Pregnancy outcome after in vitro fertilisation at the Pretoria unit.

This retrospective study was conducted to ascertain the success rate of a university-based in vitro fertilisation (IVF) programme. Over a 4-year period a total of 881 patients was aspirated with an 81.8% embryo transfer (ET) rate. This resulted in 150 biochemical pregnancies (20.8% per ET), and 92 births that produced 100 babies were recorded (12.8% per ET). Multiple pregnancies accounted for 8.7% of births and 6.5% of the 100 babies presented with minor congenital abnormalities. Delivery took place by caesarean section in 46% of cases. Birth mass of babies ranged from 1.06 to 4 kg with a mean of 2.944 +/- 0.629 kg. Mean gestational age was 260 +/- 18.2 days. Twenty-three percent of babies born were preterm, 13.8% of these were twins and presented with a low birth mass. It was concluded that the conception rate of patients did not differ with regard to the number of IVF attempts but that those who conceived during the first two attempts had a significantly better chance (P < 0.05) of carrying to term.

Successful pregnancy despite retrograde ejaculation. A case report.

In retrograde ejaculation sperm is passed into the bladder causing infertility. Among patients seen at the Reproductive Biology Research Unit of the University of Pretoria retrograde ejaculation is relatively uncommon (0.004%), but is a potentially treatable cause of infertility. The technique for collecting sperm, sperm processing and recovery described was successful and resulted in a pregnancy after transfer of 1 four-cell embryo.

[The results of consecutive stimulation of ovulation cycles in the same patient]. / Die uitkoms van opeenvolgende gestimuleerde ovulasiesiklusse by dieselfde pasiënt.

In this study oestradiol levels in consecutive cycles in the same patient using the same stimulation protocol were measured to determine whether oestradiol levels remained the same in consecutive cycles. The oestradiol patterns of 64 women in the first and consecutive stimulation cycles were individually determined, and classified into 5 patterns. The most favourable oestradiol pattern (pattern A) was significantly similar in consecutive cycles of the same patient. Therefore it is suggested that the same stimulation protocol could be used in patients with an initial A pattern.

In vitro culture of mouse embryos in human amniotic fluid.

Human amniotic fluid was compared with Ham's F-10 culture medium as a possible alternative for use in in vitro fertilisation. The cleavage success of mouse embryos in human amniotic fluid (experimental group) was 92% compared with 86% in Ham's F-10 medium. It is concluded that human amniotic fluid is a viable alternative culture medium for mouse embryos.

A preliminary study of the fine structure of in vitro fertilized human embryos.

The fine structure of rejected human in vitro fertilized embryos was studied by light and transmission electron microscopy. Apart from normal cytoplasmic features, changes suggestive of degeneration are discussed. Cytoplasmic blebs and cellular debris as well as primitive interblastomeric junctions are also described.

Chromosome studies on early human embryos fertilized in vitro.

The majority of early spontaneous abortions carry a lethal chromosomal anomaly. While it is recognized that several factors would be responsible for some IVF failures, it is important to determine the contribution of chromosomal aberrations to the preimplantation loss of embryos produced in vitro. Chromosome analysis of embryos not destined for replacement in the uterus could help to elucidate this phenomenon of early embryonic loss. Fifty-five out of 239 embryos fertilized in vitro were successfully karyotyped and amongst these the overall rate of diploidy was 25.5% in this study, which mainly comprised rejected embryos. Embryos without cleavage had mostly a chromosomal defect (20/38) and only a minority (9/38) were unfertilized. Numerical abnormalities were found in a total of 33/46 (71.7%) morphologically normal embryos. In contrast a diploid chromosomal complement was found in only 11.1% (1/9) of morphologically abnormal embryos.

Cost analysis study of an in vitro fertilisation programme.

In vitro fertilisation (IVF) and embryo transfer has established itself as a modality in the treatment of infertile patients. Estimates of the cost of this relatively new procedure were investigated with specific assumptions. The maximum cost per (first) cycle totalled R1611.16. Laboratory expenses were the single most expensive entity, accounting for 39.2% of the total cost. Patient contribution was established at 32.6% of total cost and the approximate breakdown of cost for an IVF and embryo transfer programme for a university-based unit is given.

