C. Lee Buxton

Endometrial biopsy inadvertently taken during conception cycle

Abstract The advantages of biopsy between the twentieth and the twenty-seventh day of the menstrual cycle are that at this time the response of the endometrium to hormonal stimulation can best be evaluated and that this period is convenient. In our experience with 2,500 infertility patients and 1.700 endometrial biopsies the procedure was found to be reasonably innocuous. The advantages of performing the procedure at this time in the cycle outweigh the disadvantages.

Pergonal therapy of anovulatory infertility

Thirty anovulatory infertile patients received HMG-HCG therapy. Ovulation was achieved in 26 and pregnancy resulted in 18 cases. Of eighty-four treatment cycles, forty-nine were ovulatory. Four twin and one quadruplet gestation as well as four early abortions were noted in this series. Best results occurred in women with defective gonadotropin excretion and/or prolonged amenorrhea. Issues concerning selection of patients, side effects, multiple birth, and clinical management of drug administration are discussed.

Tubal plastic surgery.

44 patients who had tubal surgery during the period 1/62 to 12/64 to cure infertility were evaluated as to type of surgery performed on eahc side of the pelvis. 28 patients exhibited postoperative patency of tubes upon insufflation or hysterosalpingography. Tubal patency however does not ensure adequacy of physiologic activities. The mammalian oviduct plays a significant role in the transport and development of gametes. Adhesions around the tubes interfere with ovum pickup or with tubal peristalsis. Often patients with adhesions do not have intrinsic tubal disease and this accounts for the good results associated with lysis of adhesions for treatment of infertility. In this series 6 of 14 patients who had lysis of adhesions subsequently conceived. In terms of patency and subsequent pregnancy bilateral cornual reimplantation of the tubes did not prove successful in this series. Only 2 term pregnancies occured in patients who had bilateral surgery. The poor results may have been due to endometrial blockage of tubal opening into the uterus. Increased knowledge of tubal function and physiology may significantly improve results of tubal surgery.