Robert R. Franklin

Further studies on sperm-agglutinating antibody and unexplained infertility.

FOR THE past two years, we have been investigating the immunologic aspects of infertility. In a recent report 1 we reviewed the history of the problem and summarized our data on 89 patients, carefully categorized as to fertility status. A remarkable percentage of the patients without demonstrable organic cause for infertility possessed circulating antibodies capable of agglutinating human spermatozoa. The present report is an extension of our previous publication, summarizing the results obtained in 214 patients. Materials and Methods All patients in this study were assigned to one of five categories strictly on the basis of history and clinical evaluation by one of us (RRF). Group A—Patients With No Demonstrable Organic Cause for Infertility.— Minimal criteria included two years without contraceptives, normal pelvic findings, Rubin test, hysterosalpingogram, endometrial biopsy, and pertinent blood studies on the patient, as well as a normal sperm count from the husband. In addition, most of

The clinical behavior of the newly born. I. The term baby.

Detailed repeated observations were made upon 61 normal infants during the first 6 hours of life. Data were collected regarding general activity, autonomic activity, pulse rate, and respiratory rate. The average activity was determined, but wide fluctuations in these parameters were noted in these normal infants. The results are discussed in relation to the infants recovery from the birth process.

Sperm agglutinins and human infertility: female.

487 patients were assigned to 1 of 5 categories based on history and clinical evaluation: group A (patients conforming to the criteria established by the American Fertility Society); Group B (patients with organic causes for infertility and who served as controls); Group C (patients of known fertility); Group D (patients of unknown fertility); and Group E (patients with secondary fertility). The patients serum was tested for sperm-agglutinating activity against ejaculate from her husband and against ejaculates from at least 3 other men. To determine the role of repeated vaginal deposition of semen in the maintenance of sperm-agglutinating antibody titers 29 couples were asked to use condoms alone or to abstain from intercourse for periods up to 1 year. In all 29 women antibody titers dropped; the titers declined to nondetectable levels in 25. Of the 29 patients 4 patients maintained circulating antibody levels even after 1 year of occlusive therapy. Of the 25 patients with nondetectable antibodies 20 became pregnant at resumption of intercourse. 3 patients were regarded as failures and 2 patients were lost to follow-up. A variety of different antibodies were found in the females including sperm-immobilizing antibodies and precipitins against components of the seminal plasma. Adsorption of various dilutions with seminal plasma did not significantly affect sperm-agglutinating titer. The findings suggest that circulating sperm-agglutinating antibody may be just a reflection of the immunologic process involved rather than the cause for the state of infertility.

The effects of clomiphene citrate on the endometrium

Abstract Our experience with clomiphene citrate has been presented. Four categories of patients were investigated. The results with the patients in Groups I and II show that this drug is a promising one for the induction of ovulation. In patients with postmenopausal endometrial hyperplasia, some regression can be anticipated. The role of this drug in the management of endometrial carcinoma cannot be clearly defined at the present time.

Asymptomatic bacteriuria of pregnancy and detection by a simple stain

T H E myriads of amber, fluid-containing flasks of the prenatal clinics at Jefferson Davis City-County Hospital and the charity hospital of Houston and Harris County assumed greater importance after the report of Kass’ in 1956. His report initiated a series of studies of the detection and significance of asymptomatic bacteriuria of pregnancy. Asymptomatic bacilluria has been associated with subsequent pyelonephritis and prematurity by Kass,le4 with premature infant deaths by Taylor and Walker,5 and with increased infection of infants by Zilliacus and Totterman.G Kaitz and Hodde? found it to be less frequent and of less consequence in the higher socioeconomic groups of Boston, and Turck8 found that charity and Negro patients had asymptomatic bacteriuria more frequently than did private patients in Seattle. All reports indicate that multiparas had a greater incidence that did primiparas. Turner,s in Scotland, found it was not necessary to wash the labia for the midstream voided specimen if examination was done in 3 hours or less. Pre-eclampsia and vascular renal problems have been loosely associated 1% 11, 16 Table I is a summary of the major recent reports of detection of asymptomatic bac-

The outpatient management of incomplete abortion

Abstract 1. The records were reviewed on 507 patients with incomplete abortion who were managed on an outpatient basis in the hospital emergency room. Two hundred and ninety-three of the patients were classified as having noninfected incomplete abortions and 215 as having infected incomplete abortions. 2. It was necessary to hospitalize 16 patients directly from the emergency room after curettage. Ten women were admitted because of persistent temperature elevation following treatment. 3. Fourteen patients had subsequent complications which were managed without difficulty and which required hospitalization in 4 cases. 4. There were no deaths or cases of septic shock in this series.

Vaginal cytology for prediction of onset of labor

Abstract An evaluation of the vaginal cytologic changes occurring during the last 6 weeks of gestation was carried out in 355 pregnant women. Cytologic changes in the vaginal smears that would indicate approaching labor or the likelihood of successful induction of labor do not occur regularly at the end of pregnancy. The gradual changes in and the variations of smear patterns make the prediction of the onset of labor quite difficult. These findings are at variance with those reported by others. Vaginal cytology as a tool in predicting the onset of labor appears to be of little practical value.

Diagnosis and management of individuals with hermaphroditic external genitals.

Abstract An operative procedure is presented for revision of the external genitals of individuals with hermaphroditic external genitals when the gender selected is female and the infant has large labioscrotal folds. The selection of gender for infants born with ambiguous external genitals can and should be made within 3 to 5 days after birth. Female pseudohermaphrodites have normal female internal genitals and should be raised as females. Male pseudohermaphrodites and true hermaphrodites may be raised as either males or females and this decision is dependent entirely on the appearance of the external genitals. Surgical procedures are performed on these infants between the ages of 18 months and 2 years.

IS PRENATAL CARE BENEFICIAL OR NECESSARY

There has never been any doubt about the efficacy of prenatal care insofar as the fetus and the mother are concerned. What is needed is education of the public to its need.