H.M. Vemer

Contraceptive use and attitudes in reunified Germany.

Contraceptive use and attitudes were assessed in a random sample of 1064 German women. The majority (76%) of the sexually active, fertile women who were not pregnant and did not wish to get pregnant at the time of the survey were using very reliable contraceptive methods, namely oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. Comparison with a previous survey showed that contraceptive practice in West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. It is concluded that German contraceptive practice is reasonably effective and that if attitudes were to become more realistic the level of effectiveness could even be raised.

Prevention of adhesions.

A survey is given on the literature of the prevention of adhesions. Various methods of adhesion prevention are discussed: limitation of peritoneal injury, inhibition of the inflammatory response, prevention of coagulation of fibrinogen, removal of fibrin and mechanical separation of injured mesothelial surfaces.

Cell of the mucous membrane of the female genital tract in culture: A comparative study with regard to the histogenesis of endometriosis

SummaryCellular elements from the mucous membrane of the uterus and oviducts and from peritoneal washings were cultured. The in vitro behavior of these cells was compared to elucidate the histogenesis of endometriosis and the role of various diagnostic procedures.In 65% of the cultured matrial obtained by uterine-tubal flushing, proliferating cells of the uterine-tubal mucous membrane were present. Their morphology and behavior corresponded to those of cultured cells obtained by separate washing of the uterine cavity and the tubes, respectively, curetted material, and biopsies of endometriosis lesions.Epithelial and stromal cells were identified using phase contrast microscopy, electron microscopy, and immunohistochemical methods. These cell types did not occur in peritoneal washings before the flushing of uterus and tubes. It was therefore assumed that they were detached and transported to the pelvic cavity during the above-mentioned procedures. In view of their intensive proliferation they may form the basis in the development of nodules of endometriosis. This would support the implantation theory concerning the pathogenesis of endometriosis. Interactions between epithelial and mesothelial cells point to the possible role of the latter in encapsulating the endometrial elements.

Oil or aqueous contrast media for hysterosalpingography: a prospective, randomized, clinical study

In this prospective randomized clinical study the pregnancy rate and the quality of the images obtained by hysterosalpingography (HSG) in 175 women with fertility problems have been compared using an oil-soluble contrast medium and an aqueous contrast medium. After the HSG there was a follow-up period of 6 months. No statistically significant difference in pregnancy rate was found. With both contrast media good images were obtained. The oil-soluble contrast medium gave a more sharply outlined uterine cavity, the aqueous contrast medium showed more tubal details. Furthermore, the control picture with the aqueous contrast medium can be prepared after ten minutes. We conclude that the use of an aqueous contrast medium for routine HSG is preferable.

Women regretting their sterilization.

This study compares 2 groups of sterilized women: 1) a group of 118 sterilized women who requested reversal between 1978 and 1984 at the Radboud University Hospital in the Netherlands and 2) 116 matched controls, who did not request reversal. The reason for the request for reversal in 89 cases (75%) was a new partner and in 26 cases (22%) the wish for more children with the same partner. Women who regret being sterilized usually do so soon after the procedure. The mean length of time between sterilization and request for reversal was 3.8 years, measured from the date the patient presented for reversal. In 20% of the patients, the sterilization took place in combination with another gynecologic or obstetric procedure, such as abortion, prolapse operation, cesarean section, or an operation for ectopic pregnancy. This combination, although clearly arranged to save the patient another anesthesia, bears the risk of making the sterilization not a well-considered and free choice. 27 of the patients reported that their relationship at the time of sterilization was already poor; some of the women said they had kept silent about their marital problems fearing that otherwise they would not be sterilized. Another alarming discovery was that 12 of the patients were sterilized after their divorce under the age of 30 years. The reason for requesting a reversal of sterilization was a divorce and a new partner in 3/4 of the cases.

Ciliogenesis following salpingostomy of rabbit hydrosalpinges

Twenty-five artificially induced hydrosalpinges were studied in New Zealand white rabbits. Hydrosalpinges had been created after 2-16 wk occlusion of both the fimbrial end and the ampullary isthmic junction (A.I.J.), using either Ethilon 8/0 or tantalum clips. Their diameters ranged from 4 to 12 mm, being larger in the clipped oviducts. In hydrosalpinges larger than 6 mm diameter, a salpingostomy was done and ampullary biopsies were taken and prepared for scanning electron microscopy, and 1-micron sections and ultrathin sections for transmission electron microscopy. The changes observed were those found in previous work (Vásquez et al., 1981). Post-salpingostomy biopsies were taken from 10 patent oviducts at different intervals of time, ranging from 2 days to 8 wk. Ciliogenesis was observed between the 2nd and 3rd wk after salpingostomy.

Importance of sperm motility after capacitation in interpreting the hamster ovum sperm penetration assay

Routine semen analysis and a zona-free hamster ovum sperm penetration assay (SPA) were carried out for 220 men from a group of infertile couples. The grade of sperm motility was determined after a preincubation period. For both the normal and abnormal semen samples, the number of positive SPAs was significantly higher when the postcapacitation motility was normal. This difference was observed also when the routine semen characteristics of density, motility, and morphologic features were considered separately regarding their relationship with the SPA. Motility after preincubation showed the most significant positive correlation with the SPA result. Therefore, the SPA score should be limited to semen samples showing adequate postincubation motility.

Treatment with a luteinising hormone-releasing hormone analogue (Buserelin) in danazol-resistant endometriosis patients

Luteinising hormone-releasing hormone agonist (Buserelin) therapy administered for a period of 6 months in 4 patients with longstanding, severe, danazol-resistant endometriosis, was found to be effective in reducing all complaints related to endometriosis. From 2 weeks on, nearly half of the E2 determinations were below the sensitivity level of the assay, while the other values were predominantly in the range of the early follicular phase. Side effects associated with the induced hypoestrogenemia were mild and well tolerated. After six months of follow-up without treatment, one patient who desired pregnancy conceived shortly after cessation of therapy and one patient showed lasting amelioration of her complaints. The symptoms relapsed in the other two, possibly due to inadequate dose and/or duration of treatment.

Experimental hydrosalpinx and salpingostomy in rabbits

In 137 oviducts of New Zealand white rabbits different kinds of occlusion techniques were tested to induce hydrosalpinges. In 99 oviducts ligatured or clipped both at the fimbrial end and at the ampullary-isthmic junction 67 hydrosalpinges were achieved, whilst in 34 oviducts ligatured or clipped only at the fimbrial end one hydrosalpinx occurred. Most severe histological changes were seen after double clipping. Ligation of the blood vessels to and from the ampulla of 4 oviducts caused no hydrosalpinx formation. After cuff salpingostomy a higher number of patent oviducts was found than after double-loop salpingostomy.

The differences between findings at laparoscopy and at subsequent fertility surgery

In a series of 42 patients, the findings during fertility microsurgery were compared to the findings at both laparoscopy performed by referring gynaecologists and re-laparoscopy performed in our regimen. Since significantly fewer discrepancies were found in the latter group, this re-laparoscopy may be considered useful and justified. The importance of meticulous laparoscopy is emphasized.