Microwave endometrial ablation: patients' experiences in the first 3 months following treatment.

The aim of this study was to investigate patients' experiences in the first 3 months following microwave endometrial ablation (MEA) for menorrhagia as well as the suitability of local anaesthesia (LA) versus general anaesthesia (GA) for these procedures. We carried out a cross-sectional questionnaire survey of 173 patients at 3 months after treatment with MEA. All were treated between September 1997 and December 1999. The setting was a small free-standing hospital day unit equipped with a minor operating theatre. Interventions were pretreatment with danazol or goserelin, followed by endometrial ablation with microwaves under GA or LA. Of the 173 patients, 98 (57%) were treated under GA, and 75(43%) under LA. The return of questionnaires was high in both groups (90% for GA and 84% for LA) and all procedures were completed with the planned anaesthetic. Commonly reported symptoms were immediate postoperative pain (61%), abdominal pain in the following weeks (75%), vaginal discharge (87%), vaginal bleeding (74%) and vaginal dryness. Reported symptoms were usually mild and not requiring medical intervention, e.g. in 124 patients (71%), postoperative pain was either absent or mild with no analgesics required. Only 4% had severe pain requiring a single dose of opiate analgesia. The results were similar in both groups. Sixty-nine per cent (104 patients) had no pain 1 week after treatment. This increased to over 90% by the end of the third week. Results were similar in those treated under LA (83% and 96%, respectively). There was early return to normal daily activity (70% by 1 week and 95% by 3 weeks). Reported symptoms were usually mild and not severe enough to warrant consultation of their doctor or the hospital. There were no blood transfusions or hysterectomy within the first 3 months of treatment. We conclude that MEA is well tolerated by patients. Reported side effects are usually minor. LA is comparable to GA and seems to have potential benefits.

Microwave endometrial ablation for menorrhagia.

Sixteen women requesting surgical treatment of menorrhagia were recruited for a study on microwave endometrial ablation. The mean age at treatment was 41.4 years and all patients had completed their family and were pre-menopausal. Average treatment time was 2 minutes 6 seconds. All patients reported a reduction in their menstrual loss and 87.5% were satisfied with their treatment after 1 year follow-up. One patient required overnight admission for analgesia while 15 patients were treated on a day case basis using light general anaesthesia. Sixty-seven per cent of patients reported a reduction in dysmenorrhoea scores at 1 year, two patients reported no change in symptoms and one patient reported a modest increase. One patient had a hysterectomy 10 months after treatment despite being amenorrhoeic. The indication for hysterectomy was pelvic pain (which was present before endometrial ablation). There were few minor complications but no uterine perforation or emergency hysterectomies.

Improved separation of motile sperm in asthenospermia and its application to artificial insemination homologous (AIH).

A method is described for the separation of motile sperm from semen by "migration' into a diluent, providing a large area of interface between the semen and the diluent and resulting in a good yield of motile sperm (58%), with a mean percentage of motility of 95%. The method provides a specimen free of seminal plasma and debris and suitable for intrauterine insemination in less than two hours. The motile fraction was used for AIH treatment of 20 couples with a mean of 4 years' infertility, where the female factor had been excluded and the male was asthenospermic. After a mean of six cycles, three pregnancies were achieved. Improvement of the percentage of motility alone did not, in this study, give a significant improvement in conception rates when compared with accepted cycles with the placebo.

Serum-prolactin in female infertility.

55 of 100 new female patients attending an infertility clinic had serum-prolactin concentrations greater than the upper limit of normal (360 mU/l). There was no significant correlation between serum-prolactin value and clinical features including age, duration of infertility, past reproduction, menstrual pattern, past use of oral contraception, or pregnancy-rate after treatment. The place of serum-prolactin estimations in the management of infertile women is unclear, particularly since the precision of currently available radioimmunoassays is questionable. The major value of serum-prolactin estimations lies in identifying those patients in whom further investigation for pituitary tumour is indicated both before treatment and during any ensuing pregnancy, and in selecting patients suitable for bromocriptine therapy.

The effect of temperature on the velocity of human spermatozoa as measured by time-lapse photography.

A method of time-lapse photography for the assessment of sperm velocity is presented. The intersampling variation was not significant, nor was the effect of dilution. Sperm velocity increased with temperature within the range 25 degrees C to 40 degrees C. The possible clinical use of the technique is discussed.

Bromocriptine in the treatment of secondary amenorrhoea and ovarian dysfunction in hyper- and normo-prolactinaemic patients.

The clinical use of bromocriptine (2.5 mg twice daily) was investigated in 40 women attending an infertility clinic and presenting with secondary amenorrhoea (18) or with ovarian dysfunction (22) which had failed to respond to anti-oestrogen therapy. Patients in each group were sub-divided into those with raised and those with normal prolactin levels, and re-examined at 3 and 12 months after the start of treatment. The results confirmed that bromocriptine is effective in the treatment of hyperprolactinaemic states whether there is amenorrhoea or not. Moreover, in cases of ovarian dysfunction as well as of amenorrhoea where the prolactin levels were within the normal range, there was evidence to suggest that bromocriptine can be associated with a return of ovulation, although the mechanism by which it might do so still needs evaluation.