[Contraception for the diabetic woman]. / La contraccezione nella donna diabetica.

The various contraceptive methods available today are examined here: natural methods; sterilization; intrauterine devices; oral contraceptives. The analysis of the advantages and disadvantages of each of them indicates that in the diabetic woman low dosages of estrogen-progestins are the most suitable for short-term contraception since they do not seem to influence diabetic control. Once the patient has completed her family, the choice of method for long-term contraception is intrauterine devices or sterilization.

PIP: The menstrual cycle of the diabetic woman is irregular, therefore natural methods are not very reliable. Among male contraceptive methods vasectomy has the advantage of simplicity, requiring only local anesthesia. It does not require surgical intervention in the diabetic woman, but the disadvantage is its irreversibility. There have been numerous attempts with steroids, vaccines, and chemical substances, however, there is no contraceptive yet that is effective and harmless. Once the diabetic woman has achieved the desired family size, sterilization is more often used and it is safe. Sterilization should not be performed during cesarean section, especially not during preterm delivery. The route of choice is laparoscopy or the vaginal route. IUDs are not recommended for nulliparous women because of the possibility of tubal inflammation and hence the effect on fertility. Oral contraceptives (OCs) have shown a diabetogenic effect that has not been fully confirmed. This effect is attributed to the progesterone component. The risk of cardiovascular disease increases in diabetic patients during long-term use according to some studies. A 1991 study indicated that low-dose contraceptives used for 6 months by women with gestational diabetes did not provoke changes in the glucose tolerance test and the lipid profile. Similar findings were obtained in 100 women followed up for 5 years who had been implanted subcutaneously with silicone capsules containing 16 mg of levonorgestrel. The contraceptive vaccine could solve all these metabolic problems, however, research is still at the beginning. In sum, for short-term use in nulliparous women low-dose OCs are suitable, while for the long term the IUD or female or male sterilization is recommended.

Gamete intrafallopian transfer by hysteroscopy as an alternative treatment for infertility.

OBJECTIVE: To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). DESIGN: We studied the pregnancy rate (PR) and the safety of this new technique. SETTING: All patients were enlisted for GIFT at our Reproductive Medicine Unit. PATIENTS: We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. INTERVENTIONS: The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. MAIN OUTCOME MEASURE: The efficacy was evaluated by the PR (25.9%). RESULTS: Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. CONCLUSIONS: Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.

Pregnancy after direct intraperitoneal insemination.

Direct intraperitoneal insemination (DIPI) and superovulation are simple procedures which may together represent a good alternative to gamete intra-Fallopian transfer (GIFT) in infertile women with patent Fallopian tubes. In the present study, pregnancy occurred in 25 of 96 couples (26%) and six (24%) of these aborted. The pregnancy rate for all cycles was 19.6% and multiple pregnancies were found in six of 25 (24%) patients. We observed no ectopic pregnancy. The combination of these techniques is concluded to be useful in achieving pregnancy in infertile women with patient Fallopian tubes.

Tissue factors influencing growth and maintenance of endometriosis.

The unpredictable response of endometriosis to steroids and its recurrence after therapy, led us to hypothesize a possible further control of this pathology by factors other than steroids. The presence of estrogen, progesterone and epidermal growth factor receptors (ER, PR, EGFr) was evaluated using immunohistochemistry before and after therapy with Danazol or a gonadotropin-releasing hormone analogue (GnRHa), Buserelin. EGFr, ER and PR were present in 100% of endometrial specimens, and in 71%, 29% and 49% of endometriotic implants, respectively. Danazol and GnRHa reduced immunohistochemical staining for EGFr antisera in the endometrial and endometriotic specimens. About 21% of endometriosis were EGFr positive and ER negative, suggesting a potential role of epidermal growth factor in growth and maintenance of endometrial ectopia.

A comparison of the delta copper T and the copper T 200 in Bologna, Italy.

