish whether paternal mononuclear cells improved the prognosis in couples with recurrent abortions. For this purpose, 107‐108 cells obtained from the blood of partners were injected intravenously, subcutaneously, and intra‐dermally into women who had had three or more consecutive miscarriages with the same partner. Control women were given normal saline, injected in the same manner. The result of the sequential analysis showed that there was no significant beneficial effect of the cells compared to control. The overall success rate was 70% (32/46 couples). The success rate in patients given cells was 62% (13/21), while in those given saline it was 76% (19/25). While the overall success rate in this study compares with a number of other studies, we find an equally high success rate with non‐immunized patients. We conclude that the value of immunization for the prevention of recurrent miscarriage has not been established.

Endometrial carcinoma: Steroid receptors and response to medroxyprogesterone acetate

The steroid receptor content of the primary endometrial cancer of 22 patients who were treated for recurrent or advanced disease has been measured and correlated with response to medroxyprogesterone acetate. No patient with a progesterone receptor (PR)-negative tumor responded and only 2 patients with PR-positive tumors responded, perhaps related to the low levels of PR in the tumors. It waits to be assessed whether receptor status is as good a guide to response to hormone therapy as tumor differentiation, site of recurrence, or disease-free interval.

Sperm Antibodies, Immunoglobulins, and Complement in Human Follicular Fluid

ABSTRACT: The levels of immunoglobulins (IgG, IgA, IgM), complement (C3, C4, C1EI) and sperm antibodies were determined in plasma and follicular fluid samples from 26 patients undergoing in vitro fertilization (IVF) treatment. The results show that IgG, IgA, C3, C4, and C1EI concentrations in follicular fluid are similar to plasma concentrations (63.1–96.1% of plasma levels). The follicular fluid concentration of IgM was severely reduced, however, being only approximately 10% of plasma concentrations. Sperm antibody titres were compared in three patients using sperm agglutination, immobilization, and immunobead binding. The titres in plasma and follicular fluid were similar, apart from antibodies of IgM class, which were undetectable in follicular fluid.

Steroid receptors and ovarian tumors: Variation within primary tumors and between primary tumors and metastases

Estrogen and progesterone receptors have been measured in primary and secondary ovarian carcinoma in eight patients, in bilateral ovarian tumors in 16 patients, and from multiple sites within the same tumor in 16 patients (12 primary and 4 secondary). In the majority of cases, metastatic tumors contained less receptors than their primary tumors. Marked variations in receptor content were noted within the same tumor and between bilateral tumors. This variation in receptor levels may explain the discrepancy between the presence of receptors and the response to hormonal treatment. Multiple sites of ovarian carcinoma need to be assayed for receptor content before a final decision can be made on receptor status.

Increased frequency of autoantibodies in men with sperm antibodies

Autoantibodies to thyroid microsomes were more frequent in 102 infertile men with complement-dependent sperm-immobilizing activity (sperm immobilization test [SIT] ) in serum (11.8%) than in a control group of 277 men of comparable ages and semen quality without sperm antibodies (4.3%, P less than 0.05). Frequencies of organ-specific antibodies (antigastric parietal cell, antithyroglobulin, and antithyroid microsome) in 57 men with genital tract obstructions and positive SIT were similar to those for control subjects, and there were no significant differences in the frequencies of non-organ-specific autoantibodies (antinuclear antibody, rheumatoid factor, antimitochondrial, and anti-smooth muscle) in the three groups. Because in men without genital tract obstruction antithyroid microsomal autoantibodies were more common with sperm antibodies than without, the possibility of a genetic factor in the causation of sperm autoimmunity should be considered.

