Shinnosuke Kawagoe

Turner's Syndrome – Review of the Literature with Reference to a Successful Pregnancy Outcome

A 30-year-old Japanese female with Turners syndrome had become pregnant and delivered a normal male infant by cesarean section. Her menarche was at age 14, and secondary sex characteristics developed normally. She had some features of Turners syndrome, and cytogenetic studies from peripheral blood lymphocytes and several tissues revealed only 45,XO karyotype without evidence of mosaicism. To our knowledge, she is only the thirteenth case of monosomy X to achieve pregnancy. A review of the literature indicates a high incidence of fetal wastage and increased chromosomal errors in the offspring of women with a 45,XO cell line with or without mosaicism.

Decreased Natural Killer Cell Activity in Women with Endometriosis

Natural killer (NK) cell activity is characterized by the spontaneous capacity of lymphoid cells derived from nonimmunized hosts to recognize and lyse certain tumor cell lines, virus-infected cells and transplanted tumor cell lines. Endometriosis is characterized by implantation and proliferation of autologous ectopic tissue in the pelvic cavity. Therefore, we focused on examining NK cell activity in women with endometriosis. NK cell activity in peripheral blood from women with endometriosis was lower than in women without endometriosis. On the basis of this finding, we analyzed also the effect of peripheral sera of women with endometriosis on NK cell activity. In the presence of peripheral sera of women with endometriosis, NK cell activity was significantly suppressed as compared with the sera of women without endometriosis. The suppressive effect of sera of women with endometriosis on NK cell activity showed dose-dependent curves. These studies provide the speculation that natural immunity mediated by NK cells may modulate the development of endometrial implants.

Aging Changes in the Alignment of Chromosomes after Human Chorionic Gonadotropin Stimulation May Be a Possible Cause of Decreased Fertility in Mice

The relation between the alignment of chromosomes in the aged oocyte and its capacities of fertilization and development of oocytes was examined. More embryos in the condition of insemination at 12 and 16 h after human chorionic gonadotropin (hCG) however grew into two and more cell stages than those in the insemination of 20, 24 and 28 h. Some embryos in the group of insemination at 12, 16 and 20 h after hCG injection had grown into the blastocyst stage. The embryos inseminated 24 h after hCG and later had shown no further development. Twelve hours after hCG injection, 67% of oocytes have chromosomes on a straight line (A), and 29% have chromosomes scattered in one group (B). Three percent of oocytes have them separated toward both spindle ends (C) and 2% of oocytes have no chromosomes (D). At 16 h after hCG, the alignments of chromosomes are almost the same as that of 12 h after hCG injection. At 20 h after hCG, the most common alignment of chromosomes was scattered in a small group. The alignment of chromosomes of most oocytes was splitting at 24 and 28 h after hCG injection. Thus the oocytes with the chromosome alignment of A or B can be fertilized and developed into the blastocyst stage. The alignment of A and B lasts only about 8 h after ovulation, and the time was extremely restricted for oocytes to develop normally.

Further Evidence that Prolactin Controls the Prepubertal Sexual Development in the Female Rat

To assess the role of prolactin (PRL) in the puberty onset and the ovarian aromatase activity, hyper- and hypoprolactinemic conditions were induced by treating chronically prepubertal female rats with PRL and bromocriptine, respectively. Injection of rat PRL (5 micrograms, twice daily) from day 20 onward advanced the day of vaginal opening. By contrast, the suppression of PRL release by bromocriptine, which was provided in the drinking water at a concentration of 40 micrograms/ml, caused a significant delay in the age of occurrence of vaginal opening. This bromocriptine-induced delayed puberty was prevented by the concomitant administration of exogenous PRL, suggesting that the effect of bromocriptine is exerted through its suppressive effect on the endogenous PRL release. The in vitro release of estradiol by the ovaries from 30-day-old rats treated with PRL was found to be higher than that from the control animals, when the ovaries were perifused for 6 h with an excess of androstenedione. On the other hand, the ovaries perifused in the presence of androgen produced less estradiol in the bromocriptine-treated rats than in their controls. It appears, therefore, that PRL is more likely related to the aromatase activity in the maturing ovary. These results suggest that PRL may be one of the factors that regulate the timing of puberty onset by influencing the aromatase activity in the ovary.

45,XO/46,X,dic(Yq) mosaicism in Turner's phenotype with endodermal sinus tumor of the ovary.

A case of a endodermal sinus tumor of the ovary in a patient with 45,XO/46,X,dic(Y) mosaicism is reported because of the rarity of the karyotype and condition. A 15-year-old girl was admitted to Yamagata University Hospital because of constipation for several days. Physical examination showed webbing of the neck, cubitus valgus and short stature. Her abdomen was bulging. Chromosomal analysis showed 45,XO/46,X,dic(Yq) mosaicism in karyotype. alpha-Fetoprotein and CA-125 in the serum were high. A left ovarian tumor was found by laparotomy; however, the right ovary was a streak gonad and the uterus was hypoplastic. An endodermal sinus tumor was diagnosed by a pathologist. After operation, cisplatin-vinblastin-bleomycin chemotherapy was instituted and the tumor marker went down. This patient is still healthy and under observation at the outpatient clinic.

