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PubMed1982

The management of infertility: where to stop.

Many empirical traditional treatments for infertility may improve various fertility parameters but have no proven effect on clinical fertility. Diagnosis and management of ovulation disorders can be undertaken by most gynaecologists and the results are relatively good. Effective treatment for male infertility is poor and largely empirical, and artificial insemination by donor (AID) remains the mainstay of management. Tubal infertility may be overcome by surgery, particularly microsurgery, in selected cases especially sterilization reversal with minimal damage. Severe tubal disease is best managed by effective in vitro fertilization (IVF) programmes. Criteria of selection for IVF treatment include ovarian accessibility at laparoscopy and a normal semen sample. As many of the new techniques are difficult and contentious the decision to accept, reject or discontinue treatment should be made by the couple themselves after they have received a full and unbiased appraisal of their problem and its chance of successful management.

Amenorrhea↗
PubMed1983

A comparison of methods to interpret the basal body temperature graph.

Specific criteria are given for several methods of determining the basal body temperature shift. The specific criteria selected have been coded for a uniform interpretation by computer, and interpretations have been compared for 8496 charts. Our results indicate that the method that defines the temperature shift as 0.3 degrees F or more above the running low average for at least 3 consecutive days provides the best concurrent chart interpretation method. A method that creates a smoothed curve that transects the average of all temperatures on a completed graph provides a good retrospective method for identifying the temperature shift. Both the temperature averaging technique and curve smoothing technique identified a temperature shift in more than 95% of the charts with complete temperature readings.

Adolescent↗
PubMed1980

[Timing of ovulation in clomiphene-induced cycles (author's transl)].

214 menstrual cycles, induced by clomiphene in 121 women desiring a family but manifesting disturbances of cycle, type WHO II (1976) were investigated with regard to pattern of cervical function. 184 were ovulatory cycles. The time of ovulation was predictable within a range of two days in 58.7% of cases by means of the cervical score, consisting of the dilatation of the cervical os, the degree of transparency, the quantity and the consistency of the cervical mucus. The occurence of the "LH peak" and the rise in basal body temperature (BBT) were set in relation to this. In 41.3% of cycles the cervical score, influenced by the antioestrogenic effect of clomiphene, gave only insufficient evidence. In subsequent treatment cycles the cervical function, in relation to the individual case and the inducible quality of the cycle, showed a similar response rate as in the first treatment cycle. Our results suggest that, after examination of the first clomiphene-induced cycle by the combined means of cervical score and hormoneanalytic methods, patients with a positive cervical response, can be investigated by any interested doctor, even if he doesn't have a laboratory at his disposal, in order to assess the timing of ovulation for therapeutic measures.

Body Temperature↗
PubMed1982

An investigation of sperm migration into the oviducts of the mare.

A total of 23 mares were inseminated once within 0-6 h after clinical detection of ovulation, 14 with fresh and 9 with deep-frozen semen containing 0.1 x 10(9) to 4.7 x 10(9) motile spermatozoa. Within these two groups, the mares were slaughtered 2, 4 or 6 h after insemination and their genital tracts removed. The utero-tubal junction, isthmus and ampulla ipsilateral to the ovary in which ovulation occurred were flushed separately for sperm recovery. In 1 or 2 mares of each group, the uterine horn and corpus uteri, the cervix and vagina were also flushed. Tissue samples were collected from the contralateral oviduct and the other genital regions and prepared for scanning electron microscopy to show spermatozoa distribution in situ. Flushings were also prepared for scanning electron microscopy. There were no significant differences in the extent of sperm migration and in the number of spermatozoa in the different regions of the oviduct 2, 4 or 6 h after insemination of fresh or frozen semen. There was, however, a striking difference in sperm number within the time intervals examined; the numbers were greatest at 4 h after insemination. SEM of spermatozoa in the various regions of the oviducts failed to indicate any alterations to the sperm-head membranes that could be associated with sperm capacitation. The majority of spermatozoa found in the uterotubal junction, isthmus and ampulla showed morphological integrity.

