Bruce Albrecht

Tubal Infertility and the Intrauterine Device

To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 while women--283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs.

The association between smoking and female infertility as influenced by cause of the infertility

Smoking histories were compared in 901 women with infertility of different types and 1264 women admitted for delivery at seven collaborating hospitals. The relative risk for infertility associated with cigarette smoking prior to the infertility diagnosis for nulliparous cases or first live birth for controls was calculated using a multivariate logistic-regression model to control for potential confounding factors, including center, age, religion, education, number of sexual partners, and contraceptive use. The adjusted risk for infertility attributed primarily to cervical factor (n = 96) was 1.7 (P = 0.04), to tubal disease unrelated to endometriosis (n = 225) was 1.6 (P = 0.009), to ovulatory factor (n = 389) was 1.0 (not significant [NS]), and to endometriosis (n = 191) was 0.9 (NS). The authors conclude that cigarette smoking is significantly associated only with certain types of primary female infertility.

Objective evidence that placebo and oral medroxyprogesterone acetate therapy diminish menopausal vasomotor flushes

The vasomotor flush (VMF) is the most common reason for menopausal women to seek hormonal therapy, but the evaluation of therapeutic regimens has been hampered by the observation that placebo therapy can decrease VMF and, until recently, by a lack of objective criteria of measurement of the VMF. Using the objective criteria of temperature elevations (TEs) and luteinizing hormone (LH) pulses, we evaluated the effect of placebo and medroxyprogesterone acetate (MPA) on VMF. MPA and possibly also placebo were found to reduce not only the subjectively noted VMF but also the frequency of TEs recorded. In addition, MPA, but not placebo, significantly reduced the frequency and amplitude of LH pulses. Possible mechanisms of action of MPA and placebo therapy are discussed.

Factors influencing the success of artificial insemination.

Factors influencing the probability of conception following artificial insemination with donor semen (AID) have been investigated in a series of 124 married females. Overall, 79 conceptions were achieved, for a cumulative rate of conception of 85.1% at the end of 1 year and an average fecundability of 15%, using life-table analysis. Women aged 30 or over or those with evidence of tubal or ovulatory problems had decreased probability of conception, although not to a significant extent. Women whose husbands were azoospermic had 20% fecundability in response to AID, significantly better than the 10% fecundability after AID observed in the women whose mates were oligospermic. Cycles during which AID was successful were significantly more likely to have had a positive postcoital test observed, compared with unsuccessful AID cycles.

Collaborative study of pregnancy rates following danazol therapy of stage I endometriosis

Pregnancy rates following danazol therapy of endometriosis vary widely. In order to reduce variations in patient selection and establish danazol effectiveness, six collaborative centers evaluated 75 infertile patients with normal infertility screening studies and mild (stage I) endometriosis documented by laparoscopy. Following diagnosis and 3 months coital exposure, all patients were treated with danazol for 6 months, and patient surveillance after danazol therapy lasted at least 12 months, with a range of 12 to 34 months. Of the 75 patients treated, 21 (28%) conceived, and the term pregnancy rate was 20% (15 of 75). The low pregnancy rate observed in these patients suggests that the role of danazol therapy for patients with mild endometriosis and infertility should be reconsidered.

Selective cut-back protocol for in-vitro fertilization (IVF) ovarian stimulation in patients with polycystic ovary syndrome (PCOS)

PCOS patients 37 years of age or less in whom there was no prior history of endometriosis or infectious tubal disease were enrolled. All subjects took 1500 mg of extended release metformin daily, 81 mg of aspirin daily, and underwent acupuncture with transfer. Cycles were initiated with birth control pill, luteal GnRH agonist, and a starting dose of 75−150 IU HP−FSH mixed in the same syringe with 150 IU HP−hMG (which contains 10 IU hCG activity per 75 IU). Depending on physician judgment, either a static dose of gonadotropin was given or it was cut−back. For cut−back, the HP−FSH was first removed. The HP−hMG either remained at the same dose or was also cut−back but never discontinued. In contrast to a protocol utilizing GnRH agonist LH suppression where FSH alone is being cut−back, this approach provided a decreasing dose of FSH while maintaining LH drive to the more mature follicular cohort expressing LH receptors. One patient received three day 3 embryos. All other patients received two embryos, 75% of them on day 5. Five patients with hyperstimulation had their oocytes retrieved but did not receive fresh transfer. Two of these patients had the evening GnRH agonist dose replaced with 250 ug of GnRH antagonist during the final 1−2 days of stimulation in an effort to foster more favorable conditions in which to proceed with oocyte retrieval.