Capillary blood luteinising hormone levels to predict ovulation.
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Capillaries↗
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Human pregnancy following oocyte and sperm transfer to the uterus.
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Chorionic Gonadotropin↗
Prognostic assessment of female fecundity.
A clomiphene citrate (CC) challenge test was used to prospectively assess future fertility potential in 51 women aged 35 or more with unexplained infertility. Baseline (day 2-3 of the menstrual cycle) and response levels (day 9-11) of follicle stimulating hormone (FSH), luteinising hormone (LH), and 17-beta oestradiol were measured before and after administration of 100 mg clomiphene on days 5-9 of the menstrual cycle. Although all the women had a normal baseline FSH, 18 had an exaggerated FSH response of 26 mIU/ml or more (over 2 standard deviations above control values); this was regarded as a diminished ovarian reserve (DOR). In the DOR group mean response FSH was 38.9 mIU/ml (SD 13.8) and in 33 women with adequate ovarian reserve (AOR) it was 11.5 (4.9) mIU/ml (p less than 0.0001). In the DOR group 1 of 18 patients and in the AOR group 14 of 33 (42%) conceived (p less than 0.05). It is suggested that despite apparently normal ovulatory cycles, the DOR group has a compromised follicular apparatus. Disparity between normal oestradiol secretory capacity of the granulosa and diminished capacity to secrete inhibin could explain the inappropriately high FSH levels in response to the CC challenge.
Adult↗
Sensitivity and specificity of ultrasound indices of ovulation in spontaneous cycles.
OBJECTIVE: Evaluation of sensitivity and specificity of 4 ultrasound indices of ovulation. STUDY DESIGN: Multicenter collaborative study of 794 abdominal and transvaginal ultrasound scanning of ovaries performed during 271 cycles in 107 normally fertile women. Comparison of sensitivities and specificities of indices using McNemar test. RESULTS: The sensitivity and specificity of the indices were 84 and 89.2, respectively, for disappearance or sudden decrease in follicle size; 38.4 and 79.7 for appearance of ultrasonic echoes in the follicle; 61.6 and 87.1 for irregularity of follicular walls; 71.0 and 88.2 for appearance of free fluid in the cul-de-sac of Douglas. CONCLUSION: Ultrasonic echoes had a significantly lower sensitivity (P<0.001) and specificity (P<0.01) than other indices.
Adult↗
Effects of post-ovulatory food deprivation on the hormonal profiles, activity of the oviduct and ova transport in sows.
The objective of the present study was to investigate the effect of post-ovulatory food deprivation on the hormonal profiles and consequently on the activity of the oviduct and ova transport in sows. Sows were randomly allocated to the control (C-group, n=6) or fasted (F-group, n=5) group. The F-group sows were fasted for four meals starting with the morning meal after detection of ovulation in the second oestrus after weaning. Ovulation was checked by transrectal ultrasonography. Blood was collected for the analyses of progesterone, oestradiol-17beta, prostaglandin F(2 approximately ) metabolite, insulin, free fatty acids and triglycerides. Oviductal isthmic motility was monitored on Polyview before and after ovulation until the time of slaughter. After slaughter, the isthmus opposite the side with transducer was divided into three equal segments and flushed separately and a third of the uterine horn part from the utero-tubal-junction (UTJ) was also flushed. A high proportion of ova in the F-group was found in the first and second parts of the isthmus. In the C-group, a high proportion of ova was found in the third part of the isthmus and the uterus. The mean isthmic pressure in the C-group decreased significantly (P<0.05) during the period immediately after ovulation while in the F-group mean pressure remained unchanged. The frequency of phasic pressure fluctuations were significantly (P<0.05) higher in the F- than in the C-group 13 to 24 h after ovulation. No significant differences in progesterone concentrations were seen between the two groups of sows. Prostaglandin metabolite levels were significantly (P<0.05) higher in the F-group than in the C-group. Oestradiol-17beta levels significantly (p<0.05) decreased earlier in the F- than in the C-group. Serum insulin levels were significantly (p=0.05) lower in the F- than in the C-group while free fatty acids were significantly (p<0.01) higher in the F- than in the C-group. There were no significant differences in the serum levels of triglycerides between the F- and the C-group. Therefore, it can be concluded in the present study that food deprivation is associated with changes in the hormonal profiles, activity of the oviduct and a delay of ova transport in sows.
Animals↗
Effect of repeated ACTH-stimulation on early embryonic development and hormonal profiles in sows.