Acrosome↗
PubMed1980

LH patterns during clomiphene-induced menstrual cycles.

A total of 409 sterility patients with amenorrhea classified as group II according to the WHO rating scheme were treated with a daily dose of 100 mg of Clomiphene daily for five days in 452 cycles. In addition, 300 infertile subjects with spontaneous cycles (375), but with slight irregularities in the lengths of cycles were included in this investigation as control group. Daily LH serum levels were monitored by rapid solid-phase coated tube RIA. 61.87% of LH single peaks, 28.53% of plateau peaks and 0.53% of double peaks were registered in spontaneous cycles. Similarly, 60.28% single peaks, 23.67% plateau peaks and 0.66% double peaks were registered in Clomiphene-induced cycles. Highest rate of LH plateau and single peaks were found 4 to 6 days and 5 to 7 days, resp., after the end of Clomiphene therapy. No LH peaks were found in 9.07% of spontaneous cycles and in 15.39% of Clomiphene-induced cycles. Data combine to suggest that timing of ovulation by a rapid LH radioimmunoassay is a valuable aid in consulting infertile couples. Failures of patients to conceive must be due to causes other than incorrect timing of ovulation.

Clomiphene↗
PubMed1981

Fluoroimmunoassay of progesterone in human serum or plasma.

We describe a fluoroimmunoassay for progesterone in serum or plasma. The assay involves use of an antiserum to progesterone-11-hemisuccinate and a labeled antigen prepared by linking fluoresceinamine to progesterone-3-carboxymethyloxime by use of a mixed-anhydride procedure. Serum or plasma samples are extracted with hexane. After incubation of a portion of the evaporated extract with antiserum and labeled antigen, antibody-bound and free antigen are separated and the fluorescence of the bound fraction is measured. Separation is effected either by using ammonium sulfate to precipitate liquid-phase antiserum or by using a solid-phase antiserum: antiserum covalently linked to magnetizable cellulose particles, which are separated with a magnet. With either separation technique, analytical recovery, linearity, and precision were acceptable and results compared satisfactorily with those obtained with a conventional radioimmunoassay. The solid-phase assay is more precise and more technically convenient, but the performance of both fluoroimmunoassays was adequate for clinical use in the detection of ovulation.

Female↗
PubMed1981

A prospective multicentre trial of the ovulation method of natural family planning. I. The teaching phase.

The percentage of 869 women in five countries capable of being taught to recognize the periovulatory cervical mucus symptom of the fertile period was determined in a prospective multicentre trial of the ovulation method of natural family planning. The women were ovulating, of proven fertility, represented a spectrum of cultures and socioeconomic levels, and ranged from illiteracy to having postgraduate education. In the first of three standard teaching cycles, 93% recorded on interpretable ovulatory mucus pattern. Eighty-eight per cent of subjects successfully completed the teaching phase; 7% discontinued for reasons other than pregnancy, including 1.3% who failed to learn the method. Forty-five subjects (5%) became pregnant during the average 3.1-cycle teaching phase. The average number of days of abstinence required by the rules of the method was 17 in the third teaching cycle (58.2% of the average cycle length). To what extent the findings of this study can be extended to other couples remains to be demonstrated.

Adult↗
PubMed1982

A one-hour radio-immuno-assay for lutropin.

For the rapid estimation of the mid-cycle lutropin peak, a commercially available four-hour lutropin radioimmunoassay kit was modified by shortening the incubation time, raising the incubation temperature and using more concentrated antisera. This RIA then required 60 min for completion. The results were compared to a commonly used 24-hour RIA from another commercial source. Calibration curves and lutropin profiles of the patients did not differ significantly. The shortened RIA is particularly suitable for a rapid and reliable estimation of the lutropin peak/ovulation time.

Adult↗