Outpatient gamete intrafallopian transfer: a clinical analysis of 710 cases.

From February 1986 to June 1989 445 infertile couples were treated with a total of 710 treatment cycles involving laparoscopic gamete intrafallopian transfer (GIFT). The median age of the female partner was 33.5 years (range, 24 to 49 years) and the median duration of infertility was 4 years (range, 2 to 20 years). The final outcome of all 217 clinical pregnancies is known. There were 150 live births among which all but one baby survived, comprising 112 singleton births, 28 twin births, nine triplet births and one quadruplet birth. There were no still births, but there were two premature, multiple live births (one triplet, one quadruplet) among which no babies survived the neonatal period. Overall, 40 of the 152 potentially viable pregnancies were multiple (26.3%). Three of 206 potentially viable babies were born with congenital anomalies (1.5%). There were 50 clinical spontaneous abortions (24.8% of uterine pregnancies), one termination of pregnancy for Down's syndrome, and 14 ectopic pregnancies rate was 30.6% per laparoscopy and, among 740 initiated cycles, a live and surviving birth-per-initiated-cycle rate of 20.2%, or 33.7% to date per couple entering the programme. The 710 laparscopies resulted in two serious complications (0.3%), one of which required laparotomy. Eight other patients were admitted to hospital for rest and observation because of painful ovarian enlargement in the luteal phase. The total inpatient admission rate was 1.4%. Outpatient laparoscopic GIFT under general anaesthesia is a safe and effective procedure when conventional treatment for infertility has been unsuccessful.

The outcome of artificial donor insemination compared to the husband's fertility status.

One thousand, three hundred and fifty-seven women were treated by artificial donor insemination (AID) using frozen semen at seven Australian centres. Eight hundred and forty-three of the husbands were azoospermic and five hundred and fifteen had pathological semen. The wives of azoospermic men had a significantly higher rate of success when the two groups were compared by life table analysis. It appears likely that the wives of oligospermic men who require AID are less fertile, and may be a contributory factor in the couple's subfertility.

Radioimmunoassay of progesterone, 17-hydroxyprogesterone, estradiol-17beta and prostaglandin F in human corpus luteum.

Radioimmunoassay procedures have been adapted for the assay of progesterone, 17-hydroxyprogesterone, estradiol-17beta, and prostaglandin F in human corpus luteum. The method utilises a single homogenisation and extraction of the tissue followed by fractionation of the steroids on alumina, and separation of the prostaglandins of the F series from the E and A series on silica gel, prior to radioimmunoassay. An attempt has been made to validate the method for the progestins by comparison with results after fractionation of the progestins on Sephadex LH-20, for estradiol-17beta by comparison with values obtained with competitive protein-binding, and for prostaglandin F by comparison with values after additional purification. The results showed that peak concentrations of the three steroids in corpora lutea from women during the luteal phase of the menstrual cycle were comparable to those found in corpora lutea from women in early pregnancy. However, in six out of fourteen corpora lutea from non-pregnant women, prostaglandin F levels were higher than those found in corpora lutea from seven women in early pregnancy, i.e. 13-46 ng/g compared with 1-7 ng/g. Of the above six corpora lutea, four were on days 23-25 of the cycle, at a time when luteolysis would be commencing. The results in this paper support the conclusion that the corpus luteum is a major site of synthesis of the three steroids examined, although the site of synthesis of prostaglandin F is still equivocal.

Electroencephalographic changes after intra-amniotic prostaglandin F2alpha and hypertonic saline.

Six major convulsions have been seen among 555 patients who had therapeutic second trimester abortion by intra-amniotic prostaglandin F2alpha (PGF2alpha). Five of 21 patients receiving intra-amniotic hypertonic saline and 5 of 16 patients receiving PGF2alpha showed abnormalities in electroencephalograms after treatment. These changes were relatively minor in all saline patients and in three receiving PGF2alpha, but two patients receiving PGF2alpha showed epileptiform spike activity after infusion. There was no correlation between the electroencephalographic (EEG) changes and peripheral venous levels of PGF2alpha or its metabolite, 13, 14 dihydro-15 keto PGF2alpha (15 keto-h2-f2alpha).

