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Systems to assess the toxicity of materials used in human assisted reproduction currently lack efficiency and/or sufficient discriminatory power. The development of 1-cell CBA/B6 F1 hybrid mouse embryos to blastocysts, expressed as blastocyst rate (BR), is used to measure toxicity. The embryos were divided into control and test groups, and were exposed to either control medium or to a potentially toxic test medium. Inferences on toxicity were based on differences in BR between the two groups. The mouse embryo assay followed a stratified (mouse), randomized (embryo), and balanced (equal number of embryos per group and per mouse) design. The number of embryos needed was calculated using power analysis. The basal BR of the hybrid strain was determined in a historical population. Sixty-nine mouse embryos per group were required to detect toxic materials with sufficient sensitivity and to account for the considerable inter-mouse variation in blastocyst development. Fifty-two samples, divided over batches of seven different products were tested before use in the study IVF centre and five of these were found to be toxic. This test system, presented as the Nijmegen mouse embryo assay (NMEA), can be used to detect embryo-toxic materials in daily IVF practice, and this report may provide a starting point for standardization.

The aim of this review is to try and answer the following questions. What is the importance of reproductive surgery? What does the field encompass? What are the deleterious effects of postoperative adhesions in reproductive age women? Is there a relationship between the mode of surgical access, laparoscopy versus laparotomy, and the degree of postoperative adhesions? What is microsurgery and what is its place in reproductive surgery? Does training in microsurgery provide benefits to the gynecologist and his/her patients? At present, when assisted reproductive techniques have recorded enormous progress and the technology has been industrialized, what is the place of reconstructive tubal surgery in the treatment of tubal infertility?

Background: Spermatozoa have to traverse the cumulus oophorus before fertilization in vivo. Evidence suggests that the cumulus oophorus plays an important role in the fertilization process. We describe the establishment of a capillary-cumulus oophorus model with which to study the action of cumulus mass on the function of human spermatozoa., Methods: Human cumulus oophorus was aspirated into a glass capillary. Spermatozoa were allowed to pass through the cumulus mass in the capillary from one end of the capillary. The spermatozoa that had traversed the mass were collected at the other end of the capillary and underwent sperm function analyses., Results: Compared with those spermatozoa cultured in medium alone, spermatozoa exposed to the cumulus mass were more likely to have normal morphology, be capacitated and acrosome reacted, with a distinct motility pattern and better zona-binding capacity., Conclusion: A novel in vitro model for spermatozoa penetration through the cumulus oophorus was established. The model can be applied to investigate the effect of the cumulus oophorus on sperm functions.

King Solomon had only two claimants for the baby whose fate he was to decide. With the new reproductive technologies, several people may assert claims to a child whose existence would have been impossible until only recently, and a mass of legal and ethical problems have been created that could barely have been envisioned even half a century ago. It can, for example, no longer be assumed that the woman who carries and gives birth to a baby is that child's biological mother. The legal claims threaten to turn a child into a piece of property rather than a human being with rights and needs. Existing statutes and competing religious or other perspectives, moreover, are not necessarily compatible with these new scientific realities, enlarging the spectrum of problems. This article reviews recent developments in reproductive technologies and some legal, ethical, and psychological issues that may be relevant in these circumstances.

Intracervical insemination continues to be employed for homologous and donor insemination in natural and stimulated cycles. Efficacy studies for potential fertility involve in vivo assessment; however, in vitro testing of particular sperm function(s) critically involved in fertilization is an important component of such evaluation. We report here on the in vitro evaluation of the effects of the silicone Veos cervical cap (Veos, London, UK) on sperm function. Donor semen was exposed to the Veos cervical cap or a sterile 15-cc centrifuge tube (control), or treated with the spermicide nonoxynol-9 (5 mg x ml(-1) in saline) for 4 h at 37 degrees C and 5% CO2 in water-saturated air. After exposure, motility characteristics, both in semen and in spermatozoa processed by standard swim-up procedure, cervical mucus penetration and sperm-zona pellucida interaction using the hemizona assay were assessed. Results indicated that exposure to the Veos cervical cap had no effect on either sperm motility characteristics or sperm-zona pellucida interaction. A small but significant difference was observed for cervical mucus penetration (P = 0.05); however, for both the control and treated groups, vanguard spermatozoa exceeded manufacturer's guidelines for a normal test, a penetration distance of > or = 30 mm. As expected, nonoxynol-9 was a potent inhibitor of sperm function. Lack of adverse effects on in vitro spermatozoa functional characteristics after exposure to the silicone Veos cervical cap supports its addition to the repertoire of fertility treatment modalities when cervical insemination is indicated.

The aim of this study was to evaluate the sperm quality analyser (SQA)-IIB, a new automated sperm analyser, and to compare its results with those obtained with a method based on the World Health Organization recommendations. Eighty-nine unprocessed semen samples and 53 selected sperm suspensions were analysed. Concentration, motility and morphology were evaluated using the routine laboratory method. The SQA-IIB measured the sperm motility index (SMI) and estimated the previously mentioned parameters. In the imprecision assay a maximal coefficient of variation (CV) of 18.8% was found. A semen sample with immunological factor showed a CV of 75.75%, which invalidates its use for these types of samples. A good correlation was obtained between SMI and concentration of progressively motile spermatozoa (CPMS) (r = 0.87), and a fair correlation with the other parameters. There was no statistically significant correlation between both methods for normal sperm morphology. The sensitivity and specificity of the SMI test in relation to CPMS were 96 and 84% respectively, for an SMI threshold value of 160. The results obtained make the SQA-IIB a good screening test to rule out oligozoospermia and asthenozoospermia when studying the male factor in the sterility outpatient clinics. However, the results suggested that it is not a valid method to evaluate morphology.

