Acetyl salicylic acid improves somatosensory evoked potentials in streptozotocin-diabetic rats.

The effects of acetyl salicyclic acid (ASA) on somatosensory evoked potentials (SEP) and neural levels of thiobarbituric acid reactive substances (TBARS), products of lipid peroxidation, were studied in streptozotocin-diabetic rats. ASA (100 mg/kg, in rat chow) was given to diabetic rats (n = 8) after the induction of diabetes for 16 weeks. ASA-treated normal control rats (n = 8), untreated diabetic rats (n = 8) and normal control rats (n = 8) were used for comparison. At the 8 weeks, SEP latency in diabetic group (15.4 +/- 0.5 ms) was significantly longer than that in normal control group (10.0 +/- 0.8 ms, P < 0.05). When compared to levels in diabetic control group, ASA shortened SEP latency significantly (12.7 +/- 0.1 ms; P < 0.05). This effect of ASA was significant in all three measurements from week 8 to 16 (P < 0.05 vs. diabetic control group). Neural TBARS level in diabetic control group (60.1 +/- 2.2 nmol/g) was significantly, higher than that in normal control group (28.5 +/- 3.6 nmol/g, P < 0.05). When compared to levels in diabetic control group, ASA depressed TBARS level significantly (41.5 +/- 12 nmol/g; P < 0.05). TBARS level in ASA-treated diabetic group (27.2 +/- 5.7 nmol/g) was comparable with that in normal control group (NS). These results suggest that ASA has beneficial effect on diabetic neuropathy and this effect may be related in part with prevention of lipid peroxidation.

Impact of baseline cysts at the time of administration of gonadotropin-releasing hormone analog for in vitro fertilization.

OBJECTIVE: To assess the effects of cysts developed prior to the commencement of luteal phase gonadotropin-releasing-hormone-agonist (GnRH-a) in IVF cycles. DESIGN: Retrospective analysis. SETTING: In vitro fertilization program in a tertiary hospital infertility clinic. PATIENTS: Women stimulated for IVF-ET. All stimulations were down-regulated with GnRH-a commenced on day 21 in a long protocol before gonadotropin stimulation. MAIN OUTCOME MEASURE: Pregnancy rate. RESULTS: Twenty-five of 121 cycles had cysts >15 mm (20.6%); these were classified as baseline (nonfunctional) (n = 12) or corpus luteum (n = 13) cysts. They had significantly longer suppression periods and lower peak estradiol levels, and used more gonadotropins during stimulation. Cysts had no impact on the number of oocytes collected or fertilization and pregnancy rates. Patients with baseline cysts had a greater duration of suppression and required more gonadotropin than those with corpus luteum cysts or those without cysts. The cycle outcomes were similar between the groups, but baseline cyst formation is likely to increase the cost of IVF. CONCLUSION: These findings suggest that baseline cyst formation causes longer suppression duration and greater gonadotropin utilization, although an impact on pregnancy rates is unlikely.

An IVF fallacy: multiple pregnancy risk is lower for older women.

INTRODUCTION: Multiple pregnancy is one of the most important and preventable complications of in vitro fertilization (IVF) and embryo transfer. The general clinical practice in many IVF clinics is to transfer four or five embryos to older women if available, since pregnancy rates are lower in women older than 35 years of age. However, it is not clear whether the risk for multiple pregnancy is also lower. OBJECTIVE: Our objective was to investigate whether transferring a higher number of embryos actually improves pregnancy outcome in older women, without increasing the risk for multiple pregnancy and to investigate other factors that may affect the occurrence of multiple pregnancy. SETTING: The setting was university-based IVF program at The Toronto Hospital. DESIGN: The design was a retrospective case series. PATIENTS AND METHODS: The outcome of 1116 IVF cycles between January 1992 and December 1993 was investigated according to different age groups. MAIN OUTCOME MEASURE: The main outcome measure was multiple pregnancies. RESULTS: Seventy multiple pregnancies resulted from a total of 242 pregnancies. Overall pregnancy and multiple pregnancy rates were inversely correlated with age. However, when the data were adjusted for the number of embryos transferred, this trend disappeared. The result of multiple regression analysis showed that the multiple pregnancy rate was higher without improving the pregnancy rate when the number of embryos transferred exceeded three, regardless of the age of the patients, especially when more embryos were available than the number of transferred ones. CONCLUSIONS: The number of embryos transferred should be limited to a maximum of three regardless of the age of patients, to reduce the high frequency of multiple gestations in an IVF program.

