Factors affecting fertilization: Endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida

Citations from the literature/International

Journal of Gynecology & Obstetrics 51 (1995) 87-97

The mean concentration of sperm decreased by 2.1% per year, from 89 x lo6 per milliliter in 1973 to 60 x lo6 per milliliter in 1992 (P < 0.001). During the same period the percentages of motile and normal spermatozoa decreased by 0.6% and 0.5% per year, respectively (both P < 0.001). After adjustment in multiple regression analyses for age and the duration of sexual abstinence, each successive calendar year of birth accounted for 2.6% of the yearly decline in the sperm concentration and for 0.3% and 0.7%, respectively, of the yearly declines in the percentages of motile and normal spermatozoa (all P < 0.001). Conclusions. During the past 20 years, there has been a decline in the concentration and motility of sperm and in the percentage of morphologically normal spermatozoa in fertile men that is independent of the age of the men.

EffeetIveueas of emmover trurpseptpl vaaeepkIkIytuostomy h treating eontpkx obstnsetive -ia Sabanegh E. Jr.; Thomas A.J. Jr. USA

FERTIL STERIL 1995 63/2 (392-395) Objective: To review the indications, surgical technique, and results of crossover transseptal vasoepididymostomies for treatment of complex obstructive azoospermia and oligospermia. Design: Retrospective review of our experience with crossover transseptal end-to-side vasoepididymostomies in 10 men. Interventions: Ten men underwent crossover transseptal end-to-side vasoepididymostomies. Nine men had primary and one had secondary infertility. Seven men were azoospermic, and the remaining 3 had severe oligospermia (sperm density < 1 x 106/ml). All had a combination of irreparable ipsilateral ductal obstruction or agenesis with a normal testis and a poorly functional or absent contralateral testis. Contralateral testicular atrophy was associated with a prior hernia repair in 3 men, varicocele-induced atrophy in 2, and severe orchitis in 2. Cryp torchidism, testicular torsion, and one unknown cause were reported for three others. Congenital absence of the vas deferens caused the ipsilateral ductal pathology in 5 men. Three men had a vas injury from pediatric inguinal surgery, and 2 had an idiopathic vas obstruction. Results: Twelve microsurgical crossover transseptal vasoepididymostomies were performed (2 men had repeat procedures). Anastomosis was performed to the caput in live men, the corpus in two, and the cauda in three men. Eight of nine men followed for 6 months or more had sperm in their ejaculate. Two of seven couples have established pregnancies. Total sperm counts ranged from 18 to 201 x lo6 (mean, 98.1 x 10’) with motility of 5 to 37% (mean, 13%). Men with congenital absence of the vas deferens had significantly lower postoperative total sperm counts than men with all other causes of ductal pathology: 37.8 x lo6 versus 135 x 106. No other characteristics (type of infertility, preop semen analysis, cause of testicular pathology, site of epididymal anastomosis) were useful predictors of postoperative sperm counts. Conclusions: If there is a solitary functioning testis with irreparable excurrent ductal obstruction or agenesis, a crossover transseptal vasoepididymostomy can restore patency in most men.

95

Comparison of the efIeetIveueas of placebo and or-blocker therapy for UK tredllent of idiopathic Oligo~Jl

