Outcome of ovum donation in Turner's syndrome patients.

OBJECTIVE: To determine whether there is a difference in the pregnancy rate in women with Turner's syndrome (45,X) in an ovum donation program compared with women with other causes of premature ovarian failure. DESIGN: Retrospective chart review of women with Turner's syndrome (n = 11) and premature ovarian failure (n = 38) in a donor ovum program using variable dose and duration of E2 replacement therapy for endometrial preparation and using only transvaginal ultrasonographic assessment of endometrial response before ET. RESULTS: The pregnancy rates in Turner's syndrome patients and control subjects were 27% and 25%, respectively. Pregnancy rates were higher in the first cycle than in subsequent cycles for both groups (40% versus 8%). CONCLUSIONS: Turner's syndrome patients given a variable dose of estrogen, for endometrial preparation, with response assessed exclusively by transvaginal ultrasonography demonstrated pregnancy rates equal to patients with other causes of premature ovarian failure.

Multiple follicular recruitment and intrauterine insemination outcomes compared by age and diagnosis.

We studied the outcome of our intrauterine insemination (IUI) programme, evaluating female age and diagnosis. One-hundred-and-twenty-six patients less than 36 years of age (mean 30.91 +/- 3.02 years) completed 306 cycles of multiple follicular recruitment (MFR) and timed IUI; 64 patients greater than or equal to 36 years of age (mean 38.36 +/- 2.08 years) completed 166 cycles (total 190 patients, 472 cycles). The male partners' semen was prepared for IUI with wash and swim-up techniques. Diagnostic groups were: male factor (n = 26), idiopathic (n = 33), endometriosis (n = 19), ovulatory disorder (n = 7), other (n = 19) and combined factors (n = 86). Pregnancy rates (% per couple, % per cycle) [overall (31.58, 12.7)] [less than 36 years (38.10, 15.69)] [greater than 36 years (18.75, 7.23)] were greater in the less than 36 years group (P less than 0.025). The probability of conception after three treatment cycles was 0.402 overall, 0.481 for age less than 36 years and 0.252 for age greater than or equal to 36 years. The probability of conception for male factor and idiopathic infertility patients was 0.469 and 0.411 respectively. An age effect was found on pregnancy rates in the idiopathic group only. In conclusion, MFR + IUI is a valuable treatment especially for male factor patients and patients less than 36 years old, with idiopathic infertility.

Acute adolescent menorrhagia.

Acute menorrhagia in adolescence is a much underestimated clinical problem, often requiring urgent medical intervention. In a 9-year case review between January, 1971, and January, 1980, we looked at all admissions to a children's hospital for acute menorrhagia, where genital tract pathology had been excluded. A primary coagulation disorder was found in almost 20% of these 59 patients. One quarter of those with severe menorrhagia (hemoglobin less than 10 gm/100 ml), one third of those requiring transfusion, and one half of those presenting at menarche had such an underlying disorder. Therefore, proper screening and therapy are essential in all girls with menorrhagia. Conventional methods of hormonal control are only partially effective in these special cases.

Editorial: Wilful exposure to unwanted pregnancy.

PIP: The circumstances surrounding willful exposure to unwanted pregnancy are discussed for the 16- and 17-year-old age group. Observations come from the 4th year of a 5 year study of the medical, psychological and sociological effects of abortion on adolescents. In this age group parental participation in the abortion decision was excluded by the girls. The provision of contraceptive counseling does not appear to effect the decision to engage in premarital sexual activity. The possibility of pregnancy appears to be disassociated from sexual activity. There is a lack of knowledge about and motivation to use contraceptives. School programs were the most frequently cited (28%) source of information on contraception. While 65% said pregnancy was accidental, only 6% of the group attributed pregnancy to a lack of knowledge or access to contraceptives. The location of intercourse in 2/3 of the cases was the boyfriend's home. Motivation for seeking abortion was given as "too young"(55%), "wanted to finish school" (15%), "wanted child but couldn't keep it"(12%), parental influence (7%), lack of desire to have a child (7%), and "other"(4%). Only 17% of fathers disassociated themselves from the relationship when pregnancy occurred.^ieng