Wet-smear diagnosis of genital schistosomiasis.

The diagnosis of genital schistosomiasis can be made only on the presence of ova on histological or cytological material. In 7 out of 8 consecutive cases of genital schistosomiasis we were able to make the diagnosis on a wet-smear preparation in an outpatient clinic.

The incidence of polyspermy during in vitro fertilisation. A study at the H. F. Verwoerd Hospital, Pretoria.

Results from 1249 in vitro-fertilised human oocytes were analysed to identify the incidence of polyspermy. In this study polyspermy occurred in 23 oocytes (1.8%). The effects of the various ovulation induction protocols employed, maturation of oocytes, incubation time before insemination and anaesthesia exposure were examined in order to identify a cause for polyspermy. Early diagnosis of polyspermy is important because the polyspermic embryo may appear morphologically normal at a later stage but should not be transferred since this nearly always results in a spontaneous abortion.

Sterilization of mentally retarded persons.

PIP: South Africa's Abortion and Sterilization Act No 2 (1975) authorizes sterilization for severely retarded women provided the procedure is performed in a state hospital, certified by 2 medical practitioners (1 a psychiatrist), and the parent or guardian gives informed consent. Since 1975, 152 sterilizations (140 female, 12 male) have been performed under the provisions of this Act at Pretoria's H F Verwoerd Hospital. 92% of the patients were under 20 years of age. The majority were classified as profoundly or severely retarded (74) or moderately severely retarded (68). There were 20 patients with Down's syndrome and 22 with cerebral palsy. Hysterectomy was the method of choice in the 109 women in whom menstrual hygiene was a pertinent factor; the remaining 31 women were sterilized by tubal ligation. 98% of the parents or guardians of hysterectomy acceptors surveyed were satisfied with their decision and its outcome. Several indicated their daughter was more calm, cooperative, productive, and less irritable once relieved of her menstrual periods. A multidisciplinary team approach to the decision making process and the individualization of each case are essential to protect the rights of the mentally retarded. Factors such as the psychological trauma likely to result from pregnancy and childbirth, an inability to use contraception, and unsuitability to rear a child must be demonstrated. To ensure that legislation pertaining to the sterilization of the mentally retarded does not lead to abuse, inputs from the mental health professions are required.^ieng

Phase II of a successful university-based in vitro fertilisation programme. Changes incorporated.

the ultimate goal of any clinical programme treating infertility by means of in vitro fertilisation and embryo replacement is to maximise the number of patients who become pregnant in a treatment cycle. A 12% pregnancy rate was previously reported from this unit. Following the instigation of changes and further modifications, an overall success rate of 27% per patient was obtained in phase II. The reasons for this improved success are hard to pinpoint, but experience and changes in methodology probably play a role. These changes are described and the results discussed.

The hormonal and morphological events of stimulated cycles in an in vitro fertilisation programme.

A better understanding of the physiological processes involved in the stimulated cycle for successful harvesting of mature eggs in an in vitro fertilisation programme is a prerequisite for obtaining good pregnancy results. The hormonal levels of oestradiol, luteinising hormone (LH) and follicle-stimulating hormone correlated with ultrasonographic studies of follicular growth, were followed during an in vitro fertilisation cycle giving an overall pregnancy rate of 32% per transfer procedure. The combined use of clomiphene citrate (Clomid; Mer-National) and human post-menopausal gonadotrophin (Pergonal; Script Intal) produces an average of 5.96 follicles per patient. Human chorionic gonadotrophin (HCG) was given prior to the oestrogen peak and no spontaneous LH peak occurred before the day of the HCG injection. Timing of this injection needs to be synchronised with definite hormonal and ultrasonography values.

Transverse myelitis caused by schistosomiasis during pregnancy. A case report.

A rare case of transverse myelitis caused by schistosomiasis of the spinal cord during pregnancy is presented. The diagnosis and treatment are discussed.

Rupture of the uterus: a changing picture.

