Search PubMed⌕ Search

Biomedical subjects

M G Hull

Publications and source records attributed to M G Hull.

At least 91 records · Page 5Linked to original sources
PubMed1990

Chlamydia trachomatis, tubal disease and the incidence of symptomatic and asymptomatic infection following hysterosalpingography.

The risk of causing or reactivating pelvic infection by hysterosalpingography (HSG) was assessed in 118 infertile women. Serological evidence of Chlamydia trachomatis infection was sought before, and 10 days and 4 weeks after HSG, using the single-antigen whole-inclusion immunofluorescence (WIF) test for species-specific antibody and the complement fixation test (CFT) for group antibody. Chlamydia antigen was detected using an ELISA. There was a close correlation between the finding of occlusive tubal damage and serum antibodies to C.trachomatis detected by both tests (P less than 0.001). Of 60 patients with WIF antibody titres greater than or equal to 1/64, 65% had evident tubal damage compared with only 16% of patients without a raised titre. Clinically suspected sepsis after HSG occurred in 4% of cases both with and without antibodies to C.trachomatis but only in those with tubal damage (10%). There was no serological evidence of C.trachomatis involvement in symptomatic or asymptomatic patients and anaerobic pathogens were isolated more commonly than C.trachomatis in those symptomatic cases. Isolation of C.trachomatis in two cases from the endocervix and also from the endometrium in one of these only after HSG was compatible with reactivation but not reinfection. Mycobacterium tuberculosis was isolated in two out of three cases with unsuspected tubal disease without antibodies to C.trachomatis. The risk of infection from HSG appears to be confined to patients with existing tubal damage, and in those unexpected cases without serological evidence of previous chlamydial infection, tuberculosis seems to be a likely cause.

Chlamydia Infections↗
PubMed1990

A comparison of the freezing of human semen in the uncirculated vapour above liquid nitrogen and in a commercial semi-programmable freezer.

The cooling rates inside 0.25-ml semen straws filled with glycerol, egg yolk, citrate buffer were compared between a standard vapour freezing procedure and freezing in a Nicool LM-10 semi-programmable freezer. During vapour freezing, the cooling rate at the bottom of the straw was much faster than at the top and there was considerable variation between replicates. By contrast, position within the straw did not affect the cooling rate in the Nicool LM-10 procedure and replicates were more consistent. More motile spermatozoa survived the Nicool freezing procedure and their lateral head displacement was greater than vapour frozen spermatozoa. However the percentage of intact spermatozoa and their velocity was very similar after the two procedures. We conclude that the freezing procedure using the Nicool LM-10 provides a comparatively economical way to achieve consistent semen freezing for research studies.

Cell Membrane↗
PubMed1990

Effect of caffeine and of pentoxifylline on the motility and metabolism of human spermatozoa.

Human spermatozoa were washed and incubated with 6 mM-caffeine or 0.15-1.2 mM-pentoxifylline. Sperm motility was measured by time-lapse photography, the rate of glycolysis by the release of tritiated water from 1 mM-[3-3H]D-glucose and the rate of mitochondrial respiration by the release of 14CO2 from 1 mM-[U-14C]-L-lactate or 1 mM-[2-14C]pyruvate. Caffeine stimulated the majority of spermatozoa to convert from the 'rolling' to the 'yawing' mode of progression with a concomitant increase in lateral head displacement from 4.1 +/- 0.09 microns (343) to 6.7 +/- 0.25 microns (105) (mean +/- s.e.m. (number of spermatozoa)). There was a 45% decline in the percentage of progressively motile spermatozoa and a very small decrease in their velocity. Pentoxifylline had only a slight effect on lateral head displacement or percentage motility but produced a significant increase in velocity. Both compounds increased the rate of glycolysis by greater than 40% but elevated the rate of 14CO2 production to a smaller extent. The concentrations of ATP and ADP changed very little. We conclude that the glycolytic pathway in human spermatozoa can respond efficiently to changes in energy demand.

