Robert H. Glass

Pregnancy following hysterosalpingography with oil and water soluble dye.

n To determine whether hysterosalpingography (HSG) increases the conception rate and to compare the therapeutic effectiveness of oil and water soluble contrast media, the histories of 744 women who attended the Yale Infertility Clinic in 1965-69 were reviewed. Exclusion of women who had been infertile less than 1 year before coming to the clinic, in whom a HSG was done outside the clinic, and in whom there was no follow-up resulted in a study population of 460. The pregnancy rate for the study group (49%) was identical to that for the larger population. The study group was divided into women who became pregnant during their clinic attendance or within 1 year of terminating clinic care and women who did not become pregnant in this period. These 2 categories were then subdivided according to whether a HSG was done. To determine the relative effectiveness of different media, the conception rate following HSG in the Yale Clinic, where the iodized oil Ethiodol was used, was compared with that among 63 women who had HSG done by a private practitioner with the water soluble dye Salpix. 221 women were in the Ethiodol HSG group, 121 (55%) of whom conceived. Of the 239 Yale Clinic patients who did not have HSG, 103 (43%) became pregnant. Exclusion of couples with organic factors that could account for infertility resulted in a pregnancy rate of 58% for the HSG group and 47% for the non-HSG group. 25 (40%) of the 63 women in the Salpix group conceived, but exclusion of couples with organic factors lowered the pregnancy rate to 38% in this group. The average length of infertility was 0.5 years longer in the non-HSG group than in the Ethiodol HSG group, but shorter in the Salpix HSG group compared to the Ethiodol group. These results suggest that Ethiodol HSG may enhance fertility. Although the oil media has been criticized on the basis that it may cause granuloma formation or embolization, documented complications in the Yale series were rare. In contrast to earlier studies, unilateral nonpatency on x-ray was not found to affect eventual conception (58% pregnancy rate among women in the Ethiodol HSG group with normal tubes compared with 50% in those with filling of only 1 tube).n

The effect of nitrous oxide on in vitro fertilization success rate

The authors studied the effect of nitrous oxide on success rates for in vitro fertilization and pregnancy in women undergoing laparoscopy for oocyte retrieval. Ninety-eight patients in an in vitro fertilization program were randomly assigned to an anesthetic regimen including either 0.7% (end-tidal) isoflurane with 60% nitrous oxide in oxygen, or 1.4% (end-tidal) isoflurane in oxygen. Success rates for fertilization and pregnancy in 44 additional patients who declined randomization were also studied. Among the 51 randomized patients who did not receive nitrous oxide, 192 oocytes were obtained and 122 fertilized (63.5%), resulting in eight pregnancies (16.3%). From the 47 randomized patients given nitrous oxide, 168 oocytes were retrieved and 114 fertilized (67.9%), resulting in nine pregnancies (19.1%). No significant differences between rates of fertilization or pregnancy emerged between groups. Such differences would have been found with an 80% probability had nitrous oxide had a 20% effect on oocyte fertilization.

Sperm-Agglutinating Antibodies in Infertile Women

n This paper explored the experience with sperm-agglutininating antibodies in 168 infertile couples. 2 of the 46 subjects with organic causes for infertility had positive sperm agglutination tests, and neither became pregnant in the 6-18 month followup period. Of the remaining 122 subjects with no organic cause for infertility, 24 (20%) had positive tests (including 13 women with primary infertility and 11 with secondary infertility). 9 of the 24 women (38%) with positive tests became pregnant following condom therapy. There was no correlation between the sperm antibody test and postcoital test, nor between sperm agglutinins and ABO incompatibility. These results suggest that a small number of women have specific reactions against sperm or seminal fluid that inhibit fertility. It is concluded that screening of serum for sperm agglutinins should be continued to provide an estimate of immunologic reactions against semen in cases of infertility.n

The resazurin reduction test provides an assessment of sperm activity

OBJECTIVEnThe objective of the study was to determine if reduction of the dye resazurin by semen could be correlated with the concentration of motile sperm.nnnDESIGNnAfter assessment of sperm count and motility, specimens were incubated for 1 hour with resazurin (25 micrograms/mL of semen) and visual color changes indicative of dye reduction noted.nnnSETTINGnSpecimens were obtained from men seeking care for infertility at one of four sites: (1) University of California, San Francisco (UCSF) In Vitro Fertilization Program; (2) UCSF Andrology Laboratory; (3) a gynecological practice in Maine; and (4) a private andrology laboratory in Southern California.nnnPATIENTSnIndividuals were self-selected by their desire to have a semen analysis in conjunction with the diagnosis or treatment of infertility.nnnINTERVENTIONSnNone.nnnMAIN OUTCOME MEASUREnThe reduction of the dye resazurin and its correlation with motile sperm density.nnnRESULTSnWhen the motile sperm concentration was greater than or equal to 20 X 10(6)/mL, 86% of specimens produced a positive color change. Conversely, 86% of specimens with a motile sperm concentration of less than 20 X 10(6)/mL either did not change color or changed only over a narrow range.nnnCONCLUSIONnReduction of resazurin offers an assessment of the active sperm in a specimen without the need to do a sperm count or evaluation of motility.