In vitro fertilization programmed for weekday-only oocyte harvest: analysis of outcome based on actual retrieval day.

OBJECTIVE: Our aim was to assess the effect of the day of ovum retrieval on outcome in an IVF program scheduled for weekday-only ovum retrievals. DESIGN: This was a retrospective study of patients who underwent transvaginal ultrasound-guided ovum retrieval (TVUS-OR) in an IVF program from August 10, 1992, to April 30, 1993. SETTING: A university-based tertiary referral hospital center was the setting. PARTICIPANTS AND METHODS: All patients (n = 501) who underwent TVUS-OR were divided into three groups: (1) patients who underwent TVUS-OR on Monday; (2) patients who underwent retrieval on Tuesday, Wednesday, or Thursday; and (3) patients who underwent retrieval on Friday. All patients were induced by the same controlled ovarian hyperstimulation protocol, which consisted of a GnRH analogue "flare-up" followed by parenteral menotropins, after a scheduled oral contraceptive-induced menses. Patients and cycle characteristics in the three groups were compared and clinical outcome was evaluated. RESULTS: The similarity of patients and cycle characteristics confirmed the uniformity of the three groups. No difference was found in any of the clinical outcomes. However, in the first half of the program, we revealed a trend in which patients at high risk for ovarian hyperstimulation syndrome, requiring freezing all embryos and not allowing transfer during the treatment cycle, occurred more commonly in women whose retrieval occurred on Monday. This trend disappeared in the second half of the analysis. CONCLUSIONS: In an in vitro fertilization program in which ovum retrievals occurred only on weekdays, no significant difference in outcome was found in patients undergoing ovum retrieval on Monday or Friday versus midweek. In addition to significant savings by eliminating weekend retrievals, IVF outcome is not compromised.

Low dose ketoconazole is an effective and a relatively safe alternative in the treatment of hirsutism.

Efficacy, clinical and hormonal effect of ketoconazole in 400 mg/day dose was tested in a prospectively-designed study. Twenty four patients with hirsutism according to the Ferriman and Gallwey score (> 8) and elevated blood androgen levels were administered 400 mg/day ketoconazole for 6 months. Basal and posttherapy early follicular phase androgens and biochemical parameters were evaluated. In 22 patients significant improvement and in 2 slight improvement was seen in subjective complaints. No side-effects were observed in these patients other than 2 cases of pruritus (transient), 2 mild gastric upset and 1 mastodynia. All patients completed the study. Low dose ketoconazole seems to be effective in the treatment of hirsutism with relatively few side-effects but still should be reserved as an alternative choice due to the potential for deleterious hepatic effects.

Second trimester pregnancy termination including fetal death: comparison of five different methods.

OBJECTIVE: To compare the efficacy of methods for second trimester pregnancy termination. METHODS: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score < or = 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. RESULTS: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% (81/82) of the patients in ethacridine group; 97.3% (35/36) of the patients in concentrated oxytocin group; 90.0% (90/100) of the patients in PGE2 group; 97.2% (71/73) of the patients in balloon group; 77.5% (38/49) of the patients in misoprostol group (P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval +/- S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 +/- 9.6, PGE2 gel: 20.0 +/- 14.5, concentrated oxytocin: 12.2 +/- 14.4, misoprostol: 24.0 +/- 22.2, balloon: 16.0 +/- 15.4 (one way ANOVA, P = 0.003, P < 0.01). CONCLUSION: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE2 and misoprostol in terms of achievement of abortion within 24 and 48 h.

PIP: The efficacy of 5 methods of second-trimester pregnancy termination was compared in a prospective, randomized study of 340 women admitted to a High Risk Pregnancy Unit in Ankara, Turkey, with an unfavorable cervical state. The women were between 14 and 28 weeks' gestation. Termination methods assessed included: extra-amniotic administration of ethacridine lactate (82 women), cervical ripening through use of prostaglandin (PG) E2 gel (100 women), intravenous infusion of concentrated oxytocin (36 women), intravaginal misoprostol (49 women), and balloon insertion (73 women). Oxytocin infusion was used to augment labor, where necessary, in all but the concentrated oxytocin group. The main indications for pregnancy termination were fetal death (50%) and fetal anomaly (25%). Abortion within 48 hours was achieved in 98.8% of women in the ethacridine group, 97.3% of those in the concentrated oxytocin group, 90.0% of women in the PGE2 group, 97.2% of patients in the balloon group, and 77.5% of those in the misoprostol group. The median induction-abortion intervals were: ethacridine lactate, 15.7 +or- 9.6 hours; PGE2 gel, 20.0 +or- 14.5 hours; concentrated oxytocin, 12.2 +or- 14.4 hours; misoprostol, 24.0 +or- 22.2 hours; and balloon, 16.0 +or- 15.4 hours. Overall, these results suggest that mid-trimester induced abortion with extraamniotic ethacridine, balloon application, or intravenous concentrated oxytocin are the most effective techniques and should be considered as alternatives to misoprostol and PGE2.

