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ABSTRACT: To perform a highly detailed semen analysis in a man whose wife had a partial mole.
Case report.
Gynecology departments of two university hospitals and a laboratory of histology/embryology.
A 32-year-old man whose wife had a partial mole.
Sperm characteristics were examined by light microscopy, morphology was analysed by electron microscopy (TEM), DNA fragmentation was evaluated by TUNEL using fluorescence microscopy, and chromosomal abnormalities were assessed by fluorescence in situ hybridization using probes for chromosomes 13, 15, 16, 18, 21, 22, X, and Y.
Sperm count, motility, morphology, DNA fragmentation, and incidence of diploidy, tetraploidy, and aneuploidy.
Sperm concentration was 61 million/mL, with 31% progressive motility and 4% normal morphology. TEM revealed a high incidence of head, neck, and tail abnormalities as well as the presence of phagocytes. DNA fragmentation was within normal limits (11.6%). Aneuploidy levels were low for all chromosomes tested. However, there was a high level of diploidy, with XY, XX, and YY constitution. Tetraploid sperm (XXYY) were also noted.
Semen analysis revealed a high incidence of abnormal morphology and increased diploidy. It may be important to perform FISH testing, to verify increased diploidy in sperm, in men whose wives have had partial moles. These couples could be informed of the option to have preimplantation genetic diagnosis as a means to distinguish between diploid and triploid embryos arising from fertilization of a haploid egg by diploid sperm.
Fertility and sterility 02/2011; 95(7):2430.e1-5. · 3.97 Impact Factor
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ABSTRACT: Introduction: The pathophysiology of subfertility in men with varicocele remains unclear as well as the role of inhibin B (Inh-B) and anti-Müllerian hormone (AMH). The aim of this study was to evaluate Inh-B and AMH concentrations in the spermatic vein of subfertile men with varicocele. Patients and Methods: A total of 61 subfertile men with varicocele and 31 fertile controls underwent standard andrological evaluation. All subfertile men underwent varicocelectomy, during which blood samples were obtained from the spermatic vein to evaluate Inh-B and AMH concentrations. Results: Peripheral vein Inh-B concentrations in men with varicocele were lower as compared to controls (52.9 [8.3-136.0) vs 116±9.7 ng/dL, P = .001). There was no difference in AMH concentrations (10.2 [4.4-45.4]) vs 10.4±0.8 pg/dL, P = 0.9). Spermatic vein Inh-B concentrations in men with varicocele were higher compared to those of peripheral vein (87.6±4.4 vs 52.9 [8.3-136.0] ng/dL, P = .001). On the contrary, spermatic vein AMH concentrations were lower compared to those from peripheral vein (8.84 [3.9-47.7] vs 10.2 [4.4-45.4] pg/dL, P = .013). Conclusions: Inh-B constitutes a reliable marker of Sertoli cell function as well as spermatogenesis. On the contrary, the clinical significance of AMH in men with varicocele remains to be elucidated.
Reproductive sciences (Thousand Oaks, Calif.) 02/2011; 18(6):551-5. · 2.31 Impact Factor
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ABSTRACT: The clinical and laboratory features as well as the diagnostic and therapeutic approach of men with XYY syndrome have not been fully described. A 41-year-old infertile man was diagnosed as having a 47,XYY karyotype and a micro-prolactinoma. His 32-year-old wife had a history of five spontaneous pregnancies, all resulting in first trimester miscarriages. Three in-vitro fertilization (IVF) attempts were made with no biochemical pregnancy. During the third attempt, a pre-implantation genetic diagnosis (PGD) was performed by fluorescent in-situ hybridization (FISH) technique. Only one out of six (16%) embryos had normal karyotype. Conclusions: (1) Karyotypic analysis of both partners is a sine qua non investigation for recurrent miscarriages; (2) the XYY syndrome results in high frequency of embryo aneuploidy; (3) PGD by FISH can contribute to the transferring of chromosomally normal embryos in cases of parental chromosomal defects; (4) investigation for a prolactinoma should be considered in men with XYY syndrome.
