After completing a short form of the Boundary Questionnaire (Appendix A), 17 students with high scores indicative of thin boundaries and 13 students with low scores indicative of thick boundaries participated in a testing session in which they reported their "most recent dream'~ their "most recent daydream ", another "dream that really stands out'~ and another "daydream that really stands out." Dreams and daydreams were rated on three 8-point scales-Bizarreness, Dreamlikeness, and Emotionality-by two independent raters who remained blind to Boundary Questionnaire scores. The dream reports were rated significantly more bizarre, more dreamlike, and more emotional than the daydream reports. In addition, the thin boundaried subjects' reports were significantly more bizarre than the thick boundaried subjects' reports. Indeed, the recent daydreams of subjects with thin boundaries were as bizarre as the recent dreams of those with thick boundaries.

A high DNA fragmentation index (DFI) when performing the sperm chromatin structural (SCSA) assay was claimed to be so specific for male subfertility that even IVF and ICSI did not result in live pregnancies. The present study was designed to corroborate or refute these findings. The SCSA test was performed on the male partner from couples failing to have a successful pregnancy despite at least 2 previous IVF attempts. In contrast to the aforementioned studies, ongoing pregnancies were found despite working with a group of recalcitrant patients. Nevertheless, a high DFI score was associated with a trend for lower ongoing pregnancy rates especially related to a high miscarriage rate. Other more recent studies seem to support our conclusions. A high DFI score should influence a patient to choose IVF as a therapeutic modality sooner, especially with ICSI.

Insufficient progesterone, effect possibly more on immune factors rather than adequate endometrial development, can be an easy remedial cause of infertility by simply supplementing the luteal phase with either vaginal or intramuscular or oral (dydrogesterone) progesterone. Progesterone will also help to reduce miscarriage rates when follicle maturing drugs are used for those with regular menses but follicular maturation defects, or women with recurrent miscarriages. One mechanism of action seems to be related to production of an immunomodulatory protein, the progesterone-induced blocking factor either in the cytoplasm or in the circulation. PIBF inhibits cytotoxicity of natural killer cells. Cancer cells may 'borrow' the same mechanism to escape NK cell immunosurveillance. KEYWORDS: cancer • growth factors • immunosuppression • infertility • miscarriage • preterm delivery • progesterone• progesterone receptor • progesterone receptor antagonist • progesterone-induced blocking factor

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Purpose To determine if exposure to progesterone alone is sufficient to increase the production of the immunomodulatory protein known as the progesterone induced blocking factor (PIBF). Also to determine what method of progesterone delivery or form of P best stimulates PIBF secretion. Methods Serum samples from patients with infertility and paid volunteers were evaluated for both PIBF and progesterone at various times during the follicular phase and the luteal phase in both natural cycles and cycles involving embryo transfer after endogenous and exogenous progesterone exposure and after various synthetic progestins. PIBF was measured by a non-commercial research ELISA assay. Comparisons were made of serum PIBF before and after exposure to progesterone, 17-hydroxyprogesterone, and oral contraceptives. PIBF was also measured before and after transfer of embryos.Results Progesterone alone without exposure to the fetal allogeneic stimulus was able to produce a marked increase in s e r u m P I B F. N e i t h e r a s y n t h e t i c p r o g e s t i n (19-nortestosterone derivative) nor 17-hydroxyprogesterone caused an increase in PIBF. Some PIBF is generally detected even in the follicular phase. Conclusions A previous concept considered that an allogeneic stimulus, e.g., from the fetal semi-allograft, was necessary to induce de novo progesterone receptors in gamma delta T cells, which, in turn, when exposed to a high concentration of progesterone, would secrete high levels of PIBF. These data show that exposure to an allogeneic stimulus is not needed to cause a marked rise in PIBF, merely progesterone alone is sufficient.