Pseudocyesis: pituitary function before and after resolution of symptoms.

Pseudocyesis was clinically established in a 39-year-old woman. Pituitary function was assessed with the use of hypothalamic peptides and dopamine receptor agonists. Basal serum concentrations of anterior pituitary and ovarian hormones were normal. An exaggerated rise in luteinizing hormone (LH) and prolactin levels was seen following the administration of luteinizing hormone-release hormone and thyrotropin-releasing hormone (TRH), respectively. A paradoxic rise in growth hormone (GH) levels followed TRH administration, whereas the response to dopamine receptor agonists was normal. Pituitary hormone secretion after deflation remained similar to that before deflation, although a normal response of GH to apomorphine was reestablished. These data indicate that the amenorrhea of pseudocyesis is associated with normoprolactinemia and a readily releasable pituitary LH pool, which suggests a suprahypophyseal etiology of the amenorrhea. The abnormalities in GH secretion may also support this contention.

Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume.

Pituitary function studies were performed on a 31-year-old man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing hormone (LH) response to luteinizing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMG)-hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMG-hCG treatment.

Arcuate and bicornuate uterine anomalies and infertility.

Twenty-three patients presenting with infertility were found to have uterine anomalies. Eighteen had primary infertility. Six (86%) of seven patients with arcuate uterus achieved a term pregnancy. Five patients of these seven had primary infertility. Of the 13 patients with bicornuate uterus, 6 subsequently underwent a metroplasty and 4 (67%) of these latter patients achieved a term pregnancy. Of the remaining seven patients with bicornuate uterus, one achieved pregnancy during investigations, one refused surgery, and five were not operated upon because of uncorrected nonuterine factors. One other patient was found to have uterus didelphys and two had a unicornuate uterus. No patients with septate uterus were found. The implications of a uterine anomaly as a cause of primary infertility are discussed.

Infertility in women over the age of 36.

Ninety-three couples of which the female partner was over 36 years of age were studied. Tubal factor was the most common etiologic factor in the women aged 36 to 40 years, and unexplained infertility was the most common factor in the women over the age of 40. It appears that in the aging infertile population, the ovulatory factor is not the most important cause of infertility. The over-all pregnancy rate (33%) is lower and the abortion rate (31%) is increased with advancing age as compared with the general infertile population. The implication of aging as a cause of infertility is discussed.

PIP: 93 infertile couples with the female partner over age 36 were studied. Tubal factor was the most common etiologic factor in women ages 36-40 and unexplained infertility was the most common factor in women over age 40. It appears that in the aging infertile population, the ovulatory factor is not the most important cause of infertility. The overall pregnancy rate (33%) is lower and the abortion rate (31%) is increased with advancing age as compared with the general infertile population. The implication of aging as a cause of infertility is discussed.

Effect of saliva on sperm motility and activity.

Infertile couples frequently experience sexual dysfunction during their infertility investigations, including inadequate vaginal lubrication. In a attempt to look for a lubricant that would not impair sperm motility and activity, saliva was added to normal semen from healthy male donors. Saliva induced a "shaking movement" in 12% of the total sperm population incubated with high concentrations of saliva. This phenomenon did not occur with low concentrations of saliva, but sperm motility and progression significantly decreased. The results indicate that saliva has a deleterious effect on sperm motility and activity and should not be encouraged as a vaginal lubricant for the infertile couple.

Altered pituitary hormone secretion in patients with pseudocyesis.

Pituitary function studies were performed in two patients with pseudocyesis, one of whom was reinvestigated during a recurrent episode. There was an exaggerated prolactin response to thyrotropin-releasing hormone, an aberrant growth hormone increase, and an impaired growth hormone response to dopamine receptor agonists (apomorphine or bromocriptine). These findings point to a derangement in hypothalamic-pituitary function in pseudocyesis and may indicate an underlying impairment in dopaminergic function in this disorder.

Reconstructive surgery of hydrosalpinx with and without the carbon dioxide laser.

Pregnancy rates and surgery-conception intervals were determined in 91 women operated on for bilateral terminal tubal occlusion with different techniques. The intrauterine pregnancy rate following salpingostomy utilizing the CO2 laser was 21.7% (n = 23) and following salpingostomy with the microdiathermy needle was 22.7% (n = 22) at 1 year's follow-up. The pregnancy rate following conventional surgery was 17.4% (n = 46) at 5 years' follow-up. The surgery-conception interval was shorter in the laser group than in the other two groups. This preliminary report suggests that there is no difference between the pregnancy rate following salpingostomy with CO2 laser or microdiathermy needle; however, the surgery-conception interval is shorter. This might reflect the rapid healing of the tube after laser surgery.

Ovarian hyperstimulation syndrome following ovulation induction with human menopausal gonadotropin.

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Ovulation induction by human menopausal gonadotropin with ultrasonic monitoring of the ovarian follicles.

One hundred sixteen cycles of human menopausal gonadotropin (hMG) treatment for ovulation induction were studied. The ovarian response to hMG treatment was monitored by the daily determination of serum estradiol (E2) or by daily serum E2 and repeated ultrasonic examination of the ovaries. There were more follicles 18 mm in diameter or larger at the time of human chorionic gonadotropin (hCG) administration in the pregnancy than in the non-pregnancy cycles, and in the hyperstimulated than in the nonhyperstimulated cycles. The ovulatory rate and the pregnancy rate per cycle did not improve with the use of ultrasound. The number of treatment cycles required to achieve pregnancy was less in patients who had ultrasonic examination of the ovarian follicles. These results suggest that ultrasonic examination of the ovarian follicle helps to reduce the number of hMG cycles required to achieve pregnancy. The development of multiple follicles results in more pregnancies. However, the use of ultrasound does not improve the pregnancy rate.

Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions.

In an attempt to evaluate the efficacy of salpingoovariolysis we studied 147 women who were found to have periadnexal adhesions on laparoscopic examination. Among these women, 69 were treated by laparotomy and salpingoovariolysis and 78 were not treated. There was no significant difference between the degree of adhesions in the treated group and in the nontreated group. With the use of life table analysis, the cumulative pregnancy rate at 12 and 24 months follow-up was 32% and 45% in the treated group and 11% and 16% in the nontreated group, respectively (p less than 10(-6)). We suggest that although pregnancy might occur in infertile women who have periadnexal adhesions, treatment with salpingoovariolysis is associated with a higher pregnancy rate.