V. Insler

The association between chlamydial-specific IgG and IgA antibodies and pregnancy outcome in an in vitro fertilization program

Chammydial-specfic IgG and IgA antibodies were determined by a single serovar (L2) immunoperoxidase assay (IPA) in the serum of all patients that have conceived in an in vitro fertilization and embryo transfer (IVF & ET) progrom (n=106) and in a group of patients that went through the program at the same period of time and did not conceive (n=94). The prevalence rate of elevated IPA IgG (titers≥1∶128) and IPA IgA (titers≥1∶16) specific to chlamydiae was significantly higher (P<0.001) in the IVF&ET pregnancy loss and nonconception groups (“failures”) versus the IVF&ET term pregnancy group (“successes”) (74 vs 47%, odds ratio=4.1, and 34 vs 14%, odds ratio=4.3, respectively). Stepwise discriminant analysis revealed that elevated specific chlamydial IgG had the greatest effect on the variance between successes and failures in this study group. Our study indicates the possible role of past or chronic active chlamydiae infection on the “take-home baby rate” in an IVF&ET program.

In utero prenatal diagnosis of Beckwith-Wiedemann syndrome; a case report

The Beckwith-Wiedemann syndrome is an unusual complex of abnormalities that includes mainly omphalocele, macroglossia, natal and postnatal gigantism, visceromegaly and neonatal hypoglycemia. A case is presented where sonographic prenatal diagnosis of this rare condition was made. Prenatal findings and postnatal management are described.

Human endometrium in cell culture: A new method for culturing human endometrium as separate epithelial and stromal components

SummaryThe present study describes a simple method for culturing human endometrium as separate epithelial and stromal components. Fifty-two samples of normal human endometrium have been initiated in tissue culture: endometrium from both the proliferative and luteal phases of the menstrual cycle showed satisfactory growth in vitro wich a success rate of about 94%. Epithelial cultures remained viable for 60 days, while from stromal cells it was possible to establish cell lines. Both cell types possessed estrogen receptors. Epithelial cells showed no clear estrogen or progesterone response. Our observations suggest that this simple method for culturing human endometrium may serve as a tool in further investigations.

Polyzoospermia: a definite pathologic entity

Polyzoospermia has been repeatedly associated with reduced fertility and increased rates of spontaneous abortion. We examined semen samples of 1374 infertile men and found an incidence of 4.2% of semen with a sperm density exceeding 250 X 10(6) sperm cells/ml. The spontaneous pregnancy rate in 30 evaluated couples in whom the male partner presented with polyzoospermia was 38.7% and the spontaneous abortion rate was 25%. Sperm penetration tests revealed normal mucus-penetrating ability in 29 of 30 men examined. The reason for reduced reproductive performance in polyzoospermic men does not seem to be disturbed sperm mucus interaction.

Is end‐stage deceleration of the fetal heart ominous?

Summary. End‐stage deceleration (ESD) defined as deep and sustained fetal bradycardia during the second stage of labour was observed in 55 patients. Fetal well‐being and neonatal outcome were assessed with fetal‐scalp pH, umbilical‐vein pH and l‐min Apgar score values. Only six infants with pathological fetal heart‐rate patterns before ESD had a l‐min Apgar score of <7 and an acidotic umbilical‐vein pH. The remaining 49 babies were born in excellent condition, although when ESD persisted for more than 15 min umbilical‐vein pH decreased.

Evaluation of reliability of history in women complaining of urinary stress incontinence

It was the aim of this study to evaluate critically the value of history in patients complaining of urinary stress incontinence. Diagnosis was established mainly by radiologic and cystomanometric assessment. History included 21 symptoms subdivided into various items. Only 3 symptoms were proven significant in distinguishing between various diagnostic groups. Assessment of stress incontinence should be regarded as incomplete without other means of evaluation in addition to history.

Treatment of hypertension during pregnancy with hydralazine monotherapy or with combined therapy with hydralazine and pindolol

Forty-four consecutive patients referred for treatment because of hypertension (greater than 150/90 mmHg) occurring during pregnancy were randomly allocated to one of two treatment groups, hydralazine alone (n = 21) or hydralazine combined with pindolol (n = 23). Satisfactory blood pressure control (diastolic pressure less than 90 mmHg) was achieved in 86% of patients receiving hydralazine alone and 91% of those on combined therapy. Although the treatment did not lower the overall incidence of hypertensive complications it appeared to delay the onset of such complications until successful surgical intervention was possible. Fetal outcome was similar in both groups and there was no perinatal mortality in this high-risk population. Although blood pressure control was similar in both groups of patients, combined therapy with hydralazine and pindolol can be considered to be superior to hydralazine monotherapy, since in patients treated with the combination the incidence and intensity of troublesome side-effects was markedly lower.

Reactivation of cytomegalovirus in endometrial cells by estradiol

The present study uses an in vitro model to test the influence of hormones on the replication and reactivation of cytomegalovirus (CMV) in endometrial tissue culture. Infection of epithelial cells of the endometrium with CMV in the presence of a high concentration of estradiol resulted in only a slightly higher yield of infectious virus. Progesterone did not cause any effect on viral replication. Arrest of CMV replication was achieved by reduction of the pH of the incubation medium. No infectious virus was detectable after incubation of infected cultures at pH 5.8. In the above-described conditions following the arrest of CMV replication by low pH, estradiol treatment was capable of reactivating the virus. The possibility that the increase in CMV infection observed in pregnancy is caused by reactivation of latent virus provoked by hormonal factors will be discussed.

Management and outcome of vertex-breech and vertex-vertex presentation in twin gestation: a comparative study

A comparative study of twin pregnancies with vertex-breech and vertex-vertex presentation was undertaken to evaluate the effect of mode of delivery on perinatal outcome. During the years 1978-1984 there were 89 cases of vertex-breech deliveries at our institution and a control group of 89 cases of vertex-vertex presentation were chosen. The cesarean section rate was 11.2% for both twins in vertex-breech, and 20.2% for the first twin and 23.6% for the second in vertex-vertex presentation. The primary indications for cesarean section were not related to the type of presentation. The perinatal mortality was 22.4/1000 in the study group and 89.8/1000 in the control population. There were no statistically significant differences in 5-min Apgar scores and perinatal morbidity between the two types of presentation. We found that the high perinatal morbidity and mortality of both twins is related to prematurity and intrauterine growth retardation and not associated with the type of presentation of the second twin. Therefore, routine cesarean section for vertex-breech presentation is not necessarily indicated.

Antigenicity of sperm cells after freezing and thawing

Freezing and thawing is thought to result in removal of spermatozoal membrane antigens. We investigated the presence of sperm antigens before and after freezing and thawing by means of the immunoperoxidase assay (IPAMA), sperm immobilization test (SIT), and separation of proteins by gel electrophoresis. The results of the IPAMA and SIT assays showed no difference in the membrane antigens before and after freezing and thawing. Analysis of surface proteins by gel electrophoresis demonstrated that freezing and thawing did not remove any particular group of proteins from the surface membrane of spermatozoa. According to the evidence of the three tests performed, there is no meaningful removal of antigens from the sperm cell surface membrane by the process of freezing, preservation, and thawing when carried out by the specific methods used. This work does not support the suggestion that in cases of immunologic incompatibility between spermatozoa and cervical mucus it would be possible to overcome the couples infertility by employing the process of freezing, preservation, and thawing.