Adenosine Diphosphate↗
PubMed1990

Clomiphene treatment for women with unexplained infertility: placebo-controlled study of hormonal responses and conception rates.

One hundred and eighteen patients with unexplained infertility were treated with clomiphene (Clomid, Merrell) in a randomized placebo-controlled cross-over study lasting up to 3 months with each preparation. Compared with placebo, clomiphene led overall to a 66% increase in mid-luteal serum progesterone levels (from mean 43 nmol/l to 71 nmol/l, p less than 0.001) and a 53% rise in the 3-month cumulative conception rate (from 14.6% to 22.33%, p less than 0.05). The greatest relative increase in conception rates with clomiphene was in women with infertility lasting more than 3 years (3-month rates from 2.9% to 14.4%, p less than 0.05). Differences in conception rates were not related to the rises in progesterone, and there was no carryover effect of clomiphene into the following placebo cycles in terms of progesterone levels or conceptions. The findings suggest that couples with unexplained infertility of less than 3 years duration are essentially normal, but with more than 3 years duration there is often a subtle disorder of ovulation that is corrected by clomiphene therapy.

Adult↗
PubMed1989

Effect of bladder filling on embryo transfer.

We have investigated a claim that bladder filling, by straightening an anteverted uterus into line with the vagina, might facilitate embryo transfer through the cervix after in vitro fertilization. In a randomized controlled trail in 66 women with and 76 without a filled bladder, we found no significant differences in difficulties encountered at embryo transfer or in the chance of pregnancy.

Adult↗
PubMed1988

Luteal deficiency not a persistent cause of infertility.

A mid-luteal serum progesterone measurement was made in 579 cycles from 159 infertile women with unexplained infertility and the results compared with those in 267 cycles from 58 normal controls. There were no significant differences between the two groups in terms of mean progesterone values (41 versus 44 nmol/l); incidence of defective cycles (progesterone less than 28 nmol/l: 17 versus 15%) or severely defective cycles (progesterone less than 14 nmol/l: 4 versus 3%); incidence of a clinical diagnosis of luteal deficiency (LD) (at least two out of three cycles defective: 13 versus 12%); or incidence of persistent LD (continuing into a second series of two to three cycles: 1.7 versus 4.9%). There were no differences related to age, previous pregnancy or duration of infertility. These findings suggest that defective cycles occur as a random phenomenon in infertility and no more often than in normal women, and a diagnosis of LD implying a persistent condition to explain prolonged infertility in women with normal menstrual cycles must be a rare entity and requires at least six cycles of investigation (or none!) before treatment is considered.

Epidemiologic Methods↗
PubMed1988

An evaluation of the role of relaxin in the penetration of cervical mucus by spermatozoa.

Relaxin-like immunoreactivity was measured in seminal plasma from men who were separated into two groups, on the basis of a previous positive or negative result in a postcoital cervical mucus penetration test. There was no difference in the relaxin concentration between the groups. The effect of exogenous porcine relaxin (0, 10 or 100 ng/ml) on human cervical mucus penetration in vitro by washed human spermatozoa was studied using a capillary tube preparation. In the positive postcoital test group the highest relaxin concentration (100 ng/ml) tended to inhibit cervical mucus penetration, although this effect was only significant for one of the parameters measured (number of spermatozoa penetrating to the 10-mm mark). The same trend was apparent for the negative postcoital test group, but no differences were significant. The results are in direct contrast to previous reports that relaxin can stimulate human spermatozoa motility and cervical mucus penetration.

Cervix Mucus↗
PubMed1987

Tubo-cornual polyps: their relevance in subfertility.

