Proximal fallopian tube occlusion: diagnosis and treatment with transcervical fallopian tube catheterization.

Transcervical fallopian tube catheterization (TFTC) was performed in 22 infertile patients with bilateral fallopian tube obstruction and a mean duration of infertility of 3.3 years. A high prevalence of previous ectopic pregnancy (n = 8, 36%), tubal ligation and/or reconstruction (n = 5, 23%), spontaneous or therapeutic abortion (n = 6, 27%), and previous intrauterine device use (n = 14, 64%) was noted. The authors successfully catheterized 40 (98%) of 41 tubes without serious complication and visualized the distal tube in 36 (88%) of 41 tubes. Free spill in at least one tube was seen in 17 (77%) of 22 patients. Nineteen patients had a history of previous laparoscopy or laparotomy for tubal disease, in 16 of whom laparoscopic results were available for review. Retrospectively, in 15 (94%) of 16 patients all clinically relevant abnormalities would have been detected by means of TFTC alone. Five patients conceived, three with intrauterine and two with ectopic pregnancies. Patients with intrauterine pregnancies had normal-appearing tubes after TFTC, while those with ectopic pregnancies had residual tubal abnormalities after recanalization. TFTC is a safe, accurate diagnostic procedure that provides more information than hysterosalpingography and, in most cases, as much or more information about the fallopian tubes than laparoscopy.

Athletic amenorrhea: lack of association with body fat.

The most commonly tested hypothetical cause of athletic amenorrhea has been low body fat. Test results have conflicted because of mixed groups of athletes and methodologic problems. In this study, we measured body fat only in distance runners (greater than 53 km X wk-1) of the same somatotype who clearly had regular menses or secondary amenorrhea; this permitted more valid group comparison of body fat using hydrostatic weighing. The regularly menstruating group (N = 7) had 12 periods X yr-1 at intervals of 26.5 +/- 1.0 (SE) days with a duration of 4.1 +/- 0.4 days. In the athletic amenorrhea group (N = 7), menstrual periods had been absent for 1 to 10 yr (average = 3.9 +/- 1.3 yr); they were gynecologically evaluated to restrict the group to those with athletic amenorrhea. The groups were similar in a number of categories: weight, height, age, menarcheal age, weekly training mileage, days/week training, years of training, and maximum oxygen uptake. Percent body fat for the two groups was the same: 17.7 +/- 2.1% for the amenorrheic athletes and 17.4 +/- 1.2% for the regularly menstruating athletes (P = 0.91). These data do not support the idea that low body fat per se causes athletic amenorrhea.

A new method for predicting and confirming ovulation.

Evaluation of a method for predicting and confirming ovulation by measurement of vaginal and salivary electrical resistance (VER and SER) was the purpose of this study. Eighteen menstrual cycles from 13 subjects were analyzed. A clearly defined nadir in VER at day 0, the day of the luteinizing hormone (LH) peak, followed by a pronounced increase the following day was observed. A peak in SER was consistently observed 5 to 6 days before day 0. The correlation coefficient (r) between the cycle day of the SER peak and cycle day of the LH peak was 0.94. After the peak in SER, values were low for several days but increased 1 to 2 days before the LH peak. Results indicate that monitoring of SER and VER may provide the basis for a simple method for predicting and confirming ovulation.

Factors influencing the success of artificial insemination.

Factors influencing the probability of conception following artificial insemination with donor semen (AID) have been investigated in a series of 124 married females. Overall, 79 conceptions were achieved, for a cumulative rate of conception of 85.1% at the end of 1 year and an average fecundability of 15%, using life-table analysis. Women aged 30 or over or those with evidence of tubal or ovulatory problems had decreased probability of conception, although not to a significant extent. Women whose husbands were azoospermic had 20% fecundability in response to AID, significantly better than the 10% fecundability after AID observed in the women whose mates were oligospermic. Cycles during which AID was successful were significantly more likely to have had a positive postcoital test observed, compared with unsuccessful AID cycles.

Objective evidence that placebo and oral medroxyprogesterone acetate therapy diminish menopausal vasomotor flushes.

The vasomotor flush (VMF) is the most common reason for menopausal women to seek hormonal therapy, but the evaluation of therapeutic regimens has been hampered by the observation that placebo therapy can decrease VMF and, until recently, by a lack of objective criteria of measurement of the VMF. Using the objective criteria of temperature elevations (TEs) and luteinizing hormone (LH) pulses, we evaluated the effect of placebo and medroxyprogesterone acetate (MPA) on VMF. MPA and possibly also placebo were found to reduce not only the subjectively noted VMF but also the frequency of TEs recorded. In addition, MPA, but not placebo, significantly reduced the frequency and amplitude of LH pulses. Possible mechanisms of action of MPA and placebo therapy are discussed.

PIP: This article describes the effects of treatment of VMF (vasomotor flush) with MPA (medroxy-progesterone acetate) and with placebo. 6 postmenopausal women participated in the study, they were randomly assigned to take either placebo or MPA for 4 weeks; then, after a period of 6 weeks without treatment, the patients were crossed over to the alternate treatment which was continued for another 4 weeks. Each subject was observed 3 times during the period, once before treatment and on the last day of each 4 week session of therapy. Skin TE (temperature elevation) and serum LH (luteinizing hormone) pulses were measured; during the same session the patients were asked to indicate the onset of each subjectively noted VMF. Results of observations showed that MPA and possibly placebo decreased not only the number of VMFs but also the frequency of TEs recorded; MPA but not placebo reduced the frequency and amplitude of LH pulses. MPA treatment was also associated with a 92% decrease in the frequency of VMFs occurring in association with rises in temperature. The mechanism by which MPA decreases VMFs and LH pulses is not known; the same goes for the mechanism by which placebo decreases VMFs. It should be noted that long-term experiments do not confirm a placebo effect on VMFs.

A randomized study of 12-mm and 15.9 mm cannulas in midtrimester abortion by laminaria and vacuum curettage.

We evaluated the adequacy of a new large-bore vacuum cannula system for midtrimester abortion by randomly allocating patients to be treated with a standard 12-mm vacuum system or the new 15.9-mm system. Cervical dilataion was accomplished by overnight placement of laminaria tents. Blood loss was similar for the two treatment groups and was significantly greater at gestational ages 17 to 18 weeks than for abortions at 16 weeks or less. Operating time was slightly less in the large-cannula group. When the 12-mm cannula was used beyond 13 weeks' gestation, forceps were usually needed to empty the uterus completely. The large-cannula system was able to empty the uterus through 16 weeks, but at 17 and 18 weeks it offered no advantage over the smaller system and forceps were always needed. Complications were minimal. We caution against forcible cervical dilatation to 16 mm and urge the use of laminaria instead. Our findings, together with published reports of the safety of late dilatations and evacuation, would appear to justify wider clinical trials by experienced investigators.