Estrogen deprivation, rather than age, is responsible for the poor lipid profile and carbohydrate metabolism in women.

UNLABELLED: The protective effect of estrogen against cardiovascular diseases (CVD) in women disappears after menopause. However, it is not clear whether the change in risk factors after menopause is related to aging or estrogen deprivation. OBJECTIVE: To assess the risks for CVD and the contribution of aging in estrogen-deprived women. METHODS: Forty-one patients with premature ovarian failure (POF) (group 1) and 30 patients with natural menopause (group 2) were investigated with respect to well-known risk factors for CVD. Fifteen young women at reproductive age (group 3) were taken as controls. The median ages (ranges) of the groups were 31 (19-40), 52 (46-67) and 26 (24-29) years, respectively. Family and personal history for CVD, smoking, oral contraceptive usage, physical examination, blood pressure measurement, body mass index (BMI), blood level of fasting insulin, diabetes mellitus, and the levels of lipoprotein proteins were the examined parameters regarding the risks for CVD. RESULTS: The levels of triglycerides and very low density lipoprotein (VLDL) cholesterol were not different in the 3 groups. The levels of fasting insulin (11.3 +/- 6.6 vs. 10.2 +/- 5.8 IU/ml), the ratio of fasting insulin to fasting blood glucose (12.2 +/- 6.3% vs. 10.5 +/- 5.4%), high density lipoprotein (HDL) cholesterol (51.9 +/- 12.9 vs. 51.6 +/- 9.7 mg/d), low density lipoprotein (LDL) cholesterol (113 +/- 47 vs. 127 +/- 37 mg/dl) and the ratio of HDL to total cholesterol (27.2 +/- 9.8% vs. 24.1 +/- 6.9%) were not different in women with POF and natural menopause. These parameters were all better in controls with respect to risk for CVD (respectively, 6.5 +/- 2.0 IU/ml, 7.4 +/- 2.2%, 37.9 +/- 5.3 mg/dl, 80 +/- 40 mg/dl, P < 0.05). CONCLUSION: Risk factors for CVD are related to estrogen deprivation. Aging does not have an important impact on CVD within the age range of this study group.

Combined use of a long-acting gonadotropin-releasing hormone agonist and low-dose danazol in advanced stage endometriosis.

In this preliminary study, the safety and efficacy of a combined GnRHa and low-dose danazol regimen was evaluated in patients with advanced stage endometriosis. Five patients with stage IV endometriosis were administered triptorelin 3.75 mg intramuscularly with monthly intervals in combination with oral danazol 100 mg/day for 6 months. Laparoscopy was performed before and after therapy to assess the change in endometriotic lesions. During controls, patients were evaluated for the change in hormonal and biochemical parameters and the side effects of the treatment. In 4 patients with ovarian endometriomas, cysts were drained during initial laparoscopy. None of the endometriomas persisted after therapy. Total scores, according to the revised American Fertility Society classification of endometriosis were, 54.8 +/- 10.9 before treatment and decreased to 31.6 +/- 10.3 (P < 0.05), whereas, endometriotic implants scores changed from an initial value of 22.8 +/- 12.1 to 1.2 +/- 1.1 (P < 0.05). No adverse effect was observed on lipid and liver metabolism. Estrogen deprivation symptoms and oily skin were the most prominent complaints and one patient had a weight gain of 6 kg. Based on these results we conclude that a combination of GnRHa and low dose danazol is an effective alternative treatment modality in the treatment of severe endometriosis without any serious side effect.

Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome.

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 +/- 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated.

The prognostic value of serum estradiol, progesterone, testosterone and free testosterone levels in detecting early abortions.

