Oocyte donors as gynecologic teaching associates.

OBJECTIVE: To fulfill the need for gynecologic teaching associates for an expanded pelvic examination module for third-year medical students, we sought women who were able to provide feedback to medical students. Oocyte donors were hypothesized as a useful potential pool of gynecologic teaching associates. METHODS: Gynecologic teaching associates were recruited from a pool of women who were involved in our oocyte donor program. Students were evaluated on a scale of 1 (best) to 5 (worst) on their performance on the pelvic examination by themselves (n = 91), by the gynecologic teaching associate (n = 10), and by the supervising faculty (n = 6). Students were shown their evaluations, and these were reviewed at the end of the session to provide students with immediate feedback. RESULTS: Students consistently ranked their skills lower than either the gynecologic teaching associate or supervising faculty member for all four categories evaluated (communication skills, technical skills, professional demeanor, and overall performance) (P < .001). Students gave their communications skills the highest mean rankings, whereas gynecologic teaching associates gave them the lowest. The highest correlation and agreement between pairs of evaluators were between the gynecologic teaching associate and the supervising faculty member. Gynecologic teaching associates and faculty members also were more likely to praise the students' performance in written comments (chi2 58.2, P < .001), whereas no student found anything praiseworthy in his or her performance. CONCLUSION: Oocyte donors represent a useful pool of potential gynecologic teaching associates. They provide important feedback to students. Their evaluation of the proficiency of the student correlates well with that of the supervising faculty member.

A randomized comparison of the methods of sperm preparation for intrauterine insemination.

OBJECTIVE: To compare the effectiveness of three methods of sperm preparation for IUI during superovulation of infertile women. DESIGN: Randomized assignment of one of three sperm preparation methods. SETTING: University infertility practice. PATIENT(S): Infertile couples undergoing superovulation and IUI. INTERVENTION(S): The method of preparation of sperm for IUI during superovulation was assigned randomly to double centrifugation, multiple-tube swim-up, or Percoll density gradient. MAIN OUTCOME MEASURE(S): Total number and percent recovery of motile sperm, percent of recovered sperm with normal morphology, and cycle fecundity. RESULT(S): No method of sperm preparation provided better cycle fecundity than the others despite differences in sperm recovery. CONCLUSION(S): Double centrifugation, multiple-tube swim-up, and Percoll density gradient sperm preparation for IUI yield similar cycle fecundity rates.

ART in women 40 and over. Is the cost worth it?

OBJECTIVE: To determine the efficacy and cost of assisted reproductive techniques in older women (40 years or older) in comparison to younger women (less than 30 years old). STUDY DESIGN: Retrospective review of records from one university-based infertility practice. RESULTS: Women 40 years or older were significantly less likely to achieve pregnancy with human menopausal gonadotropin (hMG)/intrauterine insemination as compared to women under age 30. The older women were also significantly less likely to achieve pregnancy with in vitro fertilization (IVF). The use of donor oocytes resulted in the highest pregnancy rates in older women. Costs per cycle were similar, however, for both groups. CONCLUSION: Older women will consume an equal amount of medical resources per cycle in infertility treatment as compared to younger women (aged < 30 years). However, older women utilizing assisted reproductive techniques are four to five times less likely to achieve pregnancy than the younger group. This poor prognosis for success in older women adds significantly to the mean cost per pregnancy as compared to younger women. Donor oocytes may be the most cost-effective option for achieving pregnancy in older women.

Prevalence of Chlamydia trachomatis and other micro-organisms in women seeking abortions in Pittsburgh, Pennsylvania, United States of America.

The prevalence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, group B streptococcus, herpes simplex virus, and Neisseria gonorrhoeae from cervical cultures obtained from 210 women seeking abortion in Pittsburgh, Pennsylvania, United States of America was 9.3%, 72.9%, 25.2%, 4.3%, 0.9%, and 0.9% respectively. Cultures from 40/203 (19.7%) patients failed to produce any of these organisms. C trachomatis isolation was not associated with age, race, marital status, average family income, number of sexual partners, history of gonorrhoea or syphilis, or previous pregnancies, live births, or abortions, and 82.4% of women with chlamydial infections had had no urogenital symptoms in the preceding six months. The highest concentration of U urealyticum was 10(5) colour changing units (ccu)/ml, and about half of the positive ureaplasma cultures produced less than 10(3) ccu/ml of this organism. Screening for C trachomatis, is encouraged to prevent neonatal morbidity and the common complication of pelvic inflammatory disease after abortion.