Maurice Katz

Unexplained infertility—the value of Pergonal * superovulation combined with intrauterine insemination

Sixty-two women with unexplained infertility were studied. Fifteen (group 1) had timed intrauterine insemination (IUI), 25 (group 2) were treated by Pergonal (Serono Laboratories, Ltd., Welwyn Garden City, England) superovulation, and 22 (group 3) underwent Pergonal superovulation combined with IUI. Where Pergonal treatment was followed by insemination, a significantly greater pregnancy rate per cycle (P less than 0.05) was achieved, whether this group of patients was compared with those treated by IUI alone or with those treated with Pergonal alone. Moreover, the pregnancy rate in group 3 was comparable to that reported following gamete intrafallopian transfer (GIFT). The authors therefore suggest this form of treatment for patients with unexplained infertility prior to their referral to the more invasive procedure of GIFT.

Development of the fertility adjustment scale

OBJECTIVE To develop a standardized measure of psychological adjustment to infertility. DESIGN A cross-sectional two-group comparison study. SETTING Two specialized fertility clinics in large teaching hospitals. PATIENT(S) Fifty men and 50 women undergoing evaluation and/or treatment of fertility problems. INTERVENTION(S) The Fertility Adjustment Scale was administered with the Hospital Anxiety and Depression Scale as a measure of concurrent validity. MAIN OUTCOME MEASURE(S) Scores on the Fertility Adjustment Scale and the Hospital Anxiety and Depression Scale. RESULT(S) Scores on the Fertility Adjustment Scale were distributed normally. Split-half and internal consistency were high. A significant correlation with measures of mood, anxiety, and distress provided evidence of concurrent validity. CONCLUSION(S) Preliminary results suggest that this measure will be a useful tool in assessing psychological reactions to fertility problems and outcomes of treatment.

Medical (fluoxetine) and psychological (cognitive–behavioural therapy) treatment for premenstrual dysphoric disorder: A study of treatment processes

OBJECTIVES To investigate (i) the differential changes in premenstrual symptoms, mood, cognitions, and coping strategies during two treatments [cognitive-behavioural therapy (CBT) and fluoxetine] for premenstrual dysphoric disorder (PMDD) and (ii) the characteristics of those with good vs. poor outcome post treatment and at 1 year follow-up. METHODS Premenstrual symptoms, mood (Hospital Anxiety and Depression Scale, HADS), causal attributions, and use of cognitive and behavioural coping strategies were examined during 6 months of both treatments. The two treatment groups were then combined and divided on the basis of good vs. poor outcome posttreatment and at 1 year follow-up. Baseline measures were used to predict posttreatment outcome, and baseline and posttreatment measures were examined when attempting to predict outcome at 1 year follow-up. RESULTS Both treatments were equally effective at the end of 6 months (prospective daily diary measure). Fluoxetine treatment had a more rapid effect and greater impact upon anxiety symptoms, while CBT was associated with increased use of cognitive and behavioural coping strategies and a shift from a biomedical to a biopsychosocial causal attribution of premenstrual symptoms. Depressed mood at baseline assessment was associated with poorer response to both treatments, and learning active behavioural coping strategies was associated with a good outcome at 1 year follow-up. CONCLUSION These results provide evidence of differential treatment effects of fluoxetine and CBT for PMDD and offer information that will enhance clinical decision-making.

Nitric oxide synthase inhibitor NG-monomethyl-l-arginine preserves sperm motility after swim-up

OBJECTIVE To evaluate the effect of NG-monomethyl-L-arginine (L-NMMA) on sperm motility. DESIGN Controlled study using motile sperm suspensions obtained by the swim-up technique. SETTING Endocrine Laboratory, Department of Obstetrics and Gynaecology, University College London Medical School. PATIENTS Men attending the Reproductive Medicine Unit at University College London Hospitals, Obstetric Hospital, for routine fertility investigations. INTERVENTIONS Motile sperm suspensions were incubated with either culture medium (control) or L-NMMA (test) for 24 hours at 37 degrees C. MAIN OUTCOME MEASURE Motion characteristics were assessed manually and by computer-assisted sperm motility analyzer. RESULTS In all 23 preparations either equivalent or significantly higher percentage total motility and percentage rapidly motile sperm were observed in the test compared with the control samples at 24 hours. There were no significant differences in motion characteristics between test and control specimens at 6 hours. CONCLUSIONS NG-monomethyl-L-arginine inhibits the formation of nitric oxide; its ability to prevent sperm motility decline indicates that the arginine-nitric oxide pathway may play a role in modulating sperm motility and motility survival.

Use of Hormone Replacement Therapy for Correction of High Turnover Bone Disease in Hypogonadal β-Thalassemia Major Patients Presenting with Osteoporosis: Comparison with Idiopathic Premature Ovarian Failure

Osteopenia-osteoporosis syndrome (OOS) causes considerable morbidity in 60–80% β-thalassemia major (β-TM) patients. We evaluated the effect of sex hormone replacement therapy (HRT) in β-TM patients with hypogonadism presenting with OOS using premature ovarian failure (POF) for comparative purposes. We undertook a 10-year prospective study of in 50 β-TM and 375 patients with POF and OOS. All were treated with HRT for 2–5 years. We used dual X-ray absorptiometry (DEXA), and plasma type 1-collagen markers of bone turnover for monitoring of response to therapy. Our results suggest that prior to HRT, both groups had comparable degrees of OOS. Both groups had significant improvement but the POF group had normalization of spinal T scores following HRT in contrast to the β-TM patients. Femoral T scores did not normalize in both groups. These data indicate for the first time from comparative POF control studies that hypogonadism is not the only cause of OOS in β-TM.

Induction of Ovarian Function by Using Short-Term Human Menopausal Gonadotrophin in Patients with Ovarian Failure Following Cytotoxic Chemotherapy for Haematological Malignancy

Currently no treatment has proved successful in inducing ovarian steroidogenic and/or gametogenic recovery in patients with haematological malignancies treated by cytotoxic chemotherapy once biochemical failure becomes manifest i.e., when FSH levels exceed 40 IU/L. This paper reports two such cases with classical biochemical ovarian failure in which ovarian function was induced by brief stimulation with Human Menopausal Gonadotrophin (HMG).

Plasma Alpha Tocopherol Status in Patients with Oligospermia, Impotence and Sperm Agglutination

Plasma alpha tocopherol and total lipid concentrations were measured in 30 normal males, 35 impotent men and 71 infertile patients of whom 38 had oligospermia and 33 had non-immune sperm agglutination. No significant difference war found in the alpha tocopherol level, total lipid concentration or alpha tocopherol-to-total lipid ratio between the normal controls and any of the patient groups.