Arthur Leader

The prediction of ovulation: a comparison of the basal body temperature graph, cervical mucus score, and real-time pelvic ultrasonography

Ninety-five menstrual cycles were studied in 20 women undergoing donor artificial insemination (AID). In 49 cycles basal body temperature (BBT) changes were charted daily and both daily cervical mucus scoring (modified Insler score) and daily realtime ultrasonography (USS) were performed from day 11 to ovulation. AID was performed only on the day of follicular rupture. A control group, not subjected to USS, were inseminated two to three times per cycle over 46 cycles in the periovulatory period. The Insler score was found to be a reliable indicator of follicular development and rupture. The BBT was found to be less reliable than the Insler score or USS. While USS may be used to confirm follicular development, the Insler score is reliable and less costly.

A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization.

More women of reproductive age are being sterilized. Some of these women regret the decision and subsequently request a reversal of sterilization, whereas others do not. This study was undertaken to develop a profile of easily definable traits of 159 women who requested a reversal of sterilization and compare it with that of 160 women who apparently were satisfied with sterilization. Statistically significant differences were found. Remarriage was the most common cause for regret among women in the group which requested reversal of sterilization. Women in this group married younger, completed their family earlier, and were sterilized at a younger age. These women had significantly fewer live children and had undergone more therapeutic abortions (p less than 0.005).

A comparison of Dextran 70 with carbon dioxide as the distention medium for hysteroscopy in patients with infertility or requesting reversal of a prior tubal sterilization

Our previous publications have demonstrated a high prevalence of hysteroscopic findings, particularly adhesions and polyps. It was the purpose of this study to compare the findings in 992 women in whom hysteroscopy was successfully performed by Dextran 70 with a similar group of 335 women in whom hysteroscopy was performed by CO2 as the distention medium. The incidence of uterine abnormalities in women with primary infertility, secondary infertility, and requesting reversal of sterilization when Dextran was used as the distention medium was 29%, 41%, and 33%, respectively, but only 7.2%, 11%, and 6%, respectively, when CO2 was used. It was concluded from these data that many of the findings of our preliminary studies were probably artifactual and a function of the technique of hysteroscopy and that our early reports must be read with caution.

Initial experience with in vitro fertilization and embryo transfer at the University of Calgary/Foothills Hospital

SummaryThis report serves to describe the initial experience in a Canadian in vitro fertilization program. While our unit is still early on the learning curve, we are thus far gratified with a pregnancy rate of 17.3% per treatment cycle and 20% per laparoscopy.

Psychological and relationship changes of couples undergoing an infertility investigation: Some implications for counsellors

Abstract The emotional and psychological aspects of the experience of infertility have been largely ignored by researchers. A study was accordingly undertaken of 43 infertile couples who were undergoing medical investigation of their fertility problems. Preliminary analysis of the data suggests that the infertility investigation was most stressful for the participants at the time of the initial medical interview, and that distress was greater for those who were themselves identified as having an organic fertility problem. A substantial number of the men and women involved indicated a need for the provision of psychological counselling services. The nature of the most appropriate forms of such help is explored.

Evidence for an absence of deleterious effects of ultrasound on human oocytes

Animal and human data would suggest that ultrasound causes deleterious effects to oocytes during meiosis. We directly compared the fertilization rate and embryonic development following in vitro fertilization and embryo transfer of those oocytes exposed to ultrasound and those not exposed in the same patient. In 39 unscreened patients a combination of laparoscopy and ultrasound was used for oocyte recovery. Laparoscopy was performed first on the most accessible ovary (usually the right) and at least one oocyte was obtained. Ultrasoundguided oocyte recovery was successful in the other inaccessible ovary. To assess how oocytes obtained by ultrasound or laparoscopy related to the pregnancy rate, two groups of patients were evaluated in whom the embryos transferred either had been exposed to ultrasound or had not been. The fertilization and the embryo cleavage rates were not significantly different between the ultrasoundexposed and the unexposed groups. The pregnancy rate was also not significantly different [9 of 49 (18.4%) for ultrasound exposed versus 14 of 74 (18.9%) for unexposed]. There was one early spontaneous abortion in each group. Further analysis of a group of 40 patients, in whom the oocytes were exposed to ultrasound in situ, after the endogenous luteinizing hormone (LH) surge had begun 1–27 hr earlier, revealed that 6 became pregnant (15%). This preliminary study suggests that exposure of human oocytes to ultrasonic waves, either during the different phases of meiosis or after the completion of meiosis, did not significantly influence the developmental potential of the in vitro fertilized embryos.

