Induction of relaxin secretion in nonpregnant women by human chorionic gonadotropin.

Five normal women using barrier forms of contraception has serum samples drawn every 2 days during control menstrual cycles. Relaxin was not detectable in their serum. All five subjects then received 2500 IU hCG im every 2 days beginning 8--10 days after presumed ovulation. All had immunoreactive relaxin detectable in serum 2--6 days after the first hCG injection. Relaxin rose to pregnancy levels (range, 0.26--0.62 ng/ml; mean, 0.38 +/- 0.17 ng/ml) by cycle day 31 and then declined before menstruation. Progesterone levels and cycle lengths of relaxin-secreting cycles were significantly higher (P less than 0.05) than control cycles. Three of the five subjects subsequently received 2500 IU hCG im every 2 days commencing 2--3 days after presumed ovulation until menstruation. Relaxin was not detectable in these cycles. hCG can induce relaxin secretion in nonpregnant women. A hCG stimulus which can induce relaxin secretion from an 8- to 10-day-old corpus luteum cannot induce relaxin secretion in a 2- to 3-day-old corpus luteum, suggesting that the age of the human corpus luteum of the menstrual cycle is an important determinant of responsiveness to hCG.

PIP: Serum samples were drawn every 2 days during control menstrual cycles from 5 healthy women using barrier forms of contraception. Relaxin (a peptide hormone produced by the human corpus luteum of pregnancy) was not detectable in their serum. 2500 IU hCG im were then administered in all subjects every 2 days beginning 8 to 10 days after first hCG injection, rising to pregnancy levels (range, 0.26 to 0.62 ng/ml; mean, 0.38 + or - 0.17 ng/ml) by cycle day 31 and then declining before menstruation. Progesterone levels and cycle lengths of relaxin-secreting cycles were significantly higher (p 0.05) than control cycles. Relaxin was not detectable in 3 of 5 subjects who subsequently received 2500 IU hCG im every 2 days starting 2 to 3 days after presumed ovulation until menstruation. HCG can induce relaxin secretion in nonpregnant women. It is suggested that the age of human corpus luteum of the menstrual cycle is an important determinant of responsiveness to hCG.

Hematometra-hematocolpos: a late complication of successful separation of conjoined twins.

A late complication of separation of conjoined twins, hematometra-hematocolpos, may appear with sexual maturation. An obstructed genital outflow tract can cause significant urologic and reproductive tract morbidity.

Ectopic pancreas in the fallopian tube. Report of a first case.

A case of ectopic pancreas in the fallopian tube is reported. This small, polypoid, benign tumor was in a fallopian tube contralateral to a ruptured tubal pregnancy. The patient had a tubal ligation performed six years previously. To the best of our knowledge this is the first reported case of isolated ectopic pancreas in a fallopian tube. No explanation is offered for the pathogenesis of this lesion.

Relaxin secretion in early pregnancy.

Relaxin is a peptide hormone produced solely by the corpus luteum of pregnant women. Extracts of human pregnancy corpora lutea have relaxin activity in bioassay systems. This activity can be measured in a heterologous porcine radioimmunoassay (RIA). Immunoreactive relaxin was undetectable in the RIA in 51 nonpregnant women. In conception cycles, relaxin immunoactivity is detectable in peripheral blood by the time of the missed menses. Relaxin detection may be used as a pregnancy test. Relaxin may be an important luteal factor, together with progesterone, in early pregnancy maintenance.

Hyperprolactinemia and associated pituitary prolactinomas.

The association between serum prolactin (PRL) and the presence of pituitary tumors as determined by third generation computed tomography scan was studied in hyperprolactinemic patients. Patient charts from a four-year period were reviewed to identify those patients with elevated PRL (greater than or equal to 25 ng/mL). All patients with hyperprolactinemia underwent computed tomography scan evaluation of the pituitary gland. Hyperprolactinemia was identified in 79 patients, mean PRL 59 +/- 6.1 ng/mL SEM. Pituitary tumors were identified in 35 of these patients, mean PRL 65 +/- 11.9 ng/mL. This level was not significantly different from the level in 43 patients with normal computed tomography scans (52 +/- 5.7 ng/mL). This review found that computed tomography scan identified pituitary tumors in 44% (35 of 79) of patients with hyperprolactinemia. The likelihood of finding a pituitary tumor did not correlate with the level of hyperprolactinemia. Computed tomography scan is indicated for the diagnosis of prolactinomas in all hyperprolactinemic patients regardless of the serum PRL level.

Relaxin in normal and pathogenic pregnancies.