This study was conducted to evaluate the effect of adrenal stimulation by synthetic adrenocorticotrophic hormone (ACTH) on the first 2 days of pregnancy in 22 multiparous sows. The experiment was performed during the second oestrus after weaning and the sows were divided into one control (C-group) and one experiment group (E-group). To determine the time of ovulation, transrectal ultrasonographic examination was performed. E-group sows were treated repeatedly with 0.1 mg/kg bodyweight of synthetic ACTH (tetracosactide) i.v. 4-8h after ovulation and continuing every 6h, until slaughter. Blood samples were collected every second hour from about 12h before expected ovulation until slaughter and were analyzed for cortisol, prostaglandin F(2 alpha) -metabolite, and progesterone (P(4)). All sows were slaughtered approximately 48 h after ovulation and the isthmic part of the oviduct was divided into three equally long segments and flushed separately with phosphate buffered saline (PBS). The uterine horns were also flushed with PBS. The embryos of the E-group sows tended (P=0.056) to have a lower cleavage rate than the embryos of the C-group sows but there was no difference between groups in oviductal transport rate of the embryos. In the E-group, significantly (P<0.05) more sows had only embryos with <20 spermatozoa attached to the ZP compared with the C-group. The plasma concentration of cortisol was significantly higher (P<0.0001) in the E-group sows during the time of treatment while the baseline level of prostaglandin F(2 alpha) -metabolite was significantly lower. The baseline level of progesterone increased in both groups after ovulation but there was no significant difference between the groups. Repeated ACTH-stimulation (1) had no effect on the oviductal transport rate of the embryos, (2) had a negative effect on the embryo development, (3) and caused a changed endocrine profile that might have changed oviductal milieu affecting embryo development.
Adrenocorticotropic Hormone↗
Successful embryo transfer in the silver fox (Vulpes vulpes).
Surgical embryo transfer in the silver fox was investigated as part of a larger project concerning the conservation of endangered canine species using modern artificial reproduction techniques with the farmed fox as a model. The animals were chosen on the basis of synchrony in natural oestrus. The timing of ovulation and artificial insemination was determined by measuring electrical resistance in the vagina. Twenty-nine embryos were flushed from eight humanely killed donor females and transferred surgically into the uteri of eight recipients. One recipient female gave birth to two male pups 47 days after the transfer of four expanded blastocysts and one embryo at the 16-cell stage derived from a donor female flushed 10 days after artificial insemination.
Animals↗
Natural family planning in New Zealand: a study of continuation rates and characteristics of users.
This study has determined long-term continuation rates of clients who attended clinics of the New Zealand Association of Natural Family Planning and became autonomous users. It has also identified factors which might influence the continuation of NFP use. A total of 509 female subjects, 452 of them with their male partners, were enrolled in the study at the beginning of clinic teaching. Once autonomous they were sent questionnaires at 6-monthly intervals for a period of 24 months. Time out was allowed for pregnancy. The number of female subjects entering the 2-year follow-up phase of the study was 406 (79.8%). Of these 164 completed 2 years of use with 102 (20% of study entrants) using NFP and 62 (12.2%) using fertility awareness in combination with a barrier method. Subjects for whom NFP was their first family planning method, who were Catholic or who gave religion as their reason for choosing NFP were more likely to continue long-term use. The majority of subjects (> 90%) were highly satisfied with NFP use, with the most common reasons for satisfaction being self-awareness, freedom from drugs, naturalness and effectiveness. The difficulties reported related to abstinence and cycle interpretation.
Adult↗
Effects of timing of conception on birth weight and preterm delivery of natural family planning users.
