Bailliere's clinical obstetrics and gynaecology最新文献

{"title":"7a The use of epididymal sperm for the treatment of male infertility","authors":"MD Sherman J. Silber (Director)","doi":"10.1016/S0950-3552(97)80010-7","DOIUrl":"10.1016/S0950-3552(97)80010-7","url":null,"abstract":"<div><p>Congenital absence of the vas deferens (CAV), failed vasoepididymostomy, and all irreparable obstructions were once very frustrating conditions, because these patients have normal spermatogenesis, but were previously untreatable (<span>Silber SJ, Ord T, Balmaceda J et al (1990)</span> <em>New England Journal of Medicine</em> <strong>323:</strong> 1788–1792). Microsurgical epididymal sperm aspiration (MESA) together with in vitro fertilization was introduced in 1985 and in 1988 to treat these cases, but only modest success was achieved (<span>Temple-Smith PD, Southwick GJ, Yates CA et al (1985)</span> <em>Journal of In Vitro Fertilization and Embryo Transfer</em> <strong>2:</strong> 119–122; <span>Silber SJ, Asch R, Balmaceda J et al (1988)</span> <em>Fertility and Sterility</em> <strong>500:</strong> 525–528; <span>Silber SJ, Ord T, Balmaceda J et al (1990)</span> <em>New England Journal of Medicine</em> <strong>323:</strong> 1788–1792).</p><p>It is very difficult to predict in which cases epididymal sperm will fertilize and in which cases it will not. The reason for this problem may be either sperm maturation defects that are poorly defined or senescent and pathological changes caused by the obstruction. Thus, intracytoplasmic sperm injection (ICSI) became necessary to achieve consistently good results with MESA.</p><p>The only factor in these couples which affected success had nothing to do with the sperm origin or quality but rather was simply the age and ovarian reserve of the wife. Clearly, whether sperm was from the epididymis or the testis, frozen or fresh, or whether the male had CAV, or irreparable obstruction from a variety of other causes, made no meaningful difference. The cystic fibrosis genotype, the sperm morphology and the quality of motility had no impact. Furthermore, the only factor in the wife that mattered was her age.</p><p>It is crucial to screen for <em>CF</em> in both the husband with CAV and also his wife. If the wife is negative for any of the 36 common <em>CF</em> mutations, we feel that it is quite safe to perform MESA-ICSI on the couple. The chances of a male offspring's having CAV are very remote, and the chances of the child's having cystic fibrosis are probably less than in a normal, unscreened population.</p><p>However, if the wife turns out to be a <em>CF</em> carrier herself (4% incidence in the general population), the couple can still undergo MESA-ICSI, but pre-implantation embryo diagnosis would then be mandatory. We have published the first case of successful preimplantation embryo diagnosis in a CAV-MESA case in which both partners were carriers of the ΔF508 mutation (<span>Liu J, Lissens W, Silber SJ et al (1994)</span> <em>Journal of the American Medical Association</em> <strong>23:</strong> 1858–1860. We require this as a routine approach whenever the female is discovered, on screening, to be a <em>CF</em> carrier.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 739-752"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80010-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20608509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"6 Intracytoplasmic sperm injection","authors":"MD, PhD André Van Steirteghem (Full Professor, Laboratory and Scientific Director)","doi":"10.1016/S0950-3552(97)80009-0","DOIUrl":"10.1016/S0950-3552(97)80009-0","url":null,"abstract":"<div><p>Intracytoplasmic sperm injection (ICSI) can now alleviate infertility in couples who could not conceive by other means. Most patients with obstructive azoospermia and some patients with non-obstructive azoospermia can now be treated.</p><p>The practice of five years of ICSI (1991–1995) is reviewed in terms of patient selection and counselling, controlled ovarian stimulation and oocyte handling, semen evaluation and preparation, ICSI procedure, oocyte damage and pronuclear status after ICSI, embryo development, embryo transfer, freezing of supernumerary embryos, obstetrical outcome, prenatal diagnosis and follow-up study of the children resulting from ICSI.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 725-738"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80009-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20608508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"8a Genetics of idiopathic male infertility: Y chromosomal azoospermia factors (AZFa, AZFb, AZFc)","authors":"PhD Peter H. Vogt (Research Associate and Lecturer)","doi":"10.1016/S0950-3552(97)80013-2","DOIUrl":"10.1016/S0950-3552(97)80013-2","url":null,"abstract":"<div><p>Y chromosomal spermatogenesis loci in Yq11 are disrupted with a frequency of 5–20% in men suffering from idiopathic infertility (azoospermia or severe oligozoospermia). they were designated azoospermia factors (<em>AZFa, AZFb, AZFc</em>). An efficient schedule for their molecular diagnosis in each infertility clinic is presented. In addition, I will include our current knowledge about their biological function during human germ cell development and a description of their pathology in men suffering from deletion of one or more <em>AZF</em> loci. Each Y gene expressed in testis tissue and located in Yq11, in a position overlapping one of the <em>AZF</em> loci, is an <em>AZF</em> candidate gene. Their diagnostic analysis will be described in a separate section. The clinical diagnosis of <em>AZF</em> candidate genes cannot substitute for diagnosis of the genetically defined <em>AZF</em> loci. Therefore, analysis of candidate genes is aimed at answering the question of whether mutations in their exon structures are able to induce the same pathological phenotypes as deletion of the corresponding <em>AZF</em> locus. Only after these gene mutations have been analysed can the <em>AZF</em> candidate gene be designated as a real <em>AZF</em> gene. Therefore, the basic aim of our current research is isolation and identification of all <em>AZF</em> genes.