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When clomiphene citrate (CC) is used for ovulation induction, endometrial thickness is often decreased compared with spontaneous cycles during and immediately following the days CC is taken, because of its antiestrogen effect. A triple-line pattern on the day of human chorionic gonadotropin (hCG) administration has been reported to be necessary for implantation in controlled ovarian hyperstimulation (COH) cycles, where human menopausal gonadotropin (hMG) or follicle stimulating hormone (FSH) is administered. A triple-line endometrial pattern on the day of hCG administration in in-vitro fertilization (IVF) cycles is related to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos and is unrelated to serum progesterone levels. Preclinical miscarriage, also referred to as biochemical pregnancy, in which quantitative hCG levels initially indicate pregnancy but decrease before a gestational sac can be seen on ultrasound, and clinical miscarriage of embryos with karyotype is the result of inadequate endometrial development.
This chapter reviews the clinical significance of sperm chromatin abnormalities, oxidative stress (OS), apoptosis, and microwave hazards for male gametes highlighting the laboratory methods available to assess these aspects of sperm structure and function. DNA fragmentation is particularly frequent in the ejaculates of subfertile men. Assays for detection of sperm nuclear DNA damage can be divided into three groups: sperm chromatin structural probes, tests for direct assessment of sperm DNA fragmentation, and sperm nuclear matrix assays. To accurately quantify OS, levels of reactive oxygen species (ROS) and antioxidants should be measured in fresh samples. Direct methods such as pulse radiolysis and electron-spin resonance spectroscopy have been useful for other systems of the body. Magnetic-activated cell sorting (MACS) using annexin V-conjugated super paramagnetic microbeads can effectively separate non-apoptotic spermatozoa from those with deteriorated plasma membranes based on the externalization of Phosphatidylserine (PS).
This chapter discusses the implications of oxidative stress (OS) on female reproduction and assisted reproductive technology (ART). Reactive oxygen species (ROS) such as superoxide, hydrogen peroxide, hydroxyl, and singlet oxygen radicals are capable of producing free radicals leading to OS. Various biomarkers of OS have been studied in the female reproductive tract. ROS is thought to play a regulatory role in oocyte maturation, folliculogenesis, ovarian steroidogenesis, and luteolysis. ROS may play a role in age-related decrease in estrogen production. Superoxide dismutase (SOD) and glutathione peroxidase expression decreases in the ovary from the premenopausal to menopausal period. The effects of follicular OS on oocyte maturation, fertilization, and pregnancy have also been studied. Follicular fluid ROS and lipid peroxidation levels may be markers for success with in vitro fertilization (IVF). Successful management of infertility in the ART scenario depends on overcoming OS in the in vitro conditions.
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