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Prostasomes, which are prostate-derived organelles, were purified from human seminal plasma for inclusion in Earle's balanced salt solution(EBSS) medium with or without human serum albumin. These media were used for swim-up experiments and the the subsequent analyses of sperm motility parameters at different incubtion times. The yield of motile spermatozoa after swim-up in EBSS medium enriched with boiled prostasomes was increased by 32% compared with EBSS containing albumin. Native prostasomes were less active. Combinations of albumin and either prostasomes or boiled prostasomes significantly increased the recovery of motile spermatozoa and also increased the revocery of motile spermatozoa and also increased the percentage of spermatozoa and also increased the percentage of spermatozoa displaying progressive motility after 1 h of incubation. Media lacking albumin showed lower values regarding progressive motility after 22 h of incubation. A beneficial effect of prostasomes was noted on lateral head displacement and percentage of hyperactive spermatozoa during the first 6 h of incubation. These results suggest that inclusion of prostasomes, especially boiled prostasomes, in swim-up media may improve the recovery of hyperactive motile spermatozoa forup to 6 h in cases of established male factor infertility, and consequently increase the oportunities for fertilization. [ABSTRACT FROM PUBLISHER]

Repeated transvaginal ultrasonographic examinations were performed during spontaneous ovulatory cycles to follow the texture and growth pattern of the endometrium in 23 healthy volunteers. The serum concentrations of oestradiol, progesterone and luteinizing hormone (LH) were measured regularly. The day of the LH peak was designated as day 0. On ultrasound only one thin echogenic line was seen from menstruation to day −7. From days −6 to −1 a change from one to three thin lines was observed together with an increasing hypoechogenic texture between the lines. These changes corresponded to the increasing serum concentration of oestradiol and increasing thickness of the endometrium. At ovulation there was maximum hypoechogenic texture between the lines which had become thicker. At ovulation the endometrium had a mean thickness (both layers) of 12 mm. From days +1 to +6 an increasing blurring of the three lines became apparent and the previously hypoechogenic layers gradually displayed a more echogenic texture. From day +7 to menstruation the lines were indistinguishable due to the appearance of a general hyperechogenic texture of the endometrium. In the luteal phase the growth of the endometrium plateaued. The results indicate that ultrasound assessment of endometrial growth and texture may be an important tool to evaluate normal ovulatory endometrial development. It can also be useful in monitoring stimulated cycles in different treatment modalities of assisted reproduction. [ABSTRACT FROM PUBLISHER]

In a study of intrauterine inseminations (IUI) after clomiphene stimulation, a randomized comparison was made between a new method of sperm preparation, self migration in sodium hyaluronate (SH), and a traditional method, centrifugation and swim up (CS). After two IUI cycles with either SH or CS, the sperm preparation method was swapped and the patients received another two IUI cycles. Interjacent cycles of natural intercourse after clomiphene treatment served as the control. The SH method resulted in a significantly higher percentage recovery of progressive motile spermatozoa than the CS method, 17.7% versus 8.6% (P less than 0.01). The sperm samples were prepared by SH in 68 cycles and by CS in 57 cycles, resulting in six and five pregnancies, respectively. Pregnancies were obtained in 11 of 125 IUI cycles (8.8%) and in 3 of 124 control cycles (2.4%) (P less than 0.05). The pregnancy rate following IUI was highest in the patients with cervical factor (35%) and asthenozoospermia (23%), while none became pregnant in the group with oligozoospermia. In the unexplained infertility group, no difference between the pregnancy rates in IUI cycles and control cycles was seen. SH is a simple and rapid method of sperm preparation and it appears to give a high recovery of motile spermatozoa and a number of pregnancies which is comparable to that of CS. Treatment with IUI in cycles with a simple stimulation protocol seems to be valuable in cases involving either a cervical factor or asthenozoospermia. [ABSTRACT FROM AUTHOR]

