A case of rapid deterioration in sperm quality following spinal cord injury.
Das S, Soni BM, Sharma SD, Gazvani R, Lewis-Jones DI.
STUDY DESIGN: Case report.
SETTING: Northwest Regional Spinal Injuries Unit, Southport, UK and Reproductive Medicine Unit, Liverpool Women's Hospital, Liverpool, UK.
CASE REPORT: A 28-year-old man suffered from paraplegia on sustaining a fall. Fertility preservation was an important aspect of his treatment and electro-ejaculation and cryopreservation of sperm was possible within days of sustaining the fall. The sperm samples obtained subsequently showed a rapid decline in quality. Frozen sperm from the first normal ejaculate obtained soon after the injury was used for assisted reproduction and has resulted in an ongoing pregnancy.
CONCLUSION: This case highlights the importance of collection and freezing of seminal fluid within 2 weeks of spinal cord injury (SCI), or earlier to improve fertility outcomes in spinal cord-injured men, as the clinical stability of the patient may allow.
A randomized controlled clinical trial of 2295 ultrasound-guided embryo transfers.
Drakeley AJ, Jorgensen A, Sklavounos J, Aust T, Gazvani R, Williamson P, Kingsland CR.
BACKGROUND: We wanted to test the hypothesis that using abdominal ultrasound at the time of embryo transfer to guide replacement, improved pregnancy rates by at least 5%.
METHODS: An RCT in a large assisted conception unit. A pilot study and power calculation suggested that at least 2000 embryo transfers were required to demonstrate a difference of 5%, for a test with 80% power and Type 1 error 0.05. Randomization, data entry and analysis were arranged independently. Randomization was stratified for age and fresh/frozen embryo transfer. Analysis was by intention to treat.
RESULTS: There was no difference in clinical pregnancy or live birth rates between the two groups. The clinical pregnancy rate for ultrasound-guided embryo transfer was 22% and for non-ultrasound-guided embryo transfer was 23% (odds ratio: 0.96; 95% confidence interval: 0.79-1.18).
CONCLUSIONS: We set out to determine whether ultrasound-guided embryo transfer improved clinical pregnancy rates and live birth rates in assisted conception. We used an appropriately powered RCT design. We did not demonstrate a difference. This outcome is at odds with the UKs National Institute of Clinical Excellence recommendations for fertility treatment (Fertility Assessment and Treatment for People with Fertility Problems. London, UK: RCOG Press, 2004, 112.) which used a meta-analysis of four smaller trials (range 362-800 patients, totalling 2051 embryo transfers) to conclude that ultrasound should be offered. We suggest that the current Cochrane review should be updated with data from our trial and recommend that consideration is given to accounting for heterogeneity between the included trials.
An investigation of the effects of endometriosis on the proteome of human eutopic endometrium: a heterogeneous tissue with a complex disease.
Fowler PA, Tattum J, Bhattacharya S, Klonisch T, Hombach-Klonisch S, Gazvani R, Lea RG, Miller I, Simpson WG, Cash P.
The pathogenesis of endometriosis includes the proliferation of heterogeneous endometrial cells and their invasion into ectopic sites within the peritoneal cavity. This may be due to abnormalities of the eutopic endometrium itself, predisposing the cells to survive and implant ectopically. We investigated the applicability of 2-DE gels and peptide mass mapping to identify candidate endometrial proteins with a role in endometriosis. Despite the heterogeneous nature of endometrium, our results show that combining the analysis of 2-DE gels and peptide mass mapping yields consistent data. We identified dysregulated proteins in women with endometriosis which included: (i) molecular chaperones including heat shock protein 90 and annexin A2, (ii) proteins involved in cellular redox state, such as peroxiredoxin 2, (iii) proteins involved in protein and DNA formation/breakdown, including ribonucleoside-diphosphate reductase, prohibitin and prolyl 4-hydroxylase, and (iv) secreted proteins, such as apolipoprotein A1. These proteins have functions which suggest that they could play a role in the pathogenesis of endometriosis. This study demonstrated that 2-DE gel analysis and mass spectroscopic protein identification are suitable for the identification of proteins with candidate associations with endometriosis. These techniques should be used on a larger scale to identify endometriosis-related proteins, thus improving the understanding of this complex disease.
Antibodies to Chlamydia trachomatis in serum and peritoneal fluid of women with endometriosis.
Gazvani R, Coyne L, Anttila T, Saikku P, Paavonen J, Templeton A.
The specifics of inflammation created by infection with Chlamydia trachomatis could be favourable to the genesis of endometriosis. To investigate this hypothesis, we studied the association between Chlamydia trachomatis specific IgG and IgA antibodies in serum and the peritoneal fluid of 51 women undergoing laparoscopic surgery. There was no significant difference between women with and without endometriosis with respect to the incidence of IgG and IgA in serum or the peritoneal fluid. The results of our preliminary study did not show any significant link between past infection with Chlamydia trachomatis and the presence of endometriosis.
