Department of Obstetrics and Gynecology, County Hospital Pécs, Rákóczi str. 2. Pécs, Hungary, H-7623
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Introduction |
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We read with interest the challenging paper from Bedaiwy et al. about the relationship between oxidative stress and embryotoxicity of hydrosalpingeal fluid (Bedaiwy et al., 2002). The authors confirmed that the presence of reactive oxygen species (ROS) impairs blastocyst development during IVF in mice. According to a large body of data in the literature (Strandell and Lindhard, 2002
), low rates of pregnancy and implantation may be expected in patients with hydrosalpinx. The opinion prevails that operative salpingectomy is necessary prior to IVF, since the damaging factors of hydrosalpingeal fluid certainly counteract the therapeutic effectiveness of IVF.
In human experiments shortly to be published (Török et al., 2002a,b
), we investigated the role of ROS. We studied the natural scavenger capacity of follicular fluid of patients pretreated for IVF, nutrient mixture used for oocyte culture, and endometrial tissue samples in a hydroxyl free radical-generating system using electron paramagnetic resonance (EPR) spectroscopy. According to EPR signals, follicular fluid exhibits a high scavenger capacity, while nutrient solution and the endometrial tissue samples possess diverse but definitely less protective factors against ROS. Furthermore, using the t-butyl hydroperoxide-induced chemiluminescence method, we attempted to find indirect evidence as to whether ROS may influence fertilization and implantation. Peroxidative stress caused different photoemission in samples investigated, indicating the presence of essential factors playing a role in the maintenance of pro-oxidantantioxidant balance. We have come to the conclusion that a relevant augmentative antioxidant therapy, i.e. the increase of scavenger capacity, could increase implantation rate. Therefore, we propose that: (i) scavenger compounds be added to nutrient solutions; and (ii) vitamin E and C be administered to the patients both prior to and following embryo transfer.
Bedaiwy et al. observed a decreased blastocyst development in mouse embryo culture after the administration of hydrosalpingeal fluid containing ROS at high concentration (Bedaiwy et al., 2002). According to our yet unpublished observations with chemiluminescence, the hydrosalpingeal fluid shows a prolonged photoemission after induction by organic hydroperoxide, reflecting the presence of reactive compounds. The fluid of the hydrosalpinx may reach into the lumen of the uterus before and after embryo transfer, or at the time of implantation; in which case, high ROS concentration would definitely decrease the previously mentioned low scavenger capacity of the endometrium. Consequently, the effect of hydrosalpingeal fluid should be considered as deleterious, caused by its embryotoxicity as well as its direct endometrial effect that could adversely influence the success of IVF. Therefore, we emphasise that a salpingectomy prior to IVF procedures is expedient to ensure a high success rate.
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Notes |
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References |
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Strandell, A. and Lindhard A. (2002) Why does hydrosalpinx reduce fertility? Hum. Reprod., 16, 11411145.
Török, A., Németh, P., Török, B., Berki, T., Tinneberg, H.-R. and Bódis, J. (2002a) Organic hydroperoxide-induced chemiluminescence of follicular fluid and blood serum samples obtained from women pre-treated for in vitro fertilization. Gynecol. Obstet. Invest. (in press).
Török, A., Belágyi, J., Török, B., Tinneberg, H.-R. and Bódis, J. (2002b) Scavenger capacity of follicular fluid, decidua and culture medium with regard to assisted reproduction; an in vitro study using electron paramagnetic resonance spectroscopy. Gynecol. Obstet. Invest. (in press).