Patrick J. Taylor

The prediction of ovulation: a comparison of the basal body temperature graph, cervical mucus score, and real-time pelvic ultrasonography

Ninety-five menstrual cycles were studied in 20 women undergoing donor artificial insemination (AID). In 49 cycles basal body temperature (BBT) changes were charted daily and both daily cervical mucus scoring (modified Insler score) and daily realtime ultrasonography (USS) were performed from day 11 to ovulation. AID was performed only on the day of follicular rupture. A control group, not subjected to USS, were inseminated two to three times per cycle over 46 cycles in the periovulatory period. The Insler score was found to be a reliable indicator of follicular development and rupture. The BBT was found to be less reliable than the Insler score or USS. While USS may be used to confirm follicular development, the Insler score is reliable and less costly.

Reliability and accuracy of the zona‐free hamster ova assay in the assessment of male fertility

Summary. The efficacy of the zona‐free hamster ova assay in assessing male fertility was studied in 22 men of proven fertility, 16 of unproven fertility, and 31 who were members of infertile couples. The mean hamster ova penetration rates were significantly higher in males of proven fertility (34%) and unproven fertility (30%) than in infertile males (11%). Sperm from 21 of 22 men of proven fertility penetrated >15% of ova; one man had a zero penetration rate. Sperm from 8 of 16 men of unproven fertility and 24 of 31 men of infertile couples penetrated <15% of ova. There was no correlation between penetration rates and any of the traditional measures of semen analysis. Two assays were performed on every male and six assays were performed on six males. There was good interassay reliability in all 69 males (r=0·86) and in the six males with six tests (r=0·97). The mean interassay variation was 8·6%.

The hyperprolactinemic polycystic ovary syndrome may not be a distinct entity

Thirteen women with hyperprolactinemia and clinical stigmata of the polycystic ovary syndrome (PCO) had their serum prolactin (PRL) response to thyrotropin-releasing hormon (TRH) compared with two other groups of PCO. One PCO group had an elevated ratio of basal luteinizing hormone (LH) to follicle-stimulating hormone (FSH), and another had a normal ratio of basal LH to FSH. The PRL response to TRH was similar in hyperprolactinemic PCO and elevated LH PCO, and both were significantly greater than normal LH PCO and normal women. This suggests the hyperprolactinemic polycystic ovary (HPCO) is probably produced by similar central and/or peripheral mechanisms that result in the production of an elevated serum LH. These two features are probably associated in a common pathophysiologic mechanism. The HPCO syndrome does not appear to be a distinct entity but clinically must be differentiated from other causes of mild hyperprolactinemia.

A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization.

More women of reproductive age are being sterilized. Some of these women regret the decision and subsequently request a reversal of sterilization, whereas others do not. This study was undertaken to develop a profile of easily definable traits of 159 women who requested a reversal of sterilization and compare it with that of 160 women who apparently were satisfied with sterilization. Statistically significant differences were found. Remarriage was the most common cause for regret among women in the group which requested reversal of sterilization. Women in this group married younger, completed their family earlier, and were sterilized at a younger age. These women had significantly fewer live children and had undergone more therapeutic abortions (p less than 0.005).

The effect of a progestin on gallbladder function in young women

Female sex hormones have been considered to be a risk factor for the development of cholesterol gallstone disease, because of increased cholesterol saturation of bile. Impaired gallbladder function is an additional factor which is suspect but unproved. We investigated gallbladder function in 10 young women on two occasions: first during the follicular phase of the menstrual cycle, when endogenous progesterone is low, and again after the ingestion of medroxyprogesterone acetate, 10 mg/day for 10 days, just prior to the next menstrual period. Another group, 15 young women, was studied during their luteal phase, when endogenous progesterone is high. Gallbladder filling and emptying in response to cholecystokinin (0.02 U/kg-min) was quantitated by 99mTc-HIDA cholescintigraphy. Gallbladder filling and emptying were no different in women in the follicular phase than in women in the luteal phase of the menstrual cycle. In both menstrual phases, the administration of the exogenous progestin significantly (p less than 0.05) reduced the fraction of hepatic bile entering the gallbladder. Gallbladder emptying was also depressed: the total amount ejected was less, the time to empty half the contents was prolonged, and the rate was slower (p less than 0.05). Thus, different phases of the normal menstrual cycle do not appear to have any effect on gallbladder function. Administration of an exogenous progestin, however, significantly impairs both gallbladder filling and emptying, factors which could predispose to the formation of cholesterol gallstones.

