Effect of bromo-ergocryptine on serum hPRL, hLH, hFSH, and estradiol 17-beta in women with galactorrhea-amenorrhea.

Fourteen women with amenorrhea-galactorrhea were treated with bromo-ergocryptine. Serum prolactin hPRL, hLH, hFSH, estradiol 17-beta (E2), and progesterone values were determined before and during treatment. No consistent pretreatment hormonal pattern was found. During treatment hPRL levels fell in 13 of 14 patients, and E2 rose in 12 of 14 patients. Levels of hLH became normal, and amounts of hFSH did not change. Galactorrhea lessened in all cases and ceased in 11. Menses resumed in 11 patients and 3 women became pregnant. Cessation of galactorrhea and resumption of menses occurred irrespective of initial hPRL or hLH levels. It is suggested that improvement of galactorrhea and resumption of menses in some patients with normal hPRL values are the result of increased serum E2 levels and may be due to a direct action of bromo-ergocryptine on the ovary. Bromo-ergocryptine may also be effective in treatment of amenorrhea, unassociated with galactorrhea or elevated hPRL levels.

Progestational potency of oral contraceptives.

The induction of glycogen deposition as subnuclear vacuoles was found to be a better method in estimating progestational potency of individual progestins than the delay of menses assay. Norgestrel was the most potent progestin in all assays. The progestational potency of oral contraceptives was estimated by multiply potency of individual progestins by their dose. Combination oral contraceptives containing norgestrel were in the mid range of progestational potency because of the relatively higher potency of their progestin. The progestational potency of the norethindrone "mini" pill was compared with that of the norethindrone low-progestogen combination pill and the sequential pill over a 28-day cycle, and no appreciable difference was found.

Postmenopausal symptomatology, maturation index, and plasma estrogen levels.

An attempt to correlate postmenopausal symptoms with the vaginal maturation index and plasma levels of estrogen was made in a group of patients with surgical menopause. The group was followed up monthly for 6 months in a double-blind study during which the patients received equine esterified estrogen and synthetic esterfield estrogens. No statistical difference in plasma levels of estrogen was found between the group of patients with symptoms and the patients without symptoms, with or without estrogen therapy. There was no correlation of the maturation index with the presence or absence of symptoms or with the estrogen plasma levels.

Effect of adrenal suppression in gonadal gysgenesis.

Plasma steroids, estrogen, progesterone, and testosterone, and plasma gonadotropins FSH and LH were determined before and after adrenal suppression in an 18-year-old patient with gonadal dysgenesis (XX/XO). Total plasma estrogen was initially low (9.2 plus or minus 2.4 pg/ml) and did not change after adrenal suppression. Plasma progesterone (380 plus or minus 18 pg/ml) and testosterone (236 plus or minus pg/ml) were in the range found in the normal follicular phase and fell to 50 plus or minus 17 pg/ml and 112 plus or minus pg/ml, respectively, after adrenal suppression. Mean levels of FSH and LH were unchanged after adrenal suppression. These results suggest that the adrenal may make a significant contribution to plasma levels of progesterone and testosterone in patients with gonadal dysgenesis and may also contribute to the plasma levels of these steroids during the follicular phase of the mensturual cycle.

LHRH and steroid levels in normal ovulatory women.

Synthetic LHRH was given intravenously in a dose of 250 mug to a group of 7 normal women in different phases of the menstrual cycle. The LH response was more pronounced in the preovulatory and luteal phase than in the follicular phase of the cycle. The FSH response was less than that of LH and was the same in all phases of the cycle. No significant changes were observed in the plasma levels of estradiol 17-beta, progesterone, or testosterone for up to 6 hours as well as 24 hours after LHRH administration in any of the subjects studied. In 2 of 3 subjects, administration of LHRH in the luteal phase resulted in the prolongation of the cycle. No effect on cycle length was observed when LHRH was given at other times of the cycle. LHRH did not affect the length of the subsequent cycle regardless of the day of administration.

Microorganisms in semen used for artificial insemination.

