Faculty Bibliography

OBJECTIVE: To examine fertilization, cleavage, and pregnancy rates (PRs) with semen samples yielding numbers of total motile sperm per swim-up ranging from < 1 to > 20 x 10(6) and to correlate the findings with changes, if any, in the sperm motion parameters. DESIGN: Fertilization, cleavage, and pregnancy outcomes in 439 in vitro fertilization (IVF) cycles were correlated with the total number of motile sperm per swim-up and the sperm motion parameters as determined with an automated semen analyzer. SETTING: A university-based tertiary referral hospital center. PATIENTS: Patients undergoing IVF or intrauterine insemination treatments for multiple etiologies. RESULTS: Higher numbers of motile sperm per swim-up, most notably above the value of 3 x 10(6) motile sperm, were associated with improved fertilization rates and viable PRs. Sperm velocity, linearity, amplitude of lateral head displacement, and flagellar beat per cross frequency for sperm from swim-ups with poor or good pregnancy outcome, however, showed no significant differences. CONCLUSIONS: As a group, semen samples that yield < or = 3 x 10(6) motile sperm per swim-up are associated with poor fertilization rates, cleavage rates, and PRs. This relationship can not be attributed to differences in sperm motion parameters

To determine the influence of ovarian relaxin on the secretion of pituitary GH and PRL in vivo, we evaluated circulating serum hormone levels in 17 pregnant patients with functional corpora lutea (group I) and compared them to levels in 10 patients with premature ovarian failure (POF; group II) who became pregnant with egg donation and did not have corpora lutea. Group II patients had exogenous hormonal support. Serum relaxin (RLX), GH, PRL, estradiol (E2), and progesterone levels were measured weekly by RIA from weeks 4-8 of pregnancy. Analysis of variance and covariance were used to determine hormonal relationships. Serum RLX was present in the natural pregnancy group, with a mean of 1.94 micrograms/L over the study period. Serum RLX was undetectable in the POF patients (less than 0.16 micrograms/L). No significant difference in PRL or progesterone levels between the two groups was noted. E2 levels showed an upward trend in both groups with time and were significantly higher in patients of the POF group than in group I women (P = 0.001). GH levels were significantly higher in the natural cycle patients (P = 0.02) despite lower E2 levels. These data provide additional support for the concept that RLX production in early pregnancy originates from the corpus luteum. They suggest that a luteal product, probably RLX, stimulates GH secretion in early pregnancy. This is a previously undescribed role for RLX in pituitary physiology during human pregnancy

OBJECTIVE: Leuprolide acetate (LA) has improved the efficiency of human menopausal gonadotropins (hMG) in in vitro fertilization cycles. We hypothesized that the combination of LA/hMG/intrauterine insemination (I

Follicular development and oocyte maturation were compared in 22 patients stimulated with human menopausal gonadotropins/human chorionic gonadotropin (hCG, group I) and in 52 women also treated with the gonadotropin-releasing hormone agonist (GnRH-a) leuprolide acetate (LA, group II). Suppression of endogenous leutinizing hormone (LH) surges by LA allowed delayed hCG administration, resulting in higher peripheral estradiol levels, more retrieved oocyte cumulus corona complexes, and greater numbers of cryopreserved embryos. Reduction in spontaneous LH surges in the GnRH-a cycles may have allowed time for larger follicular fluid (FF) volume accumulation during all phases of oocyte cumulus corona complex maturation, restoring synchrony between FF volume and oocyte cumulus corona complex maturity

