The gonadotrophin responses to the negative and positive feedback effects of orally administered ethinyl oestradiol in 12 women with minimal endometriosis were compared with those in six normal women of proven fertility. Basal concentrations of LH, FSH and oestradiol did not differ between the two groups. LH and FSH concentration declined within 12-24 h of starting treatment and there was no difference between minimum values, which occurred in both groups after 12-48 h. In five women with minimal endometriosis, LH concentrations subsequently increased above basal values to maximum values indistinguishable in magnitude and timing from those in the control group. An exaggerated LH response to oestrogen positive feedback occurred in one subject. In the remaining six women LH concentrations increased above levels which could be attributed to episodic variation in basal LH secretion but maximum LH values were below control limits. There was no relationship between previously documented progesterone secretion nor LH concentrations during the early luteal phase of the cycle and the LH response to oestrogen positive feedback. These data suggest that minor abnormalities of hypothalamopituitary function may contribute to infertility associated with minimal endometriosis.
Administration of pulsatile LHRH (14.4 microgram/pulse per 90 min) from day 5 to 9, or day 7 to 11 of the cycle following clomiphene pretreatment on days 2-6 induced multiple follicular growth for oocyte recovery for in vitro fertilisation. Administration of LHRH without clomiphene pretreatment failed to induce multiple follicular development. The same group of patients treated with clomiphene alone had fewer numbers of mature follicles, fewer oocytes recovered and less pre-embryos for transfer than when treated with clomiphene and LHRH in combination. Peak gonadotrophin release following commencement of LHRH was seen within the first 24 h of administration with a gradual fall in both LH and FSH toward baseline pretreatment values by the fourth day of administration. A discernible LH increment to LHRH was still present on the fourth day of LHRH treatment, but in many individuals no FSH increment was observed. The preovulatory oocytes recovered were predominantly mature with fertilisation rates of 70% and 85.7% for the two regimens. No pregnancy occurred in the six patients who underwent pre-embryo transfer.
The plethora of published studies investigating oral contraceptive pill (OC)-induced changes of various plasma lipids and their ratios together with repeated reviews of these studies in the literature, are all based on the assumption that OC-induced favourable or unfavourable lipid profiles decrease or increase a pill-associated cardiovascular risk. Some authorities have been led to recommend choice of pill formulations based on such changes of plasma lipids. In a combined review of relevant cardiovascular and OC epidemiological studies no evidence is found for these assumptions and recommendations. There is no evidence of OC-induced atherosclerotic disease, and pill-induced changes of plasma lipids within normal limits are therefore probably without any clinical relevance. Profound changes towards a so-called favourable plasma lipid profile may, on the contrary, be detrimental in terms of pill-associated cardiovascular events.
The prevalence and pattern of circulating antisperm antibodies were assessed in the serum of Korean males undergoing vasectomy, vasovasostomy, epididymovasostomy and in a control group of men with normal semen by means of the gelatin agglutination test and the tray agglutination test. Sperm-agglutinating antibodies in serum were positive at a titre of 1:32 or greater in 3% of normospermic control males and in 27% of vasectomized men. No significant changes were observed in prevalence of the antibodies over the period following vasectomy. There were no significant differences in prevalence of antibodies in patients with and without postoperative sperm granulomas. Antibodies were positive in 35% of vasectomized men just prior to vasovasostomy and in 29% of patients 12 months after a successful (patent) reversal operation. There was no significant difference in prevalence of antibodies in patients with successful and unsuccessful vasovasostomies. Antibodies were positive in 20% of men who achieved pregnancies and in 43% of those with persisting infertility in the presence of a patent vasovasostomy. Sperm agglutinating antibodies were present in 5% of the patients with pathological epididymal obstruction. They were negative in patients with a patent epididymovasostomy and positive in 17% of those with an unsuccessful epididymovasostomy. The four patients who achieved a pregnancy after epididymovasostomy were antibody-negative. The prevalence of antibodies in the serum of patients with azoospermia due to surgical vasal obstruction was higher than that in patients with azoospermia due to pathological epididymal obstruction. The agglutination patterns produced by sperm antibodies in the total group of positive sera were tail-to-tail in 56%, head-to-head in 30% and mixed in 14%.
