Percy Liedholm

The success rate of in vitro fertilization of human oocytes in relation to the concentrations of different hormones in follicular fluid and peripheral plasma

Seventeen infertile patients were stimulated with clomiphene citrate and human chorionic gonadotrophin (hCG). During laparotomy or laparoscopy, follicles were aspirated. At least one fertilizable oocyte was obtained from 13 patients, who had normal preovulatory plasma 17 beta-estradiol (mean 2.2 nmol/l) in contrast to the 4 patients with infertilizable oocytes (mean 0.4 nmol/l). A close association was found between the success rate of fertilization and the increment of plasma progesterone from the day before to the day after the operation. If the concentrations of 17 beta-estradiol and progesterone in follicular fluid were below an arbitrary limit (17 beta-estradiol less than 500 nmol/l in association with progesterone less than 2,000 nmol/l), no oocytes could be fertilized. Apparently aspiration of oocytes and follicular fluid did not disturb ovarian steroid production during the luteal phase. The results suggest that plasma 17 beta-estradiol and progesterone determinations may serve as useful predictors for oocyte fertilizability in an in vitro system, following clomiphene-hCG stimulation and multiple oocyte recovery.

Filled bladder simplifies human embryo transfer

Collection of pre-ovulatory oocytes for fertilization in vitro is now considered a quite straightforward procedure, especially in stimulated women and when using a teflon-coated aspiration needle. Moreover, cleavage of oocytes after fertilization in vitro has reached a high figure (Leeton et al. 1982). However, difficulties encountered in embryo transfer are not uncommon (Edwards et al. 1980; Leeton et al. 1982). Various technical procedures have been tried to facilitate the passage of the transfer catheter through the cervical canal into the uterine cavity. These techniques include placing the patient in different positions (Leeton et al. 1982; Jones et al. 1982), an outer cannula in the cervical canal (Leeton et al. 1982), dilatation of the cervical canal (Lopata et al. 1980), and the use of a tenaculum on the anterior lip of the cervix (Leeton et a]. 1982). Moreover, sedation of the patient has been used (Leeton et al. 1982), as some of these techniques can be uncomfortable for the patient and the procedure is occasionally protracted, while some can be unnecessarily traumatic. A simple technique is described for easy passage of the catheter into the uterine cavity in women who have an anteverted uterus. It is the angle between the cervical-uterine canal and the vagina (speculum exposed) that often makes it difficult for the transfer catheter to pass smoothly into the uterine cavity. A filled bladder will tilt the uterus to an upright position in line with the vagina (speculum exposed) (Figs 1 & 2). The woman is therefore asked to drink 1 litre of water 1 h before embryo transfer (as for an ultrasound examination). If ultrasound is used, the catheter can be seen entering the uterine cavity. Otherwise, ultrasound examination before embryo transfer is useful, to measure the exact length from the external 0 s to the fundus for controlled deposition of a transferred embryo (Leeton et al. 1982). In 14 consecutive embryo transfers, the filledbladder method was used. The woman was placed in a slight Trendelenburg position and the cervix was exposed with a bivalve speculum. An intrauterine device inserter was gently introduced 0.5-1.0 cm into the cervical canal to guide the

CLINICAL TRIAL OF A NEW ORAL CONTRACEPTIVE PILL CONTAINING THE NATURAL OESTROGEN 17β‐OESTRADIOL

The natural oestrogen, 17β‐oestradiol, has been shown not to depress fibrinolysis and apparently has less influence on liver function and lipid metabolism than ethinyl oestradiol, the synthetic oestrogen in conventional‘combined’oral contraceptive tablets. A triple‐blind study was therefore made of 215 women during 2051 treatment cycles with oral contraceptives containing either (i) 4 mg of micronized 17‐oestradiol and 3 mg norethisterone (Netagen 403), (ii) 4 mg 17‐oestradiol plus 2 mg of oestriol and 3 mg norethisterone (Netagen 423) or (iii) 50 μg ethinyl oestradiol and 3 mg norethisterone (Netasyn). There were no pregnancies or thrombotic incidents. The numbers discontinuing treatment were about the same in the three groups, the main reasons being intermenstrual spotting in those on Netagen 423, amenorrhoea and weight gain in those on Netagen 403 and nausea and weight gain in those on Netasyn. The natural oestrogen showed promise as a new and safe component of the‘combined’pill.

RISK OF PELVIC INFLAMMATORY DISEASE AMONG INTRAUTERINE-DEVICE USERS IRRESPECTIVE OF PREVIOUS PREGNANCY

The use of intrauterine devices (IUD) in 690 patients admitted to hospital for pelvic inflammatory disease (PID or acute salpingitis) was compared with the use in a sexually active age-matched control group. 220 (31.9%) of the patients and 114 (16.5%) of the controls were using an IUD. Thus, the risk of PID was raised twofold by IUD use. No significant difference was found between the women who had never been pregnant and those who had in the two groups. Neither was the risk of PID found to vary with age.

