Subcutaneously administered Repronex in female patients undergoing in vitro fertilization is as effective and well tolerated as intramuscular menotropin treatment. Repronex SC, IVF Study Group.

OBJECTIVE: To determine the efficacy and safety of Repronex SC as compared with Repronex IM and Pergonal IM in patients undergoing IVF. DESIGN: Open-label, randomized, parallel-group, multicenter study. SETTING: Fifteen academic and private fertility clinics with IVF experience. PATIENT(S): Premenopausal women with regular ovulatory menstrual cycles undergoing IVF for infertility attributable to tubal factors, endometriosis (stage I or II), or unknown factors. INTERVENTION(S): Down-regulation with leuprolide acetate followed by up to 12 days of treatments with gonadotropins, hCG administration, oocyte retrieval, and embryo transplant. MAIN OUTCOME MEASURE(S): Mean number of oocytes retrieved, chemical, clinical, and continuing pregnancies, incidence of oocyte retrieval and embryo transfer, and peak serum E2 concentrations. RESULT(S): There were no significant differences among the treatment groups except for a higher percentage of continuing pregnancies in the Repronex SC group. Gonadotropin therapy was well tolerated in all three treatment groups. The Repronex SC group had a significantly higher incidence of transient mild/moderate injection site reactions during the first few days of therapy. CONCLUSION(S): Repronex SC is comparable in therapeutic effectiveness and safety to Repronex IM and Pergonal IM in patients undergoing IVF and provides an alternative route of injection for self-administration of gonadotropin.

Infertility: is there a role for the surgeon.

No matter how successful IVF and intracytoplasmic sperm injection become, there will always be a role for the infertility surgeon in the care of the woman with infertility. The challenge is to develop evidence-based protocols that will specify when surgery is clearly a better choice than IVF. It will also be important to develop training programs in pelvic surgery that will teach techniques and strategies designed to maintain or improve fertility as well as remove or destroy pelvic pathology. With a decreasing number of surgical procedures available to train residents in infertility surgery, it will become increasingly important to consider alternative models such as virtual reality and postresidency fellowships or preceptorships.

Pseudomyxoma peritonei associated with secondary infertility.

In summary, we report a case of secondary infertility attributed to pseudomyxoma peritonei caused by ruptured appendiceal mucocele. Resection of the tumor and visible mucinous ascites resulted in spontaneous conception. We hypothesize secondary infertility was caused by significant peritoneal inflammation and inhibition of sperm-oocyte interaction from the ascites.

KTP and argon laser laparoscopy.

Although it is true that the clinical results of surgery performed with lasers through the laparoscope are no better than those achieved with laparotomy, the laser has had a significant impact on the treatment of pelvic abnormalities in infertile women. The most notable contribution of lasers has been to extend the ability of the reproductive surgeon to perform laparoscopic surgery. As a result, many patients have been spared the added expense, pain, and hospitalization associated with a laparotomy. The argon and KTP lasers provide an option for the operative laparoscopist who is looking for a user-friendly system. The simplicity of these systems is especially appealing to the beginning or occasional laser laparoscopist. Even the experienced and expert operative laparoscopist, however, will find these lasers to be an important addition to their surgical armamentarium.

Firstborn adolescent daughters and mothers with and without premenstrual syndrome: a comparison.

Firstborn adolescent daughters and their mothers with and without premenstrual syndrome (PMS) were evaluated for two menstrual cycles in order to compare menstrual, postmenstrual (follicular), and premenstrual (luteal) symptomatology. Physical and psychological symptoms were evaluated according to the Premenstrual Assessment Form (PAF) and the Utah PMS Calendar II. The onset of the luteal phase was defined as the day of the midcycle surge of luteinizing hormone (LH), determined by utilizing the CUE Ovulation Predictor. The PAF showed that 1) irrespective of diagnosis, severity of symptoms was not significantly different between adolescents and adults; however, 2) when daughters and mothers were grouped according to mother's diagnosis, the PMS mother/daughter dyads experienced significantly more premenstrual symptoms when compared to the non-PMS mother/daughter dyads. Furthermore, the PMS Calendar revealed menstrual cycle phase delineation. There were no significant differences in severity of symptoms between adults and adolescents during the postmenstrual (follicular) phase and the premenstrual (luteal) phase. However, the adolescents experienced significantly more symptoms during the menstrual phase than the adults. 1) There were no significant differences in severity of adolescents' menstrual symptoms and their premenstrual (luteal) symptoms; 2) the number and severity of luteal phase symptoms were significantly greater for the women with PMS and their daughters than women without PMS and their daughters.

Fetoscopic neodymium:YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome.