Eighty nine cases of rupture of the gravid uterus occurring over a period of 15 years with 77,133 deliveries, were analysed. The overall incidence of ruptured uteri was 1 per 866 deliveries. The patients were divided into two groups, those with a scarred uterus (47) and those with an unscarred uterus (42). Distinct differences in terms of parity, age, aetiology and pathogenesis, the clinical picture, pathology, type of surgery and outcome were seen between the two groups. Most pronounced was the difference in symptoms and signs. Lower abdominal tenderness (38.2%), and vaginal exploration after delivery (44.6%) were the clinical hallmarks in the scarred uterus group, compared to shock (33.3%), uterine bleeding (30.9%) and severe abdominal pain (23.8%) in the unscarred group. Moreover, conservative surgery was possible in 72.3% of the scarred group against 14.3% in the other group. A maternal mortality of 5.6% and fetal mortality of 52.8% was seen. All maternal deaths and 71.4% of fetal losses occurred in the unscarred group. Fortunately, the number of ruptures clearly decreased over the study period, and furthermore the ratio between spontaneous and traumatic ruptures of an unscarred uterus and ruptures of a scarred uterus increased.

Diagnostic laparoscopy v. combined screening laparoscopy and timed follicle aspiration for in vitro fertilisation.

Results from ovulation induction and laparoscopic oocyte retrieval for in vitro fertilisation and embryo transfer were compared in two groups of patients to determine whether oocyte retrieval subsequent to diagnostic laparoscopy had specific advantages over combined screening laparoscopy and timed follicle aspiration. There were no statistically significant differences in any of the factors investigated in the two groups. This study was useful in demonstrating firstly that there are no absolute criteria for selection of patients for either diagnostic or combination laparoscopy. Secondly, the procedure of choice is a combined screening laparoscopy and timed follicle aspiration if a patient is willing to accept a failure rate of 7.4% (2/27 in this study) due to ovarian inaccessibility.

Supplementation of Ham's F10 culture medium with three different sera in the culturing of baboon oocytes.

1. Ten female baboons (Papio ursinus) were stimulated for a total of 20 cycles with 3 ovulation induction agents. 2. Oocytes obtained were randomly allocated to Ham's F10 culture medium supplemented with human fetal cord serum, primate serum or commercial fetal bovine serum respectively. 3. Fertilization occurred (38.1-45.5%) in all 3 supplements, but cleavage and embryo development was more successful in culture medium supplemented with fetal bovine serum. 4. Eight embryos were cultured and 6 (75%) of these were cultured in fetal bovine serum supplemented medium.

Primate in vitro fertilization research: preliminary results on the folliculogenic effects of three different ovulatory induction agents on the chacma baboon, Papio ursinus.

1. A study was conducted on the chacma baboon, Papio ursinus with three ovulation induction agents in an effort to define a preferential stimulatory protocol with regards to the number and quality of oocytes obtained. 2. Three folliculogenic agents applied in four stimulatory protocol regimens comprised clomiphene citrate in a high (100 mg/day) and low (50 mg/day) dosage, a combination of clomiphene citrate and pregnant mare serum, and human menopausal gonadotropin. 3. A total of 159 oocytes were aspirated by laparotomy from 10 baboon females in 20 induced cycles with an average of 8.0 +/- 5.4 oocytes per aspiration. 4. The highest mean number of oocytes (11.3 +/- 6.7) were obtained with the clomiphene/pregnant mare serum gonadotropin combination. 5. The best fertilization rate was obtained with clomiphene 50 mg. 6. The highest incidence of oocytic cleavage and embryo transfer were achieved with human menopausal gonadotropin (14.8%).

Premature closure of the ductus arteriosus causing intra-uterine death. A case report.

A case of hydrops fetalis with intra-uterine death after premature closure of the ductus arteriosus because of inhibition of premature labour by the administration of indomethacin is presented. The physiology of acute and chronic intra-uterine constriction of the ductus arteriosus and the effects of indomethacin on the fetal circulation are discussed. Mention is also made of the moral conflict confronting the doctor in the management of an affected fetus during the third trimester.