Evidence of gonadal and gonadotropin antibodies in women with a suboptimal ovarian response to exogenous gonadotropin

Article Abstract:

In vitro fertilization is a procedure that involves first stimulating the ovaries to produce egg follicles, then retrieving the eggs, fertilizing them outside the body and transferring the embryos back into the uterus. The success of in vitro fertilization involves, in part, the recruitment of mature egg follicles. The more egg follicles retrieved, the greater the chances of a successful pregnancy. In some cases, women do not respond to agents which stimulate ovulation, even when stimulation protocols are changed in subsequent in vitro fertilization cycles. One of a few theories attempting to explain a low response to ovarian stimulation involves an abnormal immune response. Antibodies are produced in the body to fight off foreign substances. Occasionally, the immune system fails to recognize the body's own tissues and produces antibodies against them (autoantibodies). It is thought that women who do not respond well to ovarian stimulation may have autoantibodies against gonadotropins, hormones that stimulate ovulation. The immune response to gonadotropin was studied among 26 menstruating women termed low-responders and 25 women having a normal response to stimulation who were enrolled in an in vitro fertilization program. Follicle stimulating hormone (FSH) and luteinizing hormone (LH), the two gonadotropin hormones, and estrogen, the hormone produced in the ovaries, were measured in the blood. Women had an average FSH level of 11 milli-international units per milliliter (mIU per ml) and the highest estrogen level was no lower than 300 picograms per milliliter (pg per ml). Antibodies to gonadotropin were measured in 92 percent of the low-responders and 65 percent had antibodies to LH. Antibodies against the ovaries (ovarian autoantibodies) were detected in 77 percent of these women. To see if the positive antibody reaction was caused by abnormal interaction of cell components, antibodies to liver cells were tested as well. None of the low-responders had elevated antibodies to liver cells. None of the women having a normal response to ovarian stimulation had antibodies to ovarian cells, liver cells or gonadotropin hormones. It is concluded that women who fail to respond to ovarian stimulation have measurable amounts of autoantibodies produced against gonadotropin hormones. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Autoantibodies, Complications and side effects, Physiological aspects, Gonadotropin, Gonadotropins, Luteinizing hormone, Ovulation, Follicle-stimulating hormone

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Multinuclear spermatozoa associated with polyploidy

Article Abstract:

Polyploidy (the presence of too many chromosomes in a fertilized ovum) can result from several causes, among which is fertilization with a sperm cell that contains more than one nucleus; hence, twice the chromosomal material. The case report is presented of a couple who participated in an in vitro fertilization program (in which fertilization occurs under laboratory conditions), leading to the production of 13 eggs over three menstrual cycles. The semen, donated by the woman's husband, appeared to contain sperm of normal motility, in normal concentration; however, it also contained an abnormally large proportion of double-headed or conjoined sperm (between 10 and 12 percent). Several hours after insemination, 4 of 10 the fertilized ova contained more than two pronuclei (nuclei of egg or sperm after fertilization has taken place), a proportion that is unusually large. These ova did not go on to divide further. Examination of the sperm with electron microscopy revealed multinucleate heads (sperm heads containing more than one cell nucleus) in 12 percent, with at least partially doubled tails. Distinguishing between conjoined sperm (a frequent occurrence) and multinucleate sperm (a rare abnormality) was important for diagnostic purposes: a pituitary tumor that produced excess prolactin (a hormone) was a likely diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Causes of, Infertility, Spermatozoa, Sperm

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Is there ever a role for tubal surgery?

Article Abstract:

In vitro fertilization (IVF) may be a more effective and less expensive infertility treatment than the traditional standard treatment of tubal surgery. All infertility treatments need to be measured against the normal fertility rate of the general population, which is 20% per month. Twenty years ago, tubal surgery was the most widely available method of correcting infertility. Currently, IVF is widely available throughout the U.S. Because the cost of treatment and cost per live birth are significantly lower with IVF and the pregnancy per cycle rate is higher, IVF may displace tubal surgery as the major initial infertility treatment. Fertility rates associated with IVF are around the normal 20% per month and 2% to 4% after tubal surgery. However, IVF carries a greater risk of multiple births.

Evaluation, Tubal sterilization

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