Pramuan Virutamasen

A study failing to determine significant benefits from assisted hatching: patients selected for advanced age, zonal thickness of embryos, and previous failed attempts.

Purpose:Pregnancy and implantation rates after mechanical assisted hatching (AH) in patients aged ≥38 years, with embryos ≥15 μm in zonal thickness and two or more failed attempts, were assessed at two infertility centers using fresh and frozen embryo transfer (FET) cycles.Methods:AH was performed on 3-day-old embryos. Spare embryos cryopreserved at the two-pronucleus stage were subjected to AH after 2 days of culture and transferred to artificially prepared uteri.Results:In fresh cycles, no significant differences in pregnancy rates (clinical and ongoing) and implantation rates were observed between the AH and the controls for all three selected patient groups (Centers 1 and 2). In FET cycles, AH tended to give poor results for ≥38 year olds (clinical pregnancy rates of 0 and 5.0% with AH vs 13.3 and 16.7% for controls at Centers 1 and 2, respectively). With AH, embryos with thick zonae implanted to the same extent as those in the control group and achieved pregnancies for patients with multiple failures (four to six attempts for some) in both fresh and FET cycles.Conclusions:AH failed to show significant benefits in all three patient groups. A larger study group may confirm the effects of AH on frozen/thawed embryos and outcomes for multiple failure cases.

Transvaginal hysterosalpingo-contrast sonography (HyCoSy) compared with chromolaparoscopy.

Objective: To compare the efficacy and safety of HyCoSy with chromolaparoscopy for the diagnosis of tubal occlusion and uterine abnormalities.

Pharmacodynamic effects of depot-medroxyprogesterone acetate (DMPA) administered to lactating women on their male infants

Normal postpartum women, who had a spontaneous vaginal delivery of one full-term male infant, free of congenital abnormalities and other diseases, were recruited for this study. Thirteen women received 150 mg depot-medroxy-progesterone acetate (DMPA), intramuscularly on days 42 + 1 and 126 + 1 postpartum. Infants of nine mothers, who did not receive DMPA, served as controls. Blood samples were collected from treated mothers on days 44, 47, 74, 124, 128, and 130 postpartum for medroxyprogesterone acetate (MPA) measurements. Four-hour urine collections were obtained from all 22 infants in the morning on days 38, 40, 42, 44, 46, 53, 60, 67, 74, 88, 102, 116, 122, 124, 126, 128, 130, and 137. Urinary follicle stimulating hormone (FSH), luteinizing hormone (LH), unconjugated testosterone, and unconjugated cortisol were measured by radioimmunoassay, and serum MPA and urinary MPA metabolites were measured by gas chromatography-mass spectrometry (GC-MS). No MPA metabolites could be detected in the urine of the infants from the DMPA-receiving mothers. Hormonal profiles in the urine samples were not suppressed in comparison with those of the control infants. The present study demonstrates that DMPA, administered to the mother, does not influence the hormonal regulation of the breast-fed normal male infant.

Metabolic effects of depot-medroxyprogesterone acetate in long-term users: A cross-sectional study

Oral glucose tolerance test and determination of insulin, cholesterol, triglycerides, total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase and cortisol in blood were performed on 57 Thai women who had used depot‐medroxyprogesterone acetate (DMPA) for 5 years or more and 24 healthy non‐DMPA users. Plasma insulin, alkaline phosphatase and morning cortisol levels were significantly higher in the DMPA users than in the non‐users. There were no significant differences for other laboratory tests. The findings suggest some effects of DMPA on carbohydrate metabolism and liver function in long‐term users.

Generation of Mouse Embryonic Stem Cell Lines from Zona-Free Nuclear Transfer Embryos

Pluripotent stem cells would have great potential in cell therapies and drug development when genetically matched with the patient; thus, histocompatible cells could be used in transplantation therapy or as a source of patient-specific cells for drug testing. Pluripotent embryonic stem cells (ESCs)-generated via somatic cell nuclear transfer (SCNT) or parthenogenesis (pESC)-are potential sources of histocompatible cells and tissues for transplantation. Earlier studies used the piezoelectric microinjection (PEM) technique for nuclear transfer (NT) in mouse. No specific studies examined zona-free (ZF) NT as an alternative NT method to generate genetically matched ESCs of a nuclear donor. In this study, we compared the efficiency of nuclear transfer-derived ESC (ntESC) line establishment from ZF-NT, ZF-parthenogenetic (PGA), and ZF-fertilized embryos with that of the PEM-NT method. Different nuclei donor cells [cumulus, ESC, and mouse embryonic fibroblast (MEF)] were used and the efficiency of ntESC derivation was investigated, along with their in vitro characterization. The ZF-NT methods efficiency was higher than that of the PEM-NT using cumulus cells. When ESCs and cumulus cells were used as nuclear donor cells, they resulted in significantly higher ZF-NT-derived ntESC line establishment rates compared to MEF cells. In conclusion, the nuclear donor cell type significantly affected the efficiency of ntESC line establishment, and the ZF-NT method was efficient to establish pluripotent ntESC lines.

The effect of injectable norethisterone oenanthate on ovarian hormones in Thai women.