OBJECTIVE: Hormonal levels in early pregnancy may have predictive value in regard to outcome of pregnancy. In this study, the levels of estradiol (E2), progesterone (P), total testosterone (tT) and free testosterone (fT) were investigated in this respect. MATERIALS AND METHOD: Seventy women with early pregnancies of 6-12 weeks who applied to the hospital for a pregnancy test were included into this study and were divided into three groups according to their final diagnosis. Group 1 consisted of 20 patients with anembryonic pregnancies, group 2 consisted of 20 patients with missed abortion and group 3 had 30 patients with normal pregnancies. Serum levels of E2, P, fT and tT were measured in every patient and the ratio of fT to tT was calculated (fT ratio). RESULTS: E2, P and tT levels in patients with missed abortion or anembryonic pregnancies were significantly lower than those in the normal group, whereas fT ratio was significantly higher. The level of P over 12.3 ng/ml was found to be sensitive and specific with respect to detecting a normal pregnancy (95% and 90%, respectively). All patients whose fT ratios were 1.05 and higher, subsequently miscarried whereas the ones whose fT ratios were lower than 0.84 were considered as normal pregnancies. CONCLUSION: Serum P levels and fT ratio in early pregnancies can be used as a screening test with high sensitivity and specificity to predict a normal pregnancy.

Hydatidiform mole: clinical analysis of 310 patients.

OBJECTIVES: The aim of the study was to analyze the clinical characteristics, treatment and outcome of 310 patients with hydatidiform mole. METHODS: Three hundred ten patients with hydatidiform mole admitted to Dr Zekai Tahir Burak Women's Hospital between 1989 and 1994, were evaluated retrospectively according to their clinical characteristics, treatment modalities and follow-up. RESULTS: The incidence of molar pregnancy was 2.48 per 1000 deliveries and 1.84 per 1000 pregnancies. The age of the patients ranged from 14 to 45 years with a mean age of 25.29 +/- 7.40 years. In 60% of the patients, the molar pregnancy was their first pregnancy. A history of previous hydatidiform mole was found in 5.5% of the patients and eight of them had at least two previous molar pregnancies. The most common presenting symptom was vaginal bleeding (71%). Although theca-lutein cysts were found in 17.1% of the patients, only one patient underwent emergency surgery because of torsion. Dilatation and suction curettage was the first-line treatment; uterine perforation developed in two patients (0.6%). During follow-up 14.5% of patients were diagnosed as persistent cases according to serum beta-human chorionic gonadotropin (beta-hCG) levels. Complete remission was achieved with the administration of 2-8 courses of single-agent chemotherapy in 43 cases; combined chemotherapy (3-7 courses) was given to two patients who were resistant to single-agent therapy. CONCLUSION: Comparison of patients with spontaneous remission and patients with persistent trophoblastic disease with respect to age, histologic type, previous history, initial uterine size, gravidity, presence of theca-lutein cysts and initial beta-hCG levels did not reveal any of the above criteria to be prognostic for the occurrence of persistent disease.

The effect of intraumbilical oxytocin on the third stage of labour.

The umbilical vein administration of oxytocin in saline was compared with umbilical vein saline alone and the traditional management of the third stage of labour. Seventy-two women were randomized to 3 groups. Group 1 received intraumbilical 20 IU of oxytocin diluted to 40 mL with saline. Group 2 received intraumbilical vein 40 mL of saline while subjects in group 3 were managed according to the standard protocol without any intraumbilical injection. No significant differences were found in terms of the length of the third stage, the blood loss in the third stage and postpartum haematocrit differences among the 3 groups. The administration of diluted oxytocin or saline do not seem to have any superiority to the traditional management of the third stage of labour.

Effects of dexfenfluramine on glucose drinking and glucose-conditioned flavour preferences in rats: taste versus post-ingestive conditioning.

