Treatment of idiopathic hypogonadotropic hypogonadism in men with luteinizing hormone-releasing hormone: A comparison of treatment with daily injections and with the pulsatile infusion pump

Treatment of idiopathic hypogonadotropic hypogonadism in men with luteinizing hormone-releasing hormone: A comparison of treatment with daily injections and with the pulsatile infusion pump

Int. .I. Gynecol. Obstet., 1988,26: 329-339 International Federation of Gynecology 329 & Obstetrics Citations from the Literature This is a selec...

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Int. .I. Gynecol. Obstet., 1988,26: 329-339 International


of Gynecology


& Obstetrics

Citations from the Literature This is a selection of abstracts of papers taken from the literature in the field of obstetrics and gynecology which the Journal’s Editors feel may be of general interest to our readers* FERTILITY AND STERILITY Ethical and legal issues in cryopreservation of human embryos Robertson


School of Law, University of Texas at Austin, Austin, 78705, USA


FERTIL. STERIL.; 47/3 (371-381) 1987 Some in vitro fertilization (IVF) programs in the United States, Australia, Great Britain, and Europe are offering cryopreservation of human embryos as a component of infertility treatment. Although still experimental, the freezethawing of embryos is likely to prove effective and eventually be incorporated into routine IVF practice. This communication reviews legal, ethical, and policy issues that arise for society and for physicians and patients considering human embryo freezing. A simplified method for freezing and storage of human semen Kremer J; Dijkhuis JRH; Jager S

Fertility Unit of the Department of Obstetrics and Gynecology, University Hospital, 9713 EZ Groningen, Netherlands FERTIL. STERIL.; 4715 (838-842) 1987 The use of lo-cm-long plastic tuberculin syringes for freezing and storage of human semen is introduced. This new method reduces the number of prefreezing and posthawing manipulations to a minimum. Postthawing motility, penetration of spermatozoa into cervical mucus, and results of the hamster ovum test were similar for spermatozoa storedfrozen in tuberculin syringes and for spermatozoa storedfrozen in french straws. The results of the postinsemination test performed in six women were slightly better with fresh semen than with semen stored-frozen in tuberculin syringes. Donor insemination with fresh semen resulted in eight pregnancies per 24 insemination cycles; with semen storedfrozen in tuberculin syringes five pregnancies were achieved in 22 insemination cycles.

Sixty-three embryos produced after in vitro fertilization in 30 infertile couples were frozen and stored. Dimethylsulfoxide was used as a cryoprotectant and embryos were frozen from the two-cell stage to early blastocyst development. Replacement occurred during spontaneous ovulatory cycles 2 to 15 months after embryo freezing. Embryo replacement was performed 3 to 6 days following identification of the luteinizing hormone surge in the spontaneous cycle. Thirty-five embryos were replaced into 25 women and two viable pregnancies resulted.

In vitro fertilization and embryo transfer as a treatment for male factor infertlity Awadalla SC; Friedman

CI; Schmidt

G; et al

Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA FERTIL. STERIL.; 47/5 (807-811) 1987 In vitro fertilization was attempted in 25 consecutive cycles as a treatment for male factor infertility. These cycles were compared with 25 control cycles in which a male factor was not present. The fertilization rates for mature oocytes in male factor cases and controls were 17% and 70%, respectively (P < 0.001). For immature oocytes, the fertilization rates for study patients and controls, respectively, were 16% and 57% (P < 0.001). Embryos were available for transfer in 36% of study cycles and in 88% of control cycles (P < 0.01). The pregnancy per transfer rate for study cycles was 33% and for control cycles was 32%. The hamster ova penetration assay was 100% specific and 50% sensitive in predicting fertilization in vitro among male factor patients.

Treatment of idiopathic hypogonadotropic hypogonadism in hormone-releasing hormone: A men with luteinizing comparison of treatment with daily injections pulsatile infusion pump Shargil AA

and with the

Successful pregnancies from cryopreserved human embryos produced by in vitro fertilization

Consulting Endocrinology Unit, United Sick Fund, P.O. Box 765, 49 107 Petach-Tikva, Israel

Marrs RP; Brown J; Sato F; et al

FERTIL. STERIL.; 47/3 (492-501) 1987 Thirty husbands in childless couples, aged 24 to 35 years, were treated with luteinizing hormone-releasing hormone (LHRH) for idiopathic hypogonadotropic hypogonadism (IHH) of peripubertal (incomplete) type. They were azoospermic or oligospermic, with < 1.5 x 106/ml nonmotile spermatozoa.