One-hundred-and-seventy-four patients having hysterosalpingographs during the investigation of infertility have been reviewed to assess the incidence of tubo-cornual polyps and their relation to subsequent pregnancy. Definite polyps were present in 31 (18%) of the patients. There was no significant difference in age or parity in women with and without polyps, nor in associated infertility factors such as tubal occlusion or oligospermia. None of the patients with polyps had endometriosis. Conception rates in the two groups were not significantly different. The cumulative rates at 18 months with and without polyps were 34.5 +/- 13.7% (SE) and 43.6% +/- 3.9% respectively in the overall groups, and 36.9% +/- 24.1% and 59.0% +/- 9.1% in the couples with otherwise unexplained infertility. It is concluded that tubo-cornual polyps are not related to infertility and that they should not be treated.

Adult↗
PubMed1987

The diagnosis of male infertility--prospective time-specific study of conception rates related to seminal analysis and post-coital sperm-mucus penetration and survival in otherwise unexplained infertility.

Infertile women without any inherent female infertility factors and able to secrete normal cervical mucus were studied prospectively in relation to post-coital sperm-mucus penetration (PCT) and their partner's seminal analysis, excluding men with azoospermia. Time-specific cumulative conception rates calculated as for life-table analysis were related to each measured seminal variable on routine analysis of 2-3 samples (volume, density, proportion with progressive motility, and proportion with normal morphology); to various derivatives from combinations of these variables; to seminal findings after vital staining; and to the PCT results. The best seminal predictor of fertility was the motile normal sperm density (MNSD), the 18 month conception rates being 57.4% +/- 4.6 (SE) and 30.2% +/- 5.9 (ratio 1.9, P less than 0.001) above and below a derived threshold value of 4 x 10(6)/ml. The PCT led to rates of 55.6% +/- 4.3 and 14.9% +/- 5.1 (ratio 3.73, P less than 0.001) for positive and negative results, respectively. The PCT also gave rise to a significantly distinct intermediate poor-positive sub-group (conception rate 30.6% +/- 9.0). Seminal analysis (the MNSD) did not affect the conception rate associated with a positive PCT but helped to discriminate further with a negative PCT (conception rates 22.5% +/- 8.7 with an MNSD above 4 x 10(6)/ml versus 5.6% +/- 4.8 below, P less than 0.05). The PCT was the single best predictor of fertility but seminal analysis (the MNSD) was of additional value after a negative PCT.

Cervix Mucus↗
PubMed1987

The sperm-mucus interface: patterns of disorder in the diagnosis of specific causes of penetration failure causing infertility.

In 94 infertile couples with negative postcoital tests (PCTs) the results of an in-vitro sperm-mucus invasion test (SMIT) were compared with seminal analysis (excluding sperm density less than 1 x 10(6)/ml) and agglutination assays for antisperm antibodies in semen (MAR, TAT) and in mucus (TAT). Abnormalities at the sperm-mucus interface were classed into three types. (i) Failure to form semen clefts and of spermatozoa to colonize the clefts was closely correlated with oligo-asthenoteratozoospermia, and vice versa, the two tests agreeing in 90% of cases (P less than 0.001). Most of the discrepancies, in which sperm-dense clefts developed despite low sperm counts, were due to antisperm antibodies in semen. (ii) Failure of spermatozoa to invade mucus, despite normal sperm colonization of clefts, was closely correlated with the presence of antisperm antibodies in semen (positive MAR or TAT), and vice versa, the tests agreeing in 81% of cases (P less than 0.001). (iii) Failure of sperm survival after normal invasion of mucus could not be correlated significantly with the TAT results on mucus, but more extensive study of this question is needed. Finally a normal SMIT result was associated with a significantly improved chance of conception (39 versus 10% at 12 months), particularly with artificial insemination, suggesting undisclosed coital failure as the cause of the negative PCT. In conclusion, the invasion test, when assessed in the foregoing detail, offers a reliable and simple substitute for laboratory assessment of both seminal quality and the presence of antisperm antibodies in semen, and would be applicable in general infertility practice everywhere.

