Normalization of testosterone levels using a low estrogen-containing oral contraceptive in women with polycystic ovary syndrome.

Oral contraceptives reduce the elevated androgen levels in polycystic ovary disease. However, treatment with oral contraceptives is associated with undesirable side effects because of their high estrogen content. This study was undertaken to examine the effects of low estrogen-containing oral contraceptive (Loestrin:norethindrone acetate 1.5 mg and ethinyl estradiol 30 micrograms) on 25 women with polycystic ovary disease of ovarian origin. Loestrin treatment normalized the elevated luteinizing hormone and total and unbound testosterone levels and increased testosterone binding globulin levels. In a time-course study, unbound testosterone declined within a week of initiating treatment and by 12 to 16 weeks was completely normal. Reduction in hair growth and improvement in complexion were noted by about 12 to 16 weeks. Side effects of treatment were minimal.

Genetic screening of donors for artificial insemination.

A routine has been established for genetic screening of donors in an artificial insemination and frozen sperm bank program. This report is a summary and analysis of the information obtained on the first 168 donor applicants and 89 recipients who were genetically screened. The specific forms for screening, family information obtained, characteristics of the donor and recipient groups, and guidelines for acceptance or rejection of donors are discussed. The donor and recipient often failed to perceive that the disorders in the family were genetic. The simple question of whether or not there were genetic or hereditary problems in the family was ineffective, even when the donor or recipient had formal medical training.

Transitions in fertility research.

History reveals that the genesis of progress in fertility research comes chiefly from animal research, and that subsequent applications of this research to humans have touched on many sensitive beliefs, prejudices, religions, and philosophies. Developments in fertility research, when applied to the human, diverge into two sensitive and very complex applied research categories-assisted reproduction and contraception. History also shows that these concurrently progressing research disciplines have undergone vacillating interludes of progress and of being blocked or restricted. Many of the technological improvements considered to be major transitional states in the progress of each of these categories are identified. They include artificial insemination, the invention of the sheath and the intrauterine device, the identification of hormones, and the elucidation of their activities as well as their interdependent relationships, the social acceptance and rejection, early embryo manipulation techniques, enzyme and sperm capacitation, and certain modern techniques involved in assisted fertility. Giant steps occurred in the 1950's with the rapid and seemingly unrestrained upward movement in chemical and clinical research that produced the hormonal contraceptives. This continued into the 1960's with additional advances providing improvements and popular choices such as intrauterine devices. In the following decades, many improvements were realized in both disciplines; however, changes in the legal environment, the litigious attitude of the public, sources of financial support, and basic priorities by industry and governments have caused uncertainty in many areas. The progressive moves seem to have occurred at certain periods when our population was not preoccupied with other matters and tended to pursue intellect and logic. This paper attempts to summarize a portion of the history of discoveries and developments in fertility research within each of the two applied research categories, and thereby to reveal and discuss a few of the underlying factors and the human qualities that impacted on the evolution of fertility research.

Artificial donor insemination: analysis of 149 cases at North Carolina Memorial Hospital.

We analyzed 149 cases of artificial insemination with donor semen at North Carolina Memorial Hospital, Chapel Hill, to study its effectiveness. An overall pregnancy rate of 62.1% was achieved. Based on the mean monthly fecundity rate, the average monthly pregnancy rate was 16.5%, and the cumulative pregnancy rate after three, six, and ten cycles was, respectively, 40.3%, 68.5%, and 95.5%. A uniform evaluation of the women and correction of any treatable female factors before insemination contributed to a high success rate. Diagnostic laparoscopy after three to four failed insemination cycles yielded a high percentage of abnormal findings. These data suggest that almost all properly screened patients will conceive if allowed to undergo a sufficient number of inseminated cycles and that this procedure is a highly effective alternative means of circumventing male infertility.

Factors affecting pregnancy rates in a donor insemination program using frozen semen.

The results of therapy of 226 women receiving frozen and fresh donor semen are reported. Overall, 45.6% of patients conceived with a monthly fecundability of 0.102. The effect of a variety of factors on fertility rates was analyzed in life-table analysis of 1000 cycles. Optimal pregnancy rates were obtained in couples with azoospermia (0.17) or no female infertility factors (0.2). Patients with ovulatory dysfunction treated with clomiphene also had optimal pregnancy rates (0.17 per cycle). Endometriosis reduced fecundability significantly (0.04 per cycle). There was no significant difference in pregnancy rates per cycle between fresh (0.12) and frozen (0.09) semen. Acceptable pregnancy rates were obtained with frozen semen therapy and in patients with treated ovulatory dysfunction.

Application of interspecies in vitro fertilization in the initial assessment of the infertile couple.

Methods to evaluate male reproductive potential are limited. Conventional semen analysis does not necessarily reflect sperm functionality. In this study we investigated the correlation of the interspecies penetration test with clinical evaluation of 106 infertile couples. In vitro penetration results in 92 of 106 men correlated well with clinical diagnosis. In 28 couples with a male infertility factor, the mean penetration rate was 18%, whereas in 78 infertile couples with no known male factor, the rate was 50%. The mean for all patients tested was 40%. This was well below a mean of 73% for a donor population. The major discrepancy between the interspecies penetration test and clinical findings occurred in a group of nine patients with 0% penetration who had been judged normal by history and semen analysis. In general, the interspecies penetration test correlates well with male clinical evaluation but does the complementary information in certain cases. At present, its greatest utility seems to be in evaluation of unexplained infertility, in unexplained failure of female therapy, or in selection of patients for donor insemination.