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Clinical relevance of sperm morphology assessment using strict criteria and relationship with sperm-mucus interaction in vivo and in vitro
Citations from the literature /International
Journal of Gynecology & Obstetrics 51 (1995) 1X9- I97
with ovarian failure (study group), and 12 volunteers with normal ovarian cycles (control group). Results: Data for resistance indexes were divided into live phases according to the day of hormonal cycle: 0, pretreatment phase; I, early follicular phase (days 5 to 7); II, late follicular phase (days I I to 13); III, early luteal phase (days I7 to 21); and IV, late luteal phase (days 23 to 25). All women with ovarian failure demonstrated continuous forward end-diastolic flow velocities at phase I, whereas none showed this pattern during the pretreatment period (phase 0). Women with ovarian failure in the early follicular phase had a significantly higher resistance index (0.85 f 0.1; mean f SD) than that in the late follicular phase (0.57 f 0. I), and the resistance index in the early luteal phase (0.67 f 0.1) was significantly higher than that of the late follicular phase.There was no difference in the resistanceindex between early and late luteal phases.A similar pattern of lower resistanceindex around midcycle was observed in the control group. However, a comparison of the resistance indexes between ovarian failure and control patients revealed a significant difference between values in the early follicular phase only (0.85 f 0.I vs. 0.68 f 0. I). In the late follicular phase and during the entire luteal phase, the mean resistance index did not differ between the study and control groups. Conclusions: The observed data suggestthat standard HRT in women with premature ovarian failure enables restoration of endometrial blood flow to normal. This may imply uterine receptivity for oocyte donation. Tramdermnl estrogenwith a levonorgestrel-releasingintrauterine device for climacteric complaints: Clinical and endometrial responses Raudaskoski T.H.; Lahti E.I.; Kauppila A.J.; Apaja-Sarkkinen M.A.; Laatikainen T.J. FIN
AM J OBSTET GYNECOL 1995 172/l (114-1190) Objective: Our purpose was to study the effects of intrauterine release of a daily dose of 20 g levonorgestrel by an intrauterine device on climacteric symptoms, bleeding pattern, and endometrial histologic features in postmenopausal women receiving transdermal estrogen replacement therapy. Study design: Forty parous postmenopausal women were randomly allocated into two groups for I year: 20 women receiving a continuous transdermal daily dose of 50 pg of estradiol bad a levonorgestrel-releasing intrauterine contraceptive device inserted, and the control group of 20 women received a continuous oral dose of 2 mg of estradiol valerate and I mg of norethisterone acetate daily. The climacteric symptoms, bleeding patterns, endometrial thickness, and endometrial changes in biopsy samples were analyzed. Serum levels of estradiol in both groups and levonorgestrel levels in the intrauterine device group were also determined. Results: Both treatment regimens effectively relieved climacteric symptoms. Spotting was more common in the intrauterine contraceptive device group than in the oral therapy group for the first 3 months. After that,the proportion of women without any bleeding was similar in both groups. Two patients in each group dropped out because of bleeding, Conclusion: These preliminary findings suggest that
195
the levonorgestrel-releasingintrauterine contraceptive device is a useful alternative mode of progestin administration for certain selectedwomen receiving estrogen replacement therapy.
FERTILITY
AND STERILITY
CIIIeal relevance of sperm morphology amessmentusing strict criteria mnl relationship with sperm-mucusinteraction in vivo and in vitro Eggert-Kruse W.; Reimann-Andersen J.; Rohr Cl.; Pohl S.; Tilgen W.; Runnebaum B. DEU
FERTIL STERIL 199563/3 (612-6240) Objective: To determine the relationship of the differentiated morphological pattern of semensamplesaccording to strict criteria and sperm-mucus interaction in vivo and in vitro. Patients: One hundred sixty-three randomly chosen couples with long-standing infertility (median duration of infertility 4 years, range 1 to I9 years). Setting: Outpatient clinic of the fertility unit at the Women’s University Hospital of the University of Heidelberg, Heidelberg, Germany. Main Outcome Measures: Sperm morphology assessmentusing strict criteria (Tygerberg or Norfolk classification) parallel to standard methods of sperm analysis: Evaluation of the cervical factor of patients’ female partners, including a microbial screening of genital secretions of both partners; Examination of sperm migration ability in vivo under hormonally controlled conditions for the cervical mucus (CM) quality and in vitro with the crossed sperm-CM penetration test performed with CM of patients’ partners, as well as with CM and spermatozoa of donors; Determination of the selection capacity of CM with regard to sperm morphology by meansof a biological model; Prospective analysis of the differentiated morphological pattern with respect to couples’ subsequent fertility within 6 months. Results: Using stict criteria, amorphous sperm headswere the most frequently found sperm anomaly (severely amorphous forms: median, 28%; range, 4 to 62%). The morphology index offered a median of 45% (range, 7 to 80%). Results correlated significantly with routine sperm analysis, including standard morphology. The morphological pattern differed significantly in samples offering adequate or inadequate ability to penetrate CM in the standardized spermCM penetration test or in the postcoital test, with the percent of severely amorphous headsas the most important parameter. Neck and tail defects did not play an important role. During passage of mucus columns in vitro, the rate of pathological spermatozoa1forms was reduced significantly, from a median of 65% to a median of 38%. Better functional capacity of spermatozoa with normal head morphology also was reflected by a significantly higher pregnancy rate under natural conditions of conception. Conclusions: Sperm morphological properties, determined with strict criteria, are important factors for sperm ability to penetrate the mucus barrier at the uterine cervix before reaching the site of fertilization, but sperm morphology is only one among other parameters determining the complex phenomenon of sperm-mucusinteraction.
