George H. Arronet

Arcuate and Bicornuate Uterine Anomalies and Infertility

Twenty-three patients presenting with infertility were found to have uterine anomalies. Eighteen had primary infertility. Six (86%) of seven patients with arcuate uterus achieved a term pregnancy. Five patients of these seven had primary infertility. Of the 13 patients with bicornuate uterus, 6 subsequently underwent a metroplasty and 4 (67%) of these latter patients achieved a term pregnancy. Of the remaining seven patients with bicornuate uterus, one achieved pregnancy during investigations, one refused surgery, and five were not operated upon because of uncorrected nonuterine factors. One other patient was found to have uterus didelphys and two had a unicornuate uterus. No patients with septate uterus were found. The implications of a uterine anomaly as a cause of primary infertility are discussed.

Breast Examination does not Elevate Serum Prolactin

Serum prolactin and cortisol levels were measured in 24 patients entering the Royal Victoria Hospital infertility center both before and after a thorough physical examination that included a pelvic examination and a search for galactorrhea in both breasts. There was no significant change in the levels of prolactin or cortisol in the group as a whole in those with normal prolactin values and those with high basal prolactin values (P less than 0.05). The possible role of stress in the mediation of occasional elevation of basal prolactin values is discussed in relation to the serum cortisol levels.

Observations on the combination of clomiphene citrate-human menopausal gonadotropin-human chorionic gonadotropin in the management of anovulation

To study the effects of the addition of clomiphene citrate to human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), 23 cycles of clomiphene citrate-hMG-hCG (CHH) were administered to 10 anovulatory women. Of these 10 women, 5 also received 15 cycles of hMG-hCG (HH). Although there was a significant increase in the ovulation rate in the CHH group (p less than 0.01), there was no difference in the pregnancy rate (p less than 0.05). Patients in the CHH group required significantly less hMG for ovulation induction than the HH group (p less than 0.01). Patients receiving CHH who had low serum levels of follicle-stimulating hormone required significantly more hMG than those with normal values. The luteinizing hormone releasing hormone test may predict those patients who will require less hMG during CHH therapy. The relative safety of the CHH treatment is discussed.

Operative treatment of Fallopian tube pathology in human fertility

About 35 per cent of infertile marriages are caused by Fallopian tube abnormalities. In 173 surgical attempts to correct Fallopian tube dysfunction at the Royal Victoria Hospital, Montreal, there was an over-all pregnancy success rate of 35.5 per cent. The operative procedures used were: salpingolysis, where adhesions only were removed and where the pregnancy rate was 41 per cent; unilateral and bilateral salpingostomy, where a new opening in. the tube was made after resetting a portion of the diseased wall or hydrosalpinx; and, finally, cornual resection and reimplantation of the healthy distal portion of the tube into a reamed out opening in the myometrium. The lowest pregnancy rate was 25 per cent where bilateral salpingostomies were performed. Postoperative follow-up with serial hydrotubations was stressed. With the advent of better fibrinolytic, anti-inflammatory and antibacterial agents and a systematic approach to the operative management, even better results could be obtainable in the fuutre.

Infertility in women over the age of 36

Ninety-three couples of which the female partner was over 36 years of age were studied. Tubal factor was the most common etiologic factor in the women aged 36 to 40 years, and unexplained infertility was the most common factor in the women over the age of 40. It appears that in the aging infertile population, the ovulatory factor is not the most important cause of infertility. The over-all pregnancy rate (33%) is lower and the abortion rate (31%) is increased with advancing age as compared with the general infertile population. The implication of aging as a cause of infertility is discussed.

Clinical and Laboratory Evaluation of a New Progestational Compound

A study was carried out to evaluate the systemic effects of a new and potent progestational compound ethynodiol diacetate. In combination with .1 mg mestranol 2 mg and 1 mg dose levels of this compound are known as Metrulen and Ovulen respectively. 18 patients took Metrulen and 12 received Ovulen for a total of 130 cycles. Various tests and assays were performed. It was determined that Metrulen and Ovulen are effective in conception control. 4 infertile patients became pregnant within 1-3 months after discontinuation of the medication indicating achievement of a rebound phenomenon which indirectly suggests an improvement of hormonal interaction and more receptive target organs (cervix vagina uterus and tubes). Side effects were transitory and did not necessitate discontinuation of therapy. There were no significant electrolyte changes. Vaginal cytologic changes and changes in cervical mucus and endometrium were all transient and there was a return to normal after completion of the treatment. Hormonal assays showed a definite decrease in all urinary hormones measured except gonadotropins in 4 cases. The metyrapone (SU 4885) test performed during progestin treatment reported for the first time yielded equivocal results.

Foley catheter hysterosalpingography: a simplified technique for investigating infertility.

A simplified technique for hysterosalpingography, based on over 5,000 studies, is described. This method is quickly and easily performed. Patient acceptance is high.

Diagnostic value of kymographic recordings of tubal insufflation

Abstract 1. Assessment of the initial pressure, tone, amplitude, and frequency of kymographic recordings of 138 patients was performed. 2. The patients were of three groups: Group I, no tubal disease, Group II, no tubal disease with subsequent pregnancy, and Group III, tubal disease. 3. No statistically significant difference in initial pressure, tone or amplitude was found among the three groups. 4. The groups with no tubal disease showed a significantly higher rate of oscillation than the group with tubal disease.