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Fertility control by natural methods. Analysis of 218 cycles.

We have started to teach natural family planning (NFP) in our health centers. We have studied 218 cycles in 14 women using NFP to space or avoid pregnancies for an average of 15 months per woman. All women were taught the symptothermal method, and used temperature, mucus, calculations and cervix modifications; temperature, calculations and mucus; or mucus alone, as signs of fertility. Usually they kept track of signs of fertility in each cycle; temperature taking was frequently limited to the periovulatory period, when they noted changes in their mucus. User couples belonged to a middle-lower economic group, for whom motivation was not religious or ethical. Good information is essential in deciding to use NFP. Women who are satisfied users often inform other women. User couples easily become autonomous and acquire the required level of knowledge, abandoning methods they relied on previously. Autonomy is welcomed by these women.

Contraception↗

Monitoring of artificial insemination.

Artificial insemination (ADI) has been carried out with donor semen since 1984. Following artificial insemination 14 women out of 27 became pregnant in 1984, 30 women out of 57 in 1985 and 33 women out of 56 until October 1, 1986. The cycles were monitored. Serum LH and oestradiol levels were determined every day from the 10th day of the cycle. Follicle size was monitored daily and cervical mucus was also examined every day. LH reaches the highest level at the time of ovulation. 17-Beta-oestradiol level increases parallel with the growth of follicle. Follicular growth can be best monitored by ultrasound folliculometry, providing 50-60% effectiveness.

Female↗

Diagnosis and management of unexplained infertility: an update.

Unexplained infertility constitutes around 15% of patients presenting with infertility. A lack of agreement exists among infertility specialists with regard to the diagnostic tests to be performed and their prognostic value as well as criteria of normality. It seems that serum progesterone for detection of ovulation, hysterosalpingography and or laparoscopy for tubal patency and semen analysis are the basic tests for diagnosis of unexplained infertility. Expectant treatment is the option of choice for young patients with short period of infertility. The spontaneous pregnancy rate is very high in this group of patients. The world literature have shown that controlled ovarian hyperstimulation and intrauterine insemination (COH and IUI) is an effective treatment of unexplained infertility. According to the available data, this procedure could be limited to three trials. There is evidence that both COH and IUI are important independent positive factors in achieving better pregnancy rate in unexplained infertility. If the above measures fail to achieve pregnancy, GIFT or IVF/ICSI could be performed as it yields a high pregnancy rate.

Female↗

Diagnostic laparoscopy: a prognostic aid in the surgical management of infertility.

Laparoscopy was utilized as the final step in the infertility investigation of 155 indigent patients. Unnecessary laparotomy was avoided in 72 (46 per cent) of these patients. Depending upon the endoscopic findings, the presence of additional infertility factor(s) either positively or negatively affected prognosis. With the same anesthetic, 83 (54 per cent) of the 155 patients underwent conservative infertility operations. Unless even greater selectivity can be achieved by prior diagnostic laparoscopy, the postoperative term pregnancy rate (11 per cent) does not justify infertility operations in a population prone to pelvic inflammatory disease, particularly in those individuals with other infertility factors.

Adult↗

Cyclic changes in salivary activity of N-acetyl-beta-d-glucosaminidase; a possible efficient indicator for predicting ovulation and pregnancy.

Salivary activity of N-acetyl-beta-D-glucosaminidase showed a characteristic pattern of changes during the normal menstrual cycle with a distinct peak on Day 13, 14, or 15 before the next menstruation. This peak of enzyme activity occurred withing one day of the nadir of basal body temperature and was absent in women with spontaneous or iatrogenic anovulatory cycles. These results are stongly suggestive that the salivary determination of this activity may be convenient indicatior for determining the day of ovulation.

Body Temperature↗

A direct radioimmunoassay for estriol-16-glucuronide in urine for monitoring pregnancy and induction of ovulation.

Antibodies to estriol-16alpha-[beta-D-glucuronide] were raised in sheep with the use of keyhold limpet hemocyanin and bovine serum albumin conjugates of estriol-16alpha-[beta-D-glucuronide]. A simple, rapid method is presented for direct radioimmunoassay of estriol-16alpha-[beta-D-glucuronide] in urine with dextran-coated charcoal used for separation of free from bound and deionized water used for dilutions. The method is thrifty in its use of reagents. The assay has been evaluated in the pregnancy range, and the sensitivity has been extended into the range necessary for monitoring induction of ovulation with Pergonal.

Animals↗

Correlation between histologic dating of human corpus luteum and the luteinizing hormone peak--biopsy interval.

The purpose of this study was to assess the accuracy of retrospective dating of ovulation in women based on the histologic dating of the corpus luteum. Corpora lutea enucleated from the ovary of 39 women between one and six days following the LH peak in plasma were examined by routine histologic techniques and dated according to Corner's criteria. The correlation between the luteinizing hormone (LH) peak--biopsy interval and histologic dating was assessed. Linear regression analysis of the data gave a correlation coefficient of 0.76. However, the dating of different corpora lutea obtained at the same LH peak--biopsy interval can differ by as much as four days. In addition, it was found that the stages named by Corner as days 1 and 2 seem to develop within the first 24 hours following the LH peak, while stages corresponding to days 4 and 5 each take two days to develop. It is concluded that the use of corpus luteum morphologic features for retrospective timing of ovulation is subject to an error of variable magnitude due to unequal duration of each stage, as well as considerable individual variation.

Corpus Luteum↗

Ultrasonic observation of the mechanism of human ovulation.

Nine subjects were studied by means of ultrasound to determine the precise time of ovulation and to document follicular changes immediately prior to, during, and after rupture. There were no demonstrable changes in the size of appearance of the follicle over a period of up to 7 hours prior to its rupture. In one of the four subjects in whom follicular collapse was witnessed, the follicle emptied completely within less than 1 minute. In two of the other three subjects, there was an initial rapid loss of fluid followed by a flower release of the remaining contents. This latter process took 7 minutes in the first patient and 35 minutes in the second patient. The slow phase of follicular collapse may well be an important aspect in the release of the ovum. The corpus hemorrhagicum was seen to develop within 1 hour of ovulation.

Female↗

A randomized prospective study of the use-effectiveness of two methods of natural family planning.

The final results of a prospective comparative study of two methods of natural family planning indicate a significant difference in the 12 month net cumulative pregnancy rates between the ovulation and symptothermal methods. These differences are on the order of two to one in favor of the symptothermal method. Pearl pregnancy rates confirm similar differentials between the two methods. Dropout rates for both methods were high. Lack of interest or dissatisfaction with the method was the major reason for dropout training while pregnancy or desire for pregnancy were the major reasons for dropout during the formal phase of the study.

Adult↗