John Leeton

Collection of Human Oocytes at Laparoscopy and Laparotomy

n In order to determine whether ovarian follicular aspiration at laparoscopy would provide enough oocytes for adequate in vitro studies, oocytes were collected during the periovulatory stage of the normal menstrual cycle from 45 women undergoing laparoscopy and from 25 women undergoing laparotomy. A larger average number of oocytes was recovered per patient at laparotomy due to better oocyte recoveries from ovarian wedges. However, the average number of oocytes rocovered per patient was the same at both procedures, providing that a suction vacuum of 200 mm Hg was used at laparoscopy, and under these conditions a greater percentage of follicles yielded oocytes at laparoscopy. Overall, 498 follicles were aspirated and 217 oocytes collected; the average recovery was 3 per patient. Moreover, the mean follicular diameter was 9.1 mm in infertile and 8.0 mm in fertile patients (p less than .05).n

Fetal heart rate and acid-base status in the assessment of fetal hypoxia

Abstract This study is aimed at assessing the usefulness and correlation between measurement of fetal blood acid-base status and continuous fetal heart rate monitoring as indicators of fetal hypoxia during labor. One hundred and twenty-nine labors were studied, the majority having some obstetric condition which could increase the possibility of fetal hypoxia. When scalp blood pH was

The relationship of oral contraception to depressive symptoms.

Summary: A double‐blind cross‐over trial involving 45 patients was carried out to determine the relationship between oral contraception and pharmacologically‐induced depressive symptoms. Oral contraception produced pharmacological symptoms in 15% of women from a selected group, of whom half had previously experienced adverse side‐effects from the contraceptive pill. This depression occurred in 2 forms. Three women had endogenous depression which increased on oral contraception, becoming worse during the second month of therapy. A fourth woman had reactive depression due to associated nausea and vomiting which improved during the second month of therapy. “Scapegoat” depressive symptoms were at least as common as pharmacological effects when taking oral contraception. About half the number of women with a history of depressive ill‐nessness experienced an increase in depression on oral contraception. Oestrogen‐progesterone balance was not important in the development of depressive side‐effects; the latter bore no relationship to the cytohormonal status of the patient, either before treatment or during oral contraceptive therapy.

Gonadotrophin Stimulation for Oocyte Recovery and in Vitro Fertilization in Infertile Women

Summary: The effects of gonadotrophin stimulation were investigated by urinary oestrogen and pregnanediol analyses and by timed laparoscopic examination in 14 infertile ovulatory women with total tubal destruction who were candidates for in vitro oocyte fertilisation.

Emotional attitudes to contraceptive methods

A pilot study was carried out to determine womens attitudes to various contraceptive methods. The adjectives unnatural, tense, messy, frightening, unsafe, repulsive, sad and difficult were chosen frequently by women to describe contraceptives whilst immoral, sinful and ill health were not. Attitudes to individual contraceptives were also determined and varied markedly. One in four women found all contraceptives frightening, so that emotional barriers to their use was common. The present technique may also be useful in studying social factors which may influence attitudes to contraceptives.

STERILISATION BY OVARIOTEXY: A Reversible Technique

Because of the unreliability of reversal Summary of tubal procedures performed for sterilisation, a new technique for sterilisation was attempted. Burial of the ovary beneath the peritoneum failed in two out of six patients. However, modification of this technique so that the ovary was buried beneath the peritoneum in a silastic bag and at least 9 cm. from the fimbria of the fallopian tube was successful in each of six patients. This technique may allow a greater chance of subsequent reversal of sterilisation.

The Tortuous Tube: Pregnancy Rate Following Laparoscopy and Hydrotubation

Summary: 256 infertile women whose ovulatory and related male fertility factors were normal were investigated by diagnostic laparoscopy and dye hydrotubation. The tubes were objectively classed into 4 groups — normal, patent with macroscopic tubal adhesions, patent with one tortuosity, and patent with multiple tortuosities. The latter group had a highly significant response to the above procedures and 66% were pregnant within 1 year and 81% within 2 years. No significant effect was found in the other 3 groups. This multiple tortuosity group represents the type of tube that significantly responds to treatment inherent in all tubal patency tests. Its pathogenesis and management are discussed.

A comparative study of laparoscopy with hystero-salpingography in 100 infertility patients.

Summary: A comparative study of the findings between hystero‐salpingo‐graphy and laparoscopy on 100 infertile patients over an 18‐month period showed that in 38 the findings differed significantly. In 24 patients with normal hystero‐saipingographic findings the laparoscope demonstrated bilateral tubal disease. Conversely, in 8 patients with abnormal hystero‐saipingographic findings the laparoscope showed normal tubes and patency.

The Relationship of Oral Contraception to Depression

A single double‐blind trial on a combined contraceptive drug was carried out on a lower socio‐economic group of women between Day 21 and 42 of the puerperium. Their levels of depression were measured before and after taking these drugs by means of a questionnaire. No statistical difference was found between the mean depressive score of the group on the active pill compared with that on the placebo.

A Case of Idiopathic Thrombocytopenic Purpura Requiring Splenectomy and Trial of Labour

Idiopathic thrombocytopenic purpura is an uncommon association of pregnancy, most series containing only a few cases. However Heys (1966) presented a series of 44 cases, and suggested that this condition was more prevalent in pregnancy than was previously believed. Although much investigation has been done on idiopathic thrombocytopenic purpura in relation to both its etiology and treatment, the management of the individual patient in pregnancy is still a difficult problem that requires special consideration, since incompletely controlled idiopathic thrombocytopenic purpura is associated with a considerable mortality and morbidity in pregnancy and labour (Heys, 1966). The following case report illustrates the difficulties in management faced by the physician, the obstetrician and the paediatrician, respectively.