OBJECTIVE: Various birth defects and untoward perinatal outcomes have been claimed to be associated with pregnancies conceived by gametes aged in vivo before fertilization. Thus, these outcomes were systematically assessed in pregnancies occurring in natural family planning (NFP) users. Our international multicenter cohort study of NFP pregnancies (n = 877) is by far the largest systematic study designed to assess pregnancy outcome and is of sufficient power to allow us to address the concern of low birth weight (< 2500 g) and preterm delivery (< 37 weeks gestation). STUDY DESIGN: In addition to gathering baseline medical data, evaluation was performed at 16 weeks, 32 weeks and at term. Data were collected in a systematic cohort fashion, verified by the five collaborating international recruiting centers, and analyzed by investigators in the US. Most recruiting center principal investigators are obstetrician-gynecologists and, if not, have integral relationships with such specialists. Standard criteria could thus be applied within and among centers. In our cohort, birth weight was recorded accurately at delivery. Almost all of the deliveries occurred in hospitals; thus, data should be quite reliable. Neonatal examination for anomalies was usually conducted immediately after delivery, when birth weight was recorded. RESULTS: Analysis of risk factors for low birth weight and preterm delivery showed that this population had a low risk profile. Low birth weight infants (< 2500 g) and preterm deliveries were increased among women with a history of either prior low birth weight or preeclampsia in the index pregnancy. However, mean birth weight was unaffected by the timing of conception vis à vis ovulation or pregnancy history. Mean birth weight for the 877 singleton NFP pregnancies was 3349.6 g. The risk of preterm delivery was increased among older women who drank alcohol, but there were no significant effects of timing of conception vis à vis ovulation on preterm delivery. Results held when analysis was stratified according to whether NFP was being used for contraception or to achieve pregnancy. CONCLUSIONS: Our data do not appear to show striking differences between 877 NFP pregnancies and the general obstetric population. The timing of conception vis à vis ovulation does not exert significant effects on the birth weight or preterm delivery of resulting pregnancies, a reassuring finding for NFP users.
Birth Weight↗
Factors to address when periodic abstinence is offered by multi-method family planning programs.
Multi-method family planning programs are committed to informed free choice of contraceptives. Thus they are expected to provide information and education, and facilitate access to services for those individuals and couples who want to practice periodic abstinence. Various factors affect the commitment and ability of multi-method family planning programs for providing periodic abstinence services. These factors include the effectiveness and cost of the method, attitude and technical competence of service providers, information and education strategies, and approaches for providing services. These factors are discussed in this paper. Information on providing periodic abstinence in a multi-method service situation is very scarce. The need for research, particularly operations research, for gathering information to guide program managers and service providers in the integration of periodic abstinence services is discussed.
Attitude of Health Personnel↗
Expanding the availability and improving delivery of natural family planning services and fertility awareness education: providers' perspectives.
Despite the recognized benefits for clients and programs of providing natural family planning (NFP) services, few family planning programs offer NFP and few provide fertility awareness education. Furthermore, many non-governmental organizations (NGOs) that provide only NFP actually reach a very small percentage of the potential NFP users in the areas they serve. This paper discusses the results of interviews with selected family planning providers that were conducted to explore reasons why NFP and fertility awareness education are not offered in their programs, and with NFP providers to get their opinions on how to improve service delivery. The interviews were structured around some of the lessons learned from the successful incorporation of the lactational amenorrhea method (LAM) into several multimethod family planning programs. There is agreement that the need for NFP services* is far from being met and that most clients lack the information and skills they could learn through fertility awareness education. The providers interviewed also acknowledged that offering these services would improve the quality of reproductive health services in general. Presented here are some ideas about why these services are not offered, as well as suggestions for integrating NFP and fertility awareness education into existing family planning programs.
Attitude of Health Personnel↗
The benefits and barriers associated with a national natural family planning service: the New Zealand experience.
This paper provides a case study of a model for expanding natural family planning (NFP) from a small local program to the national level through the creation of a national association and the development of a public-private partnership. The experience of the New Zealand Association of Natural Family Planning (NZANFP) is analyzed in terms of both the benefits and barriers of using this model. Recommendations are given to guide others in developing a similar model.
Family Planning Services↗
Retrospective clinical trial of contraceptive effectiveness of the electronic fertility indicator Ladycomp/Babycomp.
The Babycomp/Ladycomp (Valley Electronics Ltd., Eschenlohe, Germany) is an electronic device that combines the temperature method and calendar method for planning and preventing pregnancy by identifying the fertile and infertile phases of the menstrual cycle. In a retrospective clinical trial, the system was tested as a contraceptive aid. A total of 648 women from Germany and Switzerland have participated: 597 women with 10,275 months of use used the device for contraception. Thirty-three unplanned pregnancies were identified, giving a total pregnancy rate of 3.8 use effectiveness according to the Pearl Index. Six method-related pregnancies occurred, producing a method Pearl Index of 0.7. Calculating the cumulative pregnancy rates by life-table analysis, it was found that, after about one year of exposure, the probability of an unintended pregnancy was 5.3% (0.053), after 2 years it was 6.8% (0.068) and after about 3 years of exposure it was 8.2% (0.082). The mean length of the identified fertile period was 14.3 days with a standard deviation of 4.6 days in all cycles reported. The acceptance of the device by the woman and her partner was good. In fact, 21 of the 33 women who became pregnant would still recommend the device for further use (63.6%).
