Clinical reproduction and fertility最新文献

Findings from a national sample of 989 persons and an 'Opinion Leader' survey of 279 executive and ordinary members of 40 organizations identified as having an interest in AID showed that Australians overall approved of the procedure for helping infertile married couples, only 17% of the national sample unequivocally disapproving. Key variables in determining opinions on AID included age, education, country of origin, family status, religion and exposure to infertility. However only 15% of national respondents accepted that AID should be made available to any unmarried women on request although opinions were more evenly spread on its provision to unmarried women in a long-term relationship with a man. Over one-third of 'Opinion Leaders' believed that children should never be told of their AID conception, 13% that they should be given identifying and one third non-identifying information on the donor. A majority believed that AID should be directly carried out or supervised by doctors in hospital clinics. There was strong opposition to business or voluntary organization involvement. Suggestions for changes in the law, while emphasizing protection of donors, recipients, children, persons who ran AID programs and control over futuristic research activities, often showed a misunderstanding of the legal process. The major reasons for exclusion of donors were genetic defects and medical problems although many behavioural characteristics were mentioned. Views on recipients' rights to choose the sex of the AID child were marginally against the proposition.

The expected, immediate, and three-minute pain response following IUCD insertion was evaluated in 84 nulliparous women undergoing a first IUCD insertion. Expected pain was significantly higher than immediate pain and both were significantly higher than three-minute pain. Immediate pain following IUCD insertion was positively related to expected pain but the relationship was not strong enough to be of clinical value. The pain was significantly related to the degree of cervical resistance and this relationship was made much more obvious by the use of the expected pain parameter which is a valuable additional clinical measurement in pain research. IUCD insertion pain consists of a short cervical (less than 3 minutes) and longer fundal component. Avoiding excessive uterine manipulation during device insertion results in lower immediate and later pain response scores for a given device when comparisons are made with other studies, where standard techniques were used.

The serum concentrations of prolactin (PRL), follicle stimulating hormone (FSH) and luteinizing hormone (LH) and the plasma concentrations of testosterone, 5-alpha-dihydrotestosterone (DHT) and oestradiol were measured in 80 infertile men and 38 men of known fertility. The infertile men had a lower mean concentration of prolactin and a higher mean concentration of FSH than the fertile controls. The mean FSH was particularly high in infertile men without antisperm antibodies but with oligospermia (sperm density up to 20 million/ml), who also had a higher mean serum LH level than the fertile controls. Both FSH and LH showed an inverse relationship with sperm density. There were no significant differences in plasma testosterone, DHT or oestradiol between fertile and infertile men. In both the fertile and infertile groups strong positive associations were found between the concentrations of FSH and LH, and between testosterone and DHT. Weaker relationships were found between DHT and oestradiol, and between testosterone and PRL. In the fertile men, positive associations were also found between LH and testosterone, and between oestradiol and both FSH and LH. Testosterone and oestradiol were associated only in infertile men. The relevance of these findings to the aetiology of male infertility is discussed.

Luteal phase abnormalities in early menstrual cycles after pregnancy have been shown to cause confusion in the practice of natural family planning (NFP) for some patients and to restrict severely the number of late infertile days available to others. The cause of the abnormalities is uncertain but appears to be related to the nursing status of the patient.

A comprehensive study is presented of a series of 102 infertile men with non-surgical obstructive azoospermia. Details are given of the presentation, clinical features, apparent aetiology, sites of obstructive lesions and treatment. Identifiable aetiological factors were present in only 50% of cases. Amongst these, associated chronic lung disease (Young's Syndrome) accounted for 23%; genital infection, trauma and previous surgery were present in low incidence. The results of corrective surgery were poor and this fact, together with the clinical and pathological features of the patients in this series suggests that an ill-defined change in the aetiology of obstructive azoospermia may have occurred over the past 2 decades.

A series of microsurgical sterilization reversal procedures has been analysed. It demonstrates that better pregnancy rates are achieved where mechanical sterilization techniques have resulted in only short lengths of tubal destruction. Isthmo-isthmic anastomoses have the most favourable outcome.

Twenty-four hour urinary oestrogen results obtained in 20 amenorrhoeic patients undergoing human menopausal gonadotrophin (hMG) therapy have been analysed in detail in an attempt to improve their value in predicting multiple conception. Of 96 treatment cycles 88 were acceptably stimulated including 76 presumed ovulatory (midluteal serum progesterone concentration greater than or equal to 30 nmol/l). Conception occurred in 27 (26% of all, 33% of ovulatory cycles), of which 10 were multiple (37%). The chance of conception or multiple conception could not be related to luteal progesterone or preovulatory peak urinary oestrogen levels (at least within the clinically imposed limits of the oestrogen values). Discriminant analysis applied to all oestrogen results in individual cycles failed to predict conception, but in the conception cycles was 86% successful in predicting a single or multiple conception. Multiple conceptions were associated with an earlier but slower rise in oestrogen excretion during the last 5 days of hMG therapy, although the starting and final oestrogen levels were approximately the same. Unfortunately, the differences were small and as conception cycles were in the minority and could not be distinguished from non-conception cycles the oestrogen results could not be used reliably in practice to predict multiple pregnancy.

The attitudes and opinions of AID donors have been neglected in the research on AID. The general community and medical attitude is that donors are a reluctant and secretive group, who wish all information about themselves to be destroyed. This paper presents data from a study of 67 donors at the Queen Victoria Hospital, Melbourne. Through questionnaires and structured interviews, donors were asked questions concerning: their reasons for donating; their attitudes to the infertile couple who receive their sperm; their attitudes to the selection of couples; the revelation of information about themselves; and the possibility of meeting their AID offspring. The data reveal that some stereotypes about the donors are not valid; they do not donate primarily for monetary reasons and they are not only medical students. Furthermore, the majority of this group would not object if information about them, apart from their name, were given to the couple for the child, and over half would not mind meeting the child at the age of 18 years. It is clear from this study that before any legislation is created, donors' viewpoints should be considered. It is not impossible that a system could be designed to accommodate all the varied needs of couples, donors, and AID offspring.

One hundred and nineteen women with sustained hyperprolactinaemia were followed for a mean duration of 5.5 years. Where pregnancy was desired, treatment with bromocriptine (+/- clomiphene) was effective in 86% of subjects. Following cessation of bromocriptine therapy one third of subjects whose initial serum prolactin (PRL) level was less than 4 times normal had a 'spontaneous' resolution of their hyperprolactinaemia and resumed cyclical menstrual activity and fertility. Subjects with higher PRL levels or those not treated with bromocriptine, did not show this beneficial effect. Pituitary or hypothalamic tumours were identified in 11% of subjects at the time of presentation and developed in a further 15.1% during follow-up. Most of these tumours were small, occurred more commonly when the PRL level was greater than 4 times normal, and were less likely to develop when treatment with bromocriptine had been administered. Bromocriptine therapy can thus be justified in hyperprolactinaemic subjects to reduce troublesome galactorrhoea, achieve pregnancy, improve the chance of a 'spontaneous' return of menstruation and fertility, control or reduce tumour growth where a pituitary tumour has been identified, and reduce the risk of tumour development in patients with normal plain X-rays of the pituitary fossa at the time of presentation.