Toshiko Toda

Reproductive capacity of the nucleus of the male gamete after completion of meiosis

PurposeOur purpose was to investigate the possibility of achieving fertilization and subsequent normal embryonic development by injecting round spermatid nuclei into rabbit oocytes.ResultsTwo- to four-cell-stage embryos developed after round spermatid nuclear injections into rabbit ooplasma could further develop in vitro up to the expanding blastocyst stage or in vivo up to complete gestation.ConclusionThe current findings show that the haploid set of chromosomes of round spermatid can pair with the chromosomes of the ootid to participate in complete fertilization and subsequent embryonic and fetal development. In addition, we suggest that postmeiotic modifications of the round spermatid are not required for the pairing of male gamete chromosomes with those of the ootid.

Ooplasmic round spermatid nuclear injection procedures as an experimental treatment for nonobstructive azoospermia

AbstractPurpose: Our objective was to apply ooplasmic round spermatid nuclear injections for the treatment of nonobstructive azoospermia. Materials: Participants were nine azoospermic men who had previously undergone diagnostic testicular biopsy. Spermatogenetic arrest was diagnosed at the round spermatid stage (n=6) or primary spermatocyte stage (n=3). A second (therapeutic) testicular biopsy was performed and round spermatid nuclei were recovered from all the participants. Results: Forty-nine mature oocytes were successfully injected with nuclei and then cultured for 72 hr. Twenty-four embryos were transferred to nine women. No pregnancy was achieved. Conclusions: Round spermatids can be recovered from therapeutic testicular biopsy material of men negative for round spermatids in previous routine diagnostic testicular biopsy specimens. Round spermatid nuclear injections may play a role in the treatment of nonobstructive azoospermia.

Luteinized unruptured follicle in the early stages of endometriosis as a cause of unexplained infertility.

OBJECTIVE We attempted to clarify the relationship between luteinized unruptured follicle, which occurs in the early stages of endometriosis, and unexplained infertility. STUDY DESIGN Seventy patients who had unexplained infertility were reviewed. RESULTS Laparoscopic examination showed that 47 patients (67%) had endometriosis; of these, 40 (85%) had minimal or mild disease. The incidence of luteinized unruptured follicle was higher (p < 0.05) in patients who had endometriosis (35%/patient and 25%/cycle) compared with patients who did not have endometriosis (11%/patient and 7%/cycle). Degenerated oocyte cumuli were collected in 6 (43%) of 14 luteinized unruptured follicles diagnosed by transvaginal ultrasound. CONCLUSIONS These results show that luteinized unruptured follicle is common in patients who have mild or minimal endometriosis and that it may be one of the causes of endometriosis-associated infertility. Transvaginal ultrasound-guided follicular puncture of luteinized unruptured follicle during the mid luteal phase may be useful in establishing a definitive diagnosis of luteinized unruptured follicle.

Transvaginal ultrasound-guided follicular aspiration in the management of anovulatory infertility associated with polycystic ovaries *

STUDY OBJECTIVE To investigate whether or not transvaginal ultrasound (US)-guided follicular aspiration can effectively induce ovulation and facilitate pregnancy in anovulatory patients with polycystic ovaries (PCO). DESIGN Eight patients with polycystic ovarian disease (PCOD) and 10 patients with PCO were participants who failed to ovulate by the medical therapies. Most of persistent follicles were punctured, and their contents were thoroughly aspirated during the midluteal phase. The same ovarian stimulation regimen as used in the previous cycles were administered in the cycles after the aspiration. MAIN OUTCOME MEASURES Evidence of ovulation and a subsequent pregnancy was ultrasonically monitored after the aspiration, and the responsiveness of pituitary gonadotropins to gonadotropin-releasing hormone was tested in these patients. RESULTS The ovulation rates were 87.5% per patient, 52.6% per cycle monitored in PCOD patients and 100% per patient, 63.3% per cycle monitored in PCO patients, respectively. Half of the patients both with PCOD and PCO achieved pregnancy after the aspiration. A significant decrease (P less than 0.05) of the basal and peak levels of serum luteinizing hormone was observed after the aspiration. CONCLUSIONS The US-guided follicular aspiration seems to be a new surgical method for treating anovulatory patients with PCO.

The Importance of the Hypoosmotic Swelling Test and Acrosin Activity Assay for Identifying Subpopulations of Idiopathic Infertile Men

Semen samples collected from fertile donors (n = 13) and pooled samples from idiopathic infertile men (n = 19) were used in this study. Measurements of the total sperm acrosin activity and the hypoosmotic swelling test (HOST) were performed in all the samples. The percentage of swollen spermatozoa and acrosin profiles were significantly lower in the infertile men than in the fertile donors. Considering the lowest values of the outcome of the HOST and the acrosin activity assay in the group of fertile men as the lowest normal values, it was proven that HOST and acrosin activity assay could identify subpopulations of infertile men of 37 and 26%, respectively. The results tend to support the employment of the HOST and the acrosin activity assay in the evaluation of idiopathic infertile men.

Effects of low dose oral contraceptive pill containing drospirenone/ethinylestradiol in patients with endometrioma.

OBJECTIVES Low dose oral contraceptive pills (OCPs) that contain synthetic estrogen and progestin are often used to relieve chronic pelvic pain associated with endometriosis. We sought to evaluate the efficacy of drospirenone/ethinylestradiol (DRSP/EE) with low-dose estrogen in treating endometrioma. STUDY DESIGN A prospective clinical study in six hospitals and one clinic in Japan was conducted. Forty-nine 23- to 45-year-old patients who suffered from endometriosis-associated dysmenorrhea were included in the study. The primary endpoint was the change in size of ovarian endometrioma as measured by transvaginal ultrasonography. The secondary endpoint was the change in dysmenorrhea as evaluated by VAS (visual analog scale) scores before treatment and at 3 and 6 cycles of treatment. In addition, serum CA125, anti-mullerian hormone (AMH), interleukin (IL)-6, and IL-8 were evaluated after 6 cycles of treatment. RESULTS The maximum diameter and volume of the ovarian endometrioma significantly decreased after 3 and 6 cycles compared with pretreatment. VAS scores of dysmenorrhea pain were also reduced after 1, 3 and 6 cycles. A significant correlation between the reduced size of the endometrioma and the decline of VAS scores was found. The levels of serum CA125 and AMH concentration were decreased after 6 cycles. No significant changes were observed in serum IL-6 and IL-8. CONCLUSION Low dose DRSP/EE therapy is a promising treatment not only to reduce the size of endometrioma but also for dysmenorrhea.

Timing of progesterone rise around a surge in endogenous luteinizing hormone or the injection of human chorionic gonadotropin in controlled ovarian stimulation for in vitro fertilization

SummaryOf 70 treatment cycles in 59 patients, the endogenous LH surge occurred in 19 cycles (27%) before fulfilling our criteria for hCG administration. Timed injections of hCG were administered in 31 cycles (44%). Twenty cycles were canceled. The elevation of P (>1.0 ng/ml) did not always occur before or during the onset of LH surge. Pregnancy occurred only during those cycles in which an elevated P level was observed during or 12 hr after the LH surge or of hCG administration. It is concluded that the timing of the P elevation as well as the P level itself has major physiological importance in controlled ovarian stimulation for IVF.

The efficacy and safety of dydrogesterone for treatment of dysmenorrhea: An open-label multicenter clinical study: Dydrogesterone for dysmenorrhea

Dydrogesterone is a retro‐progesterone preparation widely used for over a half century. We sought to evaluate the efficacy and safety of dydrogesterone in Japanese women with dysmenorrhea.