The clinical ramifications of polycystic ovarian morphology in oocyte donors.

OBJECTIVE: To determine the relationship between Polycystic Ovary (PCO) morphology and In Vitro Fertilization (IVF) outcome in oocyte donation cycles. DESIGN: Cross sectional study SETTING: Private IVF clinic PATIENTS: 164 consecutive ovum donors and their recipients were reviewed, 149 were included in the study where 113 patients had normal ovarian morphology and 36 patients had PCO morphology. INTERVENTIONS: All donors underwent ovarian stimulation in conjunction with GnRH agonist or antagonist in standard fashion. MAIN OUTCOME MEASURES: Baseline donor characteristics were recorded, as well as details of IVF stimulation and embryo data. Recipient data on pregnancy and miscarriage were also collected. RESULTS: Patients with PCO ovaries had significantly higher peak estradiol levels and required less gonadotropins during IVF stimulation. In addition, the baseline characteristics between donor groups did not differ except for ovarian morphology. The number of oocytes retrieved and indicators of embryo quality did not differ between the two groups, and there was no significant difference between pregnancy and miscarriage rates in the recipients. CONCLUSIONS: Oocyte donors with PCO morphology have equivalent pregnancy rates and do not need to be excluded as potential donors.

Micromanipulation in a center for reproductive medicine.

Several variations of micromanipulation of the female gamete (zona drilling, zona cracking, ooplasmic sperm injection, partial zona dissection) have been applied recently to human IVF to overcome severe male factor. Of the first 16 cycles attempted using partial zona dissection, one pregnancy resulted leading to a normal term delivery. Careful removal of the coronal cells, as well as stepwise removal of sucrose postpartial zona dissection, will facilitate this procedure and greatly reduce potential damage to the oocyte by pH, mechanical, or thermal injury. Micromanipulation has become a routine service offered in our program in cases where the likelihood of a poor IVF outcome is either known or suspected, and also serves as a replacement for simple reinsemination in cases of failed fertilization.

A study of the vaginal contraceptive sponge used with and without the fertility awareness method.

The actual effectiveness rates of natural and barrier methods of family planning are lower than the theoretical ones. If couples accurately defined the limits of the fertile phase and used barriers at that time, then actual effectiveness might increase. A randomized, controlled clinical trial was initiated to determine the effectiveness of the contraceptive sponge used only during the fertile time and to compare this with sponge use at every intercourse. Recruitment problems and discontinuation forced the early termination of this study, but qualitative information about compliance and acceptability was collected. Common sponge problems were reported as were misuses of the sponge, but problems and misuse were not related. Determination of the fertile phase was reportedly easy, but complaints of and discontinuation for inconvenience occurred. For unplanned pregnancies, contraceptive behaviors around the time of conception are presented.

A randomized prospective study of the use-effectiveness of two methods of natural family planning.

The final results of a prospective comparative study of two methods of natural family planning indicate a significant difference in the 12 month net cumulative pregnancy rates between the ovulation and symptothermal methods. These differences are on the order of two to one in favor of the symptothermal method. Pearl pregnancy rates confirm similar differentials between the two methods. Dropout rates for both methods were high. Lack of interest or dissatisfaction with the method was the major reason for dropout training while pregnancy or desire for pregnancy were the major reasons for dropout during the formal phase of the study.

PIP: In a prospective, comparative study in Los Angeles, California (1976-1978), 1247 volunteer couples were randomly assigned to either the ovulation method (OM) or the symptothermal method (STM) of natural family planning (NFP). 12-month Pearl pregnancy rates for both phases of the clinical trial (3-5 month training phase plus formal study phase) showed STM to be more effective (16.6 pregnancies/100 women-years) in preventing pregnancy than OM (34.9 pregnancies/100 women-years). For the formal study phase excluding training, Pearl rates were 13.7 for STM and 39.7 for OM. Both methods showed high dropout rates at 12 months (including training) 74% for OM and 64% for STM. Reasons given during the training phase were lack of interest or method dissatisfaction and during the study phase unplanned pregnancy. Of the 90 pregnancies that occurred during training (59 OM and 31 STM) and 62 during the study phase (42 OM and 20 STM), only 6 OM and none of the STM pregnancies were considered strictly method failures. Other pregnancies were due to inaccurate interpretation of mucus symptoms and failure to follow rules. The unexpected difficulty in recruiting couples is attributed to lack of public awareness of NFP, user satisfaction with and acceptance of other contraception methods, and an unwillingness to adhere to the formal requirements of the study protocol. Two-thirds of the 1247 volunteer couples responded to follow-up 1 year after the study. One-half were still using the NFP method they were taught. The other half had stopped because of desired pregnancy or inconvenience or dislike of the abstinence required.

Maternal serum human chorionic gonadotropin concentrations and fetal sex prediction.

The feasibility of using maternal serum human chorionic gonadotropin (hCG) concentrations for prenatal sex prediction was examined. hCG was mesured in 822 serum samples from 560 women with uncomplicated pregnancies. Significantly higher hCG concentrations were found in the serum of women bearing female fetuses than in the serum of women bearing male fetuses during the third trimester, especially during the 10th lunar month. The data were utilized to construct probability graphs for fetal sex prediction based upon a single maternal serum hCG determination during the third trimester and during the 10th lunar month. However, the utility of these graphs is limited by the small proportion of pregnant women with serum hCG concentrations that were high or low enough to allow a prediction with high probability.

Estrogen radioimmunoassay suitable for the monitoring of ovulation induction.

A rapid radioimmunoassay for estrogen in serum was characterized and validated. Analytical recoveries of estrone and estradiol were essentially 100%; estriol was not measured because it was eliminated by sample-handling procedures. Nonspecific interference from serum extracts, which was initially reflected by positive blanks, was eliminated by a sodium hydroxide wash of the extract. Validation of the procedure included determination of a reference interval for estrogen that agreed with the sum of estradiol and estrone concentrations reported in the literature for eugonadal women. Clinical applicability of the assay was demonstrated by monitoring estrogen concentrations during the menstrual cycle and during urogonadotropin (Pergonal)-induced follicular maturation. Because of its rapid turnaround time, the assay is ideally suited for monitoring the frequency with which urogonadotropin should be administered to the infertile patient, and the dosage, thus decreasing the likelihood of multiple pregnancies or ovarian hyperstimulation.

A randomized prospective study of the use-effectiveness of two methods of natural family planning: an interim report.

Data accumulated to date from the Los Angeles study indicate that the total termination rate for 12 months from the beginning of the training period and from formal entry into the study was high for the ovulation method (OM), and symptothermal method (STM). Voluntary withdrawal was the highest single reason for termination in both methods. The 12 month voluntary withdrawal rate, measured from formal entry into the study, was significantly higher for OM users. Pregnancy rates measured from both the beginning of training and formal entry into the study were significantly higher for OM users than for STM users. Complete analysis of the data collected during the study is currently in progress. It is anticipated that some of the causes for the differences in pregnancy rates and withdrawal rates between the two methods can be identified.

Serum human chorionic gonadotropin levels throughout normal pregnancy.

Human chorionic gonadotropin (hCG) levels were measured in the sera of 443 pregnant women by the beta-hCG radioimmunoassay in order to determine if the third-trimester secondary peak in hCG levels observed by less specific immunoassays was due to cross-reacting substances. hCG was detected as early as six days after presumed conception and peaked between 56 and 68 days, with a nadir at 18 weeks. No secondary rise in hCG levels was demonstrated, indicating that the nonspecific hCG immunoassays give spuriously high values for hCG during the last trimester of pregnancy.