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 773-795"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80013-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20608512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5a Intrauterine insemination: is it an effective treatment for male factor infertility?","authors":"BSc, PhD William C.L. Ford (Senior Research Fellow in Reproductive Medicine),&nbsp;MRCOG R.S. Mathur (Clinical Research Fellow),&nbsp;MD, FRCOG Michael G.R. Hull (Professor of Reproductive Medicine and Surgery Honorary Consultant Obstetrician and Gynaecologist)","doi":"10.1016/S0950-3552(97)80007-7","DOIUrl":"10.1016/S0950-3552(97)80007-7","url":null,"abstract":"<div><p>Results were collected from 11 studies comparing intrauterine insemination (IUI) with intracervical insemination (ICI) of frozen donor semen, 10 studies comparing IUI with timed natural intercourse (NI) or ICI in couples with semen defects and seven studies comparing ICI with NI or ICI in couples with unexplained infertility.</p><p>IUI significantly increased the pregnancy rate relative to favourably timed ICI in donor insemination (DI) with frozen semen both with and without gonadotrophin stimulation of the female partner (odds ratios (95% confidence interval) 1.92 (1.02–3.61) and 2.63 (1.52–4.54) respectively). The benefit of IUI tended to be less when the pregnancy rate for ICI was high and IUI had no benefit with fresh donor semen. Overall IUI was of significant benefit in the male factor couples compared with NI-ICI (odds ratio 2.20 (1.43–3.39) and the advantage appeared to be maintained when comparison was confined to properly timed ICI although the odds ratios were not significantly greater than 1. IUI had no benefit relative to favourably timed NI-ICI for couples with unexplained infertility; an apparent advantage overall was produced by studies where NI was late. None of the studies on male factor used a sperm function test to define male subfertility and three only included couples with good mucus penetration by sperm. The range of semen defects defined was such that many couples would have had a good chance of conceiving naturally given a normal female partner but nevertheless the overall pregnancy rate (4.8%) was considerably less than in the unexplained group (11.6%), suggesting that some sperm dysfunction was present. We conclude that the available evidence suggests that IUI is valuable for DI with cryopreserved semen and for couples with mild to moderately impaired semen quality and postulate that it overcomes failure to fertilize due to impaired mucus penetration and poor survival in the female reproductive tract.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 691-710"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80007-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20607425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5b In vitro fertilization for male infertility: when and how?","authors":"BSc Jenny Hall (Researcher in Male Infertility and Embryologist),&nbsp;BSc, PhD Simon Fishel (Director)","doi":"10.1016/S0950-3552(97)80008-9","DOIUrl":"10.1016/S0950-3552(97)80008-9","url":null,"abstract":"<div><p>The first observation that in vitro fertilization (IVF) was useful for treating oligozoospermia and oligoasthenozoospermia was reported by Fishel and Edwards in 1982. This was followed by a series of cases indicating the value of IVF in such cases. Conventional IVF has been modified and refined to achieve increased rates of conception in cases of male factor infertility. Methods such as high insemination concentration IVF for the treatment of teratozoospermia and microscopic IVF for the treatment of oligozoospermia have had some impact on fertilization and pregnancy rates; however, reports of success are varied. The recent advent of micromanipulation and, in particular, intracytoplasmic sperm injection (ICSI) has overshadowed the use of these modified IVF procedures. Because of the high fertilization and pregnancy rates achieved with ICSI, other micromanipulation techniques (subzonal insemination and partial zona dissection) have been abandoned; there have also been suggestions that other more conventional techniques, i.e. IVF, should also be abandoned and that ICSI become the sole technique for the treatment of infertility. The rapid increase in the number of centres using ICSI has led to extreme pressure for individual units to achieve high fertilization and pregnancy rates and there is a temptation to assign all patients to ICSI treatment. It is important that, in this highly competitive environment, new techniques are not applied haphazardly and reduced to the mere injection of gametes and achievement of pregnancy regardless of the cause of infertility.