Immunocytochemical evidence for the presence and location of the neurotrophin-Trk receptor family in adult human preovulatory ovarian follicles.

Objective: This study was undertaken to evaluate the presence or absence of neurotrophins and their respective receptors within adult human preovulatory follicles.

Study Design: Prospective study of neurotrophins and their receptors in follicular cells and unfertilized oocytes from women undergoing aspiration for in vitro fertilization/intracytoplasmic sperm injection. Cells (mural and cumulus granulosa cells, unfertilized oocytes) were examined for immunocytochemical staining of neurotrophin and receptor proteins.

Impact of retained embryos on the outcome of assisted reproductive technologies.

Objective: To assess the impact of embryo retention in the embryo transfer catheter followed by "immediate" retransfer on pregnancy outcome in women undergoing assisted reproduction.

Design: Retrospective analysis of embryo transfer following in vitro fertilization.

Setting: Assisted reproductive technology practice in a university in vitro fertilization program.

Neurotrophin-4/5 and neurotrophin-3 are present within the human ovarian follicle but appear to have different paracrine/autocrine functions.

Neurotrophins are a family of soluble polypeptide growth factors widely recognized for their role in the mammalian nervous system. We first reported the unique presence of one neurotrophin, brain-derived neurotrophic factor (BDNF), in the follicular fluid of the human ovarian follicle. The BDNF receptor, Trk B, was identified in mouse oocytes, and BDNF accelerated first polar body extrusion in vitro.

Early follicular serum müllerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles.

Objective: To test the hypothesis that the concentration of early follicular phase serum müllerian-inhibiting substance (MIS) is associated with ovarian response in women undergoing ovulation induction in preparation for assisted reproductive technology (ART).

Design: Retrospective analysis of frozen day 3 serum samples.

Setting: Academic ART program.

Brain-derived neurotrophic factor: a novel human ovarian follicular protein.

Neurotrophins are a family of soluble polypeptide growth factors widely recognized for their roles in the mammalian nervous system. One such neurotrophin, brain-derived neurotrophic factor (BDNF) was originally described in the nervous system but has now been shown to be expressed in a variety of nonneuronal tissues including endocrine tissues. We examined the human ovarian follicle for its possible secretion of BDNF and further studied mouse oocytes to determine BDNF's possible influence upon oocyte maturation.

The need to step up the gonadotropin dosage in the stimulation phase of IVF treatment predicts a poor outcome.

Purpose: It is a common practice to increase the gonadotropin dose during ovarian stimulation when the estradiol (E2) rise is found to be inadequate. The prognostic impact of the use of this step-up regimen on the outcome of the affected in vitro fertilization (IVF) cycle is the subject of this study.

Methods: This is a retrospective analysis of IVF cycles in a series of consecutive patients who required an increase in the gonadotropin dosage during the stimulation phase because of inadequate E2 rise.

Direct gamete uterine transfer in patients with tubal absence or occlusion.

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development.

Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used.

Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram- and laparoscopic-confirmed bilateral proximal tubal occlusion.

Controlled ovarian hyperstimulation/intrauterine insemination cycles in subfertile couples. Effect of a six-day-only laboratory work week on cycle fecundity rates.

Objective: Controlled ovarian hyperstimulation (COH) combined with intrauterine insemination (IUI) is commonly used to improve fecundability in subfertile couples with tubal patency. Daily hormonal and/or sonographic monitoring is considered important to minimize risks and determine optimal timing of human chorionic gonadotropin (hCG) administration. No patient monitoring or IUI services are available on Sundays in our program.

Does the absence or presence of seminal fluid matter in patients undergoing ovulation induction with intrauterine insemination?

Sperm preparations for intrauterine insemination (IUI) generally do not include seminal fluid, and it is not known whether the absence of this component affects pregnancy rates. Therefore we evaluated the effect of high intravaginal seminal fluid deposition on clinical pregnancy rates in patients undergoing ovulation induction and IUI therapy. A prospective, randomized, double-blind study was designed for an infertile population in a university-based infertility practice.

High-order oocyte transfer in gamete intrafallopian transfer patients 40 or more years of age.

Objective: To analyze whether a policy of high-order oocyte transfer would be effective in women > or = 40 years of age who are undergoing GIFT, and further, whether a specific subgroup of these patients could be identified where clinical pregnancy was more likely to occur.

Design: Prospective descriptive study.

Setting: Patients in a university-based reproductive endocrinology and infertility practice.

The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study.

Objective: To determine the probability of detecting the gestational sac of a normal intrauterine pregnancy by vaginal ultrasound at different gestational ages and serum hCG concentrations.

Design: Prospective, randomized study.

Setting: Pregnant human volunteers in a university-based clinical research environment.

A prospective, randomized study of the chorionic gonadotropin-time relationship in early gestation: clinical implications.

Objective: To investigate the hCG-time relationship in early pregnancy.

Design: Prospective, randomized study.

Setting: Pregnant human volunteers in a university-based clinical research environment.

The utility of a home urinary LH immunoassay in timing the postcoital test.

Objective: To evaluate whether a urinary LH immunoassay improves timing of the postcoital test compared to traditional timing methods in normally ovulating women.

