Carol A. Bergquist

Cul-de-sac fluid in women with endometriosis: fluid volume and prostanoid concentration during the proliferative phase of the cycle—days 8 to 12 *

Cul-de-sac fluid from women with histologically confirmed endometriosis (n = 45) or with no evidence of endometriosis (n = 17) was removed during the proliferative phase of the menstrual cycle (days 8 to 12) and analyzed for prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), 15-keto-13,14-dihydroprostaglandin F2 alpha (PGFM), and thromboxane B2 (TXB2). The fluid volume was recorded. Peripheral blood was also obtained to determine the concentration of PGFM. Prostanoid concentrations (PGE2, PGF2 alpha, PGFM, TXB2) in women with endometriosis were not significantly different from a comparable group of disease-free women. Furthermore, a meaningful elevation of prostanoid with increasing severity of disease could not be demonstrated. Plasma PGFM was not significantly different from controls. There was, however, an elevation of PGFM with severity of disease, although this increase was not statistically significant (P = 0.11). An increase in fluid volume was not demonstrated in women with endometriosis, as compared with controls.

Tubal anastomosis following unipolar cautery.

Twenty-five of 48 women (52%) sterilized by unipolar cautery techniques conceived following tubal anastomosis, of whom 17 (36%) had a living child. The overall cumulative probability of conception at the end of follow-up as determined by life-table analysis was 76%. Increasing age, parity, and the duration of the interval from sterilization to reversal did not influence pregnancy success. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis; however, a pregnancy was least likely to occur in women with shortened oviducts of less than or equal to 4 cm (P less than 0.01). A decreased pregnancy rate in cautery-sterilized patients undergoing reversal may be related to the destruction of a larger segment of the fallopian tube. Interestingly, 71% of the cautery-sterilized patients were noted to have associated tubal disease such as endometriosis and/or proximal hydrosalpinx. The influence of these findings on subsequent pregnancy success remains to be established.

Comparison of the operating microscope and loupe for microsurgical tubal anastomosis: a randomized clinical trial *

Reversal of sterilization was performed by microsurgical tubal anastomosis in 72 women using either loupe (n = 36) or microscope (n = 36). The study design called for the randomization of patients within pairs, which were matched for method of sterilization and site of anastomosis. A significant difference between methods could not be demonstrated at 12 months (P = 0.39) or 24 months (P = 0.37) after the procedure.

Pregnancy outcome following treatment of intrauterine adhesions

Twenty-five patients were evaluated for reproductive failure and menstrual dysfunction before and after therapy of intrauterine adhesions. The patients were classified according to the extent of adhesion formation by means of a classification proposed by Toaff and Ballas. A pretherapy successful pregnancy rate of 32% was increased to 52% posttherapy. The spontaneous abortion rate of 78% was improved to 20% posttherapy. Altered menstrual function was noted in six of 25 patients. A correlation between the extent of intrauterine adhesion formation and pregnancy outcome following therapy could not be demonstrated. The authors recommend the adoption of a classification system based on hysteroscopic findings which may serve as a standard method of reporting to allow for comparison of treatment regimens and ultimately for prediction of pregnancy outcome.