Robert A. McInnes

Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions

In an attempt to evaluate the efficacy of salpingoovariolysis we studied 147 women who were found to have periadnexal adhesions on laparoscopic examination. Among these women, 69 were treated by laparotomy and salpingoovariolysis and 78 were not treated. There was no significant difference between the degree of adhesions in the treated group and in the nontreated group. With the use of life table analysis, the cumulative pregnancy rate at 12 and 24 months follow-up was 32% and 45% in the treated group and 11% and 16% in the nontreated group, respectively (p less than 10(-6)). We suggest that although pregnancy might occur in infertile women who have periadnexal adhesions, treatment with salpingoovariolysis is associated with a higher pregnancy rate.

Arcuate and Bicornuate Uterine Anomalies and Infertility

Twenty-three patients presenting with infertility were found to have uterine anomalies. Eighteen had primary infertility. Six (86%) of seven patients with arcuate uterus achieved a term pregnancy. Five patients of these seven had primary infertility. Of the 13 patients with bicornuate uterus, 6 subsequently underwent a metroplasty and 4 (67%) of these latter patients achieved a term pregnancy. Of the remaining seven patients with bicornuate uterus, one achieved pregnancy during investigations, one refused surgery, and five were not operated upon because of uncorrected nonuterine factors. One other patient was found to have uterus didelphys and two had a unicornuate uterus. No patients with septate uterus were found. The implications of a uterine anomaly as a cause of primary infertility are discussed.

Breast Examination does not Elevate Serum Prolactin

Serum prolactin and cortisol levels were measured in 24 patients entering the Royal Victoria Hospital infertility center both before and after a thorough physical examination that included a pelvic examination and a search for galactorrhea in both breasts. There was no significant change in the levels of prolactin or cortisol in the group as a whole in those with normal prolactin values and those with high basal prolactin values (P less than 0.05). The possible role of stress in the mediation of occasional elevation of basal prolactin values is discussed in relation to the serum cortisol levels.

Observations on the combination of clomiphene citrate-human menopausal gonadotropin-human chorionic gonadotropin in the management of anovulation

To study the effects of the addition of clomiphene citrate to human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), 23 cycles of clomiphene citrate-hMG-hCG (CHH) were administered to 10 anovulatory women. Of these 10 women, 5 also received 15 cycles of hMG-hCG (HH). Although there was a significant increase in the ovulation rate in the CHH group (p less than 0.01), there was no difference in the pregnancy rate (p less than 0.05). Patients in the CHH group required significantly less hMG for ovulation induction than the HH group (p less than 0.01). Patients receiving CHH who had low serum levels of follicle-stimulating hormone required significantly more hMG than those with normal values. The luteinizing hormone releasing hormone test may predict those patients who will require less hMG during CHH therapy. The relative safety of the CHH treatment is discussed.

Altered pituitary hormone secretion in patients with pseudocyesis

Pituitary function studies were performed in two patients with pseudocyesis, one of whom was reinvestigated during a recurrent episode. There was an exaggerated prolactin response to thyrotropin-releasing hormone, an aberrant growth hormone increase, and an impaired growth hormone response to dopamine receptor agonists (apomorphine or bromocriptine). These findings point to a derangement in hypothalamic-pituitary function in pseudocyesis and may indicate an underlying impairment in dopaminergic function in this disorder.

Infertility in women over the age of 36

Ninety-three couples of which the female partner was over 36 years of age were studied. Tubal factor was the most common etiologic factor in the women aged 36 to 40 years, and unexplained infertility was the most common factor in the women over the age of 40. It appears that in the aging infertile population, the ovulatory factor is not the most important cause of infertility. The over-all pregnancy rate (33%) is lower and the abortion rate (31%) is increased with advancing age as compared with the general infertile population. The implication of aging as a cause of infertility is discussed.

Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume.

Pituitary function studies were performed on a 31-year-old man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing hormone (LH) response to luteinizing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMG)-hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMG-hCG treatment.