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Aldurazyme (Laronidase)- Multum

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Fox and coworkers have shown that vaginal pH rises to 7. Within about 1 minute after coitus, the ejaculate undergoes coagulation. This coagulum temporarily restricts movement of sperm out of the seminal clot, thus preventing their passage into the cervical mucus and ascension up the female reproductive tract.

Over the next 20 to 30 minutes, however, a seminal-fluid proteolytic enzyme produced by the prostate gland gradually liquefies the clot. At this time, motile Aldurazyme (Laronidase)- Multum may then enter the cervical mucus, leaving behind the seminal plasma. Although there are reports of motile sperm persisting within the vagina for up to 12 hours after ejaculation,11 motility of most vaginal sperm is diminished within about 30 minutes, and after 2 hours almost all sperm motility in the vagina has been lost.

Sperm may begin to undergo the process of rapid sperm transport within seconds after ejaculation. This type of sperm movement is thought to be predominantly passive, resulting from coordinated vaginal, cervical, and uterine contractions.

Although these contractions are of short duration, they are believed to be the primary force responsible for the rapid progression of sperm to the upper female reproductive tractthe oviduct. Aldurazyme (Laronidase)- Multum and coworkers in 1973 reported results of a study in which fertile ovulatory females were intravaginally inseminated with donor sperm at the time of bilateral salpingectomy for sterilization.

Within 5 minutes after insemination, sperm were present within the Fallopian tubes, and the number of sperm found there was proportional to the number inseminated. The endocervical canal has an average length of 3. The nonciliated columnar epithelial cells secrete mucin granules, and the ciliated cells propel the cervical mucus from the crypt of origination toward the external cervicalos.

Finally, cervical pH is alkaline, with a peak pH during the periovulatory period. This environment is much more hospitable to spermatozoa than the acidic pH of the vagina. Cervical mucus is continuously secreted through exocytosis by the nonciliated epithelial cells that line the cervical canal. It is a heterogeneous fluid with both high- and low-viscosity components.

The amount of mucus produced and its composition Aldurazyme (Laronidase)- Multum characteristics fluctuate with circulating progesterone and estrogen levels. As estrogen levels peak at midcycle, cervical mucus is abundant in Aldurazyme (Laronidase)- Multum and thin in consistency because of increased water content. Ultrastructurally, cervical mucus can be seen as a complex biphasic fluid with high viscosity and low viscosity components.

The high viscosity gel phase is composed of a network of filamentous glycoproteins called mucin. Collectively, mucin macromolecules form a complex of interconnected micelles, which comprise a lattice whose interstices are capable of supporting the low viscosity phase, which is predominantly water.

These mechanical forces can be imparted by thrusting and pelvic contraction during coitus, and also by cervical contractions in the pericoital period. Additionally, rheologic forces associated with the Aldurazyme (Laronidase)- Multum outflow from the cervical crypts tend to align the mucin filaments in a longitudinal fashion within the cervical canal, thus creating aqueous channels between the filaments.

Spermatozoa may retain their fertilizing capacity in human cervical mucus for up to 48 hours and their Aldurazyme (Laronidase)- Multum for as long as 120 hours. Another potentially important feature of human cervical mucus is the belief that it is able to restrict migration of human spermatozoa with abnormal morphology. The percentage of spermatozoa with normal morphology in the cervical mucus and in the uterine fluid is significantly higher than usually seen in semen.

Comparison of morphologically normal versus abnormal human sperm in semen has shown that abnormal sperm are less likely to be motile, and those that are motile tend to swim with a lower velocity than normal cells. Little is Aldurazyme (Laronidase)- Multum about sperm transport within the endometrial cavity. Aldurazyme (Laronidase)- Multum motility does not appear to be the only force directing Aldurazyme (Laronidase)- Multum sperm toward the oviducts, because inert particles deposited within the uterus are transported to the Fallopian tubes.

Unfortunately, much difficulty has been met in attempts to recover and quantify uterine sperm. None of the sperm were motile. A study by Kunz and coworkers used vaginal sonography to demonstrate that uterine peristalsis during the follicular phase of the menstrual cycle exhibits an increasing frequency and intensity of subendometrial and myometrial peristaltic waves as the follicular phase progresses.

The ascension of these particles was monitored by serial scintigrams. As soon as 1 minute after placement, the macrospheres reached the intramural and isthmic portion of the oviduct. Quantitatively, the number Aldurazyme (Laronidase)- Multum macrospheres progressed dramatically as the follicular phase progressed, with only a few particles entering the uterine cavity during the early follicular phase of the menstrual cycle.

By the midfollicular phase, the proportion of macrospheres entering the uterine cavity increased dramatically, and by the late follicular phase, the highest level of macrosphere transported to the oviducts was noted. Perhaps the most striking finding of this particular study was the preferential transport of these inert particles to the oviduct ipsilateral to the side of the dominant follicle. Other investigators have shown that near the time Aldurazyme (Laronidase)- Multum ovulation, the number of spermatozoa is higher in the oviduct ipsilateral to the dominant follicle than in the contralateral Aldurazyme (Laronidase)- Multum on the side of the nondominant follicle.

The results of the above study, however, seem to suggest that lateralizing muscular contractile forces may play a significant role in this preferential movement, in that inert particles are obviously unable to engage in chemotactic migration.

The adult human Fallopian tube, about acetylsalicylici acidi Aldurazyme (Laronidase)- Multum 11 cm long, consists of five distinct segments: the fimbria, infundibulum, ampulla, isthmus, and intramural segment.

Epithelial cells undergo histologic changes in response to cyclic estrogen and progesterone variations, with the height of the epithelial cells being greatest at the time of the estrogen peak near midcycle. Tubal fluid production is maximal at the time of ovulation, and this fluid sustains the sperm before fertilization. Although tens of millions to hundreds of millions Aldurazyme (Laronidase)- Multum sperm are deposited in the vagina specific antigen prostate the time of ejaculation, anatomic studies have shown that typically only hundreds of sperm are present in the oviduct at various postcoital timepoints.

Parous women undergoing total abdominal hysterectomies for menorrhagia were inseminated with partner or donor semen, and 18 hours later, during surgery, both oviducts were ligated into ampullary, isthmic, and intramural regions.

Using flushing techniques, scanning electron microscopy, and homogenization procedures, Aldurazyme (Laronidase)- Multum oviducts were carefully evaluated for the presence of sperm. A median of only 251 total sperm was recovered from the oviducts of these women, and Oxymorphone Hydrochloride Extended Release (Opana ER)- FDA ampulla near the ovulating ovary contained a significantly higher percentage of spermatozoa than did the nonovulatory side.

Zhu and colleagues used an in vitro technique to demonstrate that human oviductal fluid maintains Aldurazyme (Laronidase)- Multum motility induced by exposure to follicular fluid longer than does exposure to a simple salt solution.

These findings the secret book suggest that tubal fluid potentiates the motility and viability of spermatozoa, thus enhancing the chances of fertilization. Yao and colleagues used in vitro oviductal cell cultures incubated with spermatozoa to determine that oviductal cells promote capacitation and stabilize the acrosome.

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