International Journal of Fertility最新文献

Adult Wistar rats were bilaterally caput epididymectomized and the effects on testicular germinal epithelium and formation of multinucleated bodies were studied and quantified at 2, 4, 7, 14, 21, and 28 days after surgery. Sham-operated and bilaterally efferentectomized animals served as controls. No alterations were found in sham-operated animals. Efferentectomized animals showed a progressive alteration of the seminiferous tubule epithelium and a (very occasional) presence of multinucleated bodies. Epididymectomized animals presented a progressive degeneration of the germinal epithelium, which was almost complete at 28 days. This epithelial degeneration was accompanied by the formation of multinucleated bodies from germinal cells, whose number and characteristics varied with the experimental interval. The multinucleated bodies described here resemble the multinucleated cells mentioned by other authors. They do not seem to be cellular; instead, they appear to be debris, since electron microscopic observations do not reveal a plasma membrane.

A prospective study of sex preselection provided the opportunity to characterize the fertile menstrual cycle. We describe from 91 natural conceptual cycles, or sub-groups thereof, cervical mucus symptoms, basal body temperature (BBT) changes, hormonal characteristics, and the outcome of pregnancy. The cervical mucus symptoms defined a potential fertile period of 10 days' average length, with the "peak" mucus symptom occurring at a mean of day 15.5 of the cycle. A fertile period of 9 to 10 days was also indicated by pregnancies resulting from single acts of intercourse between -6 and +3 days from ovulation. The BBT chart was biphasic in 73 of 76 cycles. The duration of the LH surge as observed in early morning urine samples averaged five days, with the peak occurring 1.4 days after the onset. Considerable inter-subject variability was seen in the LH excretion levels. Hormone measurements of peripheral plasma during the luteal phase showed the first detectable presence of hCG between day 7 and day 13 after conception. Progesterone concentrations in the midluteal phase exceeded 20 nmol/L and tended to be higher than in a comparison group of nonfertile cycles, whereas the estradiol concentrations were similar in fertile and nonfertile cycles. The birth sex ratio favored males when intercourse preceded ovulation/fertilization by two days or longer. While this association was statistically significant, the number of pregnancies involved is too small to conclude that the relationship is real.

Urinary glycosaminoglycans (GAGs) content showed a characteristic pattern of fluctuation during normal and hormonally induced cycles with a distinct peak at ovulation. This peak of maximal GAGs concentration (106.7 +/- 46.2 micrograms/mL in urine) was centered according to the day of the midcycle LH surge, which serves as the reference point, designated day 0. All cycles are presumed to be ovulatory on the basis of biphasic BBT nadir, ultrasonographic studies, and progesterone assays (greater than 5 ng/mL of serum) during the secretory phase. In hormonally induced menstrual cycles, a noticeable increase in GAGs concentration (70%) was observed. This indirect evidence suggests a possible correlation between GAGs content and hormonal effect. All types of GAGs, with the exception of heparin, have been found in urine, chondroitin sulfate C being the major component at time of ovulation. These results strongly suggest that urinary GAGs determination is a precise method for ovulation detection.

This retrospective study represents our experience with cervical cerclage (suture) in pregnancies with uterine malformation. Seventeen patients with uterine malformations were involved. In these patients, the outcome of 31 gestations with cervical cerclage was evaluated. Uterine malformation was associated with cervical incompetence in 41% of the patients. Term delivery rate and fetal loss were observed in 56% and 26% of pregnancies, respectively. Infant salvage was not significantly different regardless of whether cervical incompetence was present or absent. A prolonged hospital stay and frequent use of tocolysis were noted during gestations with cerclage. Our data suggest that the outcome of pregnancies with uterine malformation was not improved by cervical cerclage when the indication for cerclage was the malformation itself.

In an 11-year period, 106 women were treated for two ectopic pregnancies (EP). Thirty-one had been surgically sterilized by the second operation. Of the 75 women with at least one patent tube, 70 (93%) were followed up regarding pregnancy outcome, with a mean follow-up period of 4.5 years. Fifty women had had a desire for pregnancy after treatment for the second EP. Of these, 26 (52%) did not achieve any conception; 16 (32%) experienced at least one more EP, and 13 (26%) had at least one intrauterine pregnancy. There were a total of 46 pregnancies, of which 21 (46%) were ectopic and 16 (35%) were carried on term. When conservative surgical techniques had been performed at the first EP, the number of intrauterine pregnancies achieved after the second EP was doubled, and the risk for a third EP was not raised. There was found no statistical difference in laterality of the second EP when the first operation was conservative. It is concluded that women experiencing repeat EP have severely impaired future fertility, with a high risk of a third EP if they conceive.

The effects of intrauterine insemination (IUI), intracervical insemination (ICI), and timed intercourse (TI) in women who were treated with human menopausal gonadotropin (hMG) for anovulation were evaluated. The pregnancy rates per cycle following IUI (70 cycles), ICI (62 cycles) and TI (158 cycles) were 20%, 9.6%, and 17.7%, respectively; these differences are not statistically significant. The abortion rate and the multiple pregnancy rate were also not significantly different. This report suggests that in women who are undergoing treatment with hMG, there is no added benefit from artificial insemination (either intrauterine or intracervical insemination) over timed intercourse.

CA 125 levels were measured in the serum of 18 patients with laparoscopically diagnosed stage 2 to stage 4 endometriosis (American Fertility Society classification) and in eight normally cycling control women. All endometriosis patients were treated medically with either Danazol or Buserelin. CA 125 levels were measured during treatment and during the 18-month follow-up period. The mean CA 125 level in women with endometriosis was significantly higher than that observed in normal women (28.6 +/- 5.1 (+/- SE) units/mL vs. 11.1 +/- 1.1 units/mL). However, there was considerable overlap of values between controls and patients with stage 2 disease. The levels in patients with stage 3 or stage 4 disease were always greater than 20 units/mL. There was a significant positive correlation (r = .51) between the implant score and CA 125 levels, while there was no correlation between the total score (which includes adhesions and implants) and the CA 125 levels. Four of the patients who had recurrence of symptoms approximately 1 year after treatment had CA 125 levels close to pretreatment levels, and recurrence of endometriosis was confirmed by laparoscopy. The CA 125 levels in the rest of the patients remained suppressed during the follow-up periods. These results indicate that (1) CA 125 level can predict active endometriosis lesions in patients with stage 3 and stage 4 endometriosis, but is of no value for predicting adhesions; (2) CA 125 levels are useful in monitoring therapy during treatment; (3) during the follow-up period, elevations in CA 125 might predict recurrence of disease in women with stage 3 and stage 4 endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)

We describe a woman who conceived by in vitro fertilization (IVF) and embryo transfer (ET). Transvaginal ultrasound demonstrated at least 1 week's difference in size of twin gestations from 1 month post-transfer of embryos to delivery. Differences in sac size, crown-rump length, and gestational growth are discussed, as are implications of ultrasound in early pregnancy.

A case is reported of ectopic pregnancy occurring within an ovary with the morphologic appearance of polycystic ovary syndrome (PCOS). The hyperandrogenism and elevated LH/FSH ratio characteristic of PCOS were noted 2 months after removal of the ovarian gestation. The thickened ovarian cortex of the PCOS ovary and a defect in oocyte-cumulus complex detachment within the follicle are suggested as possible factors contributing to intraovarian fertilization in PCOS.