Experience with progesterone gel for luteal support in a highly successful IVF programme.

Efficacy of luteal support from single daily administration of Crinone((R)) 8% (progesterone gel) was tested in 43 women in an IVF programme with historical pregnancy rates >50%. Results were compared with those achieved in 46 women concurrently undergoing IVF and receiving 50 mg i.m. progesterone, and with historical data. Pregnancy rates (PR) were evaluated approximately 2 weeks after undergoing IVF by human chorionic gonadotrophin (HCG) measurement (total PR), by ultrasound 2-4 weeks later (clinical PR), and by counting births. Prior experience with other progesterone formulations was compared with that of Crinone 8%. Demographic and IVF characteristics were comparable for both concurrently treated groups. Total PR, clinical PR and live birth rates were similar for the Crinone and the concurrent i.m. progesterone groups: 31 (72.1%) versus 34 (73.9%); 26 (60.5%) versus 28 (60.9%), and 23 (53.5%) versus 23 (50%) respectively. Clinical PR and live birth rates were also similar to the last data reported to the Society for Assisted Reproduction Therapy. Overall acceptability of Crinone 8% was excellent. Among subjects with prior i.m. injection experience, most patients (69.2%) agreed that the gel was easier to use, less painful (76.9%) and less time-consuming (61.5%) than i.m. injections. In conclusion, Crinone 8% offers an appreciable improvement, as it provides an effective luteal support option that avoids painful i.m. injections.

Hysteroscopic metroplasty of the Class Va uterus with preservation of the cervical septum.

OBJECTIVE: To assess the safety and efficacy of hysteroscopic resection of the uterine septum in patients with a Class Va septate uterus. DESIGN: Retrospective clinical study. SETTING: University outpatient surgical center. PATIENT(S): Twenty-one patients with Class Va uterus treated between 1985-1998 in the senior author's academic practice. INTERVENTION(S): Hysteroscopic metroplasty with preservation of cervical septum. MAIN OUTCOME MEASURE(S): Intraoperative and postoperative complications; postoperative cumulative pregnancy and delivery rates. RESULT(S): No long-term complications were encountered. Fourteen of 15 women who attempted pregnancy postoperatively delivered viable neonates; the 15th is in an ongoing pregnancy. CONCLUSION(S): Surgical correction of the complete uterine septum with preservation of the cervical septum is associated with low morbidity and satisfactory postoperative obstetric outcome.

Nitric oxide modulates human chorionic gonadotropin-induced ovulation in the rabbit.

OBJECTIVE: To examine the potential role of the L-arginine:nitric oxide pathway in hCG-induced ovulation in the rabbit. DESIGN: Randomized, controlled animal study. SETTING: University research laboratory. INTERVENTION(S): Nitric oxide synthase, the enzyme that produces nitric oxide (NO), was immunohistochemically localized in the ovary. NG-nitro-L-arginine methyl ester (L-NAME), an analogue of L-arginine, which inhibits the enzyme NO synthase, and the inactive D-enantiomer were administered in vivo and/or in vitro via an isolated, perfused ovary preparation during the periovulatory period. MAIN OUTCOME MEASURE(S): Rate of follicular rupture (ovulatory efficiency). RESULT(S): Immunohistochemical staining for NO synthase was localized specifically to the granulosa cell layer of the follicle and the endothelium and adventitia of ovarian blood vessels. In vivo administration of L-NAME significantly reduced the percentage of large follicles that ovulated in response to hCG (treated 24.6%, control 68.1%). Similarly, exposure of the in vitro-perfused ovary to L-NAME significantly reduced follicular rupture (treated 32.8%, control 64.2%). In contrast, addition of an equimolar concentration of D-NAME to the perfusion medium had no significant effect on the rate of ovulation (treated 83.3%, control 61.3%). CONCLUSION(S): The stereospecific inhibition of follicular rupture by the arginine analogue suggests that NO production by the ovary is an important feature of the normal physiologic processes of the periovulatory period.

A comparative study between pelvic ultrasonography and laparoscopy in the detection of pelvic pathology in the initial workup of subfertile women.

This study was conducted prospectively from June 1992 to September 1993, we evaluated 115 patients attending our infertility clinic for the first time to determine the correlation between abdominal ultrasound and laparoscopy in the detection of pelvic pathology in the initial workup of subfertile women, depicting laparoscopy as the gold standard. Normal ultrasound scans were reported in 80 women (69.56% of total) 58 of whom had also normal pelvic findings at laparoscopy. The remaining 22 patients with normal ultrasound scans had abnormal laparoscopic findings in the pelvis giving a false negative rate of 27.50 per cent. These were primarily related to; endometriosis with adhesions (10), filmy adnexal adhesions (5), omental and bowl adhesions (5), and hydrosalpinx (2). Thirty five women (30.44% of the total) had abnormal scans. Pelvic pathologies were confirmed in 30 at laparoscopy. The remaining five had a normal pelvis (three retroverted uteri, and two functional ovarian cyst had disappeared at time of laparoscopy) giving a false positive rate of 14.29 per cent for ultrasound scans. Statistical analysis revealed that abdominal ultrasound scan in the detection of pelvic pathology in the initial workup of subfertile women has a sensitivity of 57.69 per cent, specificity of 92.06 per cent, positive predictive value of 85.71 per cent with negative predictive value of 72.50 per cent and accuracy rate of 76.52 per cent. We conclude that the use of abdominal ultrasound in the detection of pelvic pathology in the initial workup of subfertile women is not an appropriate routine screening test as it has low efficiency in detecting the pelvic pathologies many of which are the causes of infertility.(ABSTRACT TRUNCATED AT 250 WORDS)

Superoxide dismutase activity, lipid peroxide production and corpus luteum steroidogenesis during natural luteolysis and regression induced by oestradiol deprivation of the ovary in pseudopregnant rabbits.