Women’s Hospital, Los Angeles County - University of Southern California Medical Center, Los Angeles, CA, USA AM. J. OBSTET. *Generated


from the Excerpta

156/6(1503-1508) Medica Database,

1987 EMBASE.

Int J Gynecol Obstet 26


Citations from the literature

The diagnosis of IHH was based on clinical and laboratory features and testicular biopsy specimen study and was further supported by results of stimulation tests and gonadotropinreleasing hormone (GnRH) test. Two treatment modalities were used: subcutaneous injections of 500 mug LH-RH twice daily; and perpetual subcutaneous injection, via portable infusion pump, of 25 ng/kg LH-RH, at 90-minute intervals. Two patients required a short second period of pulsatile treatment to cause a second pregnancy of their spouses. The pump proved to yield better results, compared with intermittent injections, in respect to endocrine responses, spermatogenesis, and fertility capacity. Normal levels of luteinizing hormone and follicle-stimulating hormone were reached in 2 to 3 weeks and normal testosterone levels in 8 to 10 weeks from the start of treatment. Sperm counts rose to > 60 x [email protected]/ml viable spermatozoa with < 15% of abnormal forms in 3 to 5 months, and the wives conceived. Of a total of 18 deliveries of healthy infants, 12 offspring were identified genetically with their fathers. Four women were still pregnant at the conclusion of the study. The pump was well tolerated, without special operational problems to the patients. Pulsatile treatment is therefore recommended in the treatment of welldiagnosed and carefully selected cases of incomplete IHH.

Right varicocelectomy in selected infertile patients who have failed to improve after previous left varicocelectomy Amelar RD; Dubin L

Department of Urology, New York University Medical Center, New York, NY 10016, USA FERTIL. STERIL.; 47/5 (833-837) 1987 In the past 8 years we found 41 infertile men with poor semen quality in whom an overlooked right varicocele might have been the reason for failure to improve after previous left varicocelectomy. None had ever fathered a child. After we performed sequential right varicocelectomy in these 41 patients, semen quality improved in 23 (56%). Twenty-seven pregnancies have been achieved to date by the wives of 18 (43%) of the patients whose semen improved. No pregnancies were caused by those whose semen failed to improve. Infertile men should be carefully examined for varicoceles on both sides, and bilateral varicocelectomy should be performed when indicated. Selected infertile patients who have failed to improve after left varicocelectomy and are found subsequently to have a right varicocele may yet improve following correction of the right varicocele. The use of sperm penetration assay in evaluation of men with varicocele Plymate SR; Nagao RR; Muller CH; Paulsen CA

Department of Internal Medicine, University of Washington, Seattle, WA, USA In vitro immune absorption of antisperm antibodies with immunobead-rise, immunomagnetic, and immunocolumn separation techniques Kiser CC; Alexander NJ; Fuchs EF; Fulgham DL Oregon Health Sciences University, Portland, OR 97201, USA FERTIL. STERIL.; 47/3 (466-474) 1987 Fourteen men with a mean duration of infertility > 3 years who had significant sperm immobilizing or spermagglutinating antibodies were studied. All patients had < 20%. IgG or IgA immunobinding to sperm in their seminal plasma and 7 had immunobinding levels of > 50%. Sperm from these men were less able to penetrate an overlaying buffer layer than sperm from a fertile control. Addition of immunobeads to the specimen was of little use, because few motile sperm could swim into the overlaying buffer; retained immunobeads were noted in the buffer layer of 18-hour capacitated specimens. Magnetic isolation of antibody-coated sperm from antibodyfree sperm avoids potential damage to fragile sperm through centrifugation. Viable spermatozoa were isolated from magnetite-complexed spermatozoa, but the motility of the isolated spermatozoa deteriorated rapidly during the subsequent capacitation period. Passage of diluted ejaculate through a column of dextran beads for antisperm antibody processing (ASAP) was associated with superior sperm quality and fertilizing potential. The use of ASAP resulted in good sperm velocity and linearity and improved sperm function, as measured with the hamster egg penetration test. Sperm from men with immunologically mediated infertility can be used for artificial processed through the ASAP and insemination of their partners or in an in vitro fertilization program.

Int J Gynecol Obstet 26

FERTIL. STERIL.; 47/4 (680-683) 1987 In order to study the ability of the sperm penetration assay (SPA) to correctly classify the fertility status of men, we prospectively examined the results of the SPA performed on the semen of three groups of men of known fertility status. The groups included 67 normal men without varicoceles whose wives were pregnant (VARN), 51 men with a palpable varicocele whose wives were pregnant (VARF), and 30 infertile men with varicoceles (VARI). Two SPAS were done on each subject. Ninety-seven percent of the VARls showed < 15% penetration on a single test, and 91% showed < 15% on both tests. On a single test 61% of the VARNs and 68% of the VARFs were < 15%. If 0 penetration were used as the criteria of infertility, then 40% of the VARIs, 27% of the VARFs, and 12% of the VARNs would be classified as being infertile. These data suggest that the SPA cannot independently define male fertility status and should be used in conjunction with the standard semen analysis and clinical evaluation of the couple to assess male fertility potential. Pharmacologic induction of multiple follicular development improves the success rate of artificial insemination with husband’s semen in couples with male-related or unexplained infertility Melis GB; Paoletti AM; Strigini F; et al

Clinica Ostetrica e Ginecologica, Universita degli Studi di Pisa, 56100 Piss, Italy FERTIL. STERIL.; 47/3 (441-445) 1987 The use of artificial insemination with (AIH) as treatment for couples with unexplained infertility is often disappointing.

husband’s semen male-related or The aim of the