Yamamoto M.; Hibi H.; Miyake K. JPN

FERTIL STERIL 1995 63/2 (396-400) Objective: To determine whether a-blocker (bunazosin) improves fertility and/or semen parameters in oligozoospennic men. Design: Placebo-controlled, double-blind clinical study. Setting: Nagoya University Hospital Andrology Clinic, Nagoya, Japan. Patients: Thirty-four men with sperm density between 5 and 20 x lo6 sperm/ml, normal serum gonadotropins and T, and a fertile partner were enrolled in this study. Interventions: After a 3-month control period, patients randomly were prescribed btmazosin 2 mg/d or a placebo, two tablets per day, for 6 months. Semen and blood samples were collected before and after therapy. Semen parameters, serum gonadotropins, T, PRL, and Ez were evaluated before and after therapy. Results: The pregnancy rate (PR) in the ablocker group was 25%, compared with 6.7% in the placebo group. There was no statistical difference in the PR between groups. The a-blocker group had significantly higher levels of sperm density and total motile sperm count. There were no differences between the placebo and a-blocker groups in seminal volume, the percentage of motile sperm, and normal morpholo gy or hormone levels. Conclusions: The authors conclude that a-blocker is a useful drug in the treatment of idiopathic moderate oligozoospermic men. Faetcas affeetlng fertBIzatiesu Es&m&aI plreentrl pmtekt 14 reducestbecaPaeItyofbumauspemmtozoatobIudtotbeIumlan znua peIhteIda Gehninger S.; Coddington C.C.; Hodgen G.D.; Seppala M. USA FERTIL STERIL 1995 63/2 (377-383) Objective: To examine whether placental protein 14 (PPl4) may affect directly those sperm functions crucial to fertilization and early embryo development. Design: In these prospective studies, we evaluated semen samples of fertile men incubated under capacitating conditions with and without PP14. Setting: Academic tertiary institution. Interventions: Biologically active PP14 was purified from human midtrimester amniotic fluid by anion exchange and immunoaffinity chromatography. After separation of the motile fraction, spermatozoa were incubated for 30 min with or without PP14 (concentration range of 0.01 to 100 &ml), washed, and then aliquots were prepared for use in the different assays. Human sperm-zona pellucida (ZP) binding was assessed using the hemizona assay (HZA) in a 4-h gametes coincubation period. Sperm motility parameters were evaluated using a computerized semen analyzer. The acrosome reaction (AR) was determined by fluorescein isothiocyanateconjugated Pisum sativum agglutinin and indirect immunofluorescence. Main Outcome Measures: Sperm-ZP binding, sperm motility patterns, and AR. Results: Preincubation of sperm (and not the hemizonae) with PP14 produced a signilicant and dose-dependent inhibition of binding in the HZA. Monoclonal antibodies generated against PP14 showed no direct effect in the HZA and partially neutralized the inhibitory

96

Citations from the literalwe / International Journal of Gynecology & Obsrerrics 51 (1995) 87-97

activity of PP14 in the HZA. Insulin-like growth factor binding protein-l (IGFBP-I), an endometrial stromal cell product, showed no effect in the HZA. Neither PP14 nor IGFBP-I interfered with sperm motility parameters or the AR. Conclusions: Placental protein 14 produced a potent, fast, and dose-dependent inhibition of binding of human spermatozoa to the human ZP without affwting other prefertilization events (i.e., hyperactivated motility or AR). The detrimental effect on sperm-zona interaction seems to be specific for this endometrial epithelial protein (not observed with an endometrial stromal product) and may have fundamental bearance to the fertilization process thus providing a mechanism for endometriosisrelated infertility.

Increased capillary permeabiity induced by human follicular fluid: A hypothesii for an ovarian origin of the byperstimulntion SyDdrome Goldsman M.P.; Pedram A.; Dominguez C.E.; Ciuffardi I.; Levin E.; Asch R.H. USA

