Teraporn Vutyavanich

A randomized double-blind trial of tinidazole treatment of the sexual partners of females with bacterial vaginosis

Objective: To determine whether a single oral 2‐g dose of tinidazole for women with clinically diagnosed bacterial vaginosis and their partners increases the cure rates as compared with the same treatment for the female patients alone. Methods: During a 15‐month period, 250 women aged 17‐40 years who attended a gynecologic outpatient clinic for abnormal vaginal discharge and/or pruritus vulvae were randomized into two groups. They received a single oral dose of 2 g tinidazole while their partners received either 2 g tinidazole or placebo. Symptomatic improvement and clinical cure rates were assessed at 1 and 4 weeks after treatment. Results: There were no statistical differences (P > .05) in symptomatic improvement, clinical cure rates, or culture results between the groups of women whose partners were treated with either tinidazole or placebo. However, male consorts of women in the tinidazole group experienced side effects more often than those in the placebo group (P = .0006). Conclusion: Routine treatment is not recommended for male partners of women with bacterial vaginosis. (Obstet Gynecol 1993;82:550‐4)

Rapid freezing versus slow programmable freezing of human spermatozoa

OBJECTIVE To compare the efficacy of rapid freezing (RF) and slow programmable freezing (SPF) of human spermatozoa. DESIGN Experimental study. SETTING University-based assisted conception laboratory. PATIENT(S) Semen from 30 normospermic men. INTERVENTION(S) Semen was processed through density gradients and divided into three groups: nonfrozen control, RF, and SPF. MAIN OUTCOME MEASURE(S) Sperm motility, kinematics, and morphology were assessed by a computer-assisted semen analyzer; viability by eosin-Y staining and the hypo-osmotic swelling test; DNA integrity by comet assay; and sperm binding by hemi-zona assay. RESULT(S) Post-thaw sperm motility (53.9%, 37.0%, and 75.5% for RF, SPF, and controls, respectively) and sperm vitality (hypo-osmotic swelling test 60.1%, 44.1%, and 77.9%; eosin-Y staining 64.8%, 50.4%, and 81.8% for RF, SPF, and controls, respectively) were higher in the RF than in the SPF group, but lower than in the nonfrozen control group. There was no significant difference in post-thawed normal sperm morphology (14.9%, 14.4%, and 16%) and sperm DNA integrity by comet assay (93.6%, 94.5%, and 94.2%) in the RF, SPF, and controls, respectively. The hemi-zona index was no different between the two cryopreserved groups. CONCLUSION(S) The RF gave superior post-thaw motility and cryosurvival than SPF.

Clinical, endocrine and ultrasonographic features of polycystic ovary syndrome in Thai women

Aim:  To study the prevalence, reproductive hormone profiles and ovarian sonographic appearance of Thai women with polycystic ovary syndrome (PCOS).

Serum Prolactin and Cortisol Levels After Suckling for Varying Periods of Time and the Effect of a Nipple Shield

Plasma prolactin and cortisol levels were measured in mothers breast feeding with or without the use of a thin latex nipple shield, and in mothers wearing a nipple shield but who were not nursing. Suckling duration and milk transfer were also recorded. Suckling duration ranged between 6 and 31 min, being significantly correlated with prolactin levels 40 to 120 min after the feed started. At the latter time, baseline prolactin level and time spent nursing accounted together for most of the variance in prolactin levels: R2 was 0.79 and 0.82 at 90 min and 120 min respectively. Prolactin was released as usual when the shield was in place: levels were not significantly different from levels without the shield. Suckling duration was also unaffected by the shield, but milk transfer was significantly reduced. Cortisol was not released by using the shield, and the shield alone (without suckling) did not release prolactin. The thin latex nipple shield has therefore no untoward effect on the release of these hormones during nursing.