Copper IUD — Influence on menstrual blood loss and iron deficiency

Abstract One of the most common side effects during the use of IUDs is increased and prolonged menstrual bleeding. This increase in blood loss was verified by estimating the menstrual blood loss in women using the Cu-T 200. There was a significant increase in blood loss in both nulliparous and parous women even one year after the insertion of the IUD. Because of this blood loss, an increased incidence of iron deficiency could be expected. However, no significant changes could be registered in the concentration of haemoglobin, serum iron, or total iron binding capacity. Thus, the food iron absorption seemed to balance the increased iron losses during one year in the studied material of healthy Swedish women.

Semen quality of smoking and non-smoking men in infertile couples in a Swedish population

A study of semen quality, using conventional semen analysis, was undertaken. 186 male smokers were compared with 164 non‐smoking men undergoing infertility investigation. The cigarette smokers were subdivided into three groups according to the number of cigarettes they smoked: < 10(n = 27), 10–19 (n = 84) and > 19 cigarettes per day (n = 7.5). No statistically significant effect of cigarette smoking on sperm density, motility or morphologic features of sperm was detected. Nor was any significant difference in sperm quality, except for semen volume and total sperm count, disclosed between men in the different smoking categories or between heavy smokers and non‐smoking men. Thus, the present study does not corroborate reports of detrimental effects of cigarette smoking alone on sperm concentration, motility or morphology on the bases of this population of Swedish men in infertile couples.

Two years experience with copper-T 200 in a Swedish population — A comparison between nulliparous and parous women

Abstract During two years 750 patients, divided into a nulliparous and a parous group, using a T-Cu 200 device have been investigated during 11,284 observation months in a Swedish population. The result shows that the copper-T device is a good contraceptive alternative, both for parous and nulliparous. The pregnancy frequency is very low and the continuation rate is well acceptable.

Basal and LRH-stimulated secretion of FSH during early pregnancy

The gonadotropin response to 25 mug of LH/FSH releasing hormone (LRH) intravenously was investigated during the very first weeks of pregnancy. It was found progressively to decrease, and no response in FSH was found for more than 5 weeks. The basal levels of FSH showed the same decreasing tendency, and a few weeks after conception they were often close to the sensitivity limit of the assay. With this report we have continued our description of the changing pituitary responsiveness to LRH from conception to the puerperium. During later stages of pregnancy the plasma levels of FSH were markedly reduced, and the response was inhibited even after 500 mug of LRH intervenously. The return of the response during the puerperium showed a specific pattern with a dissociation of the response in FSH and LH. No such dissociation was found during the period of progressive inhibition during the very first weeks of pregnancy.

Does previous Chlamydia trachomatis infection influence the pregnancy rate of in vitro fertilization and embryo replacement

The association between previous chlamydial infection, as reflected by the presence of chlamydial antibodies (specific serum immunoglobulin G antibodies with a titer greater than or equal to 32) and pregnancy outcome after in vitro fertilization and embryo replacement was studied in 121 infertile women with tubal damage. The antibody prevalence was 74.4%; the overall pregnancy rate was 26.4%. No difference in seropositivity was detected between those who became pregnant and those who did not (71.9% versus 75.3%). The geometric mean titers were also similar in the two groups. Even after subdivision of the cases into primary or repeated in vitro fertilization attempts, or after stratification of the material according to the number of embryos used for replacement, there was no correlation between chlamydial antibodies and pregnancy rate. Thus, past infection with Chlamydia trachomatis did not influence the outcome of in vitro fertilization and embryo replacement treatment in this study.

Is development of pelvic inflammatory disease in women using intra-uterine device equal regardless of parity? A one year follow-up study

Seven hundred and fifty women using IUD (TCu 200) were observed for one year after insertion. During the observation year, 16 (2.1 per cent) of the 750 women studied were hospitalized for salpingitis. The diagnosis was confirmed by laparoscopy. Every patient except one had salpingitis bilaterally and none of them had positive culture for gonorrhea at the time of hospitalization. It was noteworthy that only 7 of the patients had palpable adnexal masses. Of the 16 women, 8 belonged to the nulliparous group (3.8 per cent) and 8 to the parous group (1.5 per cent). The high risk age group for salpingitis was 16 to 25 years. The risk of developing salpingitis is greater during the first month after insertion (5 in the nulliparous group and 4 in the parous group). In only one case were leukocytes found in the vaginal smear. Only 2 patients in the high risk group of the parous women developed salpingitis within the first month. In the high risk age group for salpingitis (16–25), the yearly incidence of pelvic inflammatory disease was 47/1000 women in the nulliparous group and 42/1000 women in the parous group. In the high risk age group for salpingitis (16–25) and in the whole material, there was no difference in frequency of salpingitis between the parous and the nulliparous groups.