FERTIL STERIL 1995 63/2 (268-272) Objective: To examine the effect of follicular fluid (FF) and peritoneal fluid (PF) from patients undergoing assisted reproductive technology procedures on endothelial harrier function. This was determined in vitro by measuring the permeability of filter-grown bovine aortic endothelial cell monolayers to a permeability marker. Design: Endothelial cells obtained from bovine thoracic aortas were treated with collagenase solution and plated on millicell filters, on which they formed confluent monolayers. Flux rate was determined at 60 min by measuring the radioactive tracer (3H mannitol) permeating from the apical to the basolateral part of the filter. Fifty-eight samples of FF and PF, both from stimulated and natural cycles were analyzed and grouped according to the number of eggs retrieved. Follicular fluid and PF samples from natural cycles were used as controls. Results: There was an augmentation in the permeability rate of both FF and PF from patients undergoing controlled ovarian hyperstimulation (COH) who responded with an increasing number of eggs compared with controls (51% and 39%, respectively). When analyzing samples from patients who responded with a low number of oocytes, no significant increase was observed. Conclusions: It is known that in OHSS, the increase in capillary permeability is related to the administration of gonadotropins, and is believed to be mediated by a vasoactive substance of ovarian origin. In this study, FF and PF from patients undergoing COH showed a signiticant increase in the permeability rate through endothelial cells in vitro. Based on these findings, it could be hypothesized that if the same events took place in vivo, the isolation of this factor from ovarian source could be of significant importance to elucidate the pathogenesis of OHSS. GYNECOLOGICAL

SURGERY

(UROLOGY)

Bud colposuspemiionversus modified MarshU-MarcbettiKrantz urethropexyfor primary geouine stress urinary incontinence: A prospective,rdomized clinical trial

Colombo M.; Scalambrino S.; Maggioni A.; Milani R. ITA

AM J OBSTET GYNECOL 1994 17116(1573-1579) Objective: Our purpose was to compare the effects of the Burch colposuspension with those of the modified MarshallMarchetti-Krantz urethropexy. Study design: Eighty women underwent the two types of operation. A full urodynamic investigation was repeated 6 months after surgery. Results: Clinical follow-up continued for 2 to 7 years. Differences in subjective and objective cure rates were not statistically significant (respectively, 92% and 80% for the Burch colposuspension and 85 and 65% for the modified Marshall-Marchetti-Krantz urethropexy). The latter induced a longer hospital stay (7.4 vs. 6.3 days, P = 0.001), a later resumption of spontaneous voiding (13.8 vs. 8.5 days, P = 0.002). and was associated with considerable complications (one case of blood replacement for retropubic hematoma, one case of severe voiding difticulty one case of further treatment for stress incontinence, and three cases of symptomatic de novo detrusor instability). Conclusion: For its high cure rate, short time to resumption of spontaneous voiding, short hospital stay, and low associated morbidity, the Burch colposuspension should remain the procedure of choice for stress incontinence. Simple bladder(illinnwith a coughstress test comparedwith sh tracted cystou~try for the diagnesis of urimuy konthence Wall L.L.; Wiskind A.K.; Taylor P.A. USA

AM J OBSTET GYNECOL 1994 17116(1472-1479) Objective: Our purpose was to compare the diagnostic et& cacy of observing urine loss during simple bladder tilling (without pressure measurement) and a cough stress test, with multichannel subtracted cystometry. Study design: The urodynamic records of 77 women complaining of urinary incontinence were reviewed. All women had undergone a full evaluation that included a standardized history and physical examination, urinalysis and urine culture, uroflowmetry with measurement of postvoid residual urine, a cough stress test performed during and after simple retrograde bladder filling, and multichannel subtracted cystometry. The results of simple bladder tilling and the cough stress test were recorded as ‘urge incontinence’, ‘stress incontinence’, ‘mixed incontinence’, or ‘incontinence The not demonstrated’. subtracted cystometro&am was then performed, and the urodynamic diagnoses were recorded as ‘detrusor instability’, ‘genuine stress incontinence’, ‘mixed incontinence’, or ‘incontinence not demonstrated’. The records were reviewed, and the results of simple bladder filling with a cough stress test were compared with those obtained by subtracted multichannel provocative cystometry. Results: With the subtracted multichannel cystometrogram used as the ‘gold standard’ for diagnosis, the demonstration of ‘urge incontinence’ during simple bladder filling had a sensitivity of 64% and a specificity of 86.8% for the demonstration of detrusor instability during cystometry, with a positive predictive value of 83.3% and a negative predictive value of 70.2%. The demonstration of ‘stress incontinence’ during simple bladder filling had a sensitivity of 88.1% and a