The ability of a new sperm preparation method--self migration in sodium hyaluronate (SH)--to remove microbes from samples was compared to that of the traditional method of centrifugation/swim up (CS). Two 1-ml aliquots were taken from 20 semen samples used for inseminations, and prepared by each of the methods. Samples for culture were taken immediately before wash and at 2 and 24 h after. Microbes were found in all raw semen samples with a mean concentration of 47.8 x 10(3) colony forming units per ml (c.f.u./ml). After preparation and 2 h incubation with and without penicillin, both CS and SH were found greatly to reduce the number of isolates. There were no differences between the ability of the two methods to reduce microbe concentration, although SH recovered more progressive motile spermatozoa than CS (P less than 0.05). When penicillin preparation was omitted, both the CS and SH methods resulted in significantly more isolates after 24 h of incubation. This effect of penicillin preparation was also evident after only 2 h of incubation with CS, but not with SH. No clinical signs of infection were observed among women receiving treatment. We conclude that sperm preparation by self migration in sodium hyaluronate is a simple and safe method to remove microbes and to recover motile spermatozoa. [ABSTRACT FROM AUTHOR]

Background: This study was undertaken to determine the prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization (IVF) treatment.Methods: Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV), was used as the diagnostic tool for evaluating mood and anxiety disorders.Results: Overall, 862 (79.1%) subjects filled in the PRIME-MD patient questionnaire. Any psychiatric diagnosis was present in 30.8% of females and in 10.2% of males in the study sample. Any mood disorder was present in 26.2% of females and 9.2% of males. Major depression was the most common mood disorder, prevalent in 10.9% of females and 5.1% of males. Any anxiety disorder was encountered in 14.8% of females and 4.9% males. Only 21% of the subjects with a psychiatric disorder according to DSM-IV received some form of treatment.Conclusions: Mood disorders are common in both women and men undergoing IVF treatment. The majority of subjects with a psychiatric disorder were undiagnosed and untreated. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF)., Design: Prospective study., Setting: A university hospital in Sweden during a 2-year period., Patient(s): 825 participants (413 women and 412 men)., Intervention(s): Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records., Main Outcome Measure(s): Risk factors associated with depression and anxiety disorders., Result(s): A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder., Conclusion(s): A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Oocyte donation has been permitted by Swedish legislation since January 2003. While donors are anonymous to the receiving couple, offspring have the legal right to receive identifying information about the donor when they reach adult age. Our aim was to investigate factors of potential importance for women's willingness to donate oocytes., Method: A questionnaire regarding attitudes towards oocyte donation was sent to a randomized sample of 1000 women aged 25-35 years (73% response)., Results: Seventeen percent would consider donating oocytes, whereas 39% opposed this, and 44% were doubtful. Potential donors were less likely to have children of their own and thought the genetic link was of less importance. Potential donors would feel happy about helping a childless couple, and 38% would be glad to be contacted by the offspring. Factors that would increase women's willingness to donate were being able to talk to experienced donors, proximity to the clinic and availability of counselling., Conclusion: The results indicate considerable interest in donating oocytes among a subset of women in Sweden. Potential donors associated donation with altruistic motives. The issue of offspring's right to know about their origin appears to be complicated. This suggests that information about the consequences of donation is of great importance.

Background: Oocyte donation has been permitted by Swedish legislation since January 2003. According to the law, offspring have the right to receive identifying information about the donor when they reach a mature age. The aim of the present study was to investigate public opinion regarding different aspects of oocyte donation., Methods: A study-specific questionnaire regarding attitudes towards aspects of oocyte donation was sent to a randomized sample of 1000 women (73% response) and 1000 men (56% response)., Results: A majority of respondents supported treatment with oocyte donation. Seventeen per cent of the women considered donating in the future, whereas 56% of the men would support their partner. While nearly half of the respondents considered that offspring should receive identifying information of the donor, one-third were opposed to this. Overall, women were more positive towards disclosure to the offspring than were men (P < 0.001)., Conclusions: The present results indicate strong support for the use of oocyte donation among a subset of the Swedish population. There was considerable interest among women in donating oocytes anonymously. While a majority advocated openness regarding the donation between parents and child, there was less support for the offspring to have a legal right to receive identifying information about their donor.

