Human in-vitro fertilisation, in-vivo sperm penetration of cervical mucus, and unexplained infertility.

Oocytes were recovered at routine diagnostic laparoscopy for infertility after stimulation with clomiphene and human chorionic gonadotropin. The results of in-vitro fertilisation (IVF) with the husband's semen were compared in 3 distinct groups of fully investigated infertile couples. Those with bilateral tubal occlusion (36) were combined with fertile controls undergoing sterilisation (6) to form a "tubal" group for normal reference. In this tubal group 48/88 (55%) oocytes were fertilised, at least one oocyte being fertilised in each of 33/42 couples (79%). In couples with a negative or poor postcoital test (PCT), despite mostly normal semen analysis, 8/50 (16%) oocytes were fertilised in 6/21 (29%) couples. In couples with unexplained infertility and a positive PCT, 22/61 (36%) oocytes were fertilised in 17/25 (68%) couples. The results show that spermatozoa unable to penetrate preovulatory cervical mucus are generally also unable to fertilise the human oocyte. They emphasise the biological and prognostic importance of the PCT, and the hidden frequency of defective sperm function as a cause of unexplained infertility. Human IVF is likely to be a more helpful diagnostic investigation than hamster egg penetration testing because it is specific for individual couples. If IVF is to offer therapeutic hope to couples with impaired sperm/mucus penetration the fertilisation rates and the numbers of mature oocytes stimulated for recovery will both have to be high.

Antepartum haemoperitoneum due to placenta increta. Case report.

A patient is described in whom a placenta increta led to a haemoperitoneum. The diagnosis, made by abdominal paracentesis, led to laparatomy and Caesarean hysterectomy at 31 weeks; the child survived. Delay in diagnosis of the haemoperitoneum was mainly due to difficulties in clinical assessment caused by an episode of premature labour and maternal psychiatric illness.

Role of pelvimetry in active management of labour.

All cases referred for pelvimetry in 1970-1 and all breech presentations referred for pelvimetry in 1972-4 were reviewed. Indications for pelvimetry fell into four main categories: high head in the antenatal clinic (47-8%); high head in labour (13-9%); breech presentation (20-9%); and previous caesarean section (14-8%). In the first two categories pelvimetry rarely if ever influenced management, and it should not be performed routinely. In breech presentation and cases of caesarean section pelvimetry seemed to be of value, but in the latter group it should be performed puerperally to avoid the known radiation hazard to the fetus. A fairly close correlation between obstetric conjugate and pelvic capacity was shown, which suggested that a 3400-g baby might pass through a pelvis of obstetric conjugate of 10 cm as a cephalic trial of labour, but would need an obstetric conjugate of 11-7 cm for safe vaginal breech delivery.