Hormones (Athens, Greece) 01/2011; 10(1):72-5. · 2.44 Impact Factor
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ABSTRACT: To reappraise the currently available evidence, providing the answer to the following question: does intravenous albumin administration reduce the risk of severe ovarian hyperstimulation syndrome (OHSS) occurrence following ovarian stimulation with gonadotrophins and GnRH analogues for IVF in high-risk patients?
Systematic review and metaanalysis.
University-based hospital.
Intravenous albumin administration in high-risk patients for prevention of severe OHSS occurrence.
Severe OHSS occurrence.
Eight eligible randomized controlled trials were identified (n=1,199 patients) that offered data for statistical pooling. No statistically significant difference in the occurrence of severe OHSS in patients who received intravenous albumin (n=595) and those who did not (n=604; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.52-1.22) was detected. Moreover, no statistically significant differences were present regarding the probability of pregnancy (OR, 0.83; 95% CI, 0.64-1.07) and first trimester pregnancy loss (OR, 1.44; 95% CI, 0.73-2.85) between patients who received intravenous albumin and those who did not.
Based on the currently best available evidence, intravenous albumin administration in high-risk patients does not appear to reduce the occurrence of severe OHSS. This finding should be considered when implementing strategies for severe OHSS prevention.
Fertility and sterility 01/2011; 95(1):188-96, 196.e1-3. · 3.97 Impact Factor
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ABSTRACT: Although both serum inhibin B (Inh-B) and anti-Müllerian hormone (AMH) concentrations have been proposed as markers of spermatogenesis in men with subfertility, there are wide overlaps with fertile controls. The main aim of this study was to evaluate stimulated serum Inh-B and AMH concentrations in men with non-obstructive azoospermia (NOA). Thirty-seven men with NOA confirmed by testicular fine-needle aspiration and 17 fertile controls participated at this prospective, case-control study. All subjects underwent the Exogenous FSH SErtoli Reserve Test (EFSERT): estimation of serum Inh-B and AMH concentrations before, 24 and 48 hours after administration of 300 IU human recombinant FSH (hrFSH). Basal serum Inh-B and AMH concentrations, as well as Inh-B concentrations at 24 and 48 h were lower in men with NOA as compared to controls. No changes in Inh-B or AMH concentrations were recorded throughout the EFSERT in either men with NOA or controls nor when men with NOA were classified according to their clinical, hormonal and cytological diagnosis. Thus, stimulated serum concentrations of Inh-B and AMH, as obtained by an EFSERT, do not contribute to the diagnostic evaluation of the men with NOA, as the same information can be acquired by the basal serum concentrations of these hormones.
Gynecological Endocrinology 10/2010; 27(9):661-5. · 1.58 Impact Factor
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ABSTRACT: To investigate whether thyroid autoimmunity (TAI) is associated with increased risk for spontaneous miscarriage in subfertile, euthyroid women undergoing IVF.
Meta-analysis of observational studies.
Four prospective studies that reported data on 1098 subfertile women undergoing IVF (141 with TAI and 957 controls) were included in the meta-analysis.
Miscarriage risk ratio (RR).
Clinical pregnancy rate and delivery rate.
Euthyroid, subfertile women with TAI undergoing IVF demonstrated significantly higher risk for miscarriage compared with controls (four studies-fixed effects RR: 1.99, 95% confidence interval: 1.42- 2.79, P<0.001). No significant difference in clinical pregnancy and delivery rates was detected between groups.
Based on the currently available evidence, it appears that the presence of TAI is associated with an increased risk for spontaneous miscarriage in subfertile women achieving a pregnancy through an IVF procedure.
European Journal of Endocrinology 12/2009; 162(4):643-52. · 3.42 Impact Factor
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ABSTRACT: The aim of this study was to assess whether the levels of physical activity before and during early pregnancy are associated with the prevalence of gestational diabetes mellitus (GDM). The study group included 160 puerperas. Among them, 40 (25%) diagnosed as having GDM during their recent pregnancy, whereas the remaining 120 (75%) served as controls. The international physical activity questionnaire (IPAQ-Greek version) was applied twice, in an attempt to estimate the level of physical activity before and during early pregnancy. Women who were "inactive" before or during early pregnancy had odds ratio (OR) 7.9 [95% confidence interval (CI) 3.7-16.56] and 1.3 (95% CI 1.2-1.4) of developing GDM, compared to "minimally active" or "active" women, respectively. Pregnancy resulted in a decrease in the level of physical activity (P < 0.005) during early pregnancy, independently of the diagnosis of GDM and morbidity during early pregnancy. We conclude that physical inactivity before and during early pregnancy is associated with increased risk for developing GDM in late pregnancy.