Background: Infertile women in Sweden are offered in vitro fertilization (IVF) within the frame of the social security system. The present investigation was undertaken to evaluate the prevalence of genital human papilloma virus (HPV) infection in relation to the results of cytologic screening and to the infertility in these women., Material and Methods: Two hundred and fourteen women, mean age 32 years (range 20-40), admitted to the Center for Reproduction at Uppsala University Hospital for investigation of infertility and IVF were studied. Human papilloma virus tests were performed by a sensitive polymerase chain reaction-based technique in cervical smears obtained at a medical examination or during oocyte retrieval. Cytologic screening results were obtained from medical records or at the time of investigation. The infertile women were compared with 197 healthy female controls., Results: Infertility resulted from female factors in 47% and male factors in 29% of the cases, and remained unexplained in 24%. Seven percent of the infertile women were HPV-positive compared with 9.1% of the controls. Only genital and oncogenic HPV types were identified. Human papilloma virus type 16 was most prevalent, and examination of the HPV 16 E6 gene showed that this prototype predominated over variants. No correlation was found between HPV infection and cause of infertility. Abnormal cytology was observed in 2.3% of the infertile women and 4.1% of the controls., Conclusions: Human papilloma virus infections might appear somewhat less frequently in infertile women admitted for IVF than in a control population. In both groups HPV infection was more common than cytologic abnormalities, possibly indicating that present HPV tests are more sensitive in detecting HPV infections than cytologic screening.

Background: To determine whether prolongation of embryo culture in vitro from day 2 to day 5 after ovum pick-up (OPU) and fertilization can improve the results of in vitro fertilization (IVF), and the morphology of the spare embryos on day 2 can predict the developmental capacity during prolonged culture. We also wanted to consider this as a strategy to avoid twin pregnancies if it could be possible to transfer only one blastocyst at a time in the future., Methods: A retrospective analysis with embryo transfer timed according to the weekday of OPU. Embryo transfer was performed on day 2 in 103 cases and on day 5 in 120 cases. Only one cycle per couple was included., Results: The pregnancy rates per embryo transfer on day 2 (27/103, 26%) and day 5 (36/120, 30%) were similar. There were significantly more miscarriages in the day 5 (50%) than in the day 2 group (22%, p = 0.02), but there was no significant difference in the baby take home rate (20% in day 2 group, 15% in day 5 group). The morphological appearance of the embryos on day 2 was poorly correlated to the developmental potential during prolonged culture in vitro. On day 5, transfer of one or two blastocysts resulted in a pregnancy rate that tended to be higher than that after transfer of morulae only., Conclusion: Prolongation of embryo culture from day 2 to day 5 did not improve the clinical outcome of the IVF treatment when measured as baby take home rate. Therefore, for the time being, this strategy does not increase our chances to move towards single embryo transfer.

Objective: Prostasome-like granules are present in the PC-3 prostate cancer cells. Since the seminal prostasomes are able to promote the forward motility of human spermatozoa, we conducted a study to determine whether PC-3 prostasomes exerted effects similar to those of seminal prostasomes on buffer-washed spermatozoa from normospermic semen samples., Study Design: We used computer-assisted sperm analysis (CASA) and immunostaining of prostasomes to find out where these granules are located on the spermatozoa., Results: Addition of PC-3 prostasomes increased the proportion of motile spermatozoa from 12-15% to 50-70% (p<0.001). The optimal protein concentration of these prostasomes was 0.1mg/ml. Heat treatment of PC-3 prostasomes did not decrease their motility-promoting effect. Immunostaining with anti-prostasome monoclonal antibody (mAb78) revealed that the PC-3 prostasomes and seminal prostasomes adhered to the sperm cells. The staining, which occurred all over the spermatozoa, was intense on the mid-pieces and weaker on the sperm heads. Herewith, some prostasome component may activate the spermatic mitochondrial function, thus increasing sperm motility., Conclusion: It is concluded that PC-3 prostasomes bear a functional resemblance to seminal prostasomes as regards sperm motility promotion.

A total of 340 patients referred for in-vitro fertilization was included in a retrospective, comparative study in which zygotes were studied regarding alignment and polarization of nucleolar precursor bodies (NPB) and also early cleavage in relation to implantation and pregnancy rates for the 680 transferred embryos. At assessment of the pronucleus 18-19 h after sperm injection, NPB were checked for alignment/polarization. Twenty-six hours after sperm insemination the zygotes were assessed for early cleavage. At embryo transfer the two embryos with the best morphological score, irrespective of polarization and early cleavage, were selected for transfer. The overall rate of positive HCG tests 17 days after embryo transfer was 42% and the implantation rate 23%. Fourteen percent of the patients received two embryos with polarized NPB, with a positive HCG test of 51%. Embryo transfer with early-cleaved embryos was carried out in 21% of the cycles, with a pregnancy rate of 45%. Embryos with polarized NPB and/or early cleavage were transferred in 34% of the cycles, with a pregnancy rate of 51%, compared with a pregnancy rate of 38% when none of the embryos fulfilled these criteria (P-value 0.02). In this study the pregnancy rate was significantly higher when one or two embryos were polarized and/or early cleaved. It is concluded that in a cohort of morphologically good embryos, assessment for alignment/polarization of NPB and/or early cleavage can, together with conventional morphological criteria, serve as a simple non-invasive method for selection of embryos with high implantation potential.