An analysis is presented of a comparative study of the Delta T and Copper T 200 IUDs. A total of 195 postabortion insertions was performed between March 1981 and August 1982. All insertions were performed with an inserter. Primary bleeding/pain complaints after insertion were largely related to intermenstrual problems, with spotting the most frequently reported. Nine women had their devices removed for PID. One pregnancy occurred at ten months in the Delta T group. Both groups had one expulsion/displacement. Eight devices in each group were removed for bleeding/pain. Two women in the TCu group had their devices removed for personal reasons. The 6-months continuation rates for the two groups were 85.5 for the Delta T group and 82.2 for the TCu group. The 6-months follow-up rate for the Delta T group was 39.4 and 38.8 for the TCu group.

PIP: Complications associated with postabortion insertion of the Delta T and Copper T 200 IUDs were compared in 195 women. All insertions were performed with an inserter. There were no reported incidents of inserter-related problems, pelvic pain, or other complications at insertion. At follow-up, intermenstrual spotting was the most frequently reported complaint, involving 14 women (18.2%) in the Delta T group and 7 women (9.5%) in the TCu group. 8 Delta T acceptors (10.4%) and 12 TCu acceptors (16.2%) experienced intermenstrual bleeding. Intermenstrual pain was reported by 7 (9.1%) Delta T users and 4 (5.4%) TCu users. Other primary bleeding and pain complaints included menorrhagia, reported by 9 (11.7%) Delta T users and 9 (12.2%) TCu users, and dysmenorrhea, reported by 5 (6.5%) Delta T users and 4 (5.4%) TCu users. Pelvic inflammatory disease (PID) confined to the uterus was diagnosed in 9 (11.7%) Delta T acceptors and 5 (6.8%) TCu acceptors. 7 women (9.1%) in the Delta T group and 8 women (10.8%) in the TCu group reported PID confined to the adnexa. 1 woman from each group had PID confined to the uterus and adnexa and 5 TCu users reported PID beyond the uterus and adnexa. Of the 36 women diagnosed with PID, 9 had their devices removed. There was 1 pregnancy in the Delta T group and 1 device from each group was expelled. There were 3 removals for pain and bleeding in the Delta T group and 4 removals for this reason in the TCu group. The 6-month continuation rate was 85.5 for the Delta T device and 82.2 for the TCu IUD. Given the high incidence of spotting, intermenstrual bleeding, and PID recorded in this sample, insertion of an IUD in the immediate postabortion period is not recommended.

Uterine pathology and infertility.

The authors describe the factors influencing implantation with reference to uterine pathology; the role that it plays both in the case of failure of implantation and in the case of repeated abortions is discussed and the techniques of treatment in the presence of uterine pathology affecting fertility are listed.

Serum specific IgA antibody to Chlamydia trachomatis in patients with chlamydial infections detected by ELISA and an immunofluorescence test.

Sera obtained from 34 men with Chlamydia trachomatis positive non-gonococcal urethritis, 34 men with C trachomatis negative non-gonococcal urethritis, 42 women with acute salpingitis, 38 healthy women, and 34 healthy men were studied for the presence of specific serum C trachomatis IgA and IgG antibodies. Serological results were correlated with C trachomatis isolation in cell culture. An enzyme linked immunosorbent assay (ELISA) for C trachomatis specific serum IgA was employed using highly purified elementary bodies of C trachomatis serotype L2 grown in LLC-MK2 cells. Results obtained for C trachomatis IgA antibody by the ELISA test were compared with results obtained for the same sera by a single antigen immunofluorescence technique. A good correlation (r = 0.91) was found between two methods. Serum IgG antibody was also determined in the same sera by the immunofluorescence technique. Patients with C trachomatis positive non-gonococcal urethritis had a significantly (p less than 0.0005) higher prevalence (94.1%) of serum IgA antibody by ELISA compared with patients with C trachomatis negative non-gonococcal urethritis (20.5%) or healthy men (5.9%). Similarly, women with acute salpingitis had a significantly (p less than 0.005) higher prevalence of serum IgA antibody (45.2%) compared with healthy controls (5.2%). Comparable results were obtained for C trachomatis serum IgA antibody using the immunofluorescence technique. The prevalence of C trachomatis IgG antibody was significantly higher in patients with C trachomatis positive non-gonococcal urethritis (97.0%) compared with those with C trachomatis negative non-gonococcal urethritis (33.3%) and healthy controls (23.5%). The importance of using specific C trachomatis serum IgA in the identification of chlamydial infection is discussed.