The relationship of oxygen free radicals to corpus luteum function in rabbits was explored during various stages of pseudopregnancy, including natural and induced luteal regression. Induced luteolysis was achieved during mid-pseudopregnancy by removal of an oestradiol capsule placed at the onset of pseudopregnancy, which suppressed ovarian oestradiol production. Activity of manganese superoxide dismutase (Mn SOD) was significantly and positively correlated with ovarian progesterone production (P < 0.01) throughout pseudopregnancy and during natural regression. Oestradiol deprivation for 12, 24 or 72 h resulted in declines in Mn SOD activity and progesterone secretion, although Mn SOD rose and corpus luteum steroidogenesis was restored to normal when the capsule was replaced for 48 h before assessment, having been removed for 24 h. Lipid peroxide and progesterone concentrations were not correlated, although a significant rise in lipid peroxides in the luteal tissue was detected after deprivation of oestradiol for 72 h. Changes in progesterone production and Mn SOD activity were not associated with alterations in concentration of prostaglandin F metabolite. These data suggest that Mn SOD may be involved in regulating function of the corpus luteum during pseudopregnancy in rabbits and that oxygen free radicals may play a role in regression of corpus luteum in this species.

The incidence of human immunodeficiency virus (HIV) in fetal cord samples utilized as serum supplements for in vitro fertilization.

Prior to initiating routine fetal cord serum (FCS) supplementation in our in vitro laboratory, the incidence of HIV in 306 random fetal cord samples obtained at the Labor and Delivery Unit of the Johns Hopkins Hospital from July 1985 to January 1988 was determined from a cross-sectional patient sample. Of 306 samples, 3 (0.98%) were positive for HIV, and confirmed by Western blot analysis, enzyme immunoassay (ELISA), a prevalence significantly higher than a national sample (0.012%). The use of FCS in this setting was determined to be an unacceptable risk to patients undergoing in vitro fertilization. The 90-day quarantine period for verification of HIV seronegativity applied to semen donors may not be applicable to FCS sampling. Patient risk may also increase with pooling of FCS samples prior to HIV testing.

Effect of serum from patients with minimal to mild endometriosis on mouse embryo development in vitro.

Two-cell mouse embryos were cultured at 37 degrees C in 5% CO2, 95% air with a 7.5% serum supplement from patients with minimal to mild endometriosis, (group I, n = 31), tubal factor (group II, n = 33), male factor (group III, n = 17), fetal cord samples (group IV, n = 37), and Ham's F-10 medium (Gibco, Grand Island, NY) without a serum supplement (group V, n = 30). The progression to blastocyst stage (mean percent +/- SE) at 96 hours in groups I, II, III, IV, and V was 29.9% +/- 3.7%, 60.6% +/- 4.9%, 56.2% +/- 5.2%, 61.7% +/- 5.8%, and 63.2% +/- 6.9%, respectively. Serum factors appear to be associated with an inhibition of early embryogenesis, which may explain the decreased fertility rates observed in patients with minimal to mild endometriosis.

Interval bone mineral density with long-term gonadotropin-releasing hormone agonist suppression.

Twenty-six patients of mean age 37 +/- 4.8 (SD) years, who received a 6-month course of gonadotropin-releasing hormone (GnRH) analogue, were selected for study. Bone mineral density (BMD) was measured by dual-photon absorptiometry before initiation and after completion of agonist therapy. Mean BMD (g/cm2) by dual-photon absorptiometry at L2 to L4, femoral neck, Ward's triangle, and the trochanteric area did not change significantly (P = not significant [NS]) after 6 months of GnRH analogue suppression. Mean percent (%) expected density as standardized for age, weight, and sex remained in the range of 89.3% to 94.2% (P = NS). The interval detectable change in BMD after therapy was 0.05 +/- 0.06 g/cm2. These findings are reassuring with respect to the use of long-term GnRH analogue regimens to induce a hypoestrogenic state in the treatment of hormone-dependent conditions.

The effect of the ergoline derivative, CU 32-085, on prolactin secretion in hyperprolactinemic women.

Twelve hyperprolactinemic women were administered the alpha aminoergoline derivative, CU 32-085 (Sandoz, Inc., East Hanover, NJ), in order to determine its effect on prolactin (PRL) secretion. The mean pretreatment serum PRL level was 145.0 +/- 11.5 ng/ml. Significant declines of serum PRL occurred with total daily doses of CU 32-085 of 0.1 to 0.5 mg (P less than 0.001). The magnitude of response to therapy was dose-related. In six patients, PRL levels were reduced to less than 25 ng/ml; this effect lasted at least 24 hours after intake of a single dose. In the other six patients, the response was less dramatic. No subjects developed adverse cardiovascular side effects. The results of this study demonstrate that CU 32-085 exhibits a clinically significant dopaminomimetic action on PRL secretion in hyperprolactinemic women.