Reports concerning the benefit of reducing the co-incubation time of gametes in connection with IVF have been conflicting. The present randomized study was undertaken to determine whether a reduced co-incubation time would improve the embryo development and consequently the pregnancy and implantation rates. Oocytes from 87 patients were collected and half the oocytes from each patient (n = 488, group A) were randomized to 2 h incubation and the other half (n = 504, group B) to overnight incubation. The oocytes were then cultured according to our standard procedure. Significant difference (P = 0.02) was observed between the two groups regarding fertilization rate and polyspermy (group A 72.5%, 3% and group B 80.5%, 6% respectively). However, no difference was observed in further development and morphology of the embryos. The two embryos with the best morphological score were selected for transfer. No significant difference was found between the different transfer groups regarding positive serum HCG and implantation rate. CONCLUSION: The present results and results from previously published studies indicate that the most important factor in connection with the culture method currently used is the amount of sperm added for co-incubation. This should be optimized to reduce the concentration of harmful sperm waste products and create optimal culture conditions.

Background: A prospective randomized study was performed to evaluate the addition of a gonadotropin releasing hormone agonist (GnRH-a) during treatment with human menopausal gonadotropins (hMG) in cycles with artificial inseminations with husband's washed sperm (AIH). We also compared the pregnancy rate per cycle after one versus two AIHs., Methods: We designed a 22 factorial trial. A total of 172 couples with unexplained infertility (n=88), endometriosis (n=39), or cervical (n=24) or male (n=21) factors were included, of whom 161 fulfilled the inclusion criteria and treatment. Eighty-one women were treated with GnRH-a/hMG and another 80 with hMG only, respectively., Results: The pregnancy rates did not differ between the two stimulation protocols (12% for GnRH-a/hMG and 9% for hMG). With GnRH-a/hMG more follicles >15 mm (3.4 and 2.4, respectively; p<0.01) and a higher multiple pregnancy rate after 20 weeks of gestation were observed (55% vs. 0%; p<0.05). Eighty-seven women were treated with one AIH, whereas 65 women received two AIHs on two consecutive days. The pregnancy rates were similar in these two groups (11% and 9% respectively; n.s.), Conclusion: It is concluded that neither addition of GnRH-a before and during controlled ovarian hyperstimulation nor two AIHs compared with one single AIH per cycle has a beneficial effect on the pregnancy rate. However, GnRH-a increases the risk for multiple pregnancies.

We have studied the chromosomal content in 68 normally fertilised freeze-thawed human embryos of good morphology from 34 patients with an average maternal age of 32,6 years. Forty embryos showed post-thaw cellular division and twenty-eight post-thaw cleavage arrest. After spreading of the embryos on microscope slides, analysis of chromosomes X, Y, 15, 16, 17 and 18 was performed using two rounds of fluorescent in situ hybridisation (FISH). According to the results, the embryos were divided into four groups: (I) normal, all nuclei uniformly diploid, (II) diploid mosaics, normal diploid blastomeres in combination with abnormal blastomeres, (III) abnormal, all nuclei abnormal, (IV) chaotic, the chromosome constitution varies randomly from cell to cell. Approximately 25% of the embryos had normal number of the chromosomes tested, while the majority of the embryos were abnormal. Most of the abnormal embryos were diploid mosaics (57%). This was true for the embryos showing cleavage division as well as the embryos showing cleavage arrest. Our data show a slightly higher incidence of abnormal embryos compared to those obtained with FISH in non-cryopreserved embryos and confirm that the majority of preimplantation embryos fertilised in vitro contain abnormal blastomeres. The results, mechanisms, significance and implications are discussed.