Journal of Gynecology & Obstetrics 51 (1995) 1X9- I97
with ovarian failure (study group), and 12 volunteers with normal ovarian cycles (control group). Results: Data for resistance indexes were divided into live phases according to the day of hormonal cycle: 0, pretreatment phase; I, early follicular phase (days 5 to 7); II, late follicular phase (days I I to 13); III, early luteal phase (days I7 to 21); and IV, late luteal phase (days 23 to 25). All women with ovarian failure demonstrated continuous forward end-diastolic flow velocities at phase I, whereas none showed this pattern during the pretreatment period (phase 0). Women with ovarian failure in the early follicular phase had a significantly higher resistance index (0.85 f 0.1; mean f SD) than that in the late follicular phase (0.57 f 0. I), and the resistance index in the early luteal phase (0.67 f 0.1) was significantly higher than that of the late follicular phase.There was no difference in the resistanceindex between early and late luteal phases.A similar pattern of lower resistanceindex around midcycle was observed in the control group. However, a comparison of the resistance indexes between ovarian failure and control patients revealed a significant difference between values in the early follicular phase only (0.85 f 0.I vs. 0.68 f 0. I). In the late follicular phase and during the entire luteal phase, the mean resistance index did not differ between the study and control groups. Conclusions: The observed data suggestthat standard HRT in women with premature ovarian failure enables restoration of endometrial blood flow to normal. This may imply uterine receptivity for oocyte donation. Tramdermnl estrogenwith a levonorgestrel-releasingintrauterine device for climacteric complaints: Clinical and endometrial responses Raudaskoski T.H.; Lahti E.I.; Kauppila A.J.; Apaja-Sarkkinen M.A.; Laatikainen T.J. FIN
AM J OBSTET GYNECOL 1995 172/l (114-1190) Objective: Our purpose was to study the effects of intrauterine release of a daily dose of 20 g levonorgestrel by an intrauterine device on climacteric symptoms, bleeding pattern, and endometrial histologic features in postmenopausal women receiving transdermal estrogen replacement therapy. Study design: Forty parous postmenopausal women were randomly allocated into two groups for I year: 20 women receiving a continuous transdermal daily dose of 50 pg of estradiol bad a levonorgestrel-releasing intrauterine contraceptive device inserted, and the control group of 20 women received a continuous oral dose of 2 mg of estradiol valerate and I mg of norethisterone acetate daily. The climacteric symptoms, bleeding patterns, endometrial thickness, and endometrial changes in biopsy samples were analyzed. Serum levels of estradiol in both groups and levonorgestrel levels in the intrauterine device group were also determined. Results: Both treatment regimens effectively relieved climacteric symptoms. Spotting was more common in the intrauterine contraceptive device group than in the oral therapy group for the first 3 months. After that,the proportion of women without any bleeding was similar in both groups. Two patients in each group dropped out because of bleeding, Conclusion: These preliminary findings suggest that
195
the levonorgestrel-releasingintrauterine contraceptive device is a useful alternative mode of progestin administration for certain selectedwomen receiving estrogen replacement therapy.
FERTILITY
AND STERILITY
CIIIeal relevance of sperm morphology amessmentusing strict criteria mnl relationship with sperm-mucusinteraction in vivo and in vitro Eggert-Kruse W.; Reimann-Andersen J.; Rohr Cl.; Pohl S.; Tilgen W.; Runnebaum B. DEU
FERTIL STERIL 199563/3 (612-6240) Objective: To determine the relationship of the differentiated morphological pattern of semensamplesaccording to strict criteria and sperm-mucus interaction in vivo and in vitro. Patients: One hundred sixty-three randomly chosen couples with long-standing infertility (median duration of infertility 4 years, range 1 to I9 years). Setting: Outpatient clinic of the fertility unit at the Women’s University Hospital of the University of Heidelberg, Heidelberg, Germany. Main Outcome Measures: Sperm morphology assessmentusing strict criteria (Tygerberg or Norfolk classification) parallel to standard methods of sperm analysis: Evaluation of the cervical factor of patients’ female partners, including a microbial screening of genital secretions of both partners; Examination of sperm migration ability in vivo under hormonally controlled conditions for the cervical mucus (CM) quality and in vitro with the crossed sperm-CM penetration test performed with CM of patients’ partners, as well as with CM and spermatozoa of donors; Determination of the selection capacity of CM with regard to sperm morphology by meansof a biological model; Prospective analysis of the differentiated morphological pattern with respect to couples’ subsequent fertility within 6 months. Results: Using stict criteria, amorphous sperm headswere the most frequently found sperm anomaly (severely amorphous forms: median, 28%; range, 4 to 62%). The morphology index offered a median of 45% (range, 7 to 80%). Results correlated significantly with routine sperm analysis, including standard morphology. The morphological pattern differed significantly in samples offering adequate or inadequate ability to penetrate CM in the standardized spermCM penetration test or in the postcoital test, with the percent of severely amorphous headsas the most important parameter. Neck and tail defects did not play an important role. During passage of mucus columns in vitro, the rate of pathological spermatozoa1forms was reduced significantly, from a median of 65% to a median of 38%. Better functional capacity of spermatozoa with normal head morphology also was reflected by a significantly higher pregnancy rate under natural conditions of conception. Conclusions: Sperm morphological properties, determined with strict criteria, are important factors for sperm ability to penetrate the mucus barrier at the uterine cervix before reaching the site of fertilization, but sperm morphology is only one among other parameters determining the complex phenomenon of sperm-mucusinteraction.