Elevated interleukin-6 levels in the ovarian hyperstimulation syndrome: ovarian immunohistochemical localization of interleukin-6 signal

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those stratified by age were 0.13 (age < 22 years) and 0.39 (age ~22 years). Potential confounders included in regression models did not diminish the associations. Conclusions. Smoking is associatedwith lowered semen quality. IslfbeDmoIrmmkIagwrertBBylnwemenarteudmgMlnvBro fe-rtilhtiooprogram Sterxik K.; Strehler E.; De Santo M.; Trumpp N.; Abt M.; Rosenbusch B.; Schneider A. DEU

FERTIL STERIL 19966514(810-814) Objective. To investigate the influence of cigarette smoking of women on the fertilization and pregnancy rates obtained by in vitro fertilization (IVF) treatment. Patients. One hundred ninety-seveninfertile, otherwise healthy women who entered an IVF program for the first time. Setting. Fertility Unit at the Women’s University Hospital of the University of Ulm, Germany. Interventions. The study population consisted of 197 women (23-39 years oId) who were divided into the following groups: non-smokers(n = 68), passive smokers (n = 26) and active smokers (n = 103)according to the cotinine concentration measuredin follicular fluid. The reasonfor infertility was strictly a tubal factor with apparently normal ovulatory cycles. To guarantee an objective recording of tobacco smoke exposure, the smoking habit was not determined by questionnaires, but by cotinine, the principal metabolite of nicotine. Results. There were no signilicant differences in fertilization and pregnancy rates between the different groups. The E2 serum levels were decreasedsignificantly in women who smoked when compared with the results obtained from non-smokers and passive smokers. Overall, a strong negative correlation of the cotinine and E, levels was observed (r = -0.65). Conclusions. The results suggestthat there is no clinically detectable impairment of fertilization potential due to female smoking and that there is a greater influence on the outcome of IVF by other factors. Doeshrgelaopexcisiaaoftktrxnsformatimzolleoftbecenix pdhpoee to tbe devebpmeot of amtispem antibodks in women? Nicholson S.C.; Robinson J.N.; Sargent I.L.; Hallam N.F.; Chamock F.M.L.; Barlow D.H. GBR

FERTIL STERIL 19966514(871-873) Objective. To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa. Design. A prospective, controlled study. Setting. Colposcopy and Andrology Units at the John Radclife and Churchill Hospitals, Oxford, UK. Interventions. Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequentreproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies. Main outcome measure(s).The detection of serum antisperm antibodies by flow cytometry. Results. None of the serum samples before large loop excision of the cervical transformation

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zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of non-barrier contraception after surgery. There was no rise in antisperm antibody levels in the control population. Conclusions. Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred. latrafoukulfu bemodylmmicsbefore the administration of bumaIl dnwionk gn~~I~lvopio ia WOIIIOII at risk of the marim byperstImaIatiollayndNme Oyesanya O.A.; Parsons J.H.; Collins W.P.; Campbell S. GBR

FERTIL STERIL 19966514(874-876) Objective. To test the hypothesis that alteration of intrafollicular hemodynamicsprecedesthe ovarian hyperstimulation syndrome (OHSS). Design. A prospective study. Setting. The IVF Unit and the Doppler Imaging Laboratory of King’s College Hospital, London, UK. Patients. Twenty-four women undergoing in vitro fertilization and considered to have an exaggerated responseto ovarian stimulation and hence at risk of OHSS. Interventions. Transvaginal Doppler imaging of the intrafollicular blood flow was performed before human chorionic gonadotropin (hCC) administration to determine the indexes of intrafollicular hemodynamics. Main outcome measures. Moderate or severe OHSS. Results. There was no statistically significant difference in mean age (32.63 f 1.77 vs. 31.48 * 3.87). duration of infertility (6.00 f 2.19 vs. 5.29 t 2.73). maximum peak systolic velocity (0.25 f 0.16 vs. 0.26 f 0.21 m/s), mean of six maximal peak systolic velocity (0.15 f 0.04 vs. 0.21 t 0.10). minimum pulsatility index (0.76 i 0.26 vs. 0.59 i 0.23), mean of six minimal pulsatility indexes (0.89 t 0.30 vs. 0.79 i 0.14). minimum resistance index (0.47 f 0.06 vs. 0.41 f 0.10) and mean of six minimal resistanceindexes (0.56 f 0.05 vs. 0.53 t 0.06) of intrafollicular blood flow between the women who developed moderate or severe OHSS and matched controls. Conclusions. Measurement of intrafollicular hemodynamics before hCG administration does not predict the development of OHSS. Hated interloveIsla the ovarian bypedmdxtioa sy~+ dromrcovarim immmafIbItfocaIhtin0 of ill&.*

6NH Loret De Mola J.R.; Flores J.P.; Baumgardner G.P.; Goldfarb J.M.; Gindlesperger V.; Friedlander MA. USA OBSTET GYNECOL 1996 8714(581-587) Objective. To examine the production and immunolocalixation of interleukin-6 (H-6) in patients with the ovarian hyperstimulation syndrome. Method. The study group consisted of patients with ovarian hyperstimulation syndrome (n = 9) from whom serum and ascites samples were obtained. The control samples used were serum (n = IO), peritoneal (n = 16) and