</p><p>In his 1986 <em>IVF—Historical Perspective</em>, Fishel quoted Auguste Comte: ‘to understand science it is necessary to know its history’. IVF has much recent history in animal and also human work. Although ICSI is the most significant therapeutic advance in male infertility treatment, its application to human IVF is only 4 years old, with a paucity of animal studies on which to rely. For this reason IVF still plays a very important role in the treatment of male factor infertility and should only be ruled out when it has failed previously or the number of available sperm is limited.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 711-724"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80008-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20608507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Index","authors":"","doi":"10.1016/S0950-3552(97)80015-6","DOIUrl":"https://doi.org/10.1016/S0950-3552(97)80015-6","url":null,"abstract":"","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 819-824"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80015-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138380349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1 Clinical assessment of male infertility in the era of intracytoplasmic sperm injection","authors":"FRCS, FRCOG, FRACOG Anne M. Jequier (Head of Infertility Services, Honorary Research Fellow)","doi":"10.1016/S0950-3552(97)80003-X","DOIUrl":"10.1016/S0950-3552(97)80003-X","url":null,"abstract":"<div><p>This communication outlines the major causes of infertility in the male and, where indicated, the application of in vitro fertilization and intracytoplasmic sperm injection in their treatment. It also points out that there are many types of infertility in the male where other methods of treatment are also successful and where reproductive technology is unnecessary.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 617-639"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80003-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20607421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3 Declining sperm quality: a review of facts and hypotheses","authors":"BSc, MD, MRCOG D. Stewart Irvine (Clinical Consultant)","doi":"10.1016/S0950-3552(97)80005-3","DOIUrl":"10.1016/S0950-3552(97)80005-3","url":null,"abstract":"<div><p>A substantial body of evidence has accumulated in recent years suggesting that human semen quality may be deteriorating. This has been associated with evidence of other changes in male reproductive health, including increases in congenital malformations and testis cancer in men, and associated problems in wildlife. Unfortunately the evidence remains inconclusive. It has been suggested that these changes may be due to environmental xenoestrogens acting during development. Although there is now a large quantity of data indicating that this is a plausible hypothesis, evidence of causality, rather than association, remains to be provided. The potential importance of these changes for human health is considerable, and urgent research is required to clarify the situation.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 655-671"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80005-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20607423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"7c Use of immature germ cells for the treatment of male infertility","authors":"MD, PhD Jan Tesarik (Scientific Adviser)","doi":"10.1016/S0950-3552(97)80012-0","DOIUrl":"10.1016/S0950-3552(97)80012-0","url":null,"abstract":"<div><p>Both animal experimentation data and preliminary clinical experience converge to suggest that normal progeny can be obtained by fertilizing oocytes with spermatids, the youngest male germ cells to have a set of haploid chromosomes. Spermatids can be obtained from the ejaculate of many patients with non-obstructive azoospermia. The use of ejaculated spermatids in the treatment of non-obstructive azoospermia is thus to be considered as an alternative to that of testicular spermatozoa. Fertilization with ejaculated spermatids makes it possible to avoid the potential adverse consequences of extensive testicular biopsy and may thus become the treatment of first choice. The recourse to testicular spermatids represents a treatment of last chance if no spermatids can be recovered either from the ejaculate and no spermatozoa from the testis.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 4","pages":"Pages 763-772"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80012-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20608511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3 Acquired thrombophilia","authors":"MRCP, MRCOG Joanna Girling (Senior Registrar, Obstetrics and Gynaecology),&nbsp;MD, FRCP Michael de Swiet (Consultant Physician)","doi":"10.1016/S0950-3552(97)80021-1","DOIUrl":"10.1016/S0950-3552(97)80021-1","url":null,"abstract":"<div><p>The antiphospholipid syndrome is the most common cause of acquired thrombophilia. For obstetricians, it is important because of its association with recurrent miscarriage as well as either venous or arterial thrombosis. The evidence linking anticardiolipin antibodies and the lupus anticoagulants with thrombosis will be examined, as will the diagnostic dilemmas which arise. Thromboprophylaxis, both during pregnancy and lifelong, as well as for gynaecological surgery, will be discussed, as will management options for women suffering from recurrent miscarriage.</p></div>","PeriodicalId":77031,"journal":{"name":"Bailliere's clinical obstetrics and gynaecology","volume":"11 3","pages":"Pages 447-462"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3552(97)80021-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20412298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}