Prostasomes isolated from human seminal plasma stimulated the forward motility of buffer-washed, and therewith immobilised, normal human spermatozoa in a dose- and time-related fashion. Albumin exhibited a similar capacity for stimulation. Combining prostasomes with 5 mmol/l of any of the hexoses fructose, glucose or mannose (but not galactose) resulted in a prolongation and improvement of the effect by prostasomes (or albumin) for the first 150 min. Hence, a dose-response effect at 60 and 120 min was obtained by prostasomes on sperm forward motility provided 5 mmol/l of fructose was present--otherwise not. Many substances besides the hexoses were examined for possible positive effects on sperm forward motility in concert with prostasomes with no additional effect. Enrichment of optimum concentrations of prostasomes and glucose with 2 mmol/l of adenine stimulated further the velocity parameters of the spermatozoa over time. The effect of adenosine was less evident under these conditions. Experiments carried out with prostasomes in the presence of divalent cations or chelators suggested that magnesium ions are essential for sperm forward motility. There appeared to be a safety margin concerning calcium ions, and zinc ions did not seem to be primarily involved in sperm forward motility in the presence of prostasomes.

Prostasomes, small corpuscular organelles derived from the prostate gland, were isolated from human seminal plasma by means of ultracentrifugation and Sephadex G 200 chromatography to assess objectively their promotive effect on the motility of buffer-washed normal human spermatozoa exhibiting no forward motility. Prostasomes were efficacious in about 70% of these spermatozoa, and a maximum value was obtained with prostasomes at a concentration corresponding to a protein content of 0.7-0.8 g/l followed by a plateau at higher concentrations. Addition of albumin alone resulted in a similar response although at a somewhat lower level and about 50% of the spermatozoa were rendered motile with a maximum effect of albumin at about 2.5 g/l. Albumin concentrations exceeding 3 g/l were less active. At protein concentrations of 0.25 g/l, prostasomes were superior to albumin in every respect concerning the effects on various sperm movement characteristics. These divergent effects were abolished when comparing prostasomes corresponding to a protein concentration of 0.75 g/l with albumin at 2.3 g/l, i.e. at their respective optimum concentration. Heat treatment and ultrasonication of prostasomes did not affect their motility-promoting properties. Some problem of sperm dysfunction has generally been considered to be a major contributory factor to infertility. By supplementing sperm preparations with postasomes in cases of established male factor, the already poor quality spermatozoa may more frequently be rendered capable of fertilization after insemination.

Objective: To describe the changes in uterine volume, endometrial thickness and follicular size during the normal menstrual cycle by use of transvaginal ultrasonography and to correlate these changes with the endocrine events in the same cycle., Methods: A group of 23 healthy women with normal body mass index and with a history of regular menstruations were monitored with repeated hormonal and vaginal ultrasonographical investigations during the menstrual cycle., Results: Sixteen of the women fulfilled the hormonal criteria for ovulation. The mean length of the cycles was 28 days (range 25-30 days) with a mean length of the follicular and the luteal phases of 14.4 days (range 12-17 days) and 13.5 days (range 12-16 days), respectively. The estradiol level in serum the day before the peak of the luteinizing hormone varied between 490 and 1710 pmol/l (mean 1087 pmol/l). Ultrasonographically, the most clinically relevant changes were the increase in diameter of the dominant follicle and the growth of the endometrium. At ovulation the dominant follicle had a mean diameter of 21.4 mm (range 17.4-27.0), whereas the endometrium had a mean thickness of 12.8 mm (range 10.0-15.9). When analysed over the entire follicular phase, the serum estradiol concentration correlated both with the diameter of the dominant follicle (r = 0.93, p = 0.0001) and with the thickness of the endometrium (r = 0.79, p = 0.0001). However, no such correlations were found when only the last part of the follicular phase was analysed. In the luteal phase there was no correlation between the size of the corpus luteum and the serum concentration of progesterone., Conclusions: Vaginal ultrasonography is a practical and reliable method to monitor structural changes in the ovaries and the uterus during the menstrual cycle. The results are of clinical importance for a better understanding of the physiological changes and helpful when monitoring induction of ovulation in assisted reproduction.