Citations from the literature /International Journal of follicular fluids (I! = 8) from healthy individuals. Follicular fluid (n = 40) and serial serum sampleswere also obtained from patients undergoing menotropin stimulation for in vitro fertilization (IVF) before (n = IO) and after ovulation (n = 34). IL6 measurementswere performed using a sensitive immunoassay and conBrmed using a bioassay. Immunohistochemical localization of IL-6 was performed with a mourn monoclonal antibody in normal premenopausal (n = 5) and postmenopausal ovaries (n = 5). as well as with cells from stimulated follicular fluid aspirates (a = 3). Results. We found significantly higher serum and ascites IL-6 levels in ovarian hyperstimulation syndrome (mean 18.8 f I.1 and 810.8 f 60.7 pg/rnl, respectively) compared with postovulatory serum and peritoneal fluid from normal controls (mean 4.4 f 0.69 and 44.7 f 7.5 p#ml, respectively) (P < 0.001) or serum after menotropin stimulation (I 3.I l I. I pg/ml) (P < 0.001). At the time of ovulation, follicular fluid IL-6 levels (normal controls, mean 9 f 2.1 pg/mk menotropin stimulation, mean 10.1 + 4 pgAnl) were higher than in preovulatory serum (normal controls, mean 4.5 f 0.8 pgAnl; menotropin stimulation, mean 6.3 f 1.4 pg/ml) (P c 0.001). Immunohistochemical localization of IL6 revealed intense staining in corpora lutea and theta cells from large antral follicles and luteinimd granulosa cells in follicular aspirates after menotropin stimulation. Conclusions. Interleukin-6 levels are markedly elevated in the ovarian hyperstimulation syndrome when compared with controls. The higher follicular fluid IL-6 levels seensuggestlocal secretion of this cytokine. Immunohistochemical correlation demonstrated II.6 within ovarian theta cells. These findings suggesta local role for IL-6 both in normal and stimulated ovarian function. Whether IL-6 is directly responsible for the clinical manifestations of this syndrome is unclear. However, when produced in massive amounts, the pro-inflammatory effects of IL-6 may contribute to its pathogenesisand perhaps serveas a marker for the disease. hoor lmcmbatb~~ a eo~~parboaof bsbIaa e beterosexdcoppka-dM= Wendland C.L.; Bym F.; Hill C. USA FERTIL STERIL 19966514(764-770) Objective. To compare single women, lesbian couples and heterosexual couples receiving therapeutic donor insemination (TDI). Design. Chart review followed by anonymous mail questionnaires to donor insemination recipients and their partners. Setting. Infertility clinic in a university hospital. Patients. One hundred fifteen women receiving donor insemination were identified by chart review. Results. Too few single women responded for reliable comparison. Lesbian women were similar to married women in age, education, duration and outcome of donor insemination. When considering alternatives to TDI. married women were more likely to consider adoption and lesbians were most likely to consider using a known semen donor or having intercourse with a man awae of their desire to have a child. Married couples were less likely to tell others, including the child, about conception by donor insemination. They were also lesslikely to support disclosing identifying data about the donor to the child. Lesbians were more likely to re-

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port stress in their relationships as a result of TDI. Married men were most likely to support mandatory counseling before TDI initiation.

ENDOCRINOLOGY A eompratlve etdy of safety and efikscy of conthms bw dose aeshdblrcIeaeedfromavagbalriagcomparcdwItheoajogatcd oqube oeeogea vagbaI cream b tIbE treatnlcat of posbnenopglllmatropby Ayton R.A.; Darling G.M.; Murkies A.L.; Farrell E.A.; Weisberg E.; Selinus I.; Fraser I.S. AUS BR J OBSTET GYNAECOL 1996 10314(351-358) Objective. To compare the safety, efficacy and acceptability of a continuous low-dose estradiol-releasing vaginal ring with conjugated equine estrogen vaginal cream in the treatment of postmenopausalurogenital atrophy. Design. An open, parallel, comparative multicenter trial. Setting. Sydney and Melbourne, Australia. Participants and interventions. One hundred ninetyfour postmenopausalwomen with symptoms and signs of urogenital atrophy were randomized on a 2: I basis to I2 weeks of treatment with an estrogen vaginal ring vs. an estrogen cream. Main outcome measuresand results. Equivalence (95% confidence intervals) was demonstrated between the two treatments for relief of vaginal dryness and dyspareunia, resolution of atrophic signs, improvement in vaginal mucosal maturation indices and reduction in vaginal pH. No significant difference was demonstrated in endometrial response to a progestogen challenge test, and equivalence.was demonstrated in the incidence of intercurrent bleeding episodes. The vaginal ring was signillcantly more acceptable than the cream (P < 0.0001)and was preferred to the cream (P < 0.001). Conclusions. With equivalent effi and safety and superior acceptability to vaginal cream, the low-dose estradiol vaginal ring is an advance in vaginal delivery systems for the treatment of urogenital atrophy. Hormone replacemem therapy, hmmasmlevels, and llpoproteia cllobsteNl c!omdratIons lo ekbrly womco Paganini-Hill A.; Dworsky R.; Krauss R.M. USA AM J OBSTET GYNECOL 1996 l74/3 (897-902) Objective. Our purpose was to assessthe relationships of lipid and lipoprotein cholesterol levels to hormone replacement therapy and hormone levels in elderly women. Study design. A sample of 292 postmenopausal women 55-99 years old (mean 76 years) was drawn from Leisure World, Laguna Hills, CA, USA, an upper-middle-class,white, independent-living population. We compared 84 women receiving unopposed estrogen replacementtherapy and 38 women taking combination hormone replacementtherapy with I70 women who had never used hormone replacement therapy. Non-parametric tests for differencesin lipid and lipoprotein cholesterol levels among groups and multiple stepwiseregressionmodels were used.Results. Estrogen users(with and without progestin) had lower total and low-density lipoprotein cholesterol and higher high-density lipoprotein and high-density lipoprotein subfraction types 2, 2a