Leon R. Spadoni

Primary Tubal Infertility in Relation to the Use of an Intrauterine Device

Women who use an intrauterine device (IUD) are at increased risk of acute pelvic inflammatory disease, but the relation of the IUD to subsequent infertility is not established. We interviewed 159 nulligravid women with tubal infertility to determine their prior use of an IUD. Their responses were compared with those of a matched group who conceived their first child at the time the infertile women started trying to become pregnant. The risk of primary tubal infertility in women who had ever used an IUD was 2.6 times that in women who had never used one (95 per cent confidence interval, 1.3 to 5.2). The observed difference between cases and controls was not uniform for different types of IUD. The relative risk associated with use of a Dalkon Shield was 6.8 (1.8 to 25.2), and that associated with use of either a Lippes Loop or Saf-T Coil IUD was 3.2 (0.9 to 12.0). The smallest elevation in risk was found among users of copper-containing IUDs (relative risk, 1.9 [0.9 to 4.0] for all women who had ever used a copper-containing IUD). The relative risk for women who used only a copper-containing IUD was 1.3 (0.6 to 3.0). We conclude that use of the Dalkon Shield (and possibly of plastic IUDs other than those that contain copper) can lead to infertility in nulligravid women.

Appendectomy and the risk of tubal infertility.

We studied the importance of a history of appendectomy for appendicitis in 279 women with laparoscopically or surgically diagnosed tubal infertility and a control group of 957 fertile women. After controlling for the effects of age, use of an intrauterine device for contraception, a history of pelvic inflammatory disease, and other potential confounding variables, we found that no excess risk of tubal infertility was associated with a simple appendectomy without rupture. However, when the operation was reportedly for a ruptured appendix, the relative risk of tubal infertility was 4.8 (95 percent confidence interval, 1.5 to 14.9) for women who had never been pregnant and 3.2 (95 percent confidence interval, 1.1 to 9.6) for women with one or more previous pregnancies. We conclude that the early diagnosis and treatment of suspected appendicitis in girls and women of reproductive age may reduce the incidence of tubal infertility resulting from the sequelae of a ruptured appendix.

Hypogonadotropic Hypogonadism Associated with Anosmia in the Female

THE syndrome of hypogonadotropic hypogonadism associated with anosmia rarely occurs in females.1 2 3 4 5 Gonadotropin levels and indexes of estrogen production in three affected females were studie...

Use of human menopausal gonadotropin for the induction of ovulation

Abstract Experience with the use of human menopausal gonadotropins for the induction of ovulation is reported in 62 patients. Twenty-six pregnancies were achieved. Twenty-one pregnancies occurred during the first 3 months of treatment, suggesting that the chances for successful therapy decline significantly after this initial period. While the over-all beneficial effect to specific patients is undeniable, selection of this treatment requires a careful consideration of pretreatment diagnosis, risks involved, and also a natural history in terms of spontaneous remission of the functional anomalies to be treated.

Benefits of the sperm (hamster ova) penetration assay in the evaluation of the infertile couple

The males of 310 infertile couples and 30 control couples (current pregnancy) were evaluated with the sperm (hamster ova) penetration assay (SPA) and seminal fluid analysis (SFA). The SPA was found to have a sensitivity of 100% and a specificity of 97% compared to 41% and 90%, respectively, for the SFA. The highest degree of concordance of the two tests existed when both tests were abnormal and no female factor was identified. The poorest concordance occurred when the SFA was normal and no female infertility factor was identified. In almost all cases of unexplained infertility where no female infertility factor was present, the problem could be assigned to the man, as evidenced by an abnormal SPA. The SFA seemed to have some predictive value with respect to the outcome following treatment of the man.