PIP: 37 women were tested for convulsions after termination of pregnancies with intra-amniotic prostaglandin F2alpha (PGF2alpha) at the King George Hospital and the Royal Alfred Hospital in Sydney, Australia. All patients were 16-20 weeks pregnant. None had a history of epilepsy. 5 of 21 patients receiving intra-amniotic hypertonic saline and 5 of 16 patients receiving PGF2alpha showed abnormalities in electroencephalograms (EEG) after treatment. The former group had minor phase-reversed theta transients over the temporal areas before infusion; none of these changed after induction. No spike information occurred in any of the patients in the saline group. 3 patients receiving PGF2alpha showed relatively minor changes after induction while 2 patients showed major epileptiform spike discharges at both 1 and 4 hours. It is concluded that some EEG changes are relatively common during induced 2nd trimester abortion. There appears to be no relationship between induction of EEG abnormalities and systemic levels of PGF2alpha as measured in peripheral blood. The use of intra-amniotic PGF2alpha for termination of 2nd trimester pregnancy in patients with a history of epilepsy should be avoided.

The effect of intra-uterine prostaglandin F-2alpha on corpus luteum function in the human.

Prostaglandin F-2alpha (PGF-2alpha) was administered via a Foley catheter over a 12 hour period to 8 healthy volunteers awaiting laparoscopic sterilisation. The amount of PGF-2alpha infused varied between 500 mu-g and 2000 mu-g every 2 hours for 6 doses. Plasma progestins and oestradiol 17beta, and urinary estrogens and pregnanediol were assayed throughout the study period. There was no evidence of luteolysis in any patient although vaginal bleeding of varying duration occurred in all women within 36 hours of administration of PGF-2alpha.

Assessment of possible luteolytic effect on intra-ovarian injection of prostaglandin F-2ALPHA in the human.

A group of five patients awaiting laparoscopic tubal diathermy were followed by daily assay of luteinising hormone (LH) and progesterone. Between five and eight days after the LH peak, prostaglandin F-2ALPHA (PGF-2ALPHA) was injected into either the corpus luteum or the ovarian stroma. Doses of 100 mu-g into the corpus tuteum, 1000 mu-g into the adjacent stroma and 500 mu-g into an indeterminate ovarian structure had no effect on peripheral plasma progesterone levels or uterine bleeding. An injection of 500 mu-g or 1000 mu-g given unequivocally into the corpus luteum produced a rapid and profound fall in plasma progesterone levels, the nadir coinciding with the onset of uterine bleeding which commenced 24 hours after the injection and persisted for more than seven days. Injection of 100 mu-g in the same volume of saline had no such effect. Despite continued bleeding plasma progesterone levels returned to normal luteal levels for three days and then fell again.

PIP: A group of 5 patients awaiting laparoscopic tubal diathermy were followed by daily assay of luteinizing hormone (LH) and progesterone. Between 5 and 8 days after the LH peak, prostaglandin F2alpha (PGF2alpha) was injected into either the corpus luteum or the ovarian stroma. Doses of 100 mc into the corpus luteum, 1000 mc into the adjacent stroma, and 500 mc into an indeterminate ovarian structure had no effect on peripheral plasma progesterone levels or uterine bleeding. An injection of 500 mc or 1000 mc given unequivocally into the corpus luteum produced a rapid and profound fall in plasma progesterone levels, the nadir coinciding with the onset of uterine bleeding which commenced 24 hours after the injection and persisted for more than 7 days. Injection of 100 mc in the same volume of saline had no such effect. Despite continued bleeding plasma progesterone levels returned to normal luteal levels for 3 days and then fell again.