Most pregnancies with severe twin-twin transfusion syndrome before 27 weeks' gestation result in perinatal death. Previous attempts at therapy have been generally unsatisfactory and rarely successful. We have developed a technique for intrauterine ablation of the vascular communications between the fetoplacental circulations with a fetoscopically directed neodymium:YAG laser. The operation was performed on three women at risk for pregnancy loss from acute hydramnios at 18.5, 22, and 22.5 weeks' gestation. The first two procedures were uneventful, but the third was complicated by a placental vessel perforation. The first two patients delivered at 27 and 34 weeks after premature rupture of membranes and spontaneous labor, whereas the third woman developed severe preeclampsia at 29 weeks which necessitated delivery. Four of the six infants survived. Clinical and ultrasonographic evidence, as well as pathologic examination of the placentas, suggested that stabilization or resolution of the syndrome was due to photocoagulation of the vascular communications. This initial experience suggests that fetoscopic laser occlusion of placental vessels is feasible and superior to previous therapies because it treats the underlying pathophysiology directly.

A survey of adolescent dysmenorrhea and premenstrual symptom frequency. A model program for prevention, detection, and treatment.

Eighty-eight female high school adolescents in two separate physical education classes were surveyed for the prevalence of dysmenorrhea and premenstrual symptoms. Each group answered a questionnaire requesting age; presence, severity, and nature of dysmenorrhea and premenstrual symptoms; and course of treatment. Questions were also asked to determine the perceived impact of these symptoms on academic performance, ability to concentrate, study, or take tests, and classes missed. The results showed that the majority of the female adolescents identified dysmenorrhea and premenstrual symptoms as problems that significantly affected their academic performance and were responsible for school absenteeism. Contradictory to common belief, premenstrual symptoms in these adolescents (76 of 88, 86%) were found to be as prevalent as symptoms of dysmenorrhea (80 of 88, 91%), and most of the girls were unaware of the causes and treatments of these symptoms. Subsequently, we designed a model for use by health professionals to educate girls in self-help methods and to screen for and detect these problems.

Laparoscopic treatment of endometriosis.

Advances in operative laparoscopy have been useful in the treatment of pelvic endometriosis. While these advances have not yet led to improved pregnancy rates, they have decreased the cost and morbidity of surgery for endometriosis.

Premenstrual symptoms: evaluation and treatment.

Critics who claim there is no therapy for PMS should now recognize that there are many ways to treat this condition. Appropriate therapy for PMS is more than a pill, more than changing attitudes, more than removing stress from one's life. Indeed, therapy for PMS is not always easy, for the problems that preceded the PMS may persist and the problems created by the PMS may be slow to heal. However, the good news is that most women with PMS will experience significant improvement in their sense of well-being and their quality of life with appropriate and multidisciplinary therapy.

Premenstrual syndrome. Seven steps in management.

Many forms of therapy for premenstrual syndrome (PMS) are available, but appropriate therapy involves more than a pill, more than changing attitudes, and more than removing stress. Even with treatment, the problems that preceded the PMS may persist and those that have been created by it may be slow to resolve. However, most patients experience significant improvement in their sense of well-being and quality of life with appropriate, multidisciplinary therapy.

Are we exploiting the infertile couple?

We hope that this article brings into focus some problems that merit consideration and debate. These thoughts come from a group of individuals who are actively engaged in reproductive endocrine/infertility practices with special interests ranging from ovulation induction to IVF to laser surgery. As a group, we practice in all parts of the country, and the problems mentioned are not restricted to any individual or region. We urge that all of us be candid with ourselves and our colleagues about what we can and cannot do for the infertile couple. We suggest that gynecologists ask themselves this question and proceed when the answer is affirmative: "Is this procedure really in the patient's best interest?"

Argon laser therapy of endometriosis: a review of 92 consecutive patients.

The conception rate, relief of pain, and safety of argon laser photocoagulation of endometriosis were evaluated in 92 patients. All patients were treated at the time of diagnosis with the argon laser delivered through a flexible quartz fiber passed through the operating channel of a standard and unmodified laparoscope. The uncorrected pregnancy rate was 34% (19 of 56), with 64% of the pregnancies occurring within 6 months of therapy. The conception rate was slightly greater in women with infertility of 24 months or less and in women without other fertility factors. Ninety-two percent of 50 women with pelvic pain reported a reduction of their pain after treatment. The argon laser is an effective, simple, and safe alternative for the treatment of mild or moderate endometriosis.

Medical and psychologic characteristics of women presenting with premenstrual symptoms.

To establish the necessary elements of a program of evaluation and treatment of premenstrual syndrome, the medical and psychologic characteristics of 68 consecutive women presenting because of premenstrual symptoms were determined and compared with those of a similar group of 34 women without premenstrual symptoms (control group). Women with premenstrual symptoms exhibited a significantly greater frequency of previously undetected medical, psychologic, and marital problems than did controls. These findings demonstrate the need for a multidisciplinary comprehensive program of evaluation and treatment of the medical, psychologic, and mental health of women who present because of moderate-to-severe premenstrual symptoms.