Vincent G. Stenger

The treatment of endometriosis at laparoscopy for infertility

Endometriosis is found in some infertile women, and treatment by laparotomy and/or hormonal therapy is associated with subsequent pregnancy. In this study, 100 consecutive patients with mild/moderate endometriosis were treated at laparoscopy. Forty of these women achieved a pregnancy within 37 months postoperatively; 73% of these pregnancies occurred within 6 months, and 88% within 12 months of operation. Although this pregnancy rate is similar to rates obtained after treatment by laparotomy and/or hormonal therapy, the pregnancies in this study population occurred significantly earlier than after laparotomy or combined therapy. The age of the women, duration of infertility, parity, extent of endometriosis, or presence of additional treatable factors of infertility did not affect the pregnancy rate. There was no significant morbidity, and the procedure can be performed on an outpatient basis with local anesthesia. Laparoscopy offers a practicable alternative for the treatment of mild/moderate endometriosis in infertile women.

A Longitudinal Analysis of Artificial Insemination With Donor Semen

A longitudinal analysis of artificial insemination with donor semen (AID) in 114 consecutive couples revealed a 37% over-all pregnancy rate. The 45 pregnancies occurred in 39 patients, and approximately 90% of these pregnancies occurred within six cycles of AID. Pregnancy rates were higher in the age group 25 to 30, in those who received only fresh semen, and in those with a history of a previous pregnancy. Lower pregnancy rates were observed in patients age 31 or older, in those with pelvic disease, and in those randomly receiving freshly thawed semen or fresh semen. The use of a vaginal device for retaining semen, the use of patient positioning, or the duration of infertility did not appear to affect the success rate. When surgically correctable pelvic disease was treated, a pregnancy rate of 22% was obtained.

Movements of lactate and pyruvate in the pregnant uterus of the human

Abstract In most cases lactate was transferred from the uterus to the maternal circulation and from the fetus to the placenta, but these did not occur simultaneously at all times. There were several instances where the gradient across the placenta and across the uterus was in the opposite direction. No consistent transfer of pyruvate between either the uterus and the mother or the fetus and the placenta was found. The direct relationship of the lactate and pyruvate concentrations between the mother and fetus suggests a simple passive diffusion of these substances between the two circulations.

Observations on pentothal, nitrous oxide, and succinylcholine anesthesia at cesarean section

Abstract The present report concerns itself with observations made upon 26 pregnant women who were delivered by cesarean section. Anesthesia consisted of sodium pentothal, succinylcholine, and nitrous oxide. The observations that were made involved the collection of blood from the following vessels: a maternal artery before anesthesia, a maternal artery and uterine vein prior to opening of the uterus, umbilical vein and artery at delivery, umbilical artery shortly after birth, and umbilical artery at one hour of age. Analyses consisted of determinations of oxygen, carbon dioxide, pH, lactate, pyruvate, glucose, and pentothal. From the data we have collected in the mother and in newborn infants within the first hour of life, we are able to say that the levels of the various metabolites measured are at least as close to the accepted normal ranges as those found in women undergoing cesarean section and exposed to spinal, epidural, and cyclopropane anesthesia. With due reservations for the limitations of our own studies, we favor pentothal, nitrous oxide, and succinylcholine, for we avoid the hypotension induced by autonomic blockade, and we avoid the incidence of depression in the newborn (50 per cent) that is encountered in our unit when employing cyclopropane anesthesia.