Involvement of prolactin in the control of follicular maturation.

This study was designed to explore the role of prolactin (PRL) in the modulation of follicular growth and steroidogenesis. An ovarian perifusion technique was used to determine the effect of PRL on steroid production by ovarian tissue. Immature female rats were injected with 5 IU pregnant mares serum gonadotropin to induce follicular maturation. After 40 h rats were killed, ovaries removed, and follicles dissected out. Follicles were divided into two groups (small, less than or equal to 4 mm; large, greater than or equal to 5 mm in diameter), cut into fine fragments, and perifused for 6 in the presence or absence of ovine PRL (100 or 1,000 ng/ml). In the group of small follicles, either of the PRL doses reduced the ability of follicular tissues to convert androgen to estrogen. HCG-induced production of progesterone by small follicles was also suppressed by higher doses of PRL. On the other hand, in the group of large follicles, PRL showed no effects on the aromatization and progesterone release by the follicular fragments. These results suggest that the small immature follicle is more sensitive to the inhibitory action of PRL on steroidogenesis and folliculogenesis. Thus it is possible that PRL may have a modulatory role in follicular growth and maturation and, consequently, in the selection of ovulatory follicle.

Rapid Immunochemical Assay of Pregnanediol-3-Glucuronide in Urine and Its Clinical Application

A rapid and simple technique for assessing ovulation and luteal function is needed in clinical practice. A sensitive immunoassay kit is presented here for clinical use. An immunoassay of pregnanediol-3-glucuronide (Pd-3G) in urine was established. The sensitivity of this assay was 0.4 mg/l of Pd-3G. The standard error range of the recovery test was within 0.8 mg/l, and the coefficients of variation of within-run and day-to-day precision test were within 4%. Cross reactions of various steroids were observed in free pregnanediol, pregnanetriol and progesterone, but their reactivity exhibited less than 4%. The Pd-3G/creatinine (mg/g) ratio was demonstrated as nearly constant over a 24-hour period. A significant rise of Pd-3G coincided with a luteinizing hormone surge and continued during the luteal phase in the ovulatory menstrual cycle. In an anovulatory cycle, Pd-3G was found to be under 4 mg/g creatinine. This Pd-3G direct-assay method could be widely used in infertility clinics.

Effect of an Aromatase Inhibitor in Human Follicular Fluid on DNA Synthesis of Granulosa Cells, Theca Cells, and Follicles

An aromatase inhibitor was identified in human follicular fluid. We sought to examine the effects of this inhibitor on granulosa cells, theca cells, a mixture of granulosa and theca cells, and follicles. Granulosa cells, theca cells, the mixture of granulosa and theca cells, and follicles were incubated with [3H]-thymidine and aromatase inhibitor at 37 degrees C for 40 h in Ham F-10 medium. The radioactivities of acid-soluble fractions were counted. Aromatase inhibitor markedly inhibited the DNA synthesis of granulosa cells and follicles, but it did not inhibit the mixture of granulosa and theca cells. This suggested that aromatase inhibitor was a factor in the follicle paracrine system and acted mainly on granulosa cells.

Factors Promoting Embryo Implantation in in vitro Fertilization and Embryo Transfer

The low implantation rate after embryo transfer (ET) is the most important problem to be solved in in vitro fertilization and embryo transfer (IVF-ET). Various factors which may affect embryo implantation in the endometrium have been examined. In this study, the influence of the timing of luteinization on the establishment of pregnancy was investigated. Follicle stimulation was performed by luteinizing hormone-releasing hormone agonist, human menopausal gonadotropin and human chorionic gonadotropin (hCG). hCG was injected on the day when the mean diameter of two follicles exceeded 16 mm, and 36 h after the injection the oocyte was retrieved. Progesterone (P4) supplement was started on the day of ovum retrieval (50 mg), followed by 30 mg for 14 days. The patients were divided into three groups: (1) the pregnant patients (n = 20: group Pre); (2) the nonpregnant patients without bleeding during P4 injection (n = 35; group N), and (3) the nonpregnant patients with bleeding during P4 injection (n = 30; group B). The number of follicles that developed, endometrial thickness, the day of operation, the number of oocytes harvested, the number of good quality oocytes, the number of oocytes fertilized, the number of embryos transferred, estradiol (E2) and P4 levels, and the E2/P4 ratio were examined. The endometrial thickness of group Pre (10.9 +/- 0.6 mm; mean +/- SEM) on the day of hCG injection was significantly (p less than 0.05) greater than that of groups N (9.0 +/- 0.4 mm) and B (9.2 +/- 0.3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)