The effect of the day of initiation of ovarian stimulation in the day of luteinizing hormone surge and outcome of in vitro fertilization

It was hypothesized that the day of initiation of ovarian stimulation may influence the day of the luteinizing hormone (LH) surge onset and follicular development. Two groups of 52 patients were randomly selected to commence ovarian stimulation on either day 2 or day 4. The mean +/- standard deviation day of the LH surge was 11.0 +/- 0.9 for day 2 and 12.2 +/- 0.9 for day 4 (P less than 0.001), and the day of human chorionic gonadotropin (hCG) administration was 10.7 +/- 1.2 for day 2 and 11.4 +/- 0.9 for day 4 (P less than 0.02). The two groups also differed significantly in the mean number of days of human menopausal gonadotropin (hMG) administration (day 2, 7.4 +/- 2.7, versus day 4, 6.3 +/- 2.5), and the mean number of vials of hMG administered (day 2, 10.4 +/- 3.2, versus day 4, 8.1 +/- 2.9). However, the mean estradiol level on the day of the LH surge or hCG administration, the number of oocytes collected and fertilized, the number of embryos transferred, and the pregnancy rates were not significantly different. In conclusion, the day of the LH surge or hCG administration can be influenced by the day of initiation of ovarian stimulation, and the initiation of ovarian stimulation around day 4 of the menstrual cycle is clinically more efficient than initiation of follicular development early in the follicular phase.

“Ultrasound rescue”: A successful alternative form of oocyte recovery in patients with periovarian adhesions☆☆☆

Oocyte recoveries for in vitro fertilization/embryo transfer were performed in 82 cycles in 73 women. The status of the ovaries was unknown. Laparoscopy was performed and oocytes from accessible follicles aspirated. The remaining follicles were aspirated ultrasonographically. The recovery rates for laparoscopy of accessible follicles and for ultrasonographic recovery from laparoscopically inaccessible follicles were identical. In 26 patients laparoscopy only was performed. One or more oocytes was obtained in 92% of patients. In 56 cycles when laparoscopy was followed by ultrasound, one or more oocytes were recovered in 95% of patients; in 12 of these patients, three of whom achieved pregnancy, the only oocytes were recovered by the ultrasonographic means after laparoscopy had failed. This method provided an alternative to screening laparoscopy and indicated that cycles of controlled hyperstimulation could be performed with a satisfactory expectation of oocyte recovery in women in whom the state of the pelvis was unknown.

Outcome and effect of medical intervention in women experiencing infertility following removal of an ectopic pregnancy

The outcome of pregnancy and the effect of medical intervention were reviewed in patients who had had a previous ectopic pregnancy and a subsequent history of infertility. The case records of 3,650 patients were reviewed. Seventy met the study criteria. Twenty patients either voluntarily withdrew or were discouraged on medical grounds; one conceived. Five of the remainder of the patients conceived prior to laparoscopy. In the other 45 patients, the remaining tube was normal in 13, irreparable in 16, and suitable for surgical repair in 16. To date, among the original patients, there have been 13 live births (18.5%) and two ectopic pregnancies (2.8%). One patient was delivered of a live-born infant subsequent to surgical intervention. The pregnancy outcome in this group of patients is poor. Medical intervention was useful primarily in ruling out other causes of infertility and to provide advice to the couple on future fertility. Medical intervention altered outcome in a very few cases.