The effect of freezing semen in a cryopreservative media consisting of egg yolk glycerol with or without erythromycin was tested for its effect on the viability of microorganisms present in donor semen and on sexually transmitted pathogens seeded into semen. All donor semen contained two or three species of microorganisms that could be considered skin flora. Five of ten donor semen specimens contained Ureaplasma urealyticum that was not affected by either freezing or antimicrobial treatment. Some strains of Neisseria gonorrhoeae, when seeded into semen, survived all conditions except freezing in egg yolk glycerol containing erythromycin. Chlamydia trachomatis was erradicated when erythromycin was present in the cryopreservative. There was no detectable effect of any treatment tested on the survival of herpes simplex virus.

Peritoneal recovery of sperm in patients with infertility associated with inadequate cervical mucus.

In an effort to complete an infertility evaluation in a group of 25 patients with unexplained infertility, except for persistent inadequate cervical mucus and poor-to-negative postcoital tests, laparoscopy was scheduled as close as possible to the ovulatory day of the cycle. Patients were artificially inseminated with their husbands' sperm 2 or 3 hours before laparoscopy. Sperm was recovered at the time of laparoscopy through a second probe from the pouch of Douglas before and after hydrotubation with a dilute solution of methylene blue. The results were compared with those obtained in a group of 15 women with unexplained infertility and normal cervical mucus and postcoital tests. Sperm were recovered from 8 of 15 control subjects (53.3%) and from 14 of 25 patients (56.1%). In most cases with positive results, sperm were found in the peritoneal cavity before hydrotubation. It is apparent that sperm can reach the peritoneal cavity regardless of the quality or quantity of cervical mucus. It also appears that a normal postcoital test may not indicate adequate sperm transport into the upper genital tract. These results confirm previous observations and question the usefulness of many in vitro tests presently in use for evaluation of sperm penetration in the female genital tract.

Peritoneal recovery of motile and nonmotile sperm in the presence of endometriosis.

It has been postulated that pelvic endometriosis may cause infertility by interfering with sperm motility and transport and even by increased intraperitoneal phagocytosis. The rate of sperm recovery at the time of laparoscopy performed in the immediate preovulatory period was determined in 29 patients (27.4%) with endometriosis (AFS stage I) and in 77 patients (72.6%) without endometriosis. The number of patients with motile sperm in both groups was similar (difference P greater than 0.30). It is concluded that mild endometriosis does not affect sperm transport and survival and that increased sperm phagocytosis in vivo is unlikely.

Ovulation induction in women with premature ovarian failure: a prospective, crossover study.

A prospective crossover study comparing ovulation induction techniques in eight women with premature ovarian failure is presented. These patients were treated with FSH rebound techniques using the GnRH-a, LA, alone in one treatment cycle and the same plus menopausal gonadotropins in the other treatment cycle. Two women ovulated in each group. We conclude that ovulation does occur in women with premature ovarian failure, but that luteal P may be inadequately secreted.

Presence of thyroid antibodies in early reproductive failure: biochemical versus clinical pregnancies.

OBJECTIVE: To evaluate the clinical usefulness of thyroid antibodies in determining early pregnancy outcome. SETTING: University-based facility at the Center for Reproductive Health, University of California, Irvine. PATIENTS: Four hundred eighty-seven infertile patients that successfully conceived with assisted reproductive techniques from January 1991 to December 1992. INTERVENTIONS: An enzyme immunoassay for semiquantification of thyroglobulin (TG) and thyroid peroxidase antibodies used to determine antibody status from stored serum of these patients. MAIN OUTCOME MEASURE: Thyroid antibody status in early pregnancy. RESULTS: Of the 487 patients studied, there were 106 women who were antibody positive for anti-TG, antithyroid peroxidase, or both, and 381 who were negative. The overall incidence of positivity was 22%. In the antibody-positive group there was a 32% clinical miscarriage rate in comparison to 16% in the antibody-negative group. This did reach statistical significance. There was no significant difference between the two groups in the incidence of biochemical or ectopic pregnancies. There also was no significant difference between the groups in age, gravidity, or number of prior pregnancy losses. CONCLUSION: In our patient population, thyroid antibodies proved to be a useful marker for identifying women at risk for clinical miscarriage but they appear not to have an association with biochemical pregnancies.

Acrosome reaction of human spermatozoa in zona-free hamster egg penetration test.

