Z.M. van der Spuy

Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment

BACKGROUND Recent years have seen a growing interest in the impact of infertility on reproductive health in developing countries. Most of the research which has addressed the psychosocial consequences of infertility in African countries has been qualitative in nature and focused on women. It was the aim of this study to assess psychological distress quantitatively in men suffering from couple infertility living in an urban community in South Africa. METHODS The Symptom Checklist-90-R, a standardized instrument for the measurement of current psychological symptom status, was administered to 120 men upon first presentation to a public health sector infertility clinic (study group) in a tertiary referral centre. The control group comprised 120 men who attended an antenatal clinic with their partner. All men may have previously fathered a child. Raw test scores were converted into standard area T scores and analyzed further. RESULTS Participants in the study group differed in their psychological symptom status when compared with controls. Male partners of infertile couples had significantly elevated mean T scores for all nine primary symptom dimensions as well as the three global markers of distress (P < 0.0001 versus control), but these did not exceed the upper range of normal. CONCLUSIONS When compared with controls, male partners of infertile couples experienced elevated levels of psychological distress, but without, on average, suffering from psychopathology. A comparison with qualitative studies from African countries and with quantitative studies from the Western industrialized world revealed both similarities and differences. Understanding and addressing the male perspective of infertility is an important component of infertility management.

Gonadotropin and estradiol secretion during the week of placebo therapy in oral contraceptive pill users

The changes in the hypothalamic-pituitary-ovarian axis during the placebo week in oral contraceptive pill users were assessed. Fifteen women using the combined oral contraceptive pill were studied for eight hours at the start and at the end of the placebo week and gonadotropin secretion and estradiol concentrations were compared with those in control women in the follicular phase of an unmedicated menstrual cycle. Both gonadotropin and estradiol concentrations were suppressed at the start of the placebo week. By day 7 of placebo, gonadotropin concentrations and pulse patterns were indistinguishable from those of the control subjects although estradiol concentrations were still significantly lower.

GONADOTROPHIN CONTROL OF FOLLICULAR DEVELOPMENT

In order to investigate the endocrine requirements for induction of follicle maturation, ovulation and luteal function we have measured plasma LH and FSH concentrations in 109 cycles induced by treatment with LHRH in 25 women with amenorrhoea of diverse aetiology. The major clinical and endocrine subgroupings were polycystic ovarian disease (PCO), Kallmanns syndrome, weight related amenorrhoea and hyperprolactinaemia. By analysis of variance of the LH and FSH concentrations obtained three times per week in the follicular phase in 77 ovulatory cycles (including 24 conception cycles), we found that in women with PCO the mean LH concentration was 19·5 IU/1. In hyperprolactinaemia and secondary amenorrhoea of non‐specific aetiology the mean LH concentration was 11·6 IU/1 and in patients with hypogonadotrophic hypogonadism and weight‐related amenorrhoea it was 7·2 IU/1. These mean LH concentrations were significantly different from each other (P < 0·001). We speculate that the high LH concentrations in the follicular phase may impair the final stages of oocyte maturation and so contribute to the infertility of these patients. FSH concentrations in the follicular phase were lower in patients with hypogonadotrophic hypogonadism and weight‐related amenorrhoea than in other groups. Although the differences were statistically significant (P < 0·001) the difference was small (mean FSH in hypogonadotrophic hypogonadism and weight‐related amenorrhoea 4·3 IU/1 vs 6·3 IU/1 in the others) and of uncertain biological significance. During the luteal phase, no differences between any of the groups in LH and FSH concentrations were found.

Morphine Suppresses the Oxytocin Response in Breast-Feeding Women

The activity of opiate-mediated regulatory mechanisms of oxytocin secretion during breast-feeding was studied by the administration of either morphine, naloxone or placebo to women prior to the commencement of breast-feeding. Seventeen healthy women in the first week after delivery who had established lactation were ramdomized to receive either intravenous morphine 5 mg (n = 6), naloxone 2.4 mg (n = 6) or a placebo, sterile water (n = 5), which was given prior to commencement of breast-feeding. Oxytocin levels were measured by radioimmunoassay prior to initiation of breast-feeding and then at 2-min intervals until the feed was complete. Breast-feeding produced a significant rise in oxytocin levels in the control and naloxone groups but no significant rise in the patients given morphine. There was a significant reduction in oxytocin response following morphine administration when compared to placebo but not between naloxone and placebo. In conclusion, oxytocin secretion to breast-feeding is inhibited by exogenous morphine when compared to a control group but the administration of naloxone did not produce a significant difference from control.