Acta Diabetologica 08/2009; 47(Suppl 1):83-9. · 2.78 Impact Factor
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ABSTRACT: The mechanism explaining the association between first-trimester spontaneous miscarriages and the presence of thyroid autoimmunity remains unclear. Glycoprotein hormone receptors form a receptor subfamily, in which significant structural similarity is observed. Cross-reactivity between chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH) and their receptors (R) is suggested by the thyrotropic action of hCG during pregnancy and in patients with choriocarcinomas as well as by reports of precocious puberty in patients with juvenile hypothyroidism. If TSH can activate LH/CG-R, then, the TSH-R blocking autoantibodies could bind and block LH/CG-R in the corpus luteum through a similar cross-reactivity process. This inhibition could lead to a decrease in steroid hormones production, essential for the support of pregnancy during the first trimester and result in spontaneous miscarriages. This hypothesis, if confirmed, might have major clinical implications, such as the detection of high-risk pregnancies and the elucidation of progesterone role in the prevention of miscarriages.
Medical Hypotheses 07/2009; 73(6):1060-2. · 1.39 Impact Factor
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ABSTRACT: To evaluate the risk of gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS).
Systematic review and meta-analysis of observational studies.
Tertiary Department of Reproductive Endocrinology.
Five thousand two hundred ninety-three pregnant women (721 with PCOS and 4,572 controls without PCOS).
Literature search in the electronic databases MEDLINE, EMBASE, and CENTRAL, study of the references of all relevant trials or reviews, and manual search of the abstracts from the major meetings in the field of human reproduction.
Gestational diabetes mellitus odds ratio.
Women with PCOS demonstrated a significantly higher risk for the development of GDM as compared with women without PCOS (odds ratio 2.89, 95% confidence interval [CI] 1.68-4.98), yet with significant statistical heterogeneity (I(2) = 59.3%), durable to sensitivity analysis. In the subgroup of cohort studies, this finding remained robust (7.11, 95% CI 2.95-17.12), whereas in the subgroup of case-control studies, it did not (0.89, 95% CI 0.38-2.06). Metaregression modeling revealed a linear dependence of the outcome on study type and baseline risk (post hoc).
Significant heterogeneity among studies and dependence of the outcome on study type make the higher risk of GDM in women with PCOS a questionable finding. The conduction of properly designed studies should precede any recommendation to pregnant women with PCOS in regard to the risk of GDM.
Fertility and sterility 09/2008; 92(2):667-77. · 3.97 Impact Factor
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Fertility and sterility 05/2008; 89(4):1031; author reply 1031-2. · 3.97 Impact Factor
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ABSTRACT: To determine stimulated serum anti-Mllerian hormone (AMH) levels in men with different causes of subfertility.
We prospectively studied 82 subfertile men and 31 controls. The subfertile men underwent a diagnostic procedure to identify the causes of subfertility. Study parameters included testicular volume, levels of follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, inhibin B and AMH, and sperm parameters.
Clinical diagnoses in subfertile men were idiopathic non-obstructive azoospermia (n = 26, 32%), idiopathic non-obstructive dyspermia (n = 17, 21%), varicocele (n = 16, 20%), cryptorchidism (n = 10, 12%) and other diagnoses (n = 13, 16%). Serum AMH levels in subfertile men were 60% lower than in controls [median (interquartile range) 4.6 (3.6) vs. 11.6 (7.7) ng/ml, p 0.001], with no significant differences among the different groups of subfertile men.
Serum AMH levels differentiate control from subfertile men but not men with different causes of subfertility.
