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Item does not contain fulltext OBJECTIVE: To study the effects of folic acid and zinc sulfate treatment on semen variables in fertile and subfertile men. DESIGN: Double-blind, placebo-controlled interventional study. SETTING: Two outpatient fertility clinics and nine midwifery practices in The Netherlands. PARTICIPANT(S): One hundred eight fertile and 103 subfertile men. INTERVENTION(S): Both groups were randomly assigned to receive one of four treatments for 26 weeks: folic acid and placebo, zinc sulfate and placebo, zinc sulfate and folic acid, and two placebos. Folic acid was given at a daily dose of 5 mg, and zinc sulfate was given at a daily dose of 66 mg. MAIN OUTCOME MEASURE(S): Before and after treatment, standardized semen and blood samples were obtained for determinations of sperm concentration, motility, and morphology according to World Health Organization guidelines; semen morphology according to strict criteria; and blood folate and zinc concentrations. Effects of the four interventions were evaluated separately in subfertile and fertile men. RESULT(S): Subfertile men demonstrated a significant 74% increase in total normal sperm count and a minor increase of 4% abnormal spermatozoa. A similar trend was observed in fertile men. Pre-intervention concentrations of folate and zinc in blood and seminal plasma did not significantly differ between fertile and subfertile men. CONCLUSION(S): Total normal sperm count increases after combined zinc sulfate and folic acid treatment in both subfertile and fertile men. Although the beneficial effect on fertility remains to be established, this finding opens avenues of future fertility research and treatment and may affect public health.

Item does not contain fulltext The importance of maternal smoking in the pathogenesis of oral facial clefts is not clear. Susceptibility to cigarette smoke depends on biotransformation of the toxic compounds by mother and embryo. In a population-based case-control study, we investigated the effects of maternal smoking during the first pregnancy trimester and the interaction with polymorphisms in the biotransformation enzymes cytochrome P450 1A1 (CYP1A1) and glutathione S-transferase theta 1-1 (GSTT1) on the risk of nonsyndromic oral clefting in the offspring. We recruited 113 infants with nonsyndromic oral clefts and their mothers, as well as 104 control infants and their mothers. Maternal smoking habits were collected regarding the period 3 months before through 3 months after conception. Buccal swabs were taken from mothers and infants for genetic analysis. Maternal smoking was not strongly associated with oral clefting (odds ratio = 1.1; 95% confidence interval = 0.6-2.2), nor were CYP1A1 and GSTT1 polymorphisms. Mothers who smoked and carried the GSTT1-null genotype, however, had an increased risk for having a child with oral clefting compared with nonsmokers with the wild type genotype (odds ratio = 3.2; 95% confidence interval = 0.9-11.6). The risk was almost five times greater (odds ratio = 4.9; 95% confidence interval = 0.7-36.9) in mothers and infants both having the GSTT1-null genotype compared with both having the wild genotype. There was no interaction between CYP1A1 and maternal smoking in relation to oral clefting.

Evidence of the impact of maternal nutritional status on pregnancy outcome is increasing. However, reference values for vitamin and homocysteine concentrations in maternal blood during normal pregnancy are scarce, and are lacking for the preconceptional period and early pregnancy. Thus, in a longitudinal study we evaluated vitamin and homocysteine concentrations in 102 nulliparous women with an uneventful singleton pregnancy and normal outcome not using supplements. The physiological changes in vitamin and homocysteine concentrations in blood were determined from the preconceptional period throughout pregnancy until 6 weeks post-partum. The vitamins evaluated comprised retinol, thiamin, riboflavin, pyridoxal 5′-phosphate, folate in serum and erythrocytes, vitamin B12and α-tocopherol. The plasma homocysteine concentration was also measured, considering the essential roles of folate, vitamin B6and vitamin B12in homocysteine metabolism. The concentrations of retinol, thiamin, pyridoxal 5′-phosphate serum folate and vitamin B12decreased during pregnancy. In contrast, the concentrations of riboflavin, α-tocopherol, and folate in erythrocytes increased or showed only minor changes. Homocysteine concentrations also remained approximately constant during pregnancy. These observations emphasize the importance of preconceptional and post-partum concentrations of vitamins in the evaluation of pregnancy-induced changes. These data have provided valuable reference values for vitamins and homocysteine before, during and after pregnancy in order to contribute to better diagnosis of maternal deficiencies and to study further the relationship between maternal vitamin status and adverse course and outcome of pregnancy.

