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PubMed1982

The program for in vitro fertilization at Norfolk.

Several aspects of the program of in vitro fertilization (IVF), or, as it is called in Norfolk, the program for the Vital Initiation of Pregnancy (VIP), have been or are in the process of publication. However, because there has been no overall account, it seems appropriate to give a brief report of a general nature covering the period from the beginning of the effort in late February 1980 through December 31, 1981. Although minor changes were constantly made in the protocol, there were two major revisions. Therefore, a discussion of the program during three distinct periods, i.e., 1980, 1981-Phase I, and 1981-Phase II, is necessary. During 1980 and 1981 all patients had either no fallopian tubes or irreparable tubes.

Adolescent↗
PubMed1982

Female infertility.

Physicians can play an important role in the prevention of infertility through aggressive treatment of pelvic infections and improved surgical techniques. The cause of infertility can be diagnosed 90 percent of the time. Ovulation, tubal, peritoneal, uterine, and cervical factors should be evaluated. Sperm-cervical mucus interaction should be assessed. Basal body temperature charts are simple and reliable. An endometrical biopsy should be timed for 8 to 10 days after ovulation, histologically dated, and compared with basal body temperatures. Tubal factors are best assessed by hysterosalpingogram and treated by microsurgery. The incidence of pelvic factors increases with age, prior infection, previous surgery, and pelvic pain. Cervical mucus can be studied and changes quantitated by using a simple scoring system. Uterine anomalies increase pregnancy risk but do not usually cause infertility. Clomiphene therapy should be limited to women who ovulate infrequently or not at all. Estrogen improves cervical mucus production; progesterone treats luteal phase defects. Infertile patients are often angry, anxious, and depressed, and additional time should be set aside during an office visit for optimum communication.

Adult↗
PubMed1982

[Current determination of ovulation time. 2. Optimization of timing for oocyte recovery].

Knowledge of probable ovulation date is essential to the recovery of pre-ovulatory oocytes for in vitro fertilisation. The authors used a commercially available LH-RIA kit for blood and urine samples together with the HI-Gonavis test for urine assay for high-accuracy determination of luteinising hormone (LH) in the peri-ovulatory cycle phase. Follicle status and oocyte quality were laparoscopically described of seven patients, between the eleventh and 16th days p.m. Optimum timing for oocyte recovery has not even become known by knowledge of LH rise. Different recommendations by other authors are discussed, and reference is made to unanswered problems.

Body Temperature↗
PubMed1981

Determination of ovarian function using first morning urine steroid assays.

A new direct radioimmunoassay measuring ovarian steroid metabolites in small aliquots of urine has been evaluated. For this purpose urinary levels of estrone-3-glucuronide (E1G) and pregnanediol-3-glucuronide (PG) were correlated with plasma values of estradiol (E2) and progesterone (P), respectively, from days 5 to 24 of the cycle in 24 women with normal cycles. Urine samples were representative of 1) first morning voiding; 2) 24-hour collection; and 3) all voidings except for the first morning one. The correlation between urinary E1G and PG with plasma values of E2 and P was statistically significant for the 3 collections of urine. The first morning voiding is selected as the sample of choice to determine E1G and PG due to its ease of collection and its high correlation with plasma E2 and P levels (r = .60, P less than .001; r = .73, P less than .001, respectively).

Circadian Rhythm↗
PubMed1980

[A simple method for estimating the day of ovulation by basal body temperature chart (author's transl)].

A new method for estimating the day of ovulation was assessed. The method is as follows; The range of hypothermic phase presumed 0.1 degrees C around mean basal body temperature of early 10 menstrual days. The day of ovulation was estimated by searching for the day which is followed by at least 4 consecutive days of rising temperature within the range of hypothermic phase. The accuracy of this method was assessed by comparing the basal body temperature and urinary luteinizing hormone (LH) peak day. The estimated day fell within 2 days during which the ovulation will occur most probably in 36 cycles (69%) and fell within 4 days around most expectable ovulation time in 46 cycles (88%). This result provide some insight into the limitation of the basal body temperature which is influenced by factors other than progesterone in determining the time of ovulation. But our simple objective method is useful in some cases than any other method determined by vague criteria.

Adult↗
PubMed1980

Diagnosis of luteal phase inadequacy.

Plasma progesterone concentrations drawn at the time of endometrial biopsy in 26 infertility patients with histologically documented luteal phase inadequacy were compared with those of 26 infertility patients with normal biopsies. Although as a group the former patients had lower progesterone values and shorter cycles, there was considerable overlap. Therefore, although plasma progesterone determinations and temperature charts are useful in the detection of ovulation and in the interpretation of the biopsy results, a properly obtained endometrial biopsy is essential for the diagnosis of luteal phase inadequacy.

Adult↗
PubMed1980

Twin pregnancy suspected before implantation.

A case is reported in which the diagnosis of twin pregnancy was suspected by the appearance of 2 follicles on ultrasound examination and by high levels of plasma estradiol and progesterone.

Adult↗