The changes in concentration of hyaluronan (HYA) and myeloperoxidase in peritoneal fluid (PF) were studied during genital intraperitoneal inflammation. PF were collected from 111 women undergoing laparatomy for adhesiolysis and reconstructive surgery of the fallopian tubes, or laparoscopy in search of causes of infertility or low abdominal pain. When the number of leukocytes in the PF had been counted, the fluid samples were centrifuged and the supernatants analyzed for the concentrations of HYA and of myeloperoxidase. During genital inflammation, whether post-operative or postinfectious, leukocytosis and elevated levels of HYA and myeloperoxidase were found in the PF. Concentrations of these substances in the PF may be usable as clinical markers for genital inflammation.

Objective: To determine the relative efficacy of intrauterine insemination (IUI), direct intraperitoneal insemination, and intercourse in cycles stimulated with clomiphene citrate (CC) or human menopausal gonadotropins (hMG)., Design: A prospective randomized trial with a 2(3) factorial design with eight different treatment alternatives. Only one cycle per couple was performed., Settings: The Departments of Obstetrics and Gynecology, Central Hospital, Västerås and Akademiska Hospital, Uppsala University, Uppsala, Sweden., Patients: Of 157 randomized couples with unexplained infertility including 51 cases with minimal or mild endometriosis, 148 were selected for comparison., Main Outcome Measure: Pregnancy rate (PR)., Results: Follicular stimulation with hMG gave a higher PR than with CC in the insemination cycles, 19% (10/52) and 4% (2/49), respectively, but the PRs in intercourse cycles were not significantly different for hMG and CC, 13% (3/24) and 17% (4/23), respectively. Insemination cycles and intercourse cycles had a similar overall PR, 12% (12/101) and 13% (7/47), respectively. Furthermore, IUI and direct intraperitoneal insemination did not differ in efficacy., Conclusion: Follicular stimulation with hMG is more effective than CC in insemination cycles, but insemination as such seems to have no beneficial effect on the PR in stimulated cycles for treatment of unexplained infertility.

Aseptic peritonitis was induced in rabbits by intraperitoneal injection of irritating agents, mainly starch suspensions. The inflammatory response was followed in the peritoneal lavage fluid by cell counts (average increase about 800-fold the first day) and hyaluronan concentration (average increase about 200-fold on the second and third days). The turnover rate of hyaluronan was studied by injecting tritium-labeled hyaluronan intraperitoneally and by following the appearance of tritiated water in serum. In control animals given trace amounts of hyaluronan, half-lives of 1-14 h were recorded. When the labeled polysaccharide had been mixed with 10 mg/ml of unlabeled hyaluronan, the half-life was approximately one day. Rabbits with ongoing peritonitis exhibited half-lives between 1 and 16 h. It was concluded that there was a large individual variation in uptake kinetics, that the removal process could be receptor mediated, and that the increase in intraperitoneal hyaluronan in peritonitis mainly was due to an increased production of the polysaccharide rather than a decreased rate of removal.

Objective: To systematically investigate the expression of major histocompatibility complex (MHC) class II antigens (human leukocyte antigens, HLA-DR, -DP, and -DQ) on columnar epithelium in the fallopian tube during the menstrual cycle., Study Design: Biopsies were collected from the fallopian tube during laparotomy sterilization and immunoperoxidase staining was performed., Settings: Departments of Gynecology and Obstetrics and Clinical Immunology and Transfusion Medicine, Uppsala University, Uppsala, Sweden., Patients: Twenty healthy fertile women undergoing sterilization at different times of the menstrual cycle., Interventions: None., Main Outcome Measures: The staining of the columnar epithelium was judged on a 4-graded scale according to the distribution of class II antigens., Results: A widespread preovulatory HLA-DR expression was observed almost completely lining the columnar epithelial cells including the luminal surface, whereas postovulatory the HLA-DR expression was withdrawn from the surface. The HLA-DP and -DQ antigens varied in a similar way, although not as pronounced., Conclusions: The MHC class II antigen variation in the fallopian tube epithelium seen in this study may indicate a hormonal regulation that could reflect variable need for local immunocompetence during the menstrual cycle: a preovulatory need for immunoreactivity against invading microbes and postovulatory an optimal survival of the foreign preimplantation embryo.