Long-term follow-up of hyperprolactinemic women treated with bromocriptine.

Seventy-five women with hyperprolactinemia and demonstrable or suspected prolactinomas were treated with bromocriptine only and followed for 5 to 9 years. Biochemical, radiologic, and clinical responses were generally maintained in the long term, once established in the short term. Underlying mass effects on neurologic and pituitary function tended to improve, and no tumor progression was noted. Hypogonadal symptoms normalized in 68 of 75 women. Bromocriptine responses in long-term follow-up do not demonstrate any cumulative problems not seen in short-term therapy.

Mechanisms of Control of Prolactin Release in Response to Apprehension Stress and Anesthesia-Surgery Stress *

The response of prolactin to stress may not be controlled by a single mechanism. This study was designed to measure the prolactin response in the human female to two reproducible stresses: the apprehension (A) prior to surgery (laparoscopy and hysteroscopy) and the stress of the anesthesia-surgery (AS). Attempts to modify the release of prolactin was made by pharmacologic means. Thirty-eight normally menstruating women served either as controls or received histamine (H1), serotonin, opioid, or dopamine receptor-blocking agents and the prolactin response was measured. The release of prolactin to AS was blunted by higher-dose of opioid and by dopamine antagonists. The A release of prolactin was enhanced by the dopaminergic antagonist and blunted by the other three agents. It was concluded that the mechanism for the stress-induced release of prolactin may vary depending upon the nature of the stress.

Significance of intrauterine adhesions detected hysteroscopically in eumenorrheic infertile women and role of antecedent curettage in their formation

The increasing use of hysteroscopy as a diagnostic tool in the infertile woman has shown that intrauterine adhesions are of more concern, especially in eumenorrheic women, than previously was recognized. Their significance is not yet clear. This study was designed to compare the incidence of such lesions detected hysteroscopically in 235 women with otherwise unexplained infertility with their incidence in a group of 31 potentially fertile women. The outcome after treatment was recorded. The effect of curettage in the production of these adhesions was examined. The incidence of adhesions in the infertile group was considerably greater than in the potentially fertile group (p less than 0.05). A 50% pregnancy rate was achieved by lysis of adhesions. An antecedent history of curettage was associated with a significantly higher incidence of adhesion formation than that found in noncuretted patients (p less than 0.0005).

Effects of low-dose human chorionic gonadotropin on corpus luteum function after embryo transfer

This paper reports the effect of low-dose human chorionic gonadotropin (hCG) on the levels of serum hCG, progesterone, and estradiol, luteal-phase length, and conception in 20 patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Alternate patients in a group of 20 received 1000 IU hCG on the day of embryo transfer and 3 days after. Six and 9 days from embryo transfer 2000 IU hCG was given. The remaining patients served as controls. No patients in the treated group and four in the control group became pregnant. The endocrine profiles with respect to hCG, progesterone, and estradiol levels were similar in the treated patients compared with pregnant patients in the control group. Treated patients had significantly longer (18.0±1.1 days) luteal phases compared with nonpregnant patients in the control group (12.5±1.2 days), indicating that low-dose hCG prolonged the life of the corpus luteum. It was concluded that while the administration of low-dose hCG prolonged the life of the corpus luteum, it did not apparently improve the conception rate.

Growth of mouse embryos in bicarbonate media buffered by carbon dioxide, hepes, or phosphate.

The purpose of this study was to determine if mouse embryos could be grown successfully in a culture medium devoid of the carbon dioxide phase (CO2). Mouse embryos fertilized in vivo were collected and cultured in Hepes medium with and without bicarbonate (HCO3−) and a phosphate medium with and without HCO3−. In these experiments no CO2 gas phase was used. Further embryos were cultured in Whittinghams modified Tyrodes (T6) medium with a CO2 gas phase and served as controls. The degree of embryonic development was noted. Surviving blastocysts were transferred to the uteri of pseudopregnant mice and delivery at term was allowed to occur. There was no significant difference in the degree of embryonic development in those embryos cultured in T6 or Hepes medium (+HCO3−) or in the number of live offspring obtained when these blastocysts were placed within the mouse uterus. Although embryonic development apparently proceeded successfully in the phosphate (+HCO3−) medium, none of these blastocysts survived when transferred to mouse uteri. No embryonic growth occurred in either the Hepes or phosphate media which were devoid of HCO3−. It appears that a Hepes medium containing HCO3−, which uses no CO2 gas phase, is as effective as T6 medium, which uses a gas phase, in supporting in vitro mouse embryonic growth.