Jeffrey S. Chase

Improved semen quality after a short-interval second ejaculation

Les auteurs montrent que chez les oligospermiques plus que chez les sujets normaux, une 2eme ejaculation 30 a 60 minutes apres la 1ere fournit un specimen plus riche en spermatozoides. Ceci peut etre le fait de la reduction du volume seminal. Il semble que ceux qui ameliorent leur score dans le 2e ejaculat obtiennent des grossesses plus facilement

Ovulation induction and pregnancy with an estrogen-gonadotropin stimulation technique in a menopausal woman with marked hypoplastic ovaries

A case is described of a woman with ovarian failure and documented atrophic ovaries in whom ovulation was achieved with the use of high-dose estrogen and human menopausal gonadotropins. The proposed mechanism involves a reduction in the elevated gonadotropins, which restored an adequate number of receptors. Thus sensitivity to exogenous menotropins was reestablished.

False-positive human chorionic gonadotropin levels caused by a heterophile antibody with the immunoradiometric assay

A case of a false-positive test for the beta-subunit of human chorionic gonadotropin as performed by the immunoradiometric assay is described. Further studies revealed that this problem was secondary to a cross-reacting heterophile antibody.

First-trimester serum levels of the β-subunit of human chorionic gonadotropin in a tubal molar pregnancy

A woman is described in whom the levels of the beta-subunit of human chorionic gonadotropin were rising in a pattern consistent with a tubal pregnancy. A tubal molar pregnancy was found. Thus an early ectopic molar pregnancy is not distinguishable from a nontrophoblastic tubal pregnancy on the basis of human chorionic gonadotropin levels.

Ovarian pregnancy with a contralateral corpus luteum: Case report

A case is described of a woman who was found to have an ovarian pregnancy on the left with a corpus luteum on the right ovary. This was determined by both pelvic sonography and laparotomy. The case did fulfill the four criteria of Spiegelberg.

Fetal outcome of triplets in a Turner mosaic.

Pregnancies are now being reported resulting from fertilization of donor oocytes in women with ovarian failure. A case of triplets in a Turner mosaic is reported herein following transfers of embryos resulting from donor oocytes. She had previously demonstrated a normal sized uterine cavity by hysterosalpingography. The opinion from our group was that she should consider selective reduction but a perinatology consult thought she should have a favorable outcome. Her pregnancy was complicated by polyhydramnios, pre-term labor, and eventual fetal demise at 25 and 27 weeks of all three fetuses. Natural pregnancies in patients with gonadal dysgenesis have been reported in at least 138 patients. Many aborted or had stillbirths and this high rate of fetal mortality has been ascribed to chromosomal abnormalities. The continued use of donor oocytes will provide data to evaluate whether there will continue to be a higher spontaneous abortion rate and complications in second and third trimesters in Turners pregnancies even in single pregnancies. The outcome of this case can at least be provided to future gonadal dysgenesis patients with triplets to help them in their decision as to whether or not to have selective reduction.

A conservative treatment protocol with human menopausal gonadotropins aimed at reducing multiple births

In multicenter studies involving 3002 courses of human menopausal gonadotropins (hMG) therapy in 1286 patients, 20% of the patients who delivered had multiple gestations; 75% of these were twins and 25% were triplets or higher parity. Our stimulation regimen is very conservative in that we 1) try to allow a female with LPD and regular cycles but not reaching a mature follicle to first select her dominant follicle and wait until the serum E2 reaches approximately 100 pg/mL then add the hMG. With anovulatory women we frequently begin with only 75 IU hMG and gradually increase the hMG dosage. Using this approach we have usually attained at least a 70% pregnancy rate in six months. A study was performed to see if this conservative approach resulted in a decreased multiple birth rate percentage especially with triplets or more. The study was to evaluate the outcome of 241 consecutive pregnancies in which hMG was the sole therapy. There were 203 with one gestation and 38 with multiples. Twins--32; triplets--6. Thus 15% (38/241) had multiple births; six of 38 (15%) of the multiples had triplets or more. Though our multiple birth rate and especially higher parity rate appears to be lower than average no statistical difference was found. Thus even with conservative use of hMG multiple births cannot be easily avoided.

Amenorrhea in an ovulatory woman despite a normal uterine cavity: Case report

A 35-year-old nulliparous woman came to us for treatment of amenorrhea. Evaluation demonstrated normal ovulation with appropriate results of sequential endometrial biopsies during the luteal phase. The only abnormality found was an elevated serum level of follicle-stimulating hormone in the early follicular phase, and it is hypothesized that this somehow leads to atrophy of the endometrium without shedding.