Acyclovir treatment of twelve unexplained infertile couples.

Because of recently published research showing herpes antibodies in the endometria of patients who had aborted, as well as evidence of subacute inflammation of the endometria, 17 couples suffering from long-standing totally unexplained infertility (except for persistent subacute inflammation of the endometrial were given acyclovir over a period of six menstrual cycles. Five of these couples did not complete the treatment protocol. Of the 12 couples who did, 5 became pregnant, with successful pregnancies. Two of the five had posttreatment endometrial biopsies that were negative, and both became pregnant subsequently. In contrast to their past histories, there were no spontaneous abortions.

Mycoplasma, chlamydia, Epstein-Barr, herpes I and II, and AIDS infections among 100 consecutive infertile female patients and husbands: diagnosis, treatment, and results.

One hundred consecutive infertile patients were studied to determine the incidence of sexually transmitted diseases (STDs) among middle and upper income patients, most of whom were referred as longstanding failures by other physicians. There were no cases of syphilis, gonorrhea, or AIDS found among these patients. One patient was pregnant when first seen, and was eliminated. Genital mycoplasmas were cultured from 64 wives. Antibodies for past or recent infection with Chlamydia were present in only 23. Antibodies to Epstein-Barr virus and to herpes II were found in 92 and 65, respectively. If only the mycoplasmas, Chlamydia, and herpes II are considered possible causes of human infertility, only 7 of the 99 couples showed no evidence of ever having had any of these three infections. Edometrial histology was positive for the changes associated with Mycoplasma infection in 47 of the 86 patients biopsied. Of the 39 with negative biopsies, 24 yielded positive cultures for Mycoplasma. Hence, only 15 of the 99 patients were negative for Mycoplasma by both culture and/or endometrial histology. Treatment with the antibiotic of choice, as indicated by sensitivity testing of all Mycoplasma-positive cultures, was an important factor in producing 43 pregnancies during the first year of study. Two of these were ectopic; 11 were spontaneous abortions, with one of these women now pregnant again and in mid-trimester; 28 have delivered healthy babies; and two are still pregnant and doing well.

Evidence of improved pregnancy outcome with diethylstilbestrol (DES) treatment of women with previous pregnancy failures: a retrospective analysis.

In a longitudinal study of 2378 pregnancies, diethylstilbestrol (DES) therapy was associated with an increased live-birth rate in patients with a history of prior pregnancy wastage. The data were analyzed statistically by comparing the rates of success with and without DES treatment in pregnancies grouped according to similar reproductive histories. The effect of DES on the outcome of pregnancy has not been assessed previously in this manner.

The role of mycoplasma among 81 consecutive pregnancies: a prospective study.

1. Among 41 previously positive and treated pregnant patients who were retreated when pregnant, the fetal wastage was 15%. 2. Among 40 previously negative or never cultured pregnant patients, the fetal wastage was 25%. 3. The incidence of previous major fertility surgery was 32% for the previously positive patients, but only 7% for the previously negative patients. 4. All of the 43 1-year-old children whose mothers received Vibramycin during early pregnancy have now been reported to be normal.

Survival of Ureaplasma urealyticum on different kinds of swabs.

The survival of Ureaplasma urealyticum on five different types of swabs routinely used for obtaining clinical specimens is limited to 1 h. Wooden applicator sticks inhibit the alkaline color change in broth and result in a significant loss of isolates if broth alone is used.

Tetracycline-resistant T-mycoplasmas (Ureaplasma urealyticum) from patients with a history of reproductive failure.

The susceptibilities of T-mycoplasmas (Ureaplasma urealyticum) to minocycline, demeclocycline, doxycycline, tetracycline, and erythromycin were determined by a direct tube dilution test. T-mycoplasma-positive urine sediments of 105 patients with a history of reproductive failure were used as inocula. Minocycline was found to be the most active of the group of antibiotics commonly used to eradicate T-mycoplasma infection. Based on the median initial minimum inhibitory concentration, minocycline was the lowest with 0.03 mug/ml, followed by demeclocycline and doxycycline with 0.125 mug/ml, tetracycline with 0.25 mug/ml, and erythromycin with 2.0 mug/ml. Six T-mycoplasma isolates which had been cloned three times were also tested for susceptibility to the same five antibiotics. The same susceptibility pattern was found. Strains resistant to high concentrations of all antibiotics occurred. Strong positive correlation was seen in 21 patients between in vitro highly resistant strains and positive posttreatment cultures. These results indicate that empirical treatment of genital mycoplasma infections is not justified. Cultures should be taken pretreatment, susceptibility testing performed prior to treatment, and follow-up cultures done posttreatment.

The prevention of postoperative pelvic adhesions following conservative operative treatment for human infertility. A final 3-year follow-up report.

PIP: A combination of Decadreon (dexamethasone) and Phenergan (promethazine) was tested in this collaborative study of 240 infertility patients as a means of preventing postoperative adhesion formation after simple pelvic surgery. 24 patients were lost to follow-up. The overall pregnancy rate among the 240 patients was 51.7% (124): 49% with primary infertility and 58% with secondary infertility conceived after surgery. 90 full-term deliveries were recorded, 27 spontaneous abortions occurred, and 7 ectopic gestations were conceived. In all, 31 cases were reinspected for various reasons after the drug treatment postsurgery; 42% showed no adhesions, 23% showed minimal adhesions, and 35% had significant adhesions. Complications coincident with use of the combined medication were seen in 2.2% (11 of 240) patients. Though this study lacked controls, the authors feel thta the use of corticosteroids postoperatively after pelvic intervention may control the numbers of adhesions which form postoperatively.^ieng