The inserter tubes of the more modern copper bearing IUDs are flexible enough to give ('bow') when there is obstruction to the device. The MLCu 250, Copper 7 and Nova T inserters will bow considerably when forces of 1-3 N are exerted and the device obstructed up to 0.75 cm from its proximal end. This suggests that these devices are unlikely to cause cervical damage where their passage into the uterine cavity is impeded by cervical factors, provided the insertion attempt is discontinued when bowing of more than 2 cm off-centre is reached. However this does not apply to obstructions past the internal cervical os. In research circumstances great care should be used as it rapidly becomes possible to exert enough force to produce damage to the uterine muscle.
The efficiency of two methods of ultrasound-guided aspiration of pre-ovulatory oocytes was compared in 238 treatment cycles, of which 166 were by the transabdominal-transvesical (TA) route and 72 by the transvaginal (TV) route. Successful collection of at least one oocyte was achieved in 86% of TA attempts and in 97% of TV attempts. Significantly less oocytes were collected from follicles by the TA methods than by the TV methods: 374 oocytes were obtained from 797 follicles (46% recovery) and 242 oocytes from 338 follicles (72% recovery), respectively. Although fertilisation occurred more frequently in TA-recovered oocyte (70% versus 54%), the incidence of cleavage per inseminated oocytes collected by these TA and TV methods was similar (49% versus 44%, respectively). Results of this study therefore suggest that the TV method is superior to the TA approach for oocyte recovery.
Human sperm immaturity was tested by nuclear chromatin decondensation (NCD) in 1% sodium dodecylsulphate (SDS) of spermatozoa used in 74 consecutive IVF treatments. NCD was significantly higher in the presence of 2 mmol/l dithiothreitol (DTT) and after washing sperm from semen with 6 mmol/l ethylenediaminetetraacetic acid (EDTA). NCD was significantly less in insemination suspensions prepared by the swim-up technique than in the original semen. NCD with DTT was inversely correlated with sperm motility and motility index but there were no significant relationships between NCD and other semen analysis variables. There was no significant correlation between any NCD test and the proportion of oocytes fertilised in vitro. The only factors being significantly correlated with the fertilisation rate were proportion of sperm with normal morphology (Kendall correlation, tau = 0.36, P less than 0.001) and sperm concentration (tau = 0.14, P less than 0.05). Logistic regression analysis of fertilisation rates showed that only percentage normal sperm morphology was significant. It is concluded that NCD does not provide additional useful clinical information about sperm fertilising ability in vitro.
Human spermatozoa were preincubated for 3.5 h with various concentrations (0-100 mumol/l) of verapamil, a Ca2+ channel antagonist, before they were mixed with zona-free hamster eggs. Control spermatozoa penetrated only 3% of the eggs, whereas the highest penetration (40.3%) was reached after preincubation with 100 mumol/l verapamil. Thus, verapamil increases the ability of human spermatozoa to penetrate zona-free hamster eggs, possibly by an acceleration of the acrosome reaction. Although it has been established that the acrosome reaction requires the entry of extracellular Ca2+ into the spermatozoa, the Ca2+ ions do not seem to enter by means of Ca2+ channels.
A radioimmunoassay employing beta hCG antiserum and tracer and hCG standard was used in an attempt to detect transient luteal phase rises in hCG in urine as evidence of occult pregnancy loss. It was found that the assay lacked specificity and detected 'hCG' surges at midcycle which were not confirmed using a more specific monoclonal antibody based immunoradiometric assay. Measurements on first morning urine samples across midcycle and throughout the luteal phase in 65 cycles from 36 women attempting to conceive revealed no evidence of transient hCG production in the 56 cycles which did not go on to a clinical pregnancy.
Workers in new and personally exacting health services face particular challenges which are not evident in more traditional areas. IVF workers are involved in such an innovative service. Their perception of workplace stressors has not previously been addressed in the literature. Fifty-nine IVF workers and 32 non-IVF workers (in routine obstetrics and gynaecology) completed a battery of standardized psychological questionnaires on the symptomatology of stress and in addition answered questions on workplace problems and work satisfaction. Reported stress was highest among scientific/technical workers who varied significantly from the control group scores. IVF medical staff showed elevated stress scores, but were not significantly separated from controls, except on state anxiety. Work satisfaction scores were generally high for all IVF professions, except for pay and promotion satisfaction scores which were depressed among nurses and scientific/technical staff. It was concluded that this initial survey had revealed important information about the impact of a new scientific and clinical enterprise upon staff and should promote closer examination of the reasons for such reported stress.
