Stanley Friedman

Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery

At second-look laparoscopy, 82 of 161 women (51%) were noted to have adhesions at at least one new location. Such adhesions occurred at 31% of available sites. Among 121 women with adhesions at the initial operative procedure, the rate and type of recurrence assessed on the ovaries, fimbriae, and other sites were independent of the initial type. Additionally, neither the rate nor the type of adhesion recurrence observed at the time of second-look laparotomy was determined by the variable amount of time between the initial and second-look operative procedures. We conclude that reproductive pelvic surgical procedures are frequently complicated not only by adhesion reformation but by de novo adhesion formation as well.

Artificial Donor Insemination with Frozen Human Semen

This study describes the experience with artificial donor insemination (AID) using frozen semen in 227 women who began therapy in 1974 and were followed until March 31, 1976. Ninety-one women (40%) conceived during this period. Sixty-five women (37.9%) failed to continue treatment after three or fewer cycles; follow-up on these patients was incomplete and it is presumed that most did not conceive. The cumulative pregnancy rate was 56.5% among women who persisted in AID for four or more cycles. Additional causes for infertility were found in 53 women. Excluding these, the pregnancy rate was 67.4% for apparently fertile women who had had four or more cycles of AID. Fifty-eight per cent of conceptions occurred within the first three cycles and eighty-five per cent within the first six cycles. The pregnancy rate was not significantly affected by age, occupation, cigarette smoking, or prior fertility. The large number of dropouts after a few cycles of AID suggests a need for intensive and continuous educational, emotional, and psychologic support.

Micromanipulation in a center for reproductive medicine

Several variations of micromanipulation of the female gamete (zona drilling, zona cracking, ooplasmic sperm injection, partial zona dissection) have been applied recently to human IVF to overcome severe male factor. Of the first 16 cycles attempted using partial zona dissection, one pregnancy resulted leading to a normal term delivery. Careful removal of the coronal cells, as well as stepwise removal of sucrose postpartial zona dissection, will facilitate this procedure and greatly reduce potential damage to the oocyte by pH, mechanical, or thermal injury. Micromanipulation has become a routine service offered in our program in cases where the likelihood of a poor IVF outcome is either known or suspected, and also serves as a replacement for simple reinsemination in cases of failed fertilization.

Clinical Use of Human Semen after Long-Term Storage

The single pregnancy, following insemination of human semen which had been frozen and stored for 10 years, is often cited to indicate that such long-term storage is efficacious. To my knowledge, however, there is no published data concerning the clinical and practical aspects of long-term storage of human sperm. With an anticipated proliferation of semen banks, and an anticipated increase in the number of men having vasectomies, it is important to gather whatever information is currently available about long-term storage of human semen. With this information, some predictions may be made about the clinical usefulness of this technic, problems attendant to it may be identified, and avenues of research to ameliorate such problems may be suggested.

Artificial Insemination with Donor Semen Mixed with Semen of the Infertile Husband

Mixing an oligoasthenospermic husbands semen with that of a donor prior to insemination (AIM) has been criticized, since such semen may contain antibodies which could interfere with normal sperm function. The efficacy of AIM was reviewed in 227 patients who underwent AI with frozen donor semen. Thirty-four patients requested AIM and thirteen conceived (38.2%). Seven who failed to conceive after AIM changed to donor insemination (AID), and two conceived. One hundred and ninety-three patients had AID alone, and eighty conceived. Thus, 200 patients had AID, with 82 pregnancies (41%). There were no significant differences between the AIM and AID groups with regard to age, prior fertility, and additional infertility factors. The conception rates between groups were not significantly different. Pregnancy rates per cycle of AI and dropout rates were also similar. Postinsemination testing after AIM did not reveal any effect of husbands semen upon donor spermatozoa. This study failed to show a deleterious effect of semen from azoospermic or oligoasthenospermic, infertile men upon normal semen, as used in AIM.

Artificial Insemination with Frozen Human Semen: 227 Cases

This study describes the experience of an infertility practice which maintains a frozen semen bank as its primary source of AID. Two hundred and twenty-seven women began AID between January 1st and December 31st, 1974, and the study ended March 31st, 1976. Thus, the study period covered a relatively short duration, 27 months, during which time personnel, patient and donor selection, technics and adjunctive therapy did not vary. During these 27 months, 97 patients conceived for an overall pregnancy rate of 41.9%.