Luteinized unruptured follicle syndrome: hormone assay on peritoneal fluid in a laparoscopic study of infertile women.

33 infertile women with normal ovulatory cycles were investigated for the presence of a Luteinized Unruptured Follicle Syndrome (L.U.F.) using steroid hormone assays in peritoneal fluid and laparoscopic visualization of ovulation stigmata. We failed to identify a stigma in 36% (12) of the patients in the early luteal phase, 1 subject had a cystic corpus luteum and in 4 cases no diagnosis was made due to the presence of adhesions. The mean hormone concentrations in PF were significantly higher when the stigma was present (17-beta-estradiol, P less than 0,05; progesterone, P less than 0,01; 17-oh-progesterone, P less than 0,05). The two groups (with and without ovulation stigmata) showed no differences in plasma levels of Estradiol (E2) and Progesterone (P). Stigmata were detected only in 17% of subjects with concomitant endometriosis. 3 patients with a luteal phase defect showed low levels of steroids in PF in spite of the presence of an ovulation stigma.

Induction of ovulation with cyclophenyl.

The results of 495 cycles of treatment with Cyclophenyl given to 286 women suffering from amenorrhea, oligomenorrhea or persistent anovulation are reported. In 61 cases the drug solved the problems of infertility, with a success rate of 43%. The over-all success rate was 58% (288 ovulatory cycles produced in 495 treatment cycles). In detail:--in cases of prolonged amenorrhea, with plasma estradiol levels lower than 50 pg/ml, the positive results were only 15%;--in cases of short-term amenorrhea, with plasma estradiol levels lower than 50 pg/ml, the success rate was only 18%;--in cases with prolonged amenorrhea but with plasma estradiol levels higher than 50 pg/ml, the success rate was 43%;--in cases of short-term amenorrhea with plasma estradiol levels higher than 50 pg/ml, the success rate was 68%;--in cases of oligomenorrhea and of persistent anovulation, the success rate was 72%.

Significance of 17alpha OH progesterone assay in the evaluation of ovarian and adrenal function.

Plasma 17alpha OH progesterone was assayed radioimmunologically, using an anti-17-OH-progesterone BSA antiserum as specific binding antigen. The method consisted in extracting steroids with ethyl ether from 1 ml plasm (to which 17alpha OH progesterone-1,2-3H had been added for the assessment of losses); the extract was then submitted to chromatography on a Sephadex LH-20 column, antiserum was added and the free steroid was separated from the bound form by Charcoal-dextran. Average recovery of 17alpha OH progesterone-1,2-3H was 75+/-5%. Minimum sensitivity of the method oscillated about 7-10 pg. MIF (Method Interfering Factors) were evaluated. The method was used for the assay of 17alpha OH progesterone plasma levels during normal menstrual cycles, in women undergoing ovarian stimulation with HMG and HCG in the follicular and luteal phase respectively. Finally, changes of plasma 17alpha OH progesterone levels were assessed during adrenal stimulation and suppression in various stages of the menstrual cycle.

[Effects of L-dopa on FSH and LH secretion in men and women].

The behavior of plasma gonadotropins has been studied in amenorrhoic patients and in men suffering from disorders of spermatogenesis after L-DOPA administration. Neither clinical nor laboratory findings warrant hypotheses apt to interpret the different responses observed after the ingestion of the drug; nevertheless, keeping in mind the results reported in the literature, the relationship between L-DOPA and the hypothalamo-pituitary axis appears to deserve further study with the use of more accurate means of investigation and follow-up of the late effects observed in our research.