A comparison was made of the effects of dexfenfluramine (DF, 3-10 mg kg-1) on intake of and conditioning with glucose solutions varying in orostimulant properties (taste) and post-ingestive actions (calories), in rats. First, sham-feeding, using gastric-fistulated rats, was performed to assess the orostimulant properties of the solutions. Then, two experiments were done. In the first experiment, we examined the effects of DF, given at doses of 13 and 10 mg kg-1, on the intake of two glucose solutions having different orostimulant properties and different caloric values. The solutions were a mix of 1% glucose plus 0.125% saccharin (low caloric, more orostimulant), and 4% glucose (high caloric, less orostimulant). At doses of 10 mg kg-1, DF administration markedly reduced intake of both solutions (P < 0.05 vs Control Group, respectively). In second experiment, we examined the effects of DF (10 mg kg-1) on flavour preference conditioning in two parts. In the first part of the experiment, rats consumed two distinctively flavoured solutions having equal orostimulant properties but different caloric value for a conditioning period of 16 days. The solutions were a mix of 1% glucose plus 0.125% saccharin (low caloric), and 6.1% glucose (high caloric). At the end of the conditioning period, the flavour paired with ingestion of more calories was subsequently preferred (P < 0.05 vs low caloric glucose-saccharin mix). DF, when given during and after the conditioning period, attenuated this flavour-calorie conditioning (P < 0.05 vs Control Group). In the second part of the experiment, rats were conditioned with flavours associated with a mix of 20% glucose plus 0.4% citric acid and 20% glucose solutions. These solutions were equally caloric but differed in orostimulant properties. The flavour paired with better orostimulant properties was subsequently preferred (P < 0.05 vs less orostimulant glucose-citric acid mix). DF, when given during and after the conditioning period, also attenuated this flavour-flavour conditioning (P < 0.05 vs Control Group). These results suggest that DF may impair flavour preference learning.

The concentration of plasma atrial natriuretic peptide in normotensive and preeclamptic pregnancies.

UNLABELLED: Atrial natriuretic peptide (ANP) is a family of peptides secreted by the heart, affecting the cardiovascular, renal and endocrine systems. This study questions previous research findings regarding elevated ANP levels, despite vasoconstriction and hypovolemia, in preeclamptic patients. MATERIALS AND METHODS: Seventeen patients with preeclampsia, 5 with superimposed preeclampsia with chronic hypertension and 17 normotensive pregnant women were compared with respect to plasma ANP levels. Seventeen non-pregnant women were taken as the control group. All the women, except the ones with superimposed preeclampsia, were age matched and in their third trimester. RESULTS: ANP levels in the non-pregnant women (6.9 +/- 0.7 pg/ml) were not different from those in the normotensive pregnant women (6.4 +/- 0.7 pg/ml). ANP levels were significantly higher in women with preeclampsia (10.8 +/- 1.8 pg/ml) or superimposed preeclampsia (9.7 +/- 1.4 pg/ml) than in normotensive pregnant women and normal non-pregnant women (P < 0.05). According to the literature, there is a volume depletion in preeclamptic women. However, this wasn't demonstrated in our study group. CONCLUSION: ANP levels in preeclamptic women were found to be higher than those in normotensive pregnant women. The etiology still remains obscure.

Do the suppression criteria in GnRH-a cycles predict in vitro fertilization outcome?

The addition of gonadotropin releasing hormone analog (GnRH-a) to controlled ovarian hyperstimulation regimes has been reported to have several advantages, such as reduced cancellation rate, fewer premature luteinizations and increased clinical pregnancy rate. The aim of this study was to determine the effect of pituitary/ovarian suppression, in terms of the levels of luteinizing hormone (LH), estradiol and follicle stimulating hormone (FSH), and the duration of GnRH-a administration, on in vitro fertilization (IVF) outcome. Retrospectively, 153 IVF cycles with GnRH-a and human menopausal gonadotropin (hMG) were examined. After a minimum of 10 days of GnRH-a administration, the patients were started on hMG. The correlations were investigated between the fertilization rates, the numbers of retrieved oocytes and transferred embryos, the cancellation rates, the suppressed LH, FSH and estradiol levels, the total ampules of hMG used and the duration of GnRH-a usage. The duration of GnRH-a usage and the total ampules of hMG used were not correlated. The number of oocytes retrieved and total number of hMG ampules used showed weak correlations with suppressed levels of FSH (-0.297 and 0.285, respectively). However, the fertilization, cleavage and pregnancy rates did not correlate with the LH, FSH and estradiol levels on hMG start days. In conclusion, for selected cases, 10 days of GnRH-a administration is sufficient to suppress endogenous gonadotropin levels. Since FSH and LH are protein hormones and their bioactivity may change in a manner that is unrelated to their immunological levels, it is not necessary to measure FSH, LH and estradiol levels to detect whether suppression is adequate.

In vitro fertilization outcome in the presence of severe male factor infertility.