Objective: To compare sperm preparation with a new self-migration method in sodium hyaluronate and a centrifugation/swim-up method and to study the efficiency of direct intraperitoneal (IP) insemination., Study Design: Sodium hyaluronate and centrifugation/swim-up were used randomly for direct IP insemination in alternating cycles. Treatments were given with an interval of at least one untreated cycle. When ovulation occurred on weekends, the patients received only controlled ovarian hyperstimulation., Settings: Department of Obstetrics and Gynecology University Hospital, Uppsala, Sweden., Patients: Seventy-nine couples with unexplained infertility (n = 53), endometriosis (n = 17), and cervical factor (n = 9)., Interventions: Controlled ovarian hyperstimulation was accomplished by clomiphene citrate and gonadotropins., Main Outcome Measures: Sperm parameters and pregnancy rates., Results: Sodium hyaluronate and centrifugation/swim-up resulted in similar conception rates, but sodium hyaluronate recovered more motile spermatozoa than centrifugation/swim-up (P less than 0.0001). The number of patients who became pregnant after direct IP insemination or controlled ovarian hyperstimulation only was significantly higher than that observed after untreated cycles (P = 0.00001 and P = 0.008, respectively)., Conclusions: Sperm preparation with sodium hyaluronate can be used as an alternative to centrifugation/swim-up. Direct IP insemination appears to increase the cycle fecundity, but whether direct IP insemination/controlled ovarian hyperstimulation is more effective than controlled ovarian hyperstimulation alone has yet to be proven.

Specimens for chlamydial culture, direct fluorescent antibody (DFA) test, two enzyme immunoassays (EIA) for antigen detection, and serum for chlamydial antibodies were collected from 256 infertile women. Specimens were taken from the tubes during tuboplasty and from the cervix and endometrium during laparoscopy or tuboplasty. Antibodies to Chlamydia trachomatis were found four times more often in patients with signs of prior pelvic inflammatory disease (PID) than in infertile women with normal pelvic findings. Only 48 (37%) of 131 patients with signs of prior PID had a history of PID. Ten or more C. trachomatis elementary bodies (EBs) per smear were found in 21 (8.2%) of 256 patients. Six patients had a positive culture or a positive antigen EIA test. All six had high numbers of EBs in the DFA test. We conclude that routine culture and EIA antigen tests detect only a minority of persistent chlamydia infections in this population, but subjective factors in the interpretation of DFA methods must be considered.

Light and electron microscopic studies were performed on endometrial curettage specimens from 27 women after 6 months of contraceptive treatment with continuous intranasal gonadotropin hormone-releasing hormone (GnRH) superagonist. The GnRH superagonist nafarelin acetate (D-Nal[2]6-GnRH) was used in single daily doses of 125 or 250 micrograms. Ovulation was inhibited during all but one of the 159 treatment months. No pregnancies occurred. In 6 women with fairly regular bleedings, the endometrium displayed weak to normal proliferation. Twenty women developed oligomenorrhea or amenorrhea, 16 of them had inactive endometrium, 1 had weakly proliferative endometrium, and 3 endometrial biopsies were too sparse for adequate evaluation. One woman reported repeated episodes of heavy uterine bleedings. The endometrial biopsy from this woman showed weak proliferation. No signs of endometrial hyperplasia were observed. Generally, the electron microscopy showed signs of low metabolic activity and weak protein synthesis. Thus, long-term continuous treatment with nafarelin acetate for inhibition of ovulation does not appear to have untoward effects on the endometrium.

Morphometric methods were used at the light microscopic level to investigate the appearance of edema in the endometrial stroma of rats during estradiol-induced implantation after an experimental delay. Comparisons between blastocyst-free and blastocyst-containing sites were made at 18, 12, 16 and 24 h after injection of estradiol (h.a.e.). The development of stromal edema during implantation was found to be diphasic. First, during the initial 8--12 h.a.e., a generalized edema developed all along the uterine horns. Later, from 16 h.a.e. onwards, a local edema was present around the blastocysts. The Pontamine Blue Reaction (PBR) became visible between 20 and 24 h.a.e. The results indicate that the blastocyst is recognized by the stroma considerably before the PBR. The appearance of a local edema around the blastocysts before the PBR might be related to a slow increase in vascular permeability and/or to the increased stromal cell synthetic activity that is known to precede the PBR during early implantation.