CA125 Serum Levels and Secondary Laparotomy in Epithelial Ovarian Tumours

EDITORIAL COMMENT: Late presentation of ovarian cancer remains a major problem in gynaecology and stimulates the search for an accurate tumour marker; a simple blood test at the time of regular gynaecological examination (cervical cytology, bimanual pelvic palpation, examination of the breasts) is what is needed! Cytology of fluid aspirated from the pouch of Douglas was found to be impractical and ultrasonography, although still to be fully evaluated, is unlikely to be costeffective. The ideal tumour marker would serve as both a screening test in asymptomatic women to detect early stage disease and as an accurate monitor of therapeutic response obviating the need for second‐look laparotomy. As shown in this paper, CA125 lacks the sensitivity required to fulfil these 2 aims due to the inability to detect small volume tumour. Serial measurements of this tumour marker may serve to indicate therapeutic response in patients with advanced disease, supplementing clinical and radiographic assessment but second‐look laparotomy still remains the most satisfactory means of establishing response to therapy.

Correlation between cytoplasmic steroid receptors and tumour differentiation and invasion in endometrial carcinoma

Summary. The incidence and levels of cytoplasmic steroid receptors were studied in 155 endometrial carcinomas: oestrogen receptors (ER) were measured in all samples, progesterone receptors (PR) in 148 and androgen receptors (AR) in 118. Well‐differentiated adenocarcinomas were significantly more likely to contain ER, PR and AR than were poorly‐differentiated tumours, and mean values of ER and PR content were significantly higher in well‐differentiated adenocarcinomas than in less‐differentiated tumours. Receptor profiles in adenosquamous carcinomas and clear‐cell carcinomas were similar to those in adenocarcinomas. Deeply invasive tumours were significantly less likely to be ER, PR or AR positive and, even when positive, such tumours had significantly lower mean levels of ER and PR. Poorly‐differentiated tumours were significantly more likely to be ER‐negative PR‐positive than well‐differentiated adenocarcinomas and adenosquamous carcinomas.

Predictors of pregnancy success in repeated miscarriage.

ABSTRACT: Factors that may have a bearing on subsequent pregnancy success or failure in patients with recurrent abortion were examined in 165 women with a history of three or more consecutive miscarriages in the first trimester. The overall success rate was 67.9%. Factors that were found to correlate significantly with success rate were length of abortion history, total number of abortions, interval from last miscarriage to present pregnancy, and whether there was any degree of subfertility. Logistic regression analysis showed that the abortion × years index and maternal age accounted for all the variation observed in our data. Where all other known causes of abortions are excluded, recurrent aborters can be subdivided into two populations—namely, those with a relatively good prognosis characterized by a short abortion history and absence of subfertility problems, compared to those with a poor prognosis namely those with a long abortion history or presence of subfertility problems. These data clearly demonstrate major differences in success rates in women depending on the number of abortions and the length of abortion history (abortion × year index), particularly in women over the age of 30 years.

Immunogenetic Studies in Habitual Abortion

EDITORIAL COMMENT: Readers must judge whether their patients with habitual abortion warrant referral for the type of investigation and immunotherapy reported here. These patients are often anxious to explore every avenue to achieve a successful pregnancy. Many techniques are available with convincing and prestigious advocates. The treatment of infertility at its best is one of the marvels of modern scientific medicine — but there is a warning, many (most!) papers on the treatment of infertility lack controls, which makes it difficult to judge reported results. These comments apply to in vitro fertilization and embryo transfer, artificial insemination, tuba1 surgery, cervical ligation, ovulation induction, and immunotherapy. It is commonplace for couples with blocked tubes, anovulation and/or poor seminal quality/quantity to conceive happily, unexpectedly and successfully without treatment!

Oncofetal Antigens in Ovarian Cyst Fluids

The levels of five oncofetal antigens were measured in ovarian cyst fluids. Significantly raised levels of carcinoembryonic antigen (CEA), human chorionic gonadotropin, beta 2-microglobulin, and alpha-fetoprotein were found in ovarian cyst samples. Human placental lactogen was not detectable in any samples. Mucinous cyst fluids demonstrated higher levels of CEA than serous fluids in both malignant and benign conditions. We could not distinguish between malignant and benign conditions with any of the markers. Except for CEA, there is no difference in values between mucinous and serous cystadenocarcinomas.