Gynecological Endocrinology 04/2008; 24(3):158-60. · 1.58 Impact Factor
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ABSTRACT: To compare FSH, inhibin B (INHB), and anti-Müllerian hormone (AMH) as predictors of the recovery of sperm in testicular fine-needle aspiration biopsy (FNA) performed in men with azoospermia.
Cross-sectional, clinical study.
Academic Unit of Reproductive Endocrinology.
Fifty-one men with azoospermia and 31 controls.
Testicular FNA.
Serum FSH, INHB, and AMH levels.
Clinical diagnoses in men with azoospermia were idiopathic nonobstructive azoospermia (n = 34, 67%), cryptorchidism (n = 4, 8%), varicocele (n = 3, 6%), and other diagnoses (n = 10, 16%). In pairwise comparison of receiver operating characteristic curves, none of FSH (area under curve 0.716), INHB (0.610), AMH (0.565), or volume of the larger testis (0.693) was proved to be superior to the others as predictor of sperm retrieval during an FNA procedure. Similarly, in a logistic regression analysis, none of FSH, AMH, INHB, or volume of the larger testis could predict presence of sperm in FNA.
Serum INHB and AMH, as well as their combination, are not superior to FSH as predictors of the presence of sperm in testicular FNA in men with azoospermia and should not be used for this purpose.
Fertility and sterility 04/2008; 91(4):1279-84. · 3.97 Impact Factor
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Grigoris Grimbizis,
Themistoklis Mikos,
Konstantinos Pantazis,
Evangelia Athanassiou,
Panagiota Sevastiadou,
Athanasios Papanicolaou,
Paris Polychronou,
Dimitrios G Goulis,
Basil Tarlatzis,
John N Bontis, Ioannis Papadimas
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ABSTRACT: The aim of this study was the comparison of liquid-based cytology (ThinPrep, TS) to conventional smears (CS) in the investigation of subfertile men with testicular fine-needle aspiration (FNA). Between January and December 2004, testicular FNA biopsies were performed in 30 subfertile men. Both TS and CS were diagnosed according to Meng classification. Features specifically recorded in each smear included sample adequacy, tissue cells preservation, contamination with red blood cells, quality of smear background, ease of cell recognition, and the cytological diagnosis. There was agreement in the cytological diagnosis between TS and CS (P = 0.88) and sample adequacy (P = 0.73). TS was superior to CS regarding cell preservation, presence of red blood cells or tissue artifacts, quality of the smear background, and cell recognition (P < 0.0001). In testicular FNA cytology, TS appear to be superior to CS in respect to cell preservation, absence of red blood cells, background quality, and cell recognition. These advantages, however, are not translated in improved cytological diagnosis.
Diagnostic Cytopathology 01/2008; 36(1):1-7. · 1.16 Impact Factor
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ABSTRACT: To explore the possible relationship between sperm quality and embryo development, pregnancy and implantation rates, in patients undergoing intracytoplasmic sperm injection (ICSI).
Fertilization and cleavage rates, quality of embryos, blastocyst development, pregnancy and implantation rates were analyzed in 1020 embryos from 219 couples undergoing first ICSI treatment cycle. The couples were allocated in five groups, according to semen parameters: Group 1: patients with normal semen parameters, Group 2: patients with mild oligo-astheno-teratozoospermia, Group 3: patients with severe oligo-astheno-teratozoospermia, Group 4: patients with obstructive azoospermia, Group 5: patients with non-obstructive azoospermia.
Fertilization and cleavage rates, quality of embryos as well as blastocyst development rates were significantly reduced, as semen quality decreased. However, no significant differences were observed in clinical pregnancy and implantation rates.
Overall, a negative relationship was observed between semen quality and embryo development, even before activation of the embryonic genome, suggesting that sperm can affect embryogenesis from a very early stage.