Objective: To evaluate the impact of cigarette smoking on male factor subfertility and the semen parameters of sperm count, motility, and morphology by questionnaire and determination of the cotinine concentrations in blood and seminal plasma of fertile and subfertile males. Design: Case-control study of 107 fertile and 103 subfertile males who provided a standardized blood and semen specimen and completed a self-administered questionnaire about their smoking habits. Setting: Outpatient fertility clinic of the University Medical Centre St. Radboud, Nijmegen, The Netherlands. Patient(s): One hundred seven fertile and 103 subfertile males. Intervention(s): Vena puncture and semen collection. Main Outcome Measure(s): Blood and seminal plasma cotinine levels in relation to semen parameters. Result(s): A higher frequency of cigarette smoking was observed in subfertile males than in fertile males, with an odds ratio of 1.7 (95% confidence interval, 0.9–3.2). The self-reported number of cigarettes smoked per day correlated with the cotinine concentrations in blood and seminal plasma for both groups. A small but statistically significant correlation was found between cotinine concentrations in seminal plasma and the percentage of abnormal sperm morphology, but not for other semen parameters ( r s = 0.19). Conclusion(s): Although the mechanism of the toxicity of cotinine on sperm morphology is not clear, this study indicates only a minor effect of cigarette smoking on male factor subfertility, which is probably due to compounds in cigarette smoke other than nicotine (cotinine).

Contains fulltext : 48401.pdf (Publisher’s version ) (Closed access) Cytomegalovirus (CMV) is one of the most common causes of congenital infection without an effective treatment or an effective vaccine available to date. The emphasis has to be on preventive strategies, which rely on the epidemiological situation. The incidence of congenital CMV infections, however, is not known for The Netherlands. Therefore, a prospective virological study was carried out in a population of 7,524 pregnant women and 7,793 newborns. CMV-specific IgG antibodies were determined in cord blood by ELISA. When CMV antibodies were present, a CMV specific PCR was performed on the throat swab. A positive PCR was confirmed by urine culture. In addition, the seroepidemiology for CMV was investigated in the metropolitan region (Amsterdam and Rotterdam) which has a different ethnic composition. Congenital CMV infection was found in 7 infants (0.9 per 1,000). None had symptoms at birth or during 24 month follow-up. Carriage or CMV was 41%, with a variation between 35% and 100% depending on ethnicity. The ethnic composition in the south-eastern region was different from that in large cities, but similar to that in the rest of the country. The incidence of congenital CMV infections in The Netherlands is the lowest described to date, which does not justify special preventive policies.

Numerous disorders, including adult respiratory distress syndrome and AIDS, are associated with a deficiency of glutathione, an intracellular antioxidant. Because N-acetylcysteine is a precursor of glutathione as well as a direct radical scavenger, and because preeclampsia is associated with decreased levels of several antioxidants, a randomized, double-blind, placebo-controlled trial of orally administered N-acetylcysteine was undertaken in women with severe, early-onset preeclampsia and/or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. Severe preeclampsia was defined as a diastolic blood pressure of 110 mm Hg or higher with proteinuria of at least 0.3 g/L. Half of the 38 women admitted to the study received 3 effervescent tablets containing 600 mg N-acetylcysteine every 8 hours, whereas the others received placebo tablets. The median interval from treatment to delivery was 6 days in the women given N-acetylcysteine and 5 days in placebo recipients, not a significant difference. The treatment group had stable maternal plasma N-acetylcysteine levels of 20 μmol/L. Whole blood and plasma levels of glutathione and other thiols were unaffected in actively treated women except for lower plasma homocysteine levels. Gestational age at delivery did not differ significantly between the 2 groups. A majority of women in both groups underwent operative delivery because of the mother's worsening condition or fetal distress. Women in the 2 groups had comparable numbers of complications. Approximately one third of those in each group reported side effects. Rates of neonatal morbidity and mortality did not differ in the 2 groups. The investigators conclude that oral treatment with N-acetylcysteine does not improve either maternal or neonatal outcomes in cases of severe preeclampsia and/or HELLP syndrome. It remains possible, however, that earlier treatment might confer benefit.

To investigate the impact of calcium, magnesium, zinc, and copper in blood and seminal plasma on semen parameters, 107 fertile and 103 subfertile males provided a standardized blood and semen specimen. Total calcium and magnesium concentrations were determined with colorimetric end point assay procedures. Zinc and copper were determined by flame atomic absorption spectrophotometer (AAS). Semen analysis was performed according to World Health Organization guidelines (1992). The concentrations of calcium, magnesium, zinc, and copper in blood and seminal plasma were not different between the subfertile and fertile group. Weak correlations were demonstrated between blood plasma zinc concentrations and sperm count (rs = 0.18), sperm motility (rs = 0.15), and abnormal sperm morphology (rs = 0.13). Zinc and magnesium concentrations in seminal plasma correlated weakly with sperm count (rs = 0.17 and rs = 0.16, respectively), and copper concentrations in blood plasma with motility (rs = 0.25). Strong correlations were found between calcium, magnesium, and zinc in seminal plasma. Although calcium, magnesium, zinc, and copper play an essential role in spermatogenesis and fertility, the determination of these elements in blood and seminal plasma does not discriminate on the basis of fertility in this group of men.

In this study, the semen analysis results of a fertile population were compared with those from a subfertile population, in order to establish normal cut-off values for the standard semen parameters with the aid of receiver operating characteristic (ROC) curve analysis. The fertile group comprised healthy males (n = 107) without any history of fertility problems, the partners of whom had had a spontaneous pregnancy within one year of unprotected intercourse and were pregnant at the time of the male's inclusion into the study. A total of 103 males from couples attending the infertility clinic, and with an initial sperm count of