The acrosomal status of human sperm during preparation for the process of zona-free hamster egg penetration test (ZFHEPT) was determined. The incidence of acrosome reaction (AR), as assessed by triple-stain technique, was significantly increased after 24 hours of incubation at 4 degrees C in TES-Tris (TEST)-yolk buffer, but the absolute values were relatively low (20% or less). Sperm from fertile donors and infertile patients with normal or abnormal semen analysis displayed similar capacity to undergo the AR in vitro. Although a positive correlation was found between the incidence of AR and the score of ZFHEPT, a remarkable individual variation was noted. The incidence of AR in freely swimming human sperm does not accurately reflect the fertilizing ability of the sperm.

Recovery of microorganisms from the pelvic cavity after intracervical or intrauterine artificial insemination.

To assess the risk of introducing microorganisms into the peritoneal cavity during intracervical or intrauterine insemination, we cultured the cervix and semen from 19 couples before insemination and the peritoneal fluid from the female partner after insemination. The peritoneal cultures taken before hydrotubation grew organisms in one of ten intracervical inseminations and five of the nine intrauterine inseminations (P less than 0.05). In four of the five positive peritoneal cultures from the intrauterine group, the organism was also cultured from the semen specimen obtained before insemination and not from the cervical sample. Therefore, intrauterine insemination appears to increase the risk of introducing microorganisms into the upper genital tract and the peritoneal cavity. The clinical significance of this finding remains to be established.

Radionuclide evaluation of tubal function.

The tubal capacity to transport radioactively labeled human albumin microspheres deposited in the vaginal fornix and cervical canal and to concentrate them on the ovarian surface was evaluated in a group of 34 patient-volunteers. One millicurie of technetium-99 was used to label human albumin microspheres of 20 mu in diameter, suspended in 1 ml of saline. The distribution of the radioactive material was imaged on a gamma camera at different intervals between 15 and 240 minutes. The radiation dose to the ovaries was estimated to be similar to that of a hysterosalpingogram. The results of the radionuclide evaluation were compared with the surgical findings at the time of laparoscopy or laparotomy performed for diagnostic or therapeutic reasons. The overall correlation was 87.1%. It would appear that as opposed to the traditional hysterosalpingogram, a radionuclide test may give a better understanding of the functional capacity of the tube and may also prove a useful method in the evaluation of the results of tubal microsurgical procedures.

Effect of freezing on the relative escape force of sperm as measured by a laser optical trap.

OBJECTIVE: To determine the possible effect of freezing on sperm escape force as measured by laser trap. DESIGN: Controlled clinical study. SETTING: Normal volunteers, academic setting. PATIENTS: Normal, healthy volunteers. INTERVENTION: Sperm selection, freezing and thawing. Measurement of relative (sperm) escape force before and after freezing. MAIN OUTCOME MEASURE: Comparison of escape force as a measurement of freezing effects. RESULTS: Wide individual variations noted, with some individuals showing significant increases or decreases. The relative escape force in fresh (76.1 +/- 31.1 mW) and in frozen-thawed samples (75.6 +/- 40.0 mW) were similar. CONCLUSION: Freezing does not affect the relative escape force of normal sperm. Any possible detrimental effect of freezing on sperm may be related to other sperm functions.

Frozen zygote intrafallopian transfer: a successful approach for transfer of cryopreserved embryos.

OBJECTIVE: To assess whether frozen ET to the fallopian tube is a possible alternative for cryopreserved embryos. DESIGN: Fifty-four patients (mean age 35 years) participated, in which their embryos were cryopreserved in 1.5 M propanediol at the pronuclear or two-cell stage. Each patient then underwent a steroid replacement cycle consisting of oral micronized 17 beta-E2 2 mg on days 2 to 4, 4 mg on days 5 to 7, 6 mg on days 8 to 10, and 8 mg from day 11 on. Serial ultrasounds were performed to evaluate the endometrium until an optimal thickness of > or = 10 mm triple layer was achieved. At this time, 100 mg IM progesterone was initiated and the zygote intrafallopian transfer (ZIFT) procedure was performed on the third day of P administration. The average number of embryos transferred was 4.4. RESULTS: Twenty-two clinical pregnancies resulted, giving a pregnancy rate of 41%. Eight miscarriages occurred and one ectopic pregnancy resulted, giving a live birth rate of 24%. Implantation rate was 10.8%. The highest chance of pregnancy was seen in patients who never had a previous IVF, GIFT, or ZIFT (61%). CONCLUSION: This is the first report of a series of frozen ETs to the fallopian tubes. These results indicate that tubal transfer may offer a protective benefit of the tubal environment and avoidance of endometrial trauma, and should be added to our armamentarium of replacing cryopreserved embryos.