The ovarian hormones, progesterone and estradiol, as well as norethisterone concentrations were studied in 15 subjects receiving a single intramuscular injection of norethisterone oenanthate. Three treatment groups were studied. The 5 subjects of group A had no additional treatment, the 5 subjects of group B received ethynylestradiol and the 5 subjects of group C received combined ethynylestradiol and norgestrel orally. Additional treatment was for 5 consecutive days 6 weeks after the injection. Blood samples were obtained weekly for 12 weeks post-treatment. All subjects showed a similar pattern of norethisterone concentrations with a range of 3.5-19.5 ng/ml 1 week after injection, declining to levels of less than 0.02 ng/ml at the end of treatment period. Progesterone concentrations of greater than 4 ng/ml indicated that ovulation had occurred in 2 subjects of group A, 5 subjects of group B and 2 subjects of group C during the study period. Serum estradiol concentrations reached pre-ovulatory levels (greater than 200 pg/ml) in 4,3 and 2 subjects of group A,B and C, respectively, during the treatment period. With the other subjects, serum estradiol showed lesser increases. Among the 15 Thai women in the study, the median time of ovulation was 11 weeks, with the earliest occurring at 6 weeks. Three women receiving NET-OEN and no other treatment had ovulated by 6 weeks. Thai women in this study appear to be more resistant to the antiovulatory effect of NET-OEN as compared to women in other published studies.

A rapid method for the determination of 5α-dihydrotestosterone in Thai males receiving medroxyprogesterone acetate

A rapid method for the determination of DHT (5 alpha-dihydrotestosterone) in serum was established, utilizing potassium permanganate as an oxidising agent to convert the double bond at position 4-5 of testosterone to dihydroxy alcohols. DHT was then extracted with diethyl ether and measured directly using radioimmunoassay technique. The precision of the assay was determined at three levels of DHT added into pooled serum and found to be 4.4-5.1% for between assay percentage coefficient of variation. The sensitivity of the standard curve was found to be 4.2 pg/0.5 ml sample. The accuracy was determined in pooled serum with added standard DHT in the range of 80-800 pg. The percentage recovery of the assay was found to be 92.93-98.35%. The antisera used for DHT assay exhibited no significant cross-reaction with various steroids tested except testosterone which showed a 91.3% cross-reaction. The method was applied to measure the level of DHT in serum of Thai males receiving medroxyprogesterone acetate (MPA) as an oral contraceptive. Twenty-five subjects were divided into 5 groups. Group 1 received an oral placebo with monthly sesame oil injection. Groups 2, 3 and 4 received 5 mg, 10 mg and 20 mg MPA, respectively, with the addition of monthly injection of 250 mg testosterone enanthate (TE). Group 5 received 20 mg MPA daily with the addition of monthly injection of 500 mg TE. Blood specimens were obtained monthly. The first 4 months were used as a control period. After the 4-month period, each subject received treatment as mentioned above for 6 months, then follow-up study was resumed for another 6 months. The results revealed that subjects receiving 20 mg MPA with the addition of 250 mg TE showed a significant decrease of DHT levels (p less than 0.001).

A clinical and metabolic study of norethisterone oenanthate in Thai women

Norethisterone oenanthate (NET-OEN), an injectable contraceptive preparation containing 200 mg of steroid in 1 ml oily solution, was administered to 126 healthy Thai women of proven fertility (age, 18 to 35) at 8-week and then 12-week intervals. Vaginal bleeding, weight, blood pressure and menstrual bleeding were recorded during each visit, as were complaints and adverse effect. The 12-month continuation rate was 63/100 women-years with 5 accidental pregnancies. There were 2 pregnancies during the 2nd injection interval and 3 other pregnancies during the 3rd, 4th, and 5th injection intervals. Most frequent complaints were spotting, 32.4% and amenorrhea, 26.2%. 3.8% experienced heavy bleeding while 11.2% reported vertigo, nausea and vomiting. There were 11/100 women-years of amenorrhea, and 25/100 women-years of heavy bleeding. A statistically significant increase in the serum glucose tolerance test (p 0.05) was noted after 12 months of use, but the increase was within normal limits. The significant transient decrease in total cholesterol and triglyceride levels observed at the 3rd month of study returned to normal after 6 months.

A comparative study of Lippes loop and Delta loop intrauterine devices in early postpartum

Two IUDs (Delta loop, Lippes loop D) were randomly inserted in 260 postpartum women within 2-36 hours after delivery by uterine-packing forceps. The Delta loop was designed with the intention of lowering the expulsion rate compared with the standard Lippes loop. The analysis of the data indicated that the expulsion rate of the Delta loop was as high as the Lippes loop D at the one-month follow-up (Delta loop 24.1%, Lippes loop 23.9%). The comparison of other pertinent event rates also showed no significant differences.

Hormonal changes in normal menstrual cycle of Thai women.

The concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E2), testosterone (T) and cortisol have been measured by radioimmunoassay technique in daily serum samples of 10 Thai women throughout 10 menstrual cycles. The results show that in 10 subjects studied, 9 subjects show the patterns and levels of LH, FSH, E2 and progesterone suggestive of having ovulatory cycles. One subject shows no patterns of these hormones indicative of having ovulatory cycle. Daily serum PRL, T and cortisol concentrations, when determined for each individual subject for the entire cycle, varied among the 9 subjects studied. During the menstrual cycle, changes of hormones were observed in the women studied. There was a significant rise in the concentrations of serum PRL (2 subjects), T (2 subjects) and cortisol (3 subjects) on the day of the LH surge. When the mean levels of PRL, T and cortisol were plotted for 9 subjects in relation to the LH peak, there was no highly significant rise in the concentration of serum PRL, T and cortisol at midcycle.