Albert Bernard

HUMAN PREGNANCY FOLLOWING OOCYTE AND SPERM TRANSFER TO THE UTERUS

Abstract In 31 infertile patients, ovulation was induced with clomiphene citrate and oocytes were captured by laparoscopy 36 hours after injection of chorionic gonadotropin (hCG). The oocyte was incubated in tissue culture medium for 6 hours, sperm was added, and culture was continued for 1 further hour. The oocyte was then transferred directly into the uterus in 20 μl of fluid containing 10 000-20 000 sperm. In 14 patients (45%) β-hCG levels in urine indicated trophoblastic activity, and 2 patients have continuing intrauterine pregnancies.

A randomized comparative study of purified follicle stimulating hormone and human menopausal gonadotropin after pituitary desensitization with Buserelin for superovulation and in vitro fertilization.

Twenty patients entered a randomized, crossover study of purified follicle-stimulating hormone (pure-FSH) or human menopausal gonadotropin (hMG) superovulation, 2 ampules per day after pituitary desensitization with the luteinizing hormone-releasing hormone (LH-RH) analogue Buserelin (D-Ser tBu6 LH-RH 1-9 ethylamide) nasal spray. There were no cycles cancelled. Six patients conceived (five on pure-FSH, one on hMG). There were 24.2 +/- 2.5 (mean +/- standard error of the mean [SEM]) ampules of pure-FSH and 24.3 +/- 3.6 ampules of hMG stimulation required. There were similar numbers of preoperation follicles: 6.9 +/- 1.0 on hMG and 6.6 +/- 1.1 on pure-FSH, of oocytes collected; 8.5 +/- 1.4 on hMG and 5.8 +/- 1.4 on pure-FSH, and of pre-embryos achieved; 5.1 +/- 0.9 on hMG and 3.4 +/- 1.0 on pure-FSH; on either treatment. The fertilization rate on hMG was 60% and on pure-FSH was 55%. Pre-embryo transfer rates were 3.2 +/- 0.3 in the hMG group and 2.7 +/- 0.4 in the pure-FSH group. There were no differences in serum FSH, LH, estradiol, or progesterone levels between the hMG and pure-FSH groups. Mean +/- SEM luteal phase length was 10.6 +/- 0.4 days in the nonpregnant cycles.

Venous tone in pregnancy.

PROMINENCE of the veins, especially in the breasts and pelvic tissues, has long been recognized as an early indication of pregnancy. This finding has often been ascribed to a reduction of tone in the walls of veins and has been considered a factor in the aetiology of varicose veins. The increased production of hormones in pregnancy, notably progesterone, has frequently been held responsible (Browne and McClure Browne, 1963 ; Clyne, 1963; Cunningham, 1964). Tenney and Little (1961) state that symptoms of varicose veins may increase as a result of hormone therapy to prevent abortion. However, objective evidence of generalized, active venous dilatation in pregnancy has proved difficult to obtain, partly because of the technical difficulties of investigating the venous system. Increased venous distensibility has been reported in the finger-tip in pregnancy (McCausland et al., 1961) but considering the arteriovenous anastomoses in this region and the large increase in hand blood flow demonstrated in pregnancy (Abramson et al., 1943; Ginsburg and Duncan, 1967) it is difficult to be certain that responses measured in this region are solely venous. Furthermore, in view of the specialized vasomotor control of the circulation to the hand (Shepherd, 1963) one cannot infer that changes in the finger tip indicate those occurring in other regions. Increased venous distensibility in pregnancy has also been reported in the calf and forearm (Goodrich and Wood, 1964). However, this claim was based on relatively slight differences between data from a group of women measured on one occasion only in the third trimester of pregnancy and data from other women a few weeks after delivery. Direct recordings of venous pressure were not made. The present study reports the results of repeated determinations of venous tone in a group of pregnant women before and after delivery, using a method (Sharpey-Schafer, 1961) which included direct measurements of venous pressure. The forearm was chosen for study since it is an accessible region where the arterial inflow does not change in the course of gestation (Ginsburg and Duncan, 1967), where results are more generally applicable to skin and muscle in other regions, and where direct pressure effects due to the enlarging uterus are not operative.

Outcome of in-vitro fertilization and embryo transfer after different regimens of ovarian stimulation

Summary. Sixty‐eight women with bilateral tubal disease and fertile male partners underwent ovarian stimulation in 187 cycles for IVF after randomization to different ovulation induction regimens. All patients initially received 150 mg clomiphene citrate on days 5–9, this regimen induced sufficient stimulation in a smaller proportion of patients than the two other regimens used subsequently which included clomiphene in combination with human menopausal gonadotrophins (hMG). The fertilization rate was significantly reduced (52–4%) in oocytes collected from cycles stimulated with hMG alone (in a small sub‐group of poor responders) compared with a rate of 64·1–66·4% in cycles stimulated with clomiphene alone or in combination with hMG. Embryonic development 44–48 h after insemination was significantly retarded when clomiphene alone was utilized but a higher proportion of fragmented or abnormal embryos was observed after stimulation with hMG alone. In 118 cycles embryo transfer was performed and 20 pregnancies were established, a pregnancy rate of 16·9%. All but two pregnancies were established when two or more embryos were transferred and when the embryos were at the 4‐cell or later stage of development. The regimen of clomiphene in combination with 150 i.u. hMG resulted in significantly greater numbers of oocytes recovered and embryos available per patient for transfer than the other two regimens studied.