Clinical reproduction and fertility最新文献

A simple test of membrane function in spermatozoa has been evaluated by subjecting them to hypo-osmotic stress and determining their swelling characteristics. Correlations between the values from this test and other seminal parameters were poor (r less than 0.42), and after correction for the number of dead spermatozoa present, the relationships became weaker (r less than 0.23). Further investigations with respect to other functional tests of spermatozoal quality (e.g. penetration of homologous and heterologous ova) are warranted before the swelling test is adopted for general routine use.

A prospective six-year study (1975-1980) of 273 patients, monitored in the use of natural family planning (NFP), has shown that those with previously irregular menstrual cycles are disadvantaged in the subsequent use of the ovulation method after pregnancy in that they have fewer recognizable safe days and/or are more likely to have unplanned pregnancies than women who had regular cycles prior to pregnancy. Eight patients, seven nursing and one non-nursing mother, conceived during postpartum amenorrhoea. The reliability of memory in the recall of previous menstrual histories is discussed in relation to the results of an international study of menstrual cycles by the World Health Organization (WHO 1983). The relevance of prediction of menstrual events in natural family planning is also considered.

Numerous studies have identified specific areas in which the effects of maternal smoking during pregnancy may occur including fetal growth retardation, neonatal deaths, pregnancy complications leading to premature delivery and possible effects on lactation and long-term effects on surviving children. Despite the number of papers which have been published on this subject there is still no clear understanding of the extent to which smoking in general, and various components of cigarette smoke in particular, exert a detrimental effect on the human reproductive potential. Although epidemiological evidence is scanty there are indications that cigarette smoking decreases fertility in women, increases the frequency of menstrual abnormalities and decreases the age of spontaneous menopause. Cigarette smoking in males has also been implicated as a cause of decreased sperm numbers and an increased frequency of abnormal sperm morphology as well as a decrease in sexual performance. Experimental evidence from humans and rodents suggests that nicotine can alter the hypothalamic-pituitary axis through its stimulation of growth hormone, cortisol, vasopressin and oxytocin release which in turn inhibit luteinizing hormone and prolactin release.

Nine normal cycling subjects were monitored for mid-cycle LH surge and a subsequent rise in serum progesterone levels. Frequent samples were then taken for progesterone measurement during 8 h sessions in the early, mid and late luteal phases. These data showed: that progesterone secretion is pulsatile throughout the human luteal phase, with maximum frequency in the mid-luteal phase; that during the mid-luteal phase most subjects had progesterone levels both above and below currently accepted ovulatory thresholds; the use of a single measurement of progesterone in the mid-luteal phase is not always a reliable indicator of ovulation; a threshold greater than 20 nmol/l may yield an unacceptable number of false negative results.

Spermatozoal depletion of the extra-gonadal reserve (EGR) has been monitored in 14 men by analysing ejaculates collected daily for 5 days. It has been concluded that EGR is stabilized within 2 days and that an estimate of daily spermatozoal output can be obtained either by averaging the values from days 3 to 5 or by using the day 5 value alone. This latter parameter may prove useful clinically.

There are no specific legislative provisions regulating sterilisation in any State or Territory in Australia and there is a dearth of general case law on the subject. To determine the law relating to sterilisation, we need to consider both criminal and civil liability. In the absence of specific statutory provisions, it is necessary to examine the common law and the possible application of non-specific statutory provisions in both areas.

Female sterilisation using tubal occlusive methods are reviewed. The various techniques, failure rates, mortality, short and long-term morbidity, psychosexual effects and reversibility are discussed. Tubal occlusion is an effective method of female sterilisation but if failure should occur ectopic pregnancies are more likely if tubal diathermy, and less likely if Fallope rings or Filshie clips have been used for the original sterilisation procedure. Mortality rates are low and occur as a once-only risk when compared to ongoing contraception. Short-term morbidity rates are low when sterilisation is performed via the laparoscope, with single portal entry being more likely to result in complications. Mini-laparotomy and laparotomy also have low morbidity levels but complication rates are much higher when a transvaginal approach is used. There is no increase in morbidity when tubal sterilisation is performed at the time of pregnancy termination, providing uterine evacuation is not performed by hysterotomy. In the majority of cases no menstrual disturbance is noted; however, a small increase in menstrual disorders as a direct result of tubal sterilisation cannot be excluded absolutely. Sterilisation does not affect sexual satisfaction. Regret is more likely if the sterilisation is performed (i) post-termination or in the puerperium, (ii) when there is marital disharmony and (iii) for medical rather than social reasons. Low parity is not associated with regret except in cultures where high parity is prized. Microsurgical methods of reversal have higher pregnancy and lower ectopic rates than macrosurgical techniques. Successful reversal is inversely related to the degree of tubal destruction at the initial operation.

We conducted a multinational case-control study of ectopic pregnancy in which 1108 ectopic cases were matched by age, parity and marital status with an equal number of pregnant and non-pregnant controls. When cases were compared to pregnant controls there was an increased relative risk (RR) of ectopic pregnancy associated with the use of an intrauterine device (IUD; RR = 6.4) and sterilisation (RR = 10.9) at time of conception, but there was no increased risk associated with oral contraception or other reversible methods. There was an excess of ovarian pregnancies among cases wearing an IUD, and more cases than controls using an IUD had evidence of pelvic inflammatory disease (PID). This suggests that the IUD increases the risk of ectopic gestation possibly by providing greater protection against intrauterine (rather than extrauterine) pregnancy, and by predisposing women to PID and tubal damage. When cases were compared to non-pregnant controls the relative risk of ectopic pregnancy was reduced with all methods, but this protective effect was less marked with the IUD (RR = 0.5) than with the pill (RR = 0.1), other interval methods (RR = 0.2) or sterilisation (RR = 0.2). IUD use prior to conception did not affect the risk of ectopic gestation (RR = 0.7). A past history of PID or sexually transmitted disease (STD) was associated with an increased risk of ectopic pregnancy compared to pregnant (RR = 2.8) and non-pregnant (RR = 2.0) controls. This risk may be higher with multiple episodes of previous PID, but the results were not consistent. Prior PID in the presence of an IUD did not increase the risk over and above that associated with a high risk of recurrence (RR = 7.0 for pregnant and RR = 9.3 for non-pregnant controls). Induced abortion did not significantly affect the risk of ectopic gestation, but spontaneous abortion was associated with an increased risk compared to non-pregnant controls. This finding may have been due to selection bias. Cigarette smoking was associated with an increased relative risk of 3.1 for pregnant and 1.8 for non-pregnant controls. This was not consistent in all comparison groups and may have resulted from confounding, but requires further investigation. We did not observe a significant risk of ectopic pregnancy following gynaecological surgery.