Ovarian morphology as a predictor of hormonal values in polycystic ovary syndrome

The objective of this investigation was to correlate the severity of ultrasound abnormality in the ovaries of women suspected of having the polycystic ovary syndrome (PCOS) with their endocrinopathy in an attempt to establish which anatomical abnormalities best predict endocrine dysfunction.

A comparison of maternal calcium and magnesium levels in pre-eclamptic and normotensive pregnancies: an observational case-control study.

Supplementing pregnant women at high risk of developing pre‐eclampsia with calcium may reduce the incidence of the disease. This study examines differences in serum and hair concentrations of calcium and magnesium between women with pre‐eclamptic and normotensive pregnancies.

The short-term use of luteinising hormone-releasing hormone analogues in uterine fibroids.

Twelve patients with uterine fibroids, who were due to undergo myomectomy, were treated preoperatively with the luteinising hormone-releasing hormone analogue, Zoladex. This resulted in a marked reduction in uterine and fibroid volume and surgery was facilitated.

LABOR EXPERIENCE AND BETA-ENDORPHIN LEVELS

As part of a randomized controlled trial of labor companionship [ 1) we measured beta-endorphin levels in a subgroup of 140 women at enrolment and 1 h later. All women were low risk primigravidas in established labor, with cervices less than 6 cm dilated. Participants were allocated by randomized, sealed envelopes to a control group, who received routine care, and a support group, who in addition were accompanied for the rest of the labor by a labor companion [ 11. The objectives were to investigate whether labor companionship had any measurable effect on betaendorphin levels within a l-h time frame and the correlation of various psychological and clinical labor parameters with the hormone levels. At enrolment, baseline clinical details were recorded and subjective assessment of maternal distress made. After delivery a questionnaire on the women’s labor experience and psychological tests (state anxiety, self esteem, McGill pain rating index, depression at 6 weeks) were given on day 1 and at 6 weeks. Beta-endorphin measurements were performed by radioimmunoassay. The groups had similar median beta-endorphin concentrations at enrolment and after 1 h (Table l).As there were no significant differences between the two groups, their results were combined in the subsequent analyses. Beta-endorphin levels were significantly higher in women with ruptured membranes (median [range] 92.5 [28.1-156.81 vs. 74.7 [21.7-134.31, P = 0.004), those who required higher doses of analgesia (96.8 [27.8-120.41 vs. 71.9 [50-144.41, P = 0.006) and as the level of distress increased (50 [28.1-71.91, 73.8 [42.8-134.31, 95.2 [21.7-144.41, 86.2 (54.1-156.81, P= 0.01). There were no correlations with self-esteem, state anxiety, pain rating index, breastfeeding duration and postpartum depression scores. l Corresponding author, Department of Obstetrics and Gynaecology, Coronation/JG Strijdom Hospitals, Private Bag X 47, Auckland Park 2006, Tel.: +27 11 4890762; Fax: +27 11 4890763; Email: 09lHOFM@ChlRON.WITS.AC.ZA

Early Clinical Studies with LHRH Antagonists in Women

Over the past few years LHRH agonist analogs have been increasingly used to down-regulate. the pituitary and induce a state of hypogonadotropic hypogonadism. This form of endocrine manipulation has now become a feasible therapy option in a wide range of hormone-dependent diseases [1,2,3].

The effect on contraceptive use and pregnancy rates (postpartum) of giving expert contraceptive counseling in the antenatal clinic

Objectives: A Phase II study is ongoing to evaluate the ability of STOP device to safely and effectively prevent pregnancy in women who are seeking permanent contraception. The STOP procedure obviates the need for incisional surgery and general anesthesia. Study Methods: 88 women have been enrolled for transcervical tubal placement of the STOP device. The STOP device (Conceptus, Inc.) is a dynamic, micro-coil that is hysteroscopically inserted into the fallopian tube at a reduced diameter and expands upon deployment to the fallopian tube lemen. The mechanism of action is a combination of the space filling design of the STOP device and a local, benign tissue response to polyester fibers. Results: Bilateral device placement was achieved in 76188 patients (86%). Average procedure time was 22 minutes. Patient tolerance of the device placement procedure was rated as good to excellent in 91% of cases. Patient tolerance to wearing the devices has been rated as very good to excellent in 100% of cases. HSG performed at the three-month follow-up visit demonstrated occlusion in 100% of patients with devices placed in tubes. Device-related adverse events have been reported in 6% of cases with no clinical sequelae reported to date. There are 302 woman months of wearing and 97 woman months of effectiveness with no reports of pregnancies to date. Conclusions: Preliminary date indicate that the STOP device may be a safe and effective alternative for permanent contraception. A pivotal trial is planned to commence in the first half of 2000.