Comparison of Blastocyst and Sage Media for In Vitro Maturation of Human Immature Oocytes

In vitro maturation (IVM) of human oocytes is an attractive alternative to conventional assisted reproductive technology (ART) treatment, as it involves no or minimal ovarian stimulation. Currently, commercialized media specifically designed for IVM are often used. These media are expensive, have limited shelf life, and must be ordered in advance. If standard culture media can be used in place of the specialized IVM media, it would simplify management and make IVM more feasible and more widely employed in ART centers around the world, especially in developing countries where resources are scarce. This study was, therefore, conducted to test the hypothesis that blastocyst medium was as good as commercial IVM medium to support maturation and developmental competence of human immature oocytes as previously shown in the mouse system. Immature oocytes were obtained by needle aspiration from 89 pregnant women during cesarean deliveries between April 2012 and February 2013. Sibling oocytes were allocated to Sage IVM media (512 oocytes) or blastocyst medium (520 oocytes) and assessed for maturation 36 hours later. Mature oocytes were inseminated by intracytoplasmic sperm injection and cultured up to 144 hours. There was no difference in maturation rate (65.0% vs 68.7%; P = .218) or fertilization rate (66.9% vs 66.4%; P = .872) of oocytes matured in vitro in both media. There was also no difference in the formation of good-quality blastocysts (46.6% vs 45.9%; P = .889) in the 2 groups. Further study should be done to ascertain implantation and pregnancy potential of these embryos.

Effect of embryo density and microdrop volume on the blastocyst development of mouse two-cell embryos

OBJECTIVE To study the effect of embryo density and microdrop volume on mouse two-cell embryo development. DESIGN Experimental study. SETTING Assisted conception laboratory. ANIMAL(S) Two-cell mouse embryos (n = 1511). INTERVENTION(S) One, five, 10, or 15 embryos were cultured in 10-μL drops of cleavage medium. In the second study, embryos were cultured singly in 0.5-, 1-, 2-, 5-, and 10-μL drops. Finally, they were cultured in pair in 0.5-, 1-, and 2-μL drops. After 48 hours, embryos were transferred into blastocyst medium for an additional 24 hours. MAIN OUTCOME MEASURE(S) Cleavage and blastocyst formation and inner cell mass (ICM) and trophectoderm (TE) cell numbers. RESULT(S) No differences in cleavage or blastocyst formation were found in different groups in experiment 1, 2, or 3. Embryos cultured singly had fewer ICM and TE cells than those cultured in groups. Embryos cultured singly in 0.5 μL had fewer TE cells than those in 10 μL, but had insignificant difference in the ICM. Duo culture in 0.5-2 μL appeared to give the same results as group culture in 10-μL drops. CONCLUSION(S) Group culture is preferred when using sequential media. Beneficial effects cannot be mimicked by volume reduction in single-embryo culture.

Effects of ovarian endometriotic fluid exposure on fertilization rate of mouse oocytes and subsequent embryo development

BackgroundAccidental exposure of oocyte/cumulus complex to endometriotic fluid is not uncommon during oocyte retrieval. Only two studies were available on this subject and they gave conflicting results. In this study, we used a mouse model to evaluate the effect of controlled exposure of oocytes to ovarian endometriotic fluid.MethodsMouse oocytes/cumulus complexes (n = 862) were divided into 4 groups, and were exposed to endometriotic fluid (group 1), pooled sera from subjects without endometrioma (group 2), phosphate-buffered saline (group 3), and fertilization medium (controls). After five minutes, oocytes were washed and inseminated. Embryo development was observed daily. The quality of hatching blastocysts was assessed by counting the number of inner cell mass (ICM) and trophectoderm (TE) cells.ResultsThe fertilization, cleavage and blastocyst formation rates in the four groups were not statistically different. The proportions of hatching/hatched blastocysts from fertilized oocytes in groups 1 and 2 were significantly lower than those in group 3 and controls (P = 0.015). Hatching blastocysts from all groups showed no significant difference in the number of ICM and TE cells.ConclusionsExposure of mouse oocytes/cumulus complexes to endometriotic fluid had subtle detrimental effects on subsequent blastocyst development. However, one should be cautious in projecting the results of this study to contaminated human oocytes in a clinical setting.