Objective: To assess the sperm yield and patient acceptability of Trucut needle testicular biopsy followed by seminiferous tubule milking., Design: Prospective case analysis., Setting: The Regional Fertility Center, Royal Maternity Hospital, Belfast, Northern Ireland, United Kingdom., Patient(s): Forty-one males with obstructive azoospermia (normal testicular volume and FSH and LH levels)., Intervention(s): Trucut needle testicular biopsies under local anesthetic with milking of the seminiferous tubules., Main Outcome Measure(s): Quantitation of sperm retrieved per biopsy core and patient follow-up by questionnaire., Result(s): A mean of 105,634 sperm (range, 5,000-427,800) were retrieved, and the mean biopsy weight was 9.17 mg. Twenty-six subjects found the biopsy painless and 15 were pain-free after biopsy., Conclusion(s): The Trucut needle can be used in combination with seminiferous tubule milking to obtain large numbers of sperm in men with obstructive azoospermia.

Proficiency testing samples for antisperm antibodies (ASAB), sperm count, morphology and vitality were mailed to participating laboratories. The majority participating utilized Immunobead ASAB procedures (81 versus 14% mixed antiglobulin reaction and 5% 'other'), and there was 95.6 +/- 1.2% agreement on the presence or absence of ASAB. The majority of laboratories utilized manual (79%) versus computer assisted semen analysis (CASA; 15%) methods. Approximately 64% used the haemocytometer and 26% used the Makler counting chambers for manual counts. Coefficients of variation (CV) in sperm counts ranged from 24 to 138%, with CASA displaying lower overall CV (53 +/- 8%) than manual methods (80 +/- 9%). A wide variation in the reports of percent normal morphology was noted (CVs calculated from arc sin transformed means ranged from 15 to 93%). Participants using American Society of Clinical Pathologists (ASCP) criteria reported sperm morphology values that were clustered in the 'normal' range (11 out of 12 samples), while those using strict criteria were clustered in the 'abnormal' range (10 out of 12 samples). Good agreement was observed in sperm vitality (overall mean CV = 18%). These data highlight the urgent need for improvement in overall quality of andrology testing and indicate that practical proficiency testing programmes can be made available on a large scale.

Transvaginal ultrasound revolutionized the practice of obstetrics and gynecology in the past decade. Its 'port of entry' was its application in the diagnostic, as well as the technical and therapeutic aspects, in the reproductive aspects of infertility. This review summarizes the advances made by the continual improvement of equipment, and the ingenious use of different punctures guided by transvaginal sonography in the important area of reproductive technologies.

Still almost unbelievable, but true: light exerts force. With these forces it is indeed possible to catch and move cells or small particles and microsurgically to process them without any mechanical contact. As if by magic, objects are moved via focused laser light.

Assisted reproductive technology has achieved its place in the management of women with infertility. It is now being used to refocus gynaecological attention on patients with other enigmatic benign gynaecological conditions, such as endometriosis, and their medical treatments. Now that reasonable success rates can be achieved without risking unacceptable multiple pregnancy rates, many other medical disciplines are becoming involved. Specialists in these other disciplines need to modify their treatments accordingly to allow for future parenthood if this is appropriate. These specialists need also to be aware of past ethical dilemmas that infertility units have had to confront during the first ten years of this new technology.

Many innovations have been made in advanced reproductive technologies (ART) over the past several years. These procedures now yield pregnancy rates of over 20% per cycle, rates that compare favorably to many types of reproductive surgery. Therefore, ART now represents a viable alternative for many patients suffering from infertility. As these pregnancy rates continue to rise, gynecologists will have to choose between ART and reproductive surgery for a larger number of patients. This article reviews the commonly performed reproductive surgical procedures and compares expected postoperative pregnancy rates to those of ART in order to help the gynecologist make this decision.

Reportedly, gamete intrafallopian transfer and zygote intrafallopian transfer are successful methods in assisted conception. This pilot study describes the experiences and results of a recently developed technique of vaginal transcervical intrafallopian transfer. In a group of 38 women with unexplained infertility, oocytes were retrieved. In 25 patients, pronucleate embryos were transferred to the fallopian tubes. A positive pregnancy test was reported in 8 cases. Considerations pertaining to this method and technical implications are discussed.

The force generated by the radiation pressure of a low power laser beam induces an optical trap which may be used to manipulate sperm. We studied the effect of the optical trap on sperm motility. A Nd:YAG laser beam was coupled to a conventional microscope and focused into the viewing plane by the objective lens. Sperm were caught in the trap and manipulated by a joy stick controlled motorized stage. After different exposure periods, the velocity and patterns were analysed by a computerized image processor. There were minor changes in sperm velocity when exposed to the trap for 30 seconds or less. A gradual decrease in the mean linear velocity was observed after 45 seconds of exposure. This optical micromanipulator may also be useful for studying the force generated by a single spermatozoa and evaluating the influence of drugs on motility.