Timothy C. Rowe

Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study.

Among 2,106 couples registered in 12 Canadian infertility clinics, 470 (22.3%) were classed as unexplained infertility after a uniform evaluation of the male ejaculate, ovulation, and tubal patency. The unexplained group included more older female partners; 44% were over 30 years of age at registration in the participating clinics, compared with 36% in other infertility diagnostic groups. The mean duration of infertility was 40.1 months, and the cumulative pregnancy rate was 36.6 +/- 2.9% at 2 years after registration. When the variables were examined with the use of proportional hazards analysis, each additional month of duration of infertility reduced the expected prognosis by 2%, and a history of pregnancy in the partnership improved the prognosis by 80%. Among couples with 3 years or more duration of infertility (cumulative pregnancy rate, 27.5 +/- 3.9%), an additional year in the age of the female partner when conception was first attempted (mean, 26.8 years) reduces the prognosis by 9%.

Salpingitis isthmica nodosa: evidence it is a progressive disease.

Une etude hysterosalpingographique recente est necessaire pour detecter levolution de la salpingite isthmique moneuse

An extended 10-day course of clomiphene citrate (CC) in women with CC-resistant ovulatory disorders *

Objective To evaluate the effectiveness of extended duration clomiphene citrate (CC) (100mg for 10days) as an alternative to complex ovulation induction strategies for women who fail to ovulate despite standard incremental doses of CC of ≥150mg for 5days. Design Retrospective case series. Setting University-based infertility practice. Patient(s) Thirty women with CC-resistant World Health Organization group II ovulatory disorders. Intervention(s) At least one cycle of 100mg CC from days 3 to 12. Result(s) Fourteen patients (47%) ovulated during 31 of their 48cycles (65%). Five women (17%) conceived a total of seven singleton pregnancies, including five term deliveries and two spontaneous abortions. Weight, body mass index, and the presence of hyperandrogenism did not predict responsiveness to the extended duration CC. Side effects were similar to those reported during standard CC treatment. Conclusion(s) An extended 10-day course of CC provides a simple, noninvasive, and inexpensive alternative for a subset of women with ovulatory disorders that are refractory to standard CC treatment.

Comparison of the outcome of ovulation induction therapy in an in vitro fertilization program employing a low-dose and an individually adjusted high-dose schedule of human menopausal gonadotropins

A low-dose nonsuperovulation scheme of ovulation induction (schedule 1: 15 treatment cycles in 13 women) was compared to a high-dose, individually adjusted controlled-superovulation scheme of human menopausal gonadotropin administration (schedule 2: 18 treatment cycles in 17 women, with four women also having been treated under schedule 1). In schedule 2 more human menopausal gonadotropin was employed, 17 beta-estradiol plasma levels were higher, and more ova were retrieved per treatment cycle (p less than 0.01) with a higher rate of mature ova (p = 0.001). Also, under this schedule all treatment cycles resulted in successful retrieval of ova, whereas under schedule 1, four cycles (27%) were abandoned before laparoscopy because the follicles had ovulated (p = 0.03). Furthermore, the proportion of embryos cleaving to the two- to four-cell stage were higher under schedule 2 (38 of 53, or 72%) as compared to schedule 1 (13 of 25, or 52%), but this was not statistically significant (p = 0.07). Two pregnancies were conceived under schedule 2 giving a rate of 11% per treatment cycle. It was concluded that schedule 2, the individually adjusted controlled-superovulation scheme of human menopausal gonadotropin administration, was the superior technique of ovulation induction in an in vitro fertilization program.

The action of clomiphene in stress-induced amenorrhea

Seven women with stress-induced amenorrhea were challenged with metoclopramide, 10 mg intravenously, before and at the end of a course of clomiphene. Initial testing with luteinizing hormone releasing hormone demonstrated that all subjects had the capacity to release luteinizing hormone (LH), but in response to metoclopramide there was no increase in the levels of LH. This lack of response did not change after 5 days of clomiphene, although basal levels of LH and estradiol increased significantly. The pattern of response of prolactin to metoclopramide did not change after clomiphene. These results suggest that there is no significant dopamine-mediated inhibition of release of luteinizing hormone releasing hormone in women with stress-induced amenorrhea. The administration of clomiphene to these women does not appear primarily to alter hypothalamic dopaminergic activity.

An Extended 10-Day Course of Clomiphene Citrate (CC) in Women With CC-Resistant Ovulatory Disorders

OBJECTIVEnTo evaluate the effectiveness of extended duration clomiphene citrate (CC) (100 mg for 10 days) as an alternative to complex ovulation induction strategies for women who fail to ovulate despite standard incremental doses of CC of > or = 150 mg for 5 days.nnnDESIGNnRetrospective case series.nnnSETTINGnUniversity-based infertility practice.nnnPATIENT(S)nThirty women with CC-resistant World Health Organization group II ovulatory disorders.nnnINTERVENTION(S)nAt least one cycle of 100 mg CC from days 3 to 12.nnnRESULT(S)nFourteen patients (47%) ovulated during 31 of their 48 cycles (65%). Five women (17%) conceived a total of seven singleton pregnancies, including five term deliveries and two spontaneous abortions. Weight, body mass index, and the presence of hyperandrogenism did not predict responsiveness to the extended duration CC. Side effects were similar to those reported during standard CC treatment.nnnCONCLUSION(S)nAn extended 10-day course of CC provides a simple, noninvasive, and inexpensive alternative for a subset of women with ovulatory disorders that are refractory to standard CC treatment.