The in vitro fertilisation programme at Tygerberg Hospital and the University of Stellenbosch. Five years' experience, April 1983-January 1988.

The results of the in vitro fertilisation programme at Tygerberg Hospital for the period April 1983 to January 1988 are presented. Of the 1117 laparoscopies performed, 825 patients reached the transfer stage. A live-birth rate of 9.3% was achieved. The pregnancy rate after transfer of 4 embryos was 25.9% compared with 15.4% after 2 embryos and 10.8% after 3 embryos (P = less than 0.0001). The multiple pregnancy rate was 2.8% in the group receiving 2 embryos and 11.7% and 10.4% in those receiving 3 and 4 embryos, respectively. Of the 77 successful pregnancies (90 babies), 1 baby died at 34 weeks' gestation as the result of abruptio placentae due to preeclampsia and 1 cot death occurred. The only congenital abnormality encountered was a cleft palate.

Gamete intrafallopian transfer as treatment for infertility associated with endometriosis.

Forty-six patients with endometriosis-associated infertility underwent 59 GIFT cycles. The pregnancy rate per cycle was 30.5%. The presence of endometriomas in 11 patients did not affect this rate adversely. We conclude that, provided at least one fallopian tube is patent, GIFT compensates effectively for the possible causes of infertility in these patients.

Genital tuberculosis associated with female infertility in the western Cape.

Infertility is a common presenting symptom in women with genital tuberculosis. A study was undertaken to determine the prevalence and characteristics of this disease among the infertile patients (A and B income group) attending the Reproductive Biology Unit at Tygerberg Hospital. Between June 1986 and December 1987, the menstrual fluid from 451 infertile women was cultured for Mycobacterium tuberculosis using Löwenstein-Jensen medium. A prevalence of 7.98% (36/451) was found. Laparoscopic examination of the pelvis revealed bilateral tubal occlusion in 3 patients (8.3%); peritubular adhesions were present in 17 patients (47.2%). In the remaining 16 patients (44.5%), the pelvis was considered normal. No culture-positive patient gave a history of previous infection or contact with tuberculosis. Radiography of the chest and histological examination of the endometrium showed no evidence of infection. Of the 34 patients treated, 13 (38.2%) became pregnant after antituberculosis treatment was completed. If tuberculosis occurs in a population, menstrual fluid of infertile women should be cultured routinely for M. tuberculosis, especially if there is evidence of tubal damage.

Treatment of male sperm autoimmunity by using the gamete intrafallopian transfer procedure with washed spermatozoa.

Sixteen couples were diagnosed as having immunological infertility. To detect sperm-bound immunoglobulin (Ig), i.e., IgA, IgG, and IgM antibodies, the direct immunobead test (IBT) was used. In each individual patient, the direct IBT was greater than or equal to 70% positive for either IgA or IgG or both. The indirect IBT was positive for IgA and IgG antibodies in the serum of all the patients. Semen was collected in 15 mL medium (Ham's F10 [Gibco, Grand Island, NY] + 10% whole blood serum) and prepared with the wash and swim-up method. Patients in the study group were treated for their immunological infertility problem by performing the gamete intrafallopian transfer (GIFT) procedure. An ongoing pregnancy was achieved in 7 of the 16 (43%) couples treated with the GIFT procedure with an ongoing pregnancy rate of 24.1% (7 of 29) per cycle. The GIFT procedure appears to be an effective and safe way of treating male immunological infertility.

[Oral ketanserin in the treatment of pre-eclampsia]. / Orale ketanserien vir die behandeling van pre-eklampsie.

Oral ketanserin was used in an attempt to control gestational proteinuric hypertension and to improve perinatal outcome in 20 patients before 34 weeks. The average duration of treatment was 9 days. These patients had advanced disease which progressed despite additional treatment with a diuretic and/or methyldopa.

Intrapartum treatment of preeclamptic hypertension by ketanserin.

Ketanserin was administered intravenously as either 20 or 10 mg boluses to 16 patients with severe preeclampsia in labor. The fetal heart rate was monitored with a scalp electrode and the uterine contractions were evaluated with a fluid-filled catheter connected to a physiologic pressure transducer. A 10-minute recording before every administration of ketanserin was compared to the same period immediately afterward. Ketanserin lowered the systolic and diastolic blood pressure significantly (p less than 0.005, paired Student's t test). Maternal heart rate was unchanged but the mean fetal heart rate increased by 4.6 bpm. Long-term beat-to-beat variability and acceleration patterns were not affected. On four occasions an improvement in variable decelerations of the fetal heart, due to a reduction in uterine activity, was seen. Changes in the amplitude of contractions were not statistically significant. The frequency of contractions, however, was significantly reduced from 3.6 to 2.4 per 10 minutes (p less than 0.005). No serious adverse effects occurred.