Cyclic adenosine 3',5'-monophosphate is known to modulate smooth muscle contractility. Because both relaxin and progesterone have been demonstrated to affect myometrial cyclic adenosine monophosphate activity, we questioned whether the previously observed synergism of these two hormones in inhibiting uterine contractility is mediated via cyclic adenosine monophosphate. Immature rats were treated with estradiol benzoate (n = 7) or a combination of estradiol benzoate and progesterone (n = 7). Uterine horns were isolated, each horn was divided into two segments, and these horn segments were incubated in Ringer-Locke solution, either alone (control) or with 3-isobutyl-1-methylxanthine (MIX) 0.5 mM, MIX 0.5 mM + relaxin 10 ng/ml, or MIX 0.5 mM + relaxin 50 ng/ml. When compared with uterine segments incubated in MIX alone, treatment with MIX + relaxin 50 ng/ml significantly increased cyclic adenosine monophosphate levels in animals treated with estradiol benzoate alone or in combination with progesterone. Relaxin 10 ng/ml was sufficient to significantly elevate mean (+/- SEM) uterine cyclic adenosine monophosphate levels above that of control MIX-treated uteri in animals receiving both estradiol benzoate and progesterone (2.49 +/- 0.39 pm/micrograms deoxyribonucleic acid [DNA] versus 1.08 +/- 0.16 pm/microgram DNA, p less than 0.05) but not in animals receiving estradiol benzoate alone (2.08 +/- 0.32 pm/micrograms DNA versus 1.28 +/- 0.16 pm/micrograms DNA, NS). Compared with treatment with MIX only, MIX + relaxin 10 ng/ml and MIX + relaxin 50 ng/ml produced greater increases in uterine cyclic adenosine monophosphate in the steroid combination group than in the estradiol benzoate controls (144.8% and 233.7% versus 71.7% and 156.6%, respectively). These results suggest that the synergism of relaxin and progesterone in inhibiting uterine contractility may be mediated by intracellular cyclic adenosine monophosphate

A case of a normal pregnancy conceived spontaneously in a 22-year-old woman with hypobetalipoproteinemia evidenced peripheral levels of relaxin in the range of uncomplicated singleton pregnancies in conjunction with low peripheral levels of progesterone. The establishment and maintenance of uterine quiescence in this hypoprogestational pregnancy may be attributable to these 'normal' relaxin concentrations or to local uterine factors, including decidual relaxin production, which would not be reflected in circulating relaxin levels

This report describes the first study to correlate the ultrastructure of long-term monolayer cultures of human luteal cells with their secretion of relaxin and progesterone under basal and human chorionic gonadotropin-stimulated conditions. In culture from 14 to 28 days, cells from both corpora lutea of the menstrual cycle and corpora lutea of pregnancy took on characteristics of granulosa luteal cells, particularly after exposure to human chorionic gonadotropin. Relaxin was detectable in the luteal cell cultures only at early time points. The effect of human chorionic gonadotropin on media relaxin levels differed in cells of the cycle and cells of pregnancy. In the cells of the cycle, relaxin was detectable only on day 2 and was decreased by human chorionic gonadotropin (p less than 0.01). In cells of pregnancy, relaxin was detectable for the first 4 days of culture and was not affected by human chorionic gonadotropin. Progesterone was detectable in all the luteal cell cultures and was enhanced by human chorionic gonadotropin (10 and 50 IU/ml) after 24 days of exposure. At earlier time points in both the luteal cells of the cycle and the luteal cells of pregnancy, the human chorionic gonadotropin-induced increases in progesterone levels were not as consistent. However, in all cases of progesterone enhancement, smooth-surfaced endoplasmic reticulum was increased in the human chorionic gonadotropin-treated cells compared with corresponding controls, consistent with more active steroid production. In addition, gap junctions, considered to be responsive to trophic hormones, were increased in the treated cells. In conclusion, this long-term monolayer culture of human luteal cells, as monitored by ultrastructural and hormonal changes, retained the differentiated function of progesterone secretion and exhibited responsiveness to human chorionic gonadotropin. Therefore, morphologic and functional aspects of progesterone secretion may be investigated more closely with use of this long-term luteal cell culture system

Although endometriotic cysts are common, the occurrence of infection in these lesions has not been reported. Of 510 consecutive endometriotic cysts diagnosed at New York University Medical Center between 1965 and 1979, eleven had pathologically confirmed evidence of infection. These patients were nulliparous and had a mean age of 34.7 years at time of diagnosis and without long histories of endometriosis or pelvic infection. All were anemic. Six patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, and five patients were treated with conservative surgery. The morbidity of both groups was similar. The latter had a poor prognosis for fertility. Infected endometriotic cysts demonstrate a strong association with concomitant tubal infection and a weaker association with antecedent hysterosalpingography