[Stress and premature menopause]. / Stress et ménopause précoce.

By acting on the neuroendocrine system during the stress response, life events may greatly affect homeostasis and favor the appearance of disease. Here, we describe a relationship between stressful life events and premature ovarian failure. From a mechanistic point of view, we suggest an autoimmune origin for such premature ovarian failure on the basis of the role of cytokines in folliculogenesis and of their increased production during stressful life events.

Effects of diethylstilbestrol (DES) medication during pregnancy: report from a symposium at the 10th international congress of ISPOG.

This article is a report based on presentations at the symposium Effects of Diethylstilbestrol (DES) Medication during Pregnancy at the conference Reproductive Life, 10th International Congress of The International Society of Psychosomatic Obstetrics and Gynaecology (ISPOG) in Stockholm, Sweden June 14-17, 1992. The objective of this symposium, chaired by Eylard van Hall and Ingar Palmlund, was to provide the basis for a discussion of how the risks of DES had been evaluated in different countries. In the general discussion following the presentations everybody present expressed concerns that DES might still be given to pregnant women in many parts of the world, called for measures to alert medical professionals world-wide to the hazards of the use of DES, and requested measures to effect an international ban of DES in medication for pregnant women.

[Mourning and sterility]. / Deuil et stérilité.

The loss of a loved one, and particularly of a child, is beyond doubt a trauma which may disturb not only behavior, but also fertility. Bereavement may result in either the temporary loss of fertility or may, on the contrary, be followed by a long hoped-for and awaited conception. Both these situations are relatively commonly observed, but remain to be elucidated.

[The sterile woman, the physician and time. Number of spontaneous pregnancies in patients with functional sterility]. / La femme stérile, le médecin et le temps. Taux de grossesses spontanées chez des patientes atteintes de stérilité fonctionnelle.

We analysed a one to eight year follow-up of the women remaining infertile after a double-blind study of cyclofenil versus placebo to determine the frequency of pregnancy occurring independently of treatment. Pregnancy occurred in 64 women, 25 during treatment, 39 without treatment. We evaluated the effect of age, cause and duration of infertility on the pregnancy rate. The cumulative pregnancy rates at 36 months after the beginning of the study was 92 per cent for anovulatory cycles, 55 per cent for luteal insufficiency, 69 per cent for cervical mucus insufficiency and 49 per cent for idiopathic infertility. Of the 213 women entering the study, pregnancy occurred in 111 women, 47 in 3 cycles by a placebo effect, 39 without any treatment and 25 during a cycle with treatment. We conclude that the rate of treatment-independent pregnancy is high among infertile couples and that the two main therapeutic factors are time and the doctor-patient relationship.

[Sterility from hormonal causes and unexplained sterility. Treatment with cyclofenil. Double-blind controlled study]. / Stérilités de cause hormonale et stérilités inexpliquées. Traitement par le cyclofénil. Etude contrôlée à double insu.

We treated 213 women during 3 cycles by cyclofenil versus placebo in a double-blind study. These women had infertility caused by ovulatory deficiencies, a cervical factor or idiopathic infertility. Twenty-six of the 114 women receiving cyclofenil became pregnant and 21 of the 99 receiving the placebo. The cumulative pregnancy rates were identical in the 2 groups: 22 per cent in 3 cycles. The authors insist on the importance of a good doctor-patient relationship and the role of the placebo effect in any treatment of infertility.

[Secondary sterility]. / Stérilité secondaire.

PIP: The causes of secondary sterility in a couple are varied and may include a strong psychosomatic component. In this article, brief case histories are used to illustrate secondary sterility following abortion, maternal prohibition, and the death of a child. Sterility following abortion still occurs in France, but it is not always due to a tubal problem. During the 1st consultation for infertility the woman should be encouraged to describe the circumstances of the abortion, whether it was performed in secrecy, and her feelings about it. A 24-year-old woman who had had an abortion 2 years previously suffered from irregular cycles and was unresponsive to treatment to regulate ovulation. She became pregnant only after violently reproaching her mother for the mother's role in the abortion. Another woman had an extrauterine pregnancy, premature birth in which the infant died, and stillbirth after 2 induced abortions. She finally gave birth to a healthy term infant. In a 3rd case a Catholic woman of Irish origin felt such guilt after an abortion that she became pregnant again only after 10 years of infertility and an adoption. Some cases of infertility after a 1st live birth are explained by a prohibition on the part of the woman's mother, who herself had only 1 daughter. The reasons advanced by the mother for discouraging a daughter from becoming pregnant are not usually the true reasons, and the prohibition in some cases is difficult to overcome. Women who suffer the death of a child in utero or in infancy sometimes have difficulty becoming pregnant again. It is important to allow such patients to describe the circumstances of the death in detail. Usually at least 18 months must pass before the work of grieving is over. Hospital procedures which seek to shield the parents from the sight of their dead child may actually impair the grief process. A 27-year-old woman suffered secondary infertility and anovulation after the death of her 2nd child from congenital cardiac malformation. She was able to deliver a healthy child only after 2 miscarriages and a difficult pregnancy filled with anxiety, nightmares of death, and psychosomatic problems.^ieng

Monitoring of ovulation induction with human menopausal gonadotropin and human chorionic gonadotropin by ultrasound.

Ovarian follicular growth was monitored by ultrasound and plasma estradiol levels in 43 cycles of 27 patients. These women were treated with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) for anovulation or poor cervical mucus. Ultrasonography can help to prevent multiple pregnancies by allowing the withholding of the ovulatory injection of hCG if the number of mature follicles is too great. Nevertheless, mild to moderate hyperstimulation cannot always be prevented; it is sometimes the price one has to pay to obtain a pregnancy. Giving a direct view of follicular maturation, this method can be helpful in the determination of the best time for the induction of ovulation.

[Sterility and contraception; reciprocal incidence]. / Steriliteet contraception: incidence reciproque.

PIP: Risk of sterility after contraception by IUD can be caused by IUD failure or by IUD complications. IUD failure includes expulsion, which is not always noted by the wearer, thus often leading to pregnancy. It is imperative to remove the device, when possible, to continue the pregnancy; this would avoid complications, risk of spontaneous abortion, and/or premature delivery. IUD failure can also cause ectopic pregnancy, in which case surgery is essential; unfortunately, 50% of women undergoing this type of surgery become infertile. IUD complications include uterine perforation and pelvic infection. Infections of any kind must be detected and treated as soon as possible to avoid salpingitis or pelviperitonitis, which both very often cause sterility. For these reasons the IUD should not be prescribed to nulliparous women who might desire children later in their life.^ieng