A. Wisanto

Small diameter laparoscopy using a microlaparoscope

In order to determine the suitability of new microlaparoscopes of < 2.0 mm diameter for diagnostic laparoscopy, 28 small diameter laparoscopies (SDL) were performed during a 4 month period. These cases were performed under general anaesthesia with immediate follow-up confirmation with conventional laparoscopic equipment (group I). An additional 13 SDL procedures were performed under analgesic sedation plus local anaesthesia and were well tolerated by the patients (group II). For group I, the visualization results were comparable in 27 out of 28 procedures. In group II, patients were highly satisfied and reported less post-procedural discomfort and minimal scar formation due to the smaller access ports. In this study, two different types of microlaparoscopes were used; while both were adequate, the newer high-resolution microlaparoscope delivered an image much more similar to conventional laparoscopy and required little or no change in technique in order to obtain images. This new endoscopic technology, with optical performance comparable to that of conventional laparoscopy, has been demonstrated to be a useful procedure for certain clinical indications.

Inhibition of gonadotropic and ovarian function by intranasal administration of D-Ser (TBU)6-EA10-LHRH in normo-ovulatory women and patients with polycystic ovary disease

We investigated the effectiveness of D-Ser (TBU)6-EA10-LHRH (Buserelin) intranasally 600 μg/day given 6 times daily in desensitizing normal ovulatory women and patients with polycystic ovarian disease (PCOD) before initiation of ovarian stimulation for in vitro fertilization. We found that this regimen was sufficient to suppress the gonadotrophs in the normal women and in 8 out of 10 PCOD patients. In PCOD ovarian hormones became normal after Buserelin administration. Adrenal steroidogenesis was not affected by the GnRH agonist. We suggested that the frequency of administration of Buserelin was important to achieve a constant receptor binding and consequently a rapid desensitization. The choice of a monoclonal immunoradiometric assay for luteinizing hormone (LH) and follicle stimulating hormone (FSH) in association with the estradiol-benzoate provocation test were essential in evaluating desensitization.

In vitro fertilization techniques with frozen-thawed sperm: A method for preserving the progenitive potential of Hodgkin patients

The banked sperm of 5 of 13 Hodgkin patients was thawed for assisted reproduction. The post-thaw sperm characteristics were extremely impaired. Nevertheless, in 80% of all trials fertilization in vitro was obtained and conceptus could be transferred. All spouses became pregnant and seven healthy infants were born. One could recommend every Hodgkin patient to bank his sperm before chemotherapy. In vitro fertilization techniques with this frozen-thawed sperm reveal promising results in comparison with artificial insemination to maintain the reproductive capacity of male Hodgkin patients.

The Association of Ovarian Hyperstimulation and Zygote Intrafallopian Transfer

In 1986 we reported the first successful replacement of three zygotes in the fimbrial end of one healthy fallopian tube in a patient with female sperm antibodies.1 More pregnancies have been established, especially in male and unexplained infertility.2–5 The results of zygote intrafallopian transfer (ZIFT) in different indications i.e. unexplained, male infertility, endometriosis, polycystic ovarian disease (PCOD) and female sperm antibodies were analyzed.

Assisted procreation in the presence of a positive direct mixed antiglobulin reaction test

women were followed up for 3 to 41 months (mean, 23.8) to determine subsequent fertility. During the follow-up period, 30 pregnancies occurred among the 55 patients; 24 were intrauterine and 6 were repeat ectopic pregnancies. In the surgical group of 39 patients with salpingectomy, 60.8t70 of those desiring pregnancy achieved an intrauterine pregnancy. Of the 12 patients with salpingostomy, the three who desired pregnancy achieved it (lOOcr/o). In the tubal abortion group, the two women desiring pregnancy conceived (100%). There were six repeat ectopic pregnancies (10.9%). Of the ectopic pregnancies, one occurred in the salpingectomy group (2.6qo), four in the salpingostomy group (33.3%). and one in the tubal abortion group (25%). Five of the six ectopic gestations were found in the contralateral fallopian tube. Hysterosalpingographic evidence of contralateral tubal patency was a good prognostic indicator for subsequent intrauterine pregnancy. By contrast, one half of the study patients with findings suggesting tubal occlusion still achieved an interauterine pregnancy.

Zygote intrafallopian transfer as a successful treatment for unexplained infertility

group, resulting in the birth of 13 healthy infants. There were no statistically significant differences in pregnancy rates (per transfer) between transfers in natural cycles (14%, four pregnancies) and steroid replacement cycles (24r70, 16 pregnancies). Five pregnancies (36%) were established in women with 2 mg of E, daily 13-18 days before embryo transfer with P, starting on the day of or the day following oocyte retrieval. E, was continued for a median of 85 days (range 49-110) and P, for a median of 86 days (range 49-133) after the supposed last menstrual period. Al1 but one delivery was by caesarean section. There were no perinatal death and no ectopic pregnancies.

Success rate in gamete intrafallopian transfer using low and high concentrations of washed spermatozoa

The effect of a reduced number of spermatozoa on pregnancies and miscarriages was studied retrospectively in 307 consecutive gamete intrafallopian transfer (GIFT) cycles. The number of spermatozoa introduced per GIFT in each group was as follows: 100,000 (group I), 50,000 (group II), 10,000 (group III), 5,000 (group IV), and 2,500 (group V), which gave a pregnancy rate of 20%, 38%, 37%, 30%, and 24%, respectively (differences were not significant). With respect to the pregnancies, no correlation was found between the number of spermatozoa transferred and the cause of infertility. In the male factor group also no significant difference was observed in the pregnancy rate when the sperms were reduced from 100,000 to 2,500. Lowering the number of sperms in GIFT did not reduce the abortion rate, which remained around 33%. It was the patients with unexplained infertility who benefited most from the GIFT procedure. Their pregnancy rate was significantly higher than the pregnancy rate of those who had endometriosis, or andrologic or immunologic disorders.