Virilization coexisting with Krukenberg tumor during pregnancy

Abstract Certain ovarian tumors which are not usually considered to be functional have been found in the presence of virilism on estrinism. This report concerns an unusual case of huge, bilateral Krukenberg tumors associated with massive virilization occurring during pregnancy. Virilization of the female infant also occurred. A thorough endocrine investigation was performed preoperatively with subsequent postoperative follow-up. The decrease of the tremendously elevated urinary steroids to normal levels following removal of the ovarian tumors strongly suggest that the ovaries were the source of the androgenic hormones. Also the absence of all hormonal manifestations during recurrence of the tumor lends further support to this thought. Evidence is presented to show that the androgen production by the ovaries was not significant until after the first trimester of pregnancy. Histochemical studies of the ovarian tissue appear to offer convincing evidence that the ovarian stroma cells, rather than the tumor tissue itself, was the actual site of hormone production. At autopsy, no primary lesion of the gastrointestinal tract was found. It is postulated that the primary site of the tumor was in the breast. A review of the previously reported cases of Krukenberg tumors associated with virilization is presented.

Alkaline Phosphatase Concentration in Cervical Mucus

This study measured the alkaline phosphatase activity of the cervica l mucus and defined its response to hormonal stimulus. From a group of normal women not using any contraception serial cervical mucus specimens were obtained beginning on Day 10 of the cycle and continuing until after ovulatory period. Patients in another group were receiving gonadotropin therapy for anovulation and infertility. Patients in a third group were given a variety of estrogen and progesterone drugs. From some patients 24-hour urine specimens were also obtained and the es triol content measured. The cervical mucus was aspirated from all and the alkaline phosphatase activity determined. Results are expressed in King-Armstrong units. Preovulatory levels showed a wide variation. In normal women there was a marked upward trend after ovulation which continued as long as mucus was available. Patients receiving gonadotropin therapy showed a definite rise in mucus phosphatase activity within 24 hours of time of presumptive ovulation. Estradiol excretion obtained at the same time showed no correlation. Patients tre ated with estrogen-progestagen combination oral contraceptives showed consistent levels of alkaline phosphatase during the first 15 days. However 48 hours after administration of chlormadinone there was a marked increase in phosphatase activity. This pattern of alkaline phosphatase rise with a progestogen could be duplicated by administering mestranol for 15 days followed by mestranol in combination with norethindrone. Estriol excretion patterns in patients taking sequential oral contraceptives were extremely low. The physiologic significance of these findings is unanswered.

Tubal and peritubal surgery without magnification: An analysis☆

From June, 1973, through August, 1977, thirty consecutive tubal or peritubal operations, exclusive of sterilization reversal procedures, were performed by Dr. Spadoni at the University Hospital in Seattle, Washington, without any form of magnification. Fifty-seven percent of the patients became pregnant, with a term pregnancy rate of 53%. There was a 30% abortion rate, but no ectopic pregnancies. Of those patients with distal tubal disease who became pregnant, 89% had postoperative hydrotubation, whereas of those who did not become pregnant, only 22% had postoperative hydrotubation. Some of the possible etiologic factors in the development of tubal and peritubal disease are discussed.

Tubal Infertility in Relation to prior induced Abortion

One hundred twenty-seven women who had been given diagnoses of tubal infertility between 1979 and 1981 in King County, Washington, yet previously had been pregnant, were interviewed to determine their prior history of legally induced abortion. Their responses were compared with those of 395 women who conceived a child at the same time the infertile women began their unsuccessful attempt to become pregnant. In making the comparison, we adjusted for the effects of variables that in this population were related both to having an induced abortion and to the occurrence of infertility, i.e., age, number of prior pregnancies, number of sexual partners, cigarette smoking habits, Dalkon Shield (A. H. Robins Company, Richmond, VA) use, and whether the woman worked outside the home. The risk of tubal infertility in women who had had an induced abortion was not increased above that of other women (relative risk, 1.15; 95% confidence interval, 0.70 to 1.89). For women with two or more abortions, the relative risk was 1.29 (95% confidence interval, 0.39 to 4.20). When only the most recent pregnancy was considered, the relative risk was 1.19 (95% confidence interval, 0.72 to 1.97). Our results suggest that legal abortion, as performed during the past decade in the United States, does not carry an excess risk for future tubal infertility.