Ultrasound: a technique useful in determining the side of ovulation.

It is often assumed that ovulation commonly occurs from alternating sides each month, but it is unknown whether it can occur repeatedly from the same side. In an effort to answer this question, we selected 39 women from our infertility clinic who had six consecutive courses of ultrasound (US) to monitor ovulation and in whom the side of ovulation was recorded. Nine patients (23.1%) ovulated from the same side for six consecutive cycles, whereas no patient alternated side of ovulation in the same period of time. Stimulation with clomiphene citrate and/or human menopausal gonadotropin that results in single ovulation did not affect this pattern. The data were analyzed statistically with the use of a Markov Chain Model and the chi-square goodness-of-fit; the occurrence of persistent same-side ovulation was significant to P less than or equal to 0.001.

Radiologic evaluation of incremental intrauterine instillation of contrast material.

In view of the contradictory results of IUI reported in the literature, the present study was undertaken to determine whether the volume of material injected into the uterus can affect the delivery site of the sperm. Ten infertile women scheduled for HSG were submitted to intrauterine injection of different volumes of radiopaque dye (0.2 mL to 1.0 mL) before the procedure to mimic IUI. An x ray taken immediately after injection showed that volumes of > or = 0.4 mL reached the uterus and tubes, whereas the 0.2-mL volume did not reach the tube. These data show that volume injected is an important variable in IUI.

Comparison of techniques for the selection of bacteria-free sperm preparations.

The authors compared the three most commonly used sperm preparation techniques--swim-up, fall-down, and Percoll gradient--for their ability to recover highly motile sperm and minimize bacterial contamination. Eleven human semen samples collected by masturbation were used and run in parallel with the three methods. A semiquantitative bacterial analysis was performed in all samples and results expressed in colony-forming units per milliliter (CFU/ml). The Percoll gradient technique resulted in an average sperm concentration of 5.81 +/- 4.4 X 10(6) ml, and the average bacterial concentration dropped from 8.66 +/- 12.96 X 10(3) CFU/ml in semen to 0.01 +/- 0.03 X 10(3) CFU/ml. The bacterial count was not significantly different when the raw semen was compared with the swim-up or the fall-down preparations. The authors conclude that the Percoll gradient method yields an adequate sperm concentration, with high motility and improved morphology, while eliminating bacterial contamination.

Intrauterine inseminations with washed human spermatozoa does not induce formation of antisperm antibodies.

In this study we investigated the possible development of serum antisperm antibodies in women receiving repeated IUI. Patients acted as its own control and were evaluated before and after various (1 to 15) IUI cycles using three different assays for antisperm antibodies. It was found that only 2 out of 41 women developed antisperm antibodies. We concluded that exposure of the upper reproductive tract to washed spermatozoa during repeated IUI with partners' sperm does not significantly stimulate the appearance of serum antisperm antibodies.

Gamete intrafallopian transfer: the effect of the number of eggs used and the depth of gamete placement on pregnancy initiation.

The role of the fallopian tube in initiating pregnancy was examined in 246 consecutive gamete intrafallopian transfer (GIFT) cycles. Before actual transfer, the ampulla of each tube was measured to determine the depth at which gametes could be placed. Fifty-seven transfers were made with four oocytes into a single tube; of these, when gametes were deposited deeper than 4 cm, the pregnancy rate was higher than when they were placed at between 3 to 4 cm (69.6% compared with 41.2%). Presumably, a deeper placement is more secure and decreases the likelihood of gamete displacement. The pregnancy rate also rose with the number of oocytes used: from 0% with a single oocyte to 42.9% with four oocytes.