Serum relaxin concentrations were quantitated throughout pregnancy. Relaxin levels were higher in the first than in either succeeding trimester of pregnancy. Relaxin concentrations in third-trimester twin pregnancies were not significantly different from those in singleton pregnancies. Relaxin levels in toxemic pregnancies were similar to those of normal pregnancy. In contrast, relaxin concentrations in pregnancies beyond 43 weeks' gestation and in women with premature labor were significantly lower than levels in normal women in the third trimester of pregnancy.

Semen quality before and after processing by a swim-up method: relationship to outcome of intrauterine insemination.

Twenty-five couples with normal semen analyses and postcoital tests of less than or equal to 3 motile sperm/high-power field were treated by intrauterine insemination (IUI) with sperm prepared by a swim-up method. Eight women conceived (32%). Influence of semen parameters both before and after swim-up, patient age, and duration of infertility on outcome of IUI was assessed with logistic discriminant analysis. The percent motility of sperm after swim-up allowed significant differentiation of pregnant and nonpregnant patients (P = 0.0009). For patients with greater than 79% motility after swim-up, discrimination provided by post-swim-up motility (P = 0.0063) was enhanced by inclusion in the analysis of either total number of motile sperm used for insemination (P = 0.0021) or sperm concentration after swim-up (P = 0.0019), Predictions of nonpregnancy and pregnancy were correct at rates of 93.3 and 70%, respectively. There were no significant differences between semen parameters of conception and nonconception cycles of patients who conceived.

Inaccuracy of basal body temperature charts in predicting urinary luteinizing hormone surges.

Sixty basal body temperature (BBT) charts were reviewed by three reproductive endocrinologists in an attempt retrospectively to predict the urinary luteinizing hormone (LH) surge. LH surges had been previously detected in all cycles with the use of a commercially available monoclonal antibody kit, Ovustick (Monoclonal Antibodies, Inc., Mountain View, CA). Surges were correctly predicted to the day (day 0) 18.3% to 30.0% of the time, to within 1 day on either side of day 0 56.7% to 70.0% of the time, to within 2 days 83.3% to 98.3% of the time, and to within 3 days 96.7% to 98.3% of the time. The BBT remains an inaccurate predictor of the day of the LH surge but does provide a reasonably accurate guide to the 2- to 3-day period on either side of the surge.

PIP: The accuracy of basal body temperature (BBT) in retrospectively predicting the urinary luteinizing hormone (LH) surge was assessed in 60 cycles from 21 women undergoing artificial insemination with their husbands' semen. LH surges previously had been detected through use of commercially available monoclonal antibody kit, Ovustick. BBT charts were reviewed by 3 reproductive endocrinologists. Surges were correctly predicted to the day 18.3-30.0% of the time, to within 1 day on either side of day 0 56.7-70.0% of the time, to within 2 days 83.3-98.3% of the time, and to within 3 days 96.7-98.3% of the time. In addition, the physician who performed the inseminations calculated the relationship between the thermal nadir and the urinary LH surge. The nadir was noted on the day of the surge in 30% of cycles, between days -1 and +1 in 78.3%, and between days -2 and +2 in 100%. The results confirm the impression that the BBT is an inaccurate predictor of the precise day of the LH surge. On the other hand, it does provide a reasonably accurate guide to the 2-3 day period on either side of the LH surge. It is concluded that prospective use of the BBT, in which the endpoint for identifying the LH surge is the lowest temperature at midcycle before a sustained rise, can be useful in timing artificial insemination if multiple inseminations at 48-hour intervals are feasible.

Intracervical versus intrauterine insemination: correlation of outcome with antecedent postcoital testing.

Thirty-four infertile women alternated cycles of intracervical insemination (ICI) with whole ejaculate homologous semen (mean, 3.2 cycles/patient) versus intrauterine insemination (IUI) with washed sperm (mean, 3.4 cycles/patient). Twenty of the 34 women had prior postcoital tests consistently demonstrating less than or equal to 3 motile sperm per high-powered field (HPF). Six of those 20 conceived during IUI cycles (30.0%); 0 conceived during ICI cycles (P = 0.06, Mantel-Haenszel chi-square test). The pregnancy rate per IUI cycle was 6/72 (8.3%), compared with 0/66 (0.0%) per ICI cycle, a statistically significant difference (P = 0.04, Fisher's exact chi-square test). Fourteen of 34 women had prior postcoital tests consistently demonstrating greater than or equal to 5 motile sperm per HPF. One of the 14 conceived during an IUI cycle (7.1%), and 2 conceived during ICI cycles (14.3%), a difference that was not significant. The pregnancy rate per IUI cycle was 1/42 (2.4%), compared with 2/42 (4.8%) per ICI cycle (not significant). IUI may be helpful in the management of infertility associated with relatively poor postcoital tests (less than or equal to 3 motile sperm per HPF) but not with relatively good postcoital tests (greater than or equal to 5 motile sperm per HPF).