Effects of pH on the Migration of X and Y Sperm

n A study was undertaken to examine the influence of pH on the migration of X and Y sperm as observed in freshly ejaculated semen samples from human donors. These sperm were allowed to migrate into capillary tubes containing media of varying pH. Y-carrying sperm were i dentified using flourescent staining with quinacrine dihydrochloride. S mall changes in pH were ineffective in influencing the ratio of sperm. 6 additional samples were analyzed in a more acid pH resulting in an insignificant change in migration. This study indicated that the percentage of Y-bearing sperm migrating through a capillary tube is unaffected by the mediums pH. Evidence suggest the unlikelihood that X and Y sperm can be differentiated on the basis of migration through media of varying pH.n

Pregnancy in the rabbit following immunization with human chorionic gonadotropin

Abstract Antibodies to gonadotropins may inhibit the biologic activity of the same or closely related gonadotropins. Rabbits immunized with human chorionic gonadotropin (HCG) formed agglutinating antibodies to the HCG. The immune serum inhibited the biologic activity of HCG. However, the immunized rabbits ovulated and became pregnant despite the circulating antibodies. This suggests that there is no cross reaction between HCG and rabbit gonadotropin.

Clinical Gynecologic Endocrinology and Infertility

In a clear, user-friendly style enhanced by abundant illustrations, algorithms, and tables, the book provides a complete explanation of the female endocrine system and its disorders and offers practical guidance on evaluation and treatment of female endocrine problems and infertility. Major sections cover reproductive physiology, clinical endocrinology, contraception and infertility. This edition has a modern full-color design.

Development of the mouse blastocyst after actinomycin D treatment.

Mouse blastocysts were incubated in vitro with actinomycin D in concentrations of 10-1 to 10-5 mug/ml. After transfer to recipient animals, there was a moderate but significant decrease in implantations at 10-minus 1 to 10-minus 3 and 10-minus 5. There was a severe inhibition of subsequent development at concentrations of 10-minus 1 and 10-minus 2. One of 49 fetuses which developed after actinomycin D treatment had a major malformation; there was one major and one minor abnormality among 95 control fetuses. It is suggested that most of the RNA or protein required to effect implantation is synthesized or coded for prior to the blastocyst state. The moderate but significant decrease in implantations found after actinomycin D treatment at this stage may reflect the ability of the drug to reduce cell adhesiveness. This study confirms the impression that the preimplantation embryo is relatively impervious to teratogenic agents, even one as potent as actinomycin D.

Tubal plastic surgery.

44 patients who had tubal surgery during the period 1/62 to 12/64 to cure infertility were evaluated as to type of surgery performed on eahc side of the pelvis. 28 patients exhibited postoperative patency of tubes upon insufflation or hysterosalpingography. Tubal patency however does not ensure adequacy of physiologic activities. The mammalian oviduct plays a significant role in the transport and development of gametes. Adhesions around the tubes interfere with ovum pickup or with tubal peristalsis. Often patients with adhesions do not have intrinsic tubal disease and this accounts for the good results associated with lysis of adhesions for treatment of infertility. In this series 6 of 14 patients who had lysis of adhesions subsequently conceived. In terms of patency and subsequent pregnancy bilateral cornual reimplantation of the tubes did not prove successful in this series. Only 2 term pregnancies occured in patients who had bilateral surgery. The poor results may have been due to endometrial blockage of tubal opening into the uterus. Increased knowledge of tubal function and physiology may significantly improve results of tubal surgery.

Lack of effect of prostaglandin F2α on the fertilizing ability of rabbit sperm

Abstract Caput and cauda sperm incubated with prostaglandin F2α were inseminated into the oviduct of recipient does which were given 75 I.U. of HCG (APL, Ayerst) at the same time. None of the 18 eggs exposed to caput sperm and all of 13 eggs exposed to cauda sperm were fertilized. Capacitated ejaculate sperm incubated with prostaglandin F2α were inseminated into the oviduct of recipient does given 75 I.U. HCG 12–13 hours earlier. Of 74 eggs recovered, 53 were fertilized. The results are consistent with those found utilizing sperm without prostaglandin treatment.