Methods: Subjects included 37 infertile couples evaluated in a tertiary care setting. A randomized, prospective trial was performed of two methods of postcoital test timing: urinary LH assay or the traditional timing by cycle-averaging and/or review of basal body temperature graphs.

Use of urinary luteinizing hormone immunoassays in the assessment of luteal function in infertile women.

It has been suggested that the chronologic date of an endometrial biopsy performed to evaluate luteal adequacy should be based on the date of the luteinizing hormone surge rather than the date of the next menstrual period. Sixty-four infertile women used a urinary luteinizing hormone immunoassay to identify the luteinizing hormone surge; timed serum progesterone level tests and an endometrial biopsy were then performed. An out-of-phase endometrium was identified in 26.

Human follicular fluid contains a follicle-stimulating hormone (FSH) receptor binding inhibitor which has FSH agonist activity, is immunologically similar to FSH, but can be distinguished from FSH.

We have previously reported the presence in human follicular fluid (hFF) of a high (greater than 5000) mol wt FSH receptor binding inhibitor (FSH-BI). This hFF FSH-BI was further purified by removal of material insoluble in acidified acetone (pH 4.1) but soluble in diethyl ether (pH 10.

Identification of low and high molecular weight follicle-stimulating hormone receptor-binding inhibitors in human follicular fluid.

Various fractions of human follicular fluid (FF) were tested for follicle-stimulating hormone (FSH) receptor-binding inhibitory activity, as well as for their ability to form a dansyl derivative previously reported to be associated with FSH receptor-binding inhibitory activity in bovine FF. Pooled human FF was found to inhibit binding of radioiodinated human FSH (125I-hFSH) to its receptor in a concentration-related manner. Fractionation of human FF by sequential ultrafiltration through membranes of calibrated pore size resulted in human FF components of low (500 to 5,000) and high (greater than 5,000) molecular weight, (Mr) respectively.

The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination.

Semen parameters of raw and prepared (post-swim-up) specimens from 451 cycles of intrauterine insemination (IUI) were analyzed in relation to cycle fecundity in 232 patients undergoing ovarian stimulation with sequential clomiphene citrate/menotropin therapy. Pregnancy occurred in 42 cycles, resulting in an overall pregnancy rate of 17.7%, and a cycle fecundity of 9.

A prospective study on the lack of development of antisperm antibodies in women undergoing intrauterine insemination.

To test the hypothesis that intrauterine insemination with washed spermatozoa induces antisperm antibody formation, we measured serum antisperm antibody levels by the Immunobead technique in a population of women receiving exogenous gonadotropins. Antibody levels were measured before therapy (baseline) and then serially during subsequent stimulation cycles, for a maximum of six cycles. Twenty-eight patients underwent intrauterine insemination; each patient served as her own control.

Multiple gestation is associated with the use of high sperm numbers in the intrauterine insemination specimen in women undergoing gonadotropin stimulation.

Over a 27-month period, the authors observed 70 pregnancies in 66 women following intrauterine insemination (IUI) in conjunction with human menopausal gonadotropins/human chorionic gonadotropin (hMG/hCG) stimulation. Excluding ectopic pregnancies (n = 3) and spontaneous miscarriages (n = 15) during the first 10 weeks of gestation, 14 of the 52 pregnancies (27%) included multiple fetuses: nine twins, four triplets, and one quadruplet. Analysis of patient characteristics and clinical management, as well as semen characteristics of the conception cycle, revealed a significant correlation between gestation type (multiple versus singleton) and the total number of motile sperm in the IUI inseminate (P less than 0.

Exogenous gonadotropin requirements are increased in leuprolide suppressed women undergoing ovarian stimulation.

We used a subcutaneously administered GnRHa for 21 to 26 days prior to menotropin stimulation, to suppress endogenous LH surges in four patients participating in IVF. GnRHa-pretreated cycles were compared with previous menotropin treatment cycles. Endogenous LH surges were successfully suppressed in all patients.

Active ovulation management increases the monthly probability of pregnancy occurrence in ovulatory women who receive intrauterine insemination.

The authors examined the hypothesis that active ovulation management would increase the monthly probability of pregnancy occurrence (MPO) in ovulatory women who require intrauterine insemination (IUI). All patients were initially treated during spontaneous ovulatory cycles with IUI performed after the detection of an endogenous lutenizing hormone (LH) surge (phase 1). For phase 2, those patients who had not conceived were offered treatment with fertility medication and IUIs were scheduled accordingly.

Pixe analysis of reproductive fluids.

An external 3.8-MeV proton beam was employed to induce X-rays in 100-mg pellets of human follicular fluids and in 4-8 mg pellets of spermatozoa. The elements Cl, K, Ca, Fe, Cu, Zn, and Br were quantitatively determined in follicular fluids, whereas the elements, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, and Zn were determined in the spermatozoa.

A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women.

The effectiveness of intrauterine insemination (IUI) was compared with that of intracervical insemination (ICI) in 49 infertile couples, in whom the major cause for infertility was oligoasthenospermia. All women had ovulation stimulated with either a clomiphene citrate (CC)-human gonadotropin combination or human gonadotropins alone. The ovulatory dose of human chorionic gonadotropin (hCG) was given after adequate estradiol levels were reached.