Agricultural work and male infertility.

Data from couples (n = 103) seeking artificial insemination with donor sperm because of poor sperm quality and a control group of couples treated by in-vitro fertilization due to female causes were analysed according to the occupations of the spouses. Comparison of occupational categories revealed a significant difference in the prevalence of agricultural occupation (11/103 vs. 1/103, p < 0.01) between the group with male factor infertility and the normospermic controls. These patients also reported more long-term exposure to several insecticides and other pesticides. These toxic chemicals probably have a detrimental effect on male fertility and therefore we suggest more caution in the way they are handled.

'Chemical curettage' using intrauterine methotrexate injection.

A 22-year-old woman with multiple urogenital anomalies presented for the second time with a blighted ovum situated in the rudimentary right horn of a uterus communicans bicornis. A dilatation and curettage was not possible owing to the inaccessibility of this horn. The first blighted ovum was aborted in 1989 (at age 21 years) following the use of intramuscular prostaglandin therapy. On this occasion, therapy was by the transvaginal, intrauterine (intra-amniotic) instillation of 100 mg methotrexate and a complete abortion of the products of conception occurred. Similar to the treatment of ectopic pregnancy, in certain cases, termination of intrauterine pregnancies using local methotrexate injection may be considered.

[Transvaginal Doppler study of embryonic heart action in early pregnancy]. / Transvaginale Doppleruntersuchung der embryonalen Herzaktion in der Frühschwangerschaft.

Embryonic cardiac activity was observed by means of transvaginal Doppler ultrasound in a period from the 28th through the 78th day after conception (p. c.). We were able to detect a correlation between the embryonic heart rate and the stage of pregnancy as well as a correlation to the crown-rump length. The maternal age did not seem to have any effect on the appearance of embryonic heart activity. The number of registered Doppler echoes did not yield information on embryonic heart development.

[Vaginal ultrasonographic observation of uterine contractions in embryo transfer and its relevance to treatment success]. / Die vaginosonographische Beobachtung von Uteruskontraktionen beim Embryotransfer und ihre Relevanz im Hinblick auf den Behandlungserfolg.

441 patients were treated by in-vitro fertilisation and embryo transfer (ET) from January 1989 to May 1990. Transvaginal ultrasound allowed pre-transfer assessment of the uterine architecture and confirmation of successful transfer after the procedure. The length and direction of the cervical and uterine cavity were noted. The real-time image was observed for one minute to see, if uterine contractions occurred. These can be clearly seen as pulsatile movements, which can be distinguished from breathing motions. We also recognised the localisation and the movement of the transferred air bubble. A "double bubble sign" occurs as a result of the two air bubbles being seen in sagittal transvaginal ultrasound. The embryos are sandwiched between the two visible bubbles. As far as the subjective methods used permit a definitive statement, there is no connection between contractions, localisation and movement of the air bubble with the success or failure of the E.T.