OBJECTIVE: To assess the outcome of standard IVF treatment (nonmicromanipulated) with respect to total motile sperm number recovered by swim-up, particularly for couples with severe male factor infertility defined as total motile sperm number < 0.5 x 10(6). DESIGN: Retrospective study of patients who underwent successful oocyte retrieval in an IVF program from August 10, 1992 to December 31, 1993. SETTING: A university-based tertiary referral center (The Toronto Hospital). PATIENTS: All cycles (n = 672) were divided into four groups according to total motile sperm number recovered using standard swim-up: group 1, total motile sperm number < or = 0.50 x 10(6); group 2, total motile sperm number between 0.51 and 1.00 x 10(6); group 3, total motile sperm number between 1.01 and 1.50 x 10(6); and group 4, total motile sperm number > or = 1.51 x 10(6). All patients received the same controlled ovarian hyperstimulation protocol, which consisted of a GnRH analog flare-up followed by parenteral menotropins. Clinical and cycle characteristics in the four groups were analyzed and outcome was evaluated. RESULTS: There was no significant difference in clinical and cycle characteristics between the groups. The uniformity of the groups justified analysis of their outcome. A fertilization rate of 21.5% was achieved in couples with severe male factor (group 1). Fertilization rate and number of embryos transferred increased directly with the total motile sperm number. There was no significant difference in implantation rate per embryo between the groups. CONCLUSIONS: The results in couples with severe male factor infertility compare favorably with monospermic fertilization rates reported in the literature using partial zona dissection and subzonal insertion but is lower than with intracytoplasmic sperm injection. Therefore, we believe that couples with severe male factor infertility should be considered for standard IVF, as long as adequate total motile sperm can be recovered (100 x 10(3) per dish). If intracytoplasmic sperm injection is available, it should be offered to these couples.

Change in atrial natriuretic peptide concentration after acute plasma volume expansion in normal pregnancy and preeclampsia.

Atrial natriuretic peptide (ANP) is found to be elevated in preeclamptic patients despite the presence of hemodynamic characteristics such as vasoconstriction and hypovolemia. In this study, the effect on ANP secretion of plasma volume expansion with crystalloid solutions was investigated. Seven preeclamptic and seven normotensive pregnant women in their last trimester were compared. After basal ANP measurements, 0.9% Ringer's solution, 15 cm3/kg body weight was infused within 30 min to expand the plasma volume. Blood sampling was repeated after the infusion. Maternal blood volume expansion was calculated from the decrease in hematocrit. Plasma ANP levels were corrected according to the degree of volume expansion. Basal mean levels in both groups were not different. Although the postinfusion levels of ANP in normotensive pregnant women were similar to the basal levels (means +/- SE: 20.6 +/- 0.41 and 27.2 +/- 0.52 pg/ml, respectively, p = 0.10), the postinfusion ANP levels in preeclamptic women increased significantly (21.4 +/- 0.31 and 34.1 +/- 0.28 pg/ml, respectively, p = 0.01). Preeclampsia is associated with a greater increase in plasma ANP levels in response to volume expansion compared with normotensive pregnancy. The greater change in the right atrial pressure with volume expansion, due to decreased compliance of the capacitance vessels in preeclamptic subjects might explain the greater change in the plasma level of ANP.

Endometriosis in association with müllerian anomalies.

There have been many theories proposed regarding etiology and pathogenesis of endometriosis. The theories of retrograde menstruation, celomic metaplasia, and müllerian remnants are among these. In order to find out whether a higher prevalence exists in patients with müllerian anomalies and to test these theories, we reviewed the case records of our reproductive endocrinology clinic set up between 1989 and 1994. The study group included patients with müllerian anomalies (n =186) whereas the control group consisted of patients without müllerian anomalies (n = 3,240). The frequency of endometriosis was 37 of 186 (19.8%) in the study group as compared with 619 of 3,240 (19.1%) in the controls (p > 0.05). In 1 patient without functioning endometrium endometriosis was demonstrated. Obstructive anomalies were associated more with endometriosis as compared with nonobstructive anomalies (p < 0.001). The nonobstructive anomalies did not present a higher prevalence as compared with controls (p > 0.05). These results show that endometriosis is not more frequent in patients with müllerian anomalies as a whole, but outflow obstruction is an important contributing factor. Evaluating patients with müllerian anomalies contributes proof in favor of the theories of retrograde menstruation and celomic metaplasia, but against a possible relation of a developmental defect of differentiation or migration of the müllerian duct system during embryogenesis.