Actuarial Analysis↗
Simplifying NFP: preliminary report of a pilot study of the 'collar' method in Brazil.
Natural methods of fertility regulation are acceptable in most cultures. Many couples worldwide do not wish to use contraceptives or do not have access to them but wish to limit their family size or lengthen the time between births. Barriers to expanding use of natural family planning (NFP) methods include a lack of providers who can teach NFP and a lack of time to teach and follow couples during the initial months of NFP use. If simple yet effective methods of NFP are available, then NFP could be introduced to a wider audience. Recently, calendar rules have been revised that use a set interval to identify fertile days. These new rules provide better coverage of fertile days and require less abstinence than the rules traditionally used with the calendar method. One of these new rules is being field tested in a pilot study in Brazil. Couples are asked to abstain from day 9-19 (inclusive) of the menstrual cycle, using a beaded necklace (the 'collar') as a mnemonic device. Focus groups with the teacher-monitors and in-depth interviews with female and male users were carried out to evaluate the acceptability of the 'collar' method. A preliminary analysis of these focus groups and interviews from the first site is presented.
Brazil↗
Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study.
A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14870 cycles, 28 unintended pregnancies were studied. Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During "perfect use" the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most unforgiving for imperfect use (unprotected intercourse in the fertile phase). However, it is extremely effective when either abstinence or protected intercourse is used in the fertile phase.
Adult↗
Pregnancy outcome in natural family planning users: cohort and case-control studies evaluating safety.
Conceptions involving aging gametes are of relevance to natural family planning (NFP) because women using NFP to avoid pregnancy abstain from intercourse during the fertile time of the cycle. To help verify the safety of pregnancies occurring among NFP practitioners, our group has, since 1986, conducted a large cohort study involving six experienced NFP centers. Timing of conception was determined from NFP charts, in which women recorded days on which intercourse occurred. The number of days from the most probable conception intercourse to probable day of ovulation was first determined, and used as an estimate of the time gametes remained in the genital tract before fertilization. Several studies have already been completed, cohort as well as case-control in nature.
Abortion, Spontaneous↗
Pregnancy complications in natural family planning users.
A multicenter cohort study was designed to assess pregnancy outcome among natural family planning (NFP) users, and provide the opportunity to address complications in NFP users by planning status and by timing of conception with respect to day of ovulation. There were 877 singleton births in this sample. Complications evaluated were abnormal vaginal bleeding, urinary tract infection, vaginal infection, hypertension of pregnancy, proteinuria, glycosuria, and anemia. There was no significant difference in the mean age, number of prenatal visits or birth weight among optimally and non-optimally timed pregnancies or for planned and unplanned pregnancies. There were higher incidences of "parity 2 or more" and current smokers in the non-optimally timed pregnancies and lower incidences of prior pregnancy loss and "currently employed" in the non-optimally timed pregnancies. There was little difference in pregnancy complications with respect to pregnancy timing, with the exception of a significant increased risk of vaginal bleeding late in pregnancy among non-optimally timed conceptions (11.5%) compared to optimally timed pregnancies (5.2%, RR = 2.2, 95% CI 1.3-3.7). More differences were observed in pregnancy complication rates by planning status. Unplanned pregnancies were associated with significantly more late pregnancy bleeding, vaginal infections, proteinuria, glycosuria and medication use than planned pregnancies. Unplanned pregnancies had lower incidences of maternal anemia. Complications of pregnancy were low in this NFP population, irrespective of planned versus unplanned status. Women with planned pregnancies had even fewer complications during pregnancy than women with unplanned conceptions, suggesting that women using NFP to plan their reproduction may be at particularly low risk.
Cohort Studies↗
Comparing a public and private sector NFP program: implications for NFP expansion.
This paper synthesizes a six year collaboration between a natural family planning (NFP) non-governmental organization (NGO) and the National Health Service of the Emilia Romagna region in Italy. It also compares the public program experience with NFP services provided in the private sector in the adjacent region of Veneto. Midwives provided NFP services in government family health clinics while in the private sector NFP was taught by non-health laypersons in a church-based facility. The populations served by these two programs were different. Women in the public sector were slightly older and two-thirds were married. Forty percent of the clients had chosen to use NFP to achieve a pregnancy. The private sector client, recruited in part through premarriage counseling programs, was equally divided between married and single women, though the majority came for advice on avoiding or spacing pregnancies. In both regions NFP users were more highly educated than the general population.
Contraception↗