Can history, ultrasound, or ELISA chlamydial antibodies, alone or in combination, predict tubal factor infertility in subfertile women?
Logan S, Gazvani R, McKenzie H, Templeton A, Bhattacharya S.
BACKGROUND: This study aimed to determine whether medical history, transvaginal ultrasound (TVU) or Chlamydia trachomatis antibody testing (CAT), alone or in combination, could provide a non-invasive, clinically useful screening test for predicting tubal factor infertility (TFI) in subfertile women.
METHODS: Prior to tubal evaluation, relevant medical history, TVU findings, and enzyme-linked immunosorbent assay (ELISA) IgG CAT results were collected. Sensitivity, specificity, likelihood ratios (LR) and accuracy for predicting TFI, as determined by laparoscopy and dye hydrotubation, were calculated for each test alone, and in parallel and series combination.
RESULTS: Thirty per cent (63/207) were diagnosed with TFI. The highest sensitivity (67%, 95% CI: 54-77) included any positive test, yet missed one in three women with TFI. The highest specificity (100%, 95% CI: 97-100) required all three tests positive, but identified only three women. Only the combination of CAT and TVU rated as a good clinical test, but confidence intervals were wide due to the small numbers affected. The combination of CAT or TVU and CAT alone reported the highest accuracy (73%, 95% CI: 66-78), misdiagnosing one in four women.
CONCLUSION: Medical history, TVU appearances, and ELISA IgG CAT alone, or in combination, failed to predict accurately TFI in subfertile women.
Cystic fibrosis mutation screening before assisted reproduction.
Gazvani R, Lewis-Jones DI..
Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians, with a reported incidence of one in 2500. In 97-98% of men with CF, a congenital bilateral absence of the vas deferens (CBAVD) blocks the transport of spermatozoa from testicular or epididymal structures to the outer genital tract, resulting in azoospermia. Abnormalities in semen parameters have also been identified in males with CF. Around 10% of obstructive azoospermia is congenital and is due to mutations the CF gene. It is therefore suggested that men who have CBAVD should be considered for CF screening prior to intracytoplasmic sperm injection (ICSI) treatment. Men with azoospermia of unknown origin should also be considered for screening. Couples requesting surgical sperm retrieval/ICSI should therefore be advised and counselled to bear an elevated risk for CF in their offspring. Counselling of these couples is vitally important in order to help them understand and cope with the diagnosis.
Cystic fibrosis screening in assisted reproduction.
Gazvani R, Lewis-Jones I.
PURPOSE OF REVIEW: The purpose of this review is to discuss the incidence of cystic fibrosis in the general population, in ethnically diverse populations and specifically in couples needing assisted reproduction caused by male factor subfertility. We review the current understanding of risks for reproductive couples and discuss ideal screening strategies.
RECENT FINDINGS: In ethnically diverse populations, a large difference in clinical sensitivity and birth prevalence exists between the broad racial/ethnic groups examined. Extensive data clearly demonstrate the cost-effectiveness of cystic fibrosis screening. Testing for cystic fibrosis gene mutations is reliable and, with a 26-mutation panel, nearly 90% of possible severe mutations can be detected. To halve the incidence of cystic fibrosis in the community, by offering genetic testing of the fetus if both partners are carrier positive, may also be possible.
SUMMARY: Recent guidelines suggest that all couples contemplating pregnancy should be informed of molecular screening for cystic fibrosis carrier status for purposes of genetic counselling. In ethnically diverse populations, ethnic-specific mutations should be included in the mutation panels.
Do lunar phases affect conception rates in assisted reproduction?
Gazvani R, .Das S, Dodd S, Lewis-Jones DI, Patel FM, Drakeley AJ, Kingsland CR,
OBJECTIVES: To assess the effect of the phases of the moon on pregnancy rates in humans following in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.
DESIGN: Retrospective, observational study.
SETTING: Reproductive Medicine Unit, Liverpool Women's Hospital.
PATIENT: Complete data for all women undergoing assisted conception procedures over a period of 13 years (1995-2002).
INTERVENTION: Assisted conception procedures--IVF and ICSI. MAIN OUTCOME MEASURES: Biochemical pregnancy that is positive pregnancy test result following embryo transfer.
RESULTS: There was no significant effect of any lunar phase on the incidence of biochemical pregnancy (p-value 0.71). Age of the woman significantly affects the chances of pregnancy, (OR 0.95, 95% CI 0.91, 0.998, and p-value 0.04). The chances of pregnancy rises significantly with increase in the number of embryos replaced from 1 to 2 (OR 2.97, CI 1.36, 6.48, and p-value 0.01).
CONCLUSION: Pregnancy rates in humans, following assisted conception, appears to be independent of the effect of the lunar phase during which embryo transfer is carried out.