Raynaud's phenomenon in infertile women treated with bromocriptine.

Two cases are reported of infertile women who developed cold-induced digital vasospasm (Raynaud's phenomenon) on low-dose Parlodel (5.0 to 7.5 mg/day). The cases are reported to alert clinicians to the potential relationship between Raynaud's phenomenon and low-dose Parlodel usage in women using the drug for hyperprolactinemic or infertility indications.

Clomiphene citrate in the management of infertility associated with shortened luteal phases.

Repetitively short luteal phases were found in eight infertile women. The short luteal phase was defined as 10 days or less from the presumed time of ovulation (as assessed by basal body temperature recording) to the onset of menses. Clomiphene citrate (Clomid) therapy resulted in pregnancy in two patients and lengthened the luteal phase in the other six. Ultimately, seven of eight patients conceived during Clomid therapy. Clomid therapy can lengthen the luteal phase in patients with luteal temperature elevation of 10 days or less. The occurrence of short luteal phases may be associated with infertility.

The effect of preimplantation culture conditions on murine embryo implantation and fetal development.

Ham's F-10 medium (Gibco, Grand Island, NY) and medium T6 with and without 15% fetal calf serum (FCS) were compared for their ability to support development of murine blastocysts with the capacity to implant and produce normal fetuses when transferred to pseudopregnant females. All media supported equal rates of blastocyst development from 2-cell embryos. In addition, there were no differences in the rates of blastocyst implantation. However, once implanted, blastocysts grown in T6 produced a significantly higher proportion of normal fetuses (58.5% to 65.9%) than blastocysts grown in either Ham's F-10 (2.4%) or T6 with FCS (27.6%). These results demonstrate that the rate of murine blastocyst development from 2-cell embryos in vitro is not a good criterion of healthy embryos. Murine blastocysts transferred in medium with 0% versus 50% FCS implanted and developed into normal fetuses at equal rates.

Relationship of within-patient semen variability to outcome of intrauterine insemination.

To define the subpopulation of infertility patients who would benefit from intrauterine insemination (IUI) with swim-up homologous sperm, the relationship of within-patient semen variability to outcome of IUI was studied. The 61 women in the study had negative workups. Men had at least one semen sample with greater than or equal to 20 x 10(6) sperm/ml. The 6-month cumulative pregnancy rate for all patients was 31.8%. Patients with original sperm motilities consistently greater than or equal to 30% had a higher cumulative pregnancy rate (62.9%) than patients with one or more motility less than 30% (22.0%, P = 0.0015, log-rank test). Patients with post-swim-up motilities consistently greater than or equal to 70% had a cumulative pregnancy rate (51.2%) significantly greater than patients inconsistent for this parameter (15.6%, P = 0.0116). Consistency of sperm motility is a useful parameter for defining the subpopulation of patients who would benefit from IUI.

Accessory cervix: an unusual congenital malformation.

A woman with a septate vagina and two cervices was observed. One of the cervices ended blindly. The other cervix communicated with a normal corpus and two normally positioned patent fallopian tubes. Two explanations for the origin of this accessory cervix are offered: (1) that it originated from a fusion failure of the lower portions of the müllerian ducts, and (2) that it arose from the urogenital sinus.

Proximal tubal occlusion: microsurgery versus IVF--a review.

The success of IVF has established it as a viable alternative to microsurgery in the treatment of infertility associated with certain types of tubal occlusion. The authors have recently reported on the success rates of microsurgery versus IVF in cases of distal tubal occlusion. The present study summarizes the results reported in the world literature for microsurgery in cases of proximal tubal occlusion secondary to surgical sterilization, previous infection, or endometriosis, and compares them with the results reported for IVF. Based on what has been published to date, it appears that microsurgical tubocornual anastomosis remains the procedure of choice for proximal tubal occlusion.

Distal tubal occlusion: microsurgery versus in vitro fertilization--a review.

The success of in vitro fertilization (IVF) has established it as a viable alternative in the treatment of infertility associated with distal tubal occlusion (DTO). In an attempt to adequately counsel patients with DTO as to whether their primary treatment should be microsurgery or IVF, the authors have performed a comprehensive world-wide literature review. Based on what has been published to date, it would appear that patients with mild to moderate tubal disease should be offered salpingoneostomy as their first treatment modality. For patients with severe disease accompanied by extensive pelvic adhesions, salpingoneostomy should be discouraged.