Marian D. Damewood

Disappearance of exogenously administered human chorionic gonadotropin

Concentrations of human chorionic gonadotropin (hCG) were measured after intramuscular hCG administration in 34 patients undergoing ovarian stimulation in an in vitro fertilization program. Serum hCG levels were detectable by an immunoenzymetric assay up to 14 days after injection. Individual variation in hCG concentration after injection could be minimized by expressing the daily hCG level as a fractional distribution of the value observed 36 hours after hCG administration (hCG0). In nonpregnant patients, less than 10% of the hCG0 value was found on day 10. The disappearance rate measured 36 hours after injection of hCG was exponential with a mean half-life of 2.32 days. These findings are significant for ovarian stimulation protocols, including exogenous hCG, with respect to timing and accuracy of quantitative pregnancy testing.

A comparison of the reproductive outcome between women with a unicornuate uterus and women with a didelphic uterus

OBJECTIVE To compare the reproductive performance of women with a unicornuate uterus with the reproductive performance of women with a didelphic uterus. DESIGN Retrospective. SETTING Reproductive endocrinology service of a tertiary referral hospital. MAIN OUTCOME MEASURES The proportion of pregnancies resulting in spontaneous abortion, preterm delivery, term delivery, and living children was determined for each group. RESULTS Twenty-nine women with a unicornuate uterus and 25 women with a didelphic uterus were identified. Twenty women with a unicornuate uterus produced a total of 40 pregnancies, whereas 13 women with a didelphic uterus produced a total of 28 pregnancies. The 33% spontaneous abortion rate in the unicornuate group was not significantly different from the 23% rate in the didelphic group. The proportion of pregnancies resulting in preterm delivery, term delivery, and living children was similar in both groups. CONCLUSIONS The reproductive performance of women with a unicornuate uterus is similar to the performance of women with a didelphic uterus.

Effect of serum from patients with minimal to mild endometriosis on mouse embryo development in vitro

Two-cell mouse embryos were cultured at 37 degrees C in 5% CO2, 95% air with a 7.5% serum supplement from patients with minimal to mild endometriosis, (group I, n = 31), tubal factor (group II, n = 33), male factor (group III, n = 17), fetal cord samples (group IV, n = 37), and Hams F-10 medium (Gibco, Grand Island, NY) without a serum supplement (group V, n = 30). The progression to blastocyst stage (mean percent +/- SE) at 96 hours in groups I, II, III, IV, and V was 29.9% +/- 3.7%, 60.6% +/- 4.9%, 56.2% +/- 5.2%, 61.7% +/- 5.8%, and 63.2% +/- 6.9%, respectively. Serum factors appear to be associated with an inhibition of early embryogenesis, which may explain the decreased fertility rates observed in patients with minimal to mild endometriosis.

Neosalpingostomy for distal tubal obstruction: prognostic factors and impact of surgical technique*

We reviewed the clinical records of all women who underwent microsurgical terminal neosalpingostomy for distal tubal obstruction between January 1983 and June 1988. We identified 95 women whose preoperative evaluation revealed no other contributory factors for infertility and analyzed their pregnancy outcome after this procedure. Pregnancy success was inversely related to the extent of tubal distortion (dilation, rugal integrity, and status of the fimbria) and degree of adnexal adhesions. Using our classification system for distal tubal obstruction, patients with mild disease had an 80% pregnancy rate, whereas patients with moderate and severe disease had a 31% and 16% success rate, respectively. We found no statistically significant difference in pregnancy outcome when we compared this series with our previous group, reported in 1978, where contemporary microsurgical technique was not used. Although we feel that optimal surgical technique is important to maximize success, we conclude that the most important prognostic factor in pregnancy outcome after neosalpingostomy for distal tubal disease is the anatomical and functional integrity of the tube.

Sexual functioning and psychologic evaluation of in vitro fertilization couples

Couples requesting in vitro fertilization (IVF) may be sexually dysfunctional either as an etiologic factor in their infertility or because they experience decreased sexual satisfaction as a reaction to previous infertility treatment. The present study assessed the sexual functioning and psychologic status of 45 married couples who had requested IVF. The couples were given complete psychosexual evaluation by senior staff members of the Sexual Behaviors Consultation Unit and each participant completed the Derogatis Sexual Functioning Inventory (DSFI). Seven couples (15.5%) were experiencing a sexual dysfunction and 13 individuals (14.4%) were given Diagnostic and Statistical Manual of Mental Disorders III diagnoses. In total, 19 individuals (21%) of the sample were found to have either a sexual dysfunction or psychologic disorder. Couples with a sexual dysfunction were more likely (P = 0.05) to have unexplained infertility. Norms for psychologic evaluation as part of IVF are suggested and the role of such evaluation discussed.

Laparoscopic cautery in the treatment of endometriosis-related infertility

Life table analysis and the two-parameter exponential method have been applied to pregnancy rates in 72 patients undergoing laparoscopic cautery exclusively. Patients with male factor infertility were excluded. Estimated cure rates for patients with stage I and II disease were 98.2% and 76.6%, respectively (not significantly different). No significant difference was seen when anovulation complicated the endometriosis (68.6%). When greater than one infertility factor was present, a significant difference was observed (50.6%). Patients with stage I disease had an average fecundity of 10.30% with decreasing values observed in stage II (7.59%), anovulation (6.67%), and more than one infertility factor (3.33%). We conclude that laparoscopic cauterization is an effective mode of therapy for the treatment of stage I and II endometriosis associated with infertility.

Cutaneous metastasis of endometrial carcinoma.

Five cases of endometrial carcinoma with cutaneous metastases are reported. Cutaneous metastases of endometrial carcinoma are uncommon. There are no other cases reported in the literature. In 91 autopsy cases only one example (1%) could be found. The appearance of subcutaneous nodules is evidence of widespread dissemination and a harbinger of early demise.

A Noninvasive Test to Determine Paternity in Pregnancy

By comparing markers of circulating fetal DNA with markers of maternal DNA and those of DNA obtained from both the biologic father and an unrelated man, investigators were able to identify the biol...

Interval bone mineral density with long-term gonadotropin-releasing hormone agonist suppression

Twenty-six patients of mean age 37 +/- 4.8 (SD) years, who received a 6-month course of gonadotropin-releasing hormone (GnRH) analogue, were selected for study. Bone mineral density (BMD) was measured by dual-photon absorptiometry before initiation and after completion of agonist therapy. Mean BMD (g/cm2) by dual-photon absorptiometry at L2 to L4, femoral neck, Wards triangle, and the trochanteric area did not change significantly (P = not significant [NS]) after 6 months of GnRH analogue suppression. Mean percent (%) expected density as standardized for age, weight, and sex remained in the range of 89.3% to 94.2% (P = NS). The interval detectable change in BMD after therapy was 0.05 +/- 0.06 g/cm2. These findings are reassuring with respect to the use of long-term GnRH analogue regimens to induce a hypoestrogenic state in the treatment of hormone-dependent conditions.

Treatment independent pregnancy with operative laparoscopy for endometriosis in an in vitro fertilization program

Thirty-nine patients with Stage I to IV endometriosis and at least 5 years of primary infertility were enrolled in the Johns Hopkins In Vitro Fertilization Program. At the time of laparoscopic oocyte retrieval, operative endoscopy with lysis of adhesions, fulguration or resection of pelvic endometriosis, or enucleation of ovarian endometriomas was performed. Although the in vitro fertilization-embryo transfer cycle did not result in pregnancy, 12 patients (28%) conceived within 10 months of the operative laparoscopic procedure. Nine of the pregnancies occurred in patients with Stage I to II endometriosis.