Melvin R. Cohen

Antigonadotropin (danazol) in the treatment of endometriosis: Evaluation of posttreatment fertility and three-year follow-up data

Ninety-nine women who completed danazol treatment for endometriosis proved by operation were re-evaluated clinically an average of 37 months later. The recurrence of symptoms was reported by 39 per cent and pelvic findings suggestive of endometriosis were noted in 33 per cent. An average time interval between the end of treatment and the recurrence was 15 months for the entire group. However, 31 women who conceived subsequent to treatment had a much lower recurrence rate of the disease (15 per cent) and a much longer average time until the recurrence (31 months). Of 84 infertile women who desired pregnancy after treatment, 39 conceived, for a pregnancy rate of 46.4 per cent. However, when patients with absolute sterility due to other causes were excluded, the corrected pregnancy rate was 72.2 per cent. The majority of conceptions (23) occurred within the first six months after discontinuation of danazol and a total of 30 occurred within the first year. Four second- and third-trimester intrauterine fetal deaths were observed among women who conceived within the first three cycles after discontinuation of the drug.

Twenty-Four to Ninety-Six-Hour Storage of Human Spermatozoa in Test-Yolk Buffer

The feasibility of a simple, inexpensive technique of short-term (24- to 96-hour) preservation of human spermatozoa in TEST-yolk buffer is demonstrated. Preservation of spermatozoa for up to 72 hours would require no addition of antibiotics. There is little loss of motility when semen is added to TEST-yolk buffer and kept in a standard refrigerator. Such semen would then be available for multiple inseminations during the periovulatory period. One objection to this procedure is that it is necessary to dilute semen 1:1 in TEST-yolk buffer, resulting in a 50% lower sperm density, and this may be objectionable when oligospermia is present. Results obtained in this study are in agreement with similar studies performed on domestic animals.

Alterations in progesterone metabolism and luteal function in infertile women with endometriosis

The concentrations of pregnanediol-3-glucuronide (PGD) and pregnanolone (PN) were measured in daily morning urine specimens from 66 infertile women (40 with varying degrees of endometriosis and 26 control subjects) and correlated with daily changes in basal body temperature (BBT) and with midluteal levels of serum progesterone (P). PN and BBT rose at midcycle in women with endometriosis, as expected, indicating secretion of some P at that time. However, PGD, the major endpoint of P metabolism, was delayed in its excretion. Endometrial biopsies were similarly delayed (out of phase) in women with endometriosis, and a significantly higher incidence of follicular luteinization was seen. It appears that while P secretion begins at midcycle, the bulk of P secretion is delayed, perhaps because of the process of follicular luteinization, and that a shortened functional luteal phase thus exists in women with endometriosis.

Relationship of luteinizing hormone, pregnanediol-3-glucuronide, and estriol-16-glucuronide in urine of infertile women with endometriosis

The concentration of luteinizing hormone (LH), pregnanediol-3-glucuronide (PGD), and estriol-16-Glucuronide (E3G) were measured in daily morning urine specimens from 53 infertile women. In 26 of 29 women with various degrees of proven endometriosis, two distinct midcycle peaks of LH were found 2 or 3 days apart. Patients with LH peaks separated by 3 days had significantly more severe endometriosis than those with a single peak. Maximum concentrations of E3G were found to be delayed until after the first LH peak in these patients, and PGD concentrations did not rise until the time of the second LH peak, making actual luteal function of shorter duration than normal. From the data on LH, it appears that an inappropriate hormonal feedback mechanism is operative in endometriosis.

Bilateral polycystic ovaries the Stein syndrome

Abstract 1.1. There is a definite clinical syndrome, associated with bilateral polycystic ovaries, and characterized by menstrual irregularity, featuring amenorrhea and sterility. Hirsutism is a frequent associated finding. 2.2. The changes in the ovaries are refractory to all present forms of hormonal therapy. 3.3. Restoration of normal menstrual and reproductive function follows bilateral wedge resection of the polycystic ovaries. 4.4. Marked hyperplasia of the theca-interna layer is a constant finding in sections of the ovarian tissue removed. Luteinization of this layer is a frequent finding. 5.5. A working hypothesis for the pathogenesis of this syndrome is presented.

Sperm Survival at Estimated Ovulation Time: Prognostic Significance

In a group of 25 infertile couples the wives were asked to report daily for vaginal smears for evaluation of timing of ovulation. Basal body temperature was also recorded. Artificial insemination was performed or coitus was recommended to take place during estimated time of ovulation. 150 examinations of cervical secretions were made daily for 7 days from 1 1/2 hours to 72 hours after insemination. Data on 1) amount and consistency of cervical mucus; 2) number of pus cells and spermatozoa and 3) grade of sperm motility were analyzed from standpoint of timing of ovulation; effect of drugs (stilbestrol sulfonamides and hyaluronidase) and; prognostic significance of sperm survival. Spermatozoa survived routinely in the cervical mucus at ovulation time from 1 1/2 to 72 hours post-insemination (average 22 hours; mode 24 hours). There was a direct relationship between increased quantity and diminished viscosity of cervical secretions and prolonged sperm survival. Survival time of spermatozoa in the mucus is improved by the administration of estrogens but not by hyaluronidase. Where cervicitis exists sulfonamides serve to increase sperm survival. In the absence of estrogen therapy sperm survival for 24 hours or more in the cervical mucus signals ovulation time. Nevertheless optimal sperm survival in cervical mucus does not guarantee pregnancy.

Jelly contraceptives: A three-year investigation☆

Abstract 1. 1. It has been shown by Stix that birth control measures are not equally effective in reducing the risk of pregnancy in the various social classes. She concluded that the condom is only 65 per cent effective in relief recipients in comparison with 88 per cent effectiveness in whitecollar workers. The clientele represented in our study was drawn essentially from families on relief. 2. 2. Of the 310 patients who registered in our Birth Control Clinic at Mandel Clinic, 231 remained active for a period ranging from three months to three years. They made a total of 816 clinic visits. Most of the patients who accepted the method and cooperated with us were contented with it. 3. 3. An analysis of preclinic experience revealed that two-thirds of the patients had previously used various birth control methods, both single and combined, with unsatisfactory results. 4. 4. A total of 47 pregnancies occurred in the active clinic group, but when these histories were analyzed, only 20 could be charged against the jelly-alone method. 5. 5. The results of this study confirm our opinion regarding the value of the jelly-alone method which was based upon our previous experience with this method a decade ago. 6. 6. The effectiveness of jelly alone as a contraceptive is shown by the 87.1 per cent reduction in fertility. This compares most favorably with the results of the diaphragm and jelly method which Stix has shown was only 76 per cent effective in relief recipients, a clientele similar to ours. 7. 7. Acceptability of the method is proved by the fact that while 37 per cent of the total group, or 50 per cent of the group active in the clinic for some time, used the method, a very small number had any real objection to or complaint against the method. Because of the low acceptability of any single method of birth control, multiple techniques should be available in birth control clinics. 8. 8. In our opinion, it is the jelly and not the diaphragm that is the potent factor in the diaphragm and jelly technique of contraception.