[Technical aspects of intrauterine contraception in difficult cases].
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Biomedical subjects
Publications and source records attributed to A J Audebert.
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The treatment of unexplained sterility is a gamble, since by definition it is sterility in which investigation does not show any abnormality in the couple. Sterility cannot be regarded as "unexplained" until after an investigation of which the author describes the progression from the simplest to the most complicated. Uncertainties, paradoxes and controversies will still trouble the unexplained sterilities, within the limits of our means of investigation, for a long time to come.
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Artificial insemination with donor semen (AID) frozen in 0.25-ml straws yielded an overall pregnancy rate of 64% in a series of 131 patients. The pregnancy rate was significantly higher in patients whose husbands were azoospermic (70%) than in women whose husbands were severely subfertile (48.8%) (P less than 0.02). Equivalent ages of patients as well as donor distribution between both groups were confirmed. This study brings evidence that patients turning to AID because of severe male subfertility represent a selected hypofertile population, from which the highly fertile females have disappeared through previous spontaneous conception.
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The form of sterility which is called "unexplained" is an entity which acquires various definitions as our knowledge and means of exploration gradually progress. At the moment, the frequency of this type of sterility if of about 10% of cases, but this figure should decrease in the future with the discovery of new causes of infertility. The laparoscopy reveals a lesion in about 50% of cases and is followed in several cases by a spontaneous pregnancy within six months; several recent discoveries have emphasized the importance of the role played by the peritoneal liquid and of the spatial relationship between the tube and the ovary.
Clomiphene citrate, 50 mg/day, was administered to 105 patients with idiopathic azoospermia or oligoasthenospermia. Plasma FSH, LH, testosterone, and in a few cases estradiol were evaluated on day 0 and day 15 of therapy. Twelve other patients with no treatment were assayed in the same way. Statistical analysis demonstrated that, as a group, the infertile male population responds normally to clomiphene administration. On the other hand, three types of individual responses were recorded: complete positive response, dissociated positive response, and negative response. Sixty-nine patients were randomly selected for clomiphene therapy, 50 mg/day for 100 days; however, of 54 who completed the treatment schedule, only 11 showed elevated sperm counts. A study of correlations between hormonal and semen responses to clomiphene indicates that a complete or dissociated endocrine response is not an accurate predictor of possible semen amelioration on long-term therapy; on the other hand, sperm characteristics did not improve in those patients who did not demonstrate a positive hormonal response, mainly testosterone, on the 15th day of therapy.
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