Photographic slides of 36 sperm were shown to a group of 28 observers with different lengths of experience in assessing sperm morphology. Experienced observers were generally consistent (10 or more of the 17 agreeing) in classifying sperm as normal, amorphous, small heads, lacking acrosomes, and having tail defects or cytoplasmic droplets but categorization was more variable for large, tapering and pyriform heads. This study highlights the need for more widespread agreement about definition of sperm shapes and the development of practical objective methods of assessment.
The exact time of day of onset of menstruation was studied in 86 women over 4-6 cycles. Detailed information on the time of retiring the previous night, time of rising in the morning, time of onset of premenstrual spotting and time of onset of any menstrual cramps was obtained from 48 of these women. A significantly greater number of cycles (70.4%) commenced during the night or in the first 4 h after rising, compared with later in the day. In a large proportion of these (29 out of 76), blood was noted to be present on waking, menstruation thus having begun at some time during the hours of sleep. Premenstrual spotting of greater than 3 h duration was more common than expected and was noted by 67% of women. Onset of menstrual cramps was fairly evenly distributed closely either side of commencement of menstruation proper in the 50% of women who experienced them. In only 13% of women studied did bleeding commence within the same 3-hour time interval in each of four cycles, and almost 50% demonstrated a very wide variation with onset at almost any time of day.
A survey of Canadian providers of AID was conducted, along with a parallel survey of adoption workers. The questionnaire focused upon non-medical criteria for patient acceptance (for AID and adoption), including acceptance/rejection of single, lesbian, and common-law women, those economically or mentally unable to support children, and those who themselves have or whose partners have criminal records. Further questions concerned decision-making in patient selection, referral of unacceptable patients elsewhere, and the influence if any of legal advice. Most characteristics reflect great disagreement and lack of consensus within the profession. Attitudes towards characteristics may be influenced by the size and form (university vs private) of the practice, as well as by experience with patients with those characteristics. Systematic differences between AID and adoption providers are detailed and explored, as are implications of the study for the development of bioethical thinking and policy making.
The ability of human spermatozoa to penetrate zona-free hamster ova in a heterologous ovum penetration (HOP) test was compared with the fertilisation of human oocytes in 54 normospermic couples. Concordant results were seen in 45/54 (83%) cases. However, false-positive HOP test results occurred in 5/45 (11%) couples and false-negative results in 4/9 (44%) couples. The data suggest that a positive HOP test result is a good indication that fertilisation will occur, although a negative HOP test result does not necessarily mean that fertilisation will not take place.
Seminal plasma proteins were separated by sodium dodecylsulphate polyacrylamide gel electrophoresis and the patterns for different conditions compared by densitometry. The changes in pattern with time after ejaculation because of proteolysis could be largely prevented by addition of bacitracin. Patterns were similar within the one man and little influenced by duration of abstinence from ejaculation. There were marked variations in pattern between individuals and no specific differences could be detected between samples from men with normal semen analyses, vasectomy, or azoospermia from seminiferous tubule failure. However, there were distinct patterns with congenital absence of the vasa and seminal vesicles and with androgen deficiency. Methods for identification of testicular and epididymal proteins in semen would expand the clinical usefulness of examination of seminal plasma proteins.
Twenty-two women with hyperprolactinaemia without evidence of microadenoma, either untreated (n = 3), treated with bromocriptine for a total of less than 1 year (n = 12), or treated with bromocriptine for a total of more than 1 year (n = 7) were followed up by retrospective case-note review for at least 53 months. More than 50% of the women showed a fall in serum prolactin concentrations by more than 40% over the period of follow-up. The occurrence of a fall did not appear to be related to either length of treatment with bromocriptine or to the occurrence of pregnancy. Some women elected to remain untreated, despite symptoms, in preference to taking tablets and having to use contraception. The wisdom of leaving patients untreated in the light of these findings is discussed.
In ejaculates from selected infertile couples, the degree of coagulation revealed significant positive correlations with liquefaction time, sperm count and motility, but negative correlation with semen volume. Comparison of presumptively fertile and infertile ejaculates also showed significant variations in their amount of coagulum and liquefaction time. The study suggested a possible relationship between the coagulation-liquefaction property of human ejaculates and their semen quality.