Comparison of Medicult and Sage Media for In Vitro Maturation of Immature Oocytes Obtained during Cesarean Deliveries

Background: The success of in vitro maturation (IVM) of oocytes depends on many factors. Culture medium is one crucial part of the technique, but evidence-based selection of the medium is difficult because very few trials are available on this subject. In this study we compared two widely available commercial media, namely Medicult (Origo, Malov, Denmark) and Sage medium (Cooper Surgical, Trumbull, CT, USA) for IVM of human oocytes. Methods: One thousand and fifteen immature oocytes were collected by needle aspiration from ninety-three women, who underwent cesarean deliveries during a five-month period at a University Hospital in Thailand. Sibling oocytes were allocated to either Medicult (509 oocytes) or Sage IVM medium (506 oocytes) and assessed for maturation after 36 hours in culture. Mature oocytes were inseminated by intracytoplasmic sperm injection and cultured up to 144 hours. χ2-tests were used to compare maturation, fertilization, cleavage and blastocyst formation rates between the two groups. Results: There was no statistical difference (p>0.05) in maturation (65.0 vs. 64.2 %), fertilization (69.9 vs. 65.2 %), cleavage (61.7 vs. 61.2 %), or blastocyst formation (48.1 vs. 46.7 %) between oocytes in the two groups. Conclusions: Despite the unfavorable hormonal milieu, immature oocytes obtained during pregnancies are developmentally competent. Given equal efficacy, the choice of Medicult or Sage IVM medium depends on availability, cost, and ease of use. This approach is an attractive alternative to conventional oocyte donation and may be used to generate mature oocytes for stem cell research.

Factors affecting pregnancy rates after microsurgical reversal of tubal sterilization.

The aim of this study was to determine the prognostic factors and pregnancy rates after microsurgical reversal of tubal sterilization. Patients undergoing tubal anastomosis from 2001 to 2008 were included. Relevant data were extracted from their medical records. Pregnancy outcomes were ascertained by responses to mailed questionnaires and telephone contact. A total of 98 patients were identified. We found that the mean duration of follow-up was 67 ± 28 months. Fifty-five patients conceived (pregnancy rate 62.5%; 95% confidence interval [CI] 52 to 72.8%). Of these, 50 were intrauterine and 5 were tubal pregnancies. Life-table analysis estimated cumulative pregnancy rates to be 30.7%, 39.8%, 49%, and 53.7% at 6, 12, 18, and 24 months after reversal, respectively. Age at the time of reversal was the only significant prognostic factor multivariate model. We concluded that age of the patient at the operation is the most important prognostic factor.

No difference in high-magnification morphology and hyaluronic acid binding in the selection of euploid spermatozoa with intact DNA.

In this study, we compared conventional sperm selection with high-magnification morphology based on the motile sperm organellar morphology examination (MSOME) criteria, and hyaluronic acid (HA) binding for sperm chromosome aneuploidy and DNA fragmentation rates. Semen from 50 severe male factor cases was processed through density gradient centrifugation, and subjected to sperm selection by using the conventional method (control), high magnification at ×6650 or HA binding. Aneuploidy was detected by fluorescence in situ hybridization with probes for chromosomes 13, 18, 21, X and Y, and DNA fragmentation by the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) method. Spermatozoa selected under high-magnification had a lower DNA fragmentation rate (2.6% vs. 1.7%; P=0.032), with no significant difference in aneuploidy rate (0.8% vs 0.7%; P=0.583), than those selected by the HA binding method. Spermatozoa selected by both methods had much lower aneuploidy and DNA fragmentation rate than the controls (7% aneuploidy and 26.8% DNA fragmentation rates, respectively). In the high-magnification group, the aneuploidy rate was lower when the best spermatozoa were selected than when only the second-best spermatozoa were available for selection, but the DNA fragmentation rate was not different. In conclusion, sperm selection under high magnification was more effective than under HA binding in selecting spermatozoa with low DNA fragmentation rate, but the small difference (0.9%) might not be clinically meaningful. Both methods were better than the conventional method of sperm selection.