Autoantibodies↗
PubMed1987

Pain after laparoscopy related to posture and ring versus clip sterilization.

In an attempt to reduce pain after laparoscopy, presumed to be due to persistence of CO2 in the peritoneal cavity especially under the diaphragm, women were kept 30 degrees head down for 30 min immediately after operation. By random selection 67 treated patients were compared with 64 kept flat, postoperative symptoms being recorded at fixed times for 3 days. Although tilting was found to be of no significant benefit there were two useful findings. In both groups there was a significant fall in the frequency of upper abdominal pain during the first postoperative night from about 53% to about 25%, followed by a rise after returning home on the first postoperative day to about 60% and only a slow fall in the next 2 days. The severity of pain followed the same pattern. Patients should be warned to expect increased pain on ambulation after leaving hospital. Also, there was doubling in lower abdominal pain during the first 6 h associated with the use of Falope rings for sterilization, compared with either Hulka clip sterilization or only diagnostic laparoscopy.

Female↗
PubMed1987

Abdominal pain after laparoscopy: the value of a gas drain.

In an attempt to reduce pain after laparoscopy, a drain was left for 6 h in the peritoneal cavity through the umbilical incision to take advantage of visceral peristaltic and voluntary muscle movements to expel residual gas. In a randomized study 25 treated patients were compared with 28 controls. Use of the drain was found to approximately halve the frequency of pain throughout the first 2 postoperative days. The severity of pain was also significantly reduced in the first 6 h and after mobilization at home the next day when pain is usually at its worst.

Abdomen↗
PubMed1987

Prolactin measurement in the investigation of infertility in women with a normal menstrual cycle.

Basal serum prolactin concentrations were compared with mid-luteal serum progesterone concentrations and prospectively studied conception rates up to 12 months in women with otherwise unexplained infertility including a normal menstrual cycle. There were altogether 188 women with mean prolactin levels up to 3075 mU/l: 47 with prolactin up to 200 mU/l, 100 with prolactin 201-400 mU/l, 18 up to 600 mU/l, 16 up to 800 mU/l, and 7 greater than 800 mU/l. There were no significant differences in the mean progesterone values or chance of conception between any of the groups. The findings indicate that prolactin measurement is generally of no value in normally menstruating women, except possibly in the unusual event of evidence of persistent distinct luteal deficiency (not found in the present study).

Adolescent↗
PubMed1987

The value of artificial insemination with husband's semen in infertility due to failure of postcoital sperm-mucus penetration--controlled trial of treatment.

Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density less than 1 x 10(6)/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4.7 (SE 3.8)% and without treatment was 6.6 (SE 3.9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.

Cervix Mucus↗
PubMed1987

Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies.

The frequency of polycystic ovarian disease (PCOD) as a cause of oligo-amenorrhea and infertility was determined, first by characterizing clinically occult PCOD using endocrinological methods, and secondly by estimating the frequency of overt and occult PCOD amongst infertile women residing in a particular area. Four groups of infertile women with oligo-amenorrhea due to 'functional' disorder were compared. The results show that by contrast with the groups having hyperprolactinemia or hypothalamic disorder the group with hirsutism (and therefore presumed PCOD) was closely resembled by a non-hirsute group in terms of estrogenization, LH level, LH/FSH ratio, prolactin level, body mass and responsiveness to clomiphene. The last group was therefore concluded to have a mild occult form of PCOD. The population studies revealed, first, that overt and occult PCOD accounted for 90% of patients with oligomenorrhea and 37% with amenorrhea, or 73% with oligo- or amenorrhea. Oligo- or amenorrhea accounted for 21% of couples with infertility and the annual incidence was 247 patients per million of the general population. The annual incidence of infertility due to PCOD per million was 41 with overt PCOD and 139 with occult PCOD (total 180). Of those, 140 appeared to respond well to clomiphene (78%) but 40 (22%) failed, requiring alternative therapy.

Clomiphene↗