Journal of Assisted Reproduction and Genetics 03/2006; 23(2):69-74. · 1.84 Impact Factor
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ABSTRACT: An 18-year old, phenotypically female individual was examined for primary amenorrhea. Three months before her referral, the patient underwent surgery and a pelvic mass was removed. The physical examination revealed normal female external genitalia, normal breast development, sparse pubic hair and absence of axillary hair. The gynecological examination revealed a short blind vagina pouch and absence of cervix and uterus. Serum testosterone and dihydrotestosterone levels were very high. Karyotype was that of a normal male (46,XY). The transabdominal ultrasound, computed tomography (CT) and Magnetic resonance imaging (MRI) showed absence of uterus and fallopian tubes and revealed testis-like gonads located at the internal opening of the inguinal canal bilaterally. Bilateral gonadectomy was subsequently performed. The pathology report was that of "hamartomatous testes" and associated paratesticular leiomyoma. The clinical, laboratory, imaging, genetic and histological findings confirmed the diagnosis of complete androgen insensitivity syndrome. DNA analysis revealed a R831X mutation in exon 7 of the androgen receptor gene. A Sertoli-cell dynamic test showed elevated basal serum inhibin-B and anti-Müllerian hormone levels without further rise following FSH stimulation. The patient was started on hormone replacement therapy with conjugated estrogens. Complete androgen insensitivity syndrome must be considered in any case of primary amenorrhea. Gonadectomy must be planned to eliminate the risk of gonadal malignancy.
Hormones (Athens, Greece) 5(3):200-4. · 2.44 Impact Factor
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ABSTRACT: Inhibin-B (Inh-B) is produced by Sertoli cells and controls Follicle Stimulating Hormone (FSH) secretion through a negative feedback mechanism. The primary aim of this study was to compare Iotanh-B with FSH as predictors of the recovery of sperm in testicular fine needle aspirate in men with azoospermia.
In 51 men with azoospermia basal values of Luteinizing Hormone (LH), FSH, prolactin and testosterone as well as Inh-B values before and 24 h and 48 h after the administration of 300 IU recombinant human FSH were determined. Testicular Fine Needle Aspiration (FNA) was also carried out. Thirty-one young healthy men were also enrolled in the study as controls.
There was significant difference between men with azoospermia and controls with regard to the basal Inh-B levels [median (interquartile range) 37.2 (36) vs. 103.0 (90) pg/mL, respectively, p=0.003] but not to the stimulated Inh-B levels [40.5 (41) vs. 73.0 (44) pg/mL, p=0.113 at 24 h and 34.3 (34) vs. 82.0 (50) pg/mL, p=0.098 at 48 h)]. The Area Under Curve in Receiver Operating Characteristic curves were similar for Inh-B and FSH (0.610 vs. 0.716, respectively, p=0.151) as far as prediction of sperm retrieval is concerned.
Basal serum Inh-B values are significantly lower in men with azoospermia compared to controls. However, Inh-B is not superior to FSH in predicting the presence of sperm in testicular fine needle aspirate.
Hormones (Athens, Greece) 7(2):140-7. · 2.44 Impact Factor
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ABSTRACT: A non-invasive test, which could predict the presence of sperm during a testicular sperm extraction (TESE) procedure in men with non-obstructive azoospermia (NOA), would be of profound clinical importance. Inhibin B (Inh-B) and anti-Müllerian hormone (AMH) have been proposed as direct markers of Sertoli cell function and indirect markers of spermatogenesis.
A search was conducted in the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through June 2009. Thirty-six different studies reported data on the predictive value of one or more index markers (serum Inh-B: 32 studies, seminal Inh-B: 5 studies, serum AMH: 2 studies, seminal AMH: 4 studies) and were included in the systematic review. Nine studies, which had serum Inh-B as index marker, met the predefined criteria and were included in the meta-analysis.
Serum Inh-B demonstrated a sensitivity of 0.65 (95% confidence interval [CI]: 0.56-0.74) and a specificity of 0.83 (CI: 0.64-0.93) for the prediction of the presence of sperm in TESE. When the pre-test probability of 41% was incorporated in a Fagan's nomogram, resulted in a positive post-test probability of 73% and a negative post-test probability of 23% for the presence of sperm in TESE.
Serum Inh-B cannot serve as a stand-alone marker of persistent spermatogenesis in men with NOA. Although limited, evidence on serum AMH and serum/seminal AMH do not support their diagnostic value in men with NOA.
Human Reproduction Update 16(6):713-24. · 9.23 Impact Factor
