Henri Kurunmäki

Direct intraperitoneal or intrauterine insemination and superovulation in infertility treatment : a randomized study

Direct intraperitoneal or intrauterine insemination in combination with superovulation was used randomly as the treatment of infertility that was unexplained or due to male subfertility or mild endometriosis in 124 couples during 326 cycles. The pregnancy rate per couple was 24% in the direct intraperitoneal insemination group and 31% in the IUI group. The difference was not significant. The pregnancy rates with both treatments were significantly higher than those seen during the 326 control cycles of the same couples (1.1% and 0.6%).

Experience of in vitro fertilization surrogacy in Finland

Background.  In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10‐year period.

Contraception with subdermal ST-1435 capsules: side-effects, endocrine profiles and liver function related to different lengths of capsules.

One Silastic capsule of 15 mm, 20 mm or 30 mm length was inserted subcutaneously into the ventral aspect of the left forearm or upper arm of 28 healthy women during menstrual bleeding or not later than on the seventh day of the menstrual cycle. A new capsule of the same length was inserted after six months and both capsules were removed twelve months after the first insertion. Side-effects, including changes in body weight, blood pressure, menstrual bleeding and liver function test results, were registered. Blood samples were taken from selected subjects twice a week during the 1st, 2nd, 3rd, 6th, 7th and 12th month of use. Plasma concentrations of ST-1435 were measured by radioimmunoassay and the effects of treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. There were no differences in hormonal side-effects between subjects who had a 30 mm capsule or subjects who had 20 mm or 15 mm capsules, but subjects who had 20 or 15 mm capsules had significantly longer bleeding or spotting periods in comparison with subjects who had a 30 mm capsule. There were no changes in blood pressure, body weight or liver function test results in comparison with pre-insertion values. The plasma level of ST-1435 was not significantly higher during the use of 30 mm capsules than during the use of 20 or 15 mm capsules. During the use of the shorter ST-1435 capsules, plasma estradiol elevation and slightly suppressed FSH were seen, while the use of longer capsules resulted in a slight suppression of LH. Progesterone concentrations during monitored cycles indicated anovulation. No pregnancies occurred during the study period of one year. The continuation rate at one year was 71% in the 30 mm capsule group and 57% in the 20 and 15 mm capsule groups taken together.

CONTRACEPTION WITH LEVONORGESTREL-RELEASING SUBDERMAL CAPSULES, NORPLANTTM, AFTER PREGNANCY TERMINATION

Six Silastic levonorgestrel-releasing capsules, Norplant, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirty-eight patients immediately after first trimester pregnancy termination. In the control group, a Nova-T device was inserted immediately after pregnancy termination in thirty patients. Clinical examination was performed after three, six and twelve months of use. The continuation of the Norplant at one year was 91.7 per cent and that of the Nova-T 73.9 per cent. No pregnancies occurred during the study period of one year. Hemoglobin concentrations and the diastolic blood pressures of the Norplant users increased significantly. Dysmenorrhea and menstrual flow increased in the IUD group. Menstrual disturbances were the main side effects in the Norplant group during the first five months of use.

INTRACERVICAL RELEASE OF LEVONORGESTREL FOR CONTRACEPTION

Twenty-one women used a levonorgestrel-releasing intracervical contraceptive device, which was designed to release 20 microgram/ay. The devices were inserted after cessation of menstrual bleeding. Patterns of bleeding and clinical performance wer evaluated and plasma concentrations of levonorgestrel, estradiol and progesterone in selected subjects were measured by radioimmunoassay. The results of the initial 90-day treatment are presented. Levonorgestrel was detected in peripheral plasma by 30 minutes after insertion of the device. Considerable variation of plasma levonorgestrel concentrations was observed between subjects, but within each subject, the plasma level of levonorgestrel was very stable with time. Of 24 cycles monitored by blood sampling, 19 were ovulatory. One subject did not ovulate at all. During the first 30-day period of treatment, frequent intermenstrual bleeding or spotting periods occurred. Two spontaneous expulsions occurred 9 and 22 days after insertion. Both of these subjects were nulligravidas. Side-effects were few and no pregnancies occurred during the study period.

Pituitary and ovarian function and clinical performance during the use of a levonorgestrel-releasing intracervical contraceptive device

A levonorgestrel-releasing intracervical device (ICD) was inserted postmenstrually to twenty-one voluntary women. Eight subjects gave blood samples twice a week during the initial three months of use of the ICD and during the seventh and twelfth months of use. Clinical performance was studied; plasma concentrations of levonorgestrel were measured by radioimmunoassay and the effects of the treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. The results of the first year are presented. Dysmenorrhea, menstrual flow and the number of days of bleeding decreased during the first treatment year. Three spontaneous expulsions occurred; two at the very beginning of the treatment and one after six months of use. Side-effects were few. The plasma level of levonorgestrel remained fairly constant during the observation time of 12 months. Thirty-one of the 36 cycles were ovulatory as judged by plasma progesterone elevations. No pregnancies occurred during the study period of one year.

