Dopamine treatment for severe ovarian hyperstimulation syndrome

Seven oliguric patients with severe ovarian hyperstimulation syndrome following gonadotrophin treatment for in-vitro fertilization or gamete intra-Fallopian transfer, were treated with low doses of dopamine by peripheral infusion. Five patients were pregnant. The rationale for this therapeutic approach was to increase renal blood flow and glomerular filtration. In addition to dopamine, fluid intake was restricted to 500 ml/day and a protein and salt-rich diet was provided in order to increase serum osmolarity. Within 24-48 h from the beginning of the dopamine treatment, the syndrome started to regress in all cases. No adverse maternal or fetal effects occurred. We conclude that dopamine therapy may constitute a major advance towards the management of severe ovarian hyperstimulation syndrom

IVF treatment of moderate male factor infertility: a comparison of mini-Percoll, partial zona dissection and sub-zonal sperm insertion techniques

In this study we examined various techniques of in-vitro fertilization (IVF) for treating couples in whom the male had subnormal semen parameters. We compared two sperm preparation methods (mini-Percoll and conventional swim-up) for efficiency of recovery after preparation and for fertilization rates after IVF, and compared the suitability of partial zona dissection (PZD) and sub-zonal sperm insertion (SUZI) to patients with different types of male factor infertility. The mini-Percoll technique allowed the recovery of significantly more motile spermatozoa from the same semen sample compared to the swim-up method. More oocytes were fertilized after spermatozoa were prepared by the mini-Percoll technique. An increased number of spermatozoa recovered from an ejaculate led to an improvement in the quality of spermatozoa in the insemination droplet. Subsequently, when using the PZD technique, the fertilization rate increased when there was a higher number of spermatozoa in the patient's ejaculate. When comparing the two micromanipulation techniques, SUZI provided patients with oligoasthenzoo-spermia (i.e. < 10 × 106 spermatozoa/ml and 40% motility) with a higher chance of obtaining 2-pronculeate egg

Breaking bad news in assisted reproductive technology : a proposal for guidelines

Background: The issue of breaking bad news in assisted reproductive technology (ART) has been only partially explored by literature, and although some recommendations are available, specific guidelines are lacking. The present study aimed to explore the applicability of the oncologic SPIKES Protocol to the ART context. Methods: Thirteen ART clinicians (7 gynecologists; 4 psychologists; 1 biologist; 1 obstetrician) completed the Critical Incidents Report (CIR) to describe the experience of delivering bad news in ART. The CIRs were first discussed with clinicians, then a focus group was created composed of 13 clinicians, one health communication expert and a patient to discuss the applicability of the six-step (SPIKES) Buckman Protocol to ART. The discussion was audiotaped, transcribed and analyzed with content analysis. Results: The SPIKES Protocol seems to fit ART consultations and participants found it practical and easy to understand. Some specificities were found for the ART context: the reiteration of bad news, the "patient" as a couple and the fact that ability to conceive is closely related to self-esteem, as well as to social and family identity. During the discussion of the SPIKES Protocol, participants highlighted the importance of: 1) providing a caring setting, by adding a reflection on the value of communication by phone; 2) exploring patients perceptions but also misinformation; 3) exploring patients desires and expectations, while balancing the need to be honest and clear; 4) applying Buckmans suggestions for delivering information, and integrating clinical aspects with psychosocial ones; 5) managing and legitimizing patients emotions, in particular anger; 6) having a strategy for follow-up and supporting couples to make meaning of the ART experience. Conclusion: The proposal of a shared protocol for giving bad news in ART could be the starting point for training and experimental studies

L- and T-type voltage-gated Ca2+ channels in human granulosa cells: functional characterization and cholinergic modulation

Using the whole-cell configuration of the patch-clamp technique, we have characterized two types of ionic currents through voltage-dependent Ca2+ channels in human granulosa cells. One is long-lasting, activates at approximately -20 mV, reaches the peak at approximately +20 mV, has an inactivation time constant of 132.5 ± 5.6 msec at 20 mV, and is sensitive to dihydropyridines. The other is transient, activates at approximately - 40 mV, peaks at approximately -10 mV, has an inactivation time constant of 38.8 ± 1.8 msec at -10 mV, displays a voltage-dependent inactivation, and is sensitive to 100 μM Ni2+, but not to dihydropyridines. Biophysical and pharmacological properties of these currents indicate that they are gated through L- and T-type calcium channels, respectively. The cholinergic receptor agonist carbachol (50 μM) reduces the amplitude of the currents through both L-type (- 34.7 ± 6.4%; n = 10) and T-type (- 52.6 ± 7.4%; n = 8) channels, suggesting a possible role of these channels in the cholinergic regulation of human ovarian functions

Diagnostic testicular biopsy and cryopreservation of testicular tissue as analternative to repeated surgical openings in the treatment of azoospermic men.

HUM. REPROD