Intracervical release of ST-1435 for contraception

Seven women used an ST-1435-releasing intracervical contraceptive device (ST-ICD), inserted immediately after the cessation of menstrual bleeding. Patterns of bleeding and clinical performance were evaluated and plasma concentrations of ST-1435, estradiol, progesterone and gonadotropins were measured by radioimmunoassays. The results of ten months of treatment are presented. There were no uniform patterns of bleeding. No hormonal side-effects were registered. The plasma concentration of ST-1435 reached 100 pg/ml within two hours after insertion of an ST-ICD. No ovulations occurred during the initial three months of treatment. A rapid decline in the plasma concentrations of ST-1435 was observed; during the tenth month the concentration of ST-1435 was under the sensitivity of the radioimmunoassay of ST-1435. Hence, the release of ST-1435 from Silastic was too rapid for long-acting contraceptive purposes.

Pharmacokinetic observations on ST-1435 administered subcutaneously and intravaginally

Plasma levels of ST-1435 were determined by radioimmunoassay in 36 women and three men during treatment with subdermal capsules releasing ST-1435. The total lengths of the capsules used were 180 mm, 90 mm, 30 mm, 15 mm and 7.5 mm. A linear correlation between the mean plasma concentrations of ST-1435 and capsule length was found during the treatment period studied. However, great interindividual variation in plasma levels of ST-1435 between study subjects having similar capsules was observed. In comparison with the mean plasma concentrations in the initial months, only less than half of these plasma concentrations of ST-1435 were measured after six months of treatment, which indicates a short lifetime for this contraceptive system. In two women the disappearance of ST-1435 from the circulation was studied by measuring ST-1435 concentrations in the plasma after removal of a contraceptive vaginal ring (CVR) releasing ST-1435. Triphasic disappearance curves of ST-1435 were found, with half-lives 0.7-1.0 h, 3.1-4.0 h, and 10.7.3-11.8 h.

Immediate postabortal contraception with NORPLANTR : Levonorgestrel, gonadotropin, estradiol, and progesterone levels over two postabortal months and return of fertility after removal of NORPLANTR capsules

Six Silastic levonorgestrel-releasing capsules, Norplant, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirteen patients immediately after first trimester pregnancy termination. Blood samples were taken twice a week over two months after abortion and from one subject over one month after removal of Norplant capsules. Plasma concentrations of levonorgestrel were measured by radioimmunoassay and the effects of treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. If removal of Norplant capsules took place because of planning pregnancy, the subjects were asked to inform us if they had become pregnant. During the first month after abortion the mean levonorgestrel concentration (489 pg/ml) was statistically significantly higher than during the second month (237 pg/ml). The mean estradiol values fell to prefollicular levels within four days, remaining a little suppressed. The mean progesterone concentrations were below 2 ng/ml three days after abortion. Three subjects had a transient increase in plasma progesterone concentrations nine days after abortion. Thereafter no ovulatory progesterone concentrations were seen. The LH concentrations ranged within normal values of the follicular phase and FSH values were just beneath the lower limit of follicular phase FSH values, apart from a few peaks, indicating mild suppression. After removal of Norplant capsules, progesterone concentrations increased to ovulatory levels fifteen days after removal. The Norplant capsules were removed from two subjects because of planning pregnancy and they delivered healthy babies 9.5 and 12.5 months after removal.

Intraductal Foreign Body in the Breast Found on Sonography

oreign bodies in the breast are uncommon, with few cases reported in the medical literature. They are often objects that can be seen on x-ray mammography and are usually iatrogenic,1 such as remnants of surgical procedures or broken needles.2 Some x-ray–negative foreign bodies, however, cannot be seen at all on mammography but might be visible on sonography. Our patient was a 46-year-old woman. She had noticed a lump in her right breast several weeks before undergoing a sonographic examination. Both breasts had a very dense structure that was rich in mastopathic fibrous tissues. Some benign cysts were seen in both breasts. In the retroareolar region of the right breast, a hypoechoic mass measuring 13.5 ×2.9 mm was seen in the 9-o’clock position (Figure 1). Inside this mass, a small thin hyperechoic foreign body was seen (Figure 2). Its length was about 9 mm, and it was located inside an enlarged duct about 3 to 4 cm from the tip of the mammilla. Sonographically guided fine-needle aspiration biopsy was performed. Cytologic results showed inflammatory cells, indicating an abscess. During biopsy, the foreign body could be touched with the tip of the needle and had an elastic texture. It was removed under sonographic guidance with thin long-tipped forceps and local anesthesia. On examination by our surgical team, the foreign body seemed to be a piece of brownish hair about 9 mm long. This is the first case of its kind that we have encountered. We think that a piece of hair must have entered a duct opening in the mammilla during the patient’s visit to a hair salon. References