[Laparoscopy in the treatment of uterine perforation in induced abortions]. / Laparoskopija u rjesavanju perforacija maternice kod artificijalnih abortusa.

From 1981 to 1988, 32 uterine perforations per 44,052 artificial abortions (0.07%) were recorded. Also three more perforations having occurred outside the Department were treated. In two patients the perforation was done by a probe and the evacuation of the uterus was completed vaginally. Six perforations were in the parametrium, producing no injury of the serosa; three of them required laparotomy because of abundant bleeding (laparotomy had to be applied previously in the two) and in the remaining 27 patients the uterine corpus was perforated either by a dilatator, forceps, curette or aspiration cannula. If the injuries of the abdominal organs were evident, laparotomy was applied in the first place (in two patients) and the same was done in perforations by the aspiration canulla with the inclusion of the negative pressure (three patients). In 28 patients laparoscopy was applied, three of them having been selected for laparotomy. Out of the remaining 25 patients, the perforation opening in 22 was treated endothermically by the low voltage current or electrocoagulation by a probe of high frequency current to stop bleeding. In three patients the uterus was adequately contracted, there was no bleeding from the edges of the perforation opening and therefore no coagulation was necessary.

Chromosomal preparations of human triploid zygotes and embryos fertilized in vitro.

Forty-eight zygotes with more than two pronuclei were identified after in vitro fertilization, representing 6.1% of all fertilized oocytes. The chromosome preparations from pronuclear stage to the cleaved human embryos were examined. Prophase was found in eight out of ten zygotes. The spreading of chromosomes allowed an adequate counting in only two cases. Six of the eight preparations displayed a late prophase. In this stage each haploid group of chromosomes can be analysed separately. Kariogamy usually occurred 4 to 5 h after the pronuclei had disappeared, and polyploid number of chromosomes were found in well-spread metaphases. The chromosomal preparations were made for eleven human embryos arising from zygotes with three pronuclei. Out of ten preparations, where the chromosomes could be counted, seven embryos (70%) contained hypodiploidic groups of chromosomes. In two of the cases, however, triploid metaphases were found, and in the last one a triploid/diploid mosaicism.

[Fertilization in vitro in the treatment of male infertility]. / Fertilizacija in vitro u lijecenju muske neplodnosti.

Thirty marital couples were included in an in vitro fertilization study of male infertility. Second-degree oligospermia (less than or equal to 5 X 10(6)/ml mobile sperms) was found in 3 couples, first-degree oligospermia (less than or equal to 12 X 10(6)/ml mobile sperms) in 21 couples, and asthenospermia (less than 20% of mobile sperms) in 6 couples. The semen for insemination was prepared by the standard procedure and the overlay technique. After the separation (removal) of seminal fluid and capacitation the sperms were found to be significantly more mobile. Ovarian cells obtained by laparoscopy were inseminated with 50,000 to 250,000 mobile sperms. The results were compared with those in a group of patients with normospermia (greater than or equal to 12 X 10(6)/ml mobile sperms). The number of fertilized ovarian cells proved to be significantly lower in patients with second-degree oligospermia (P less than 0.001). There was no difference in the rate of fertilization and ovarian cell division either in patients with first-degree oligospermia or asthenospermia or normospermia. Seven clinical pregnancies were recorded: 2 in the second-degree oligospermia group, 4 in the first-degree oligospermia group, and 1 in the asthenospermia group.

[Pregnancy after fertilization in vitro and embryo transfer]. / Trudnoce nakon izvantjelesne oplodnje i prijenosa zametka u materiste.

The first 13 pregnancies established by in vitro fertilization and embryo transfer. A tubal factor was the main indication for in vitro fertilization (IVF) in 10 patients, whereas in three couples infertility was caused by the infertile sperm. The mean age and duration of infertility in female patients were 33.5 and 11.4 years, respectively. Multiple follicular growth was stimulated by either clomiphene citrate (100-150 mg during 5 days), clomiphene citrate + HMG + HCG, or HMG + HCG. Timing of ovulation was determined by assaying serum estradiol, progesterone and LH levels. The ultrasound monitoring of follicular growth was determined on a daily basis. Endogenous LH surge was observed in one patient, whereas in others 5000-10,000 IU HCG were needed to induce ovulation. All oocytes were recovered by laparoscopy. There were 3.8 oocytes per patient on an average. Fifty-six percent of oocytes were preovulatory. All oocytes were allowed to mature in vitro for 3 to 7 hours (mean 5.7 hours). The fertilization and cleavage rates were 76% and 72% respectively. Only one polyspermic fertilization was observed. Forty-five hours after the insemination the embryos between the 2-cell and 6-cell stages were reimplanted into the uterus. Using various ET cannulas, one to seven embryos per patient (2.7 embryos on the average) were replaced into the uterine cavity, 5 mm below the fundus. Only four embryo replacements were completely atraumatic. No medications were used for the luteal phase support. The corpus luteum function and early pregnancy were controlled by serial measurements of serum progesterone, estradiol and beta HCG. Three clinical miscarriages and full-term deliveries were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of delayed insemination on fertilization in vitro and the development of human embryos]. / Ucinak odogodene inseminacije na oplodnju in vitro i razvoj humanih zametaka.

Extracorporeal fertilization of 363 oocytes was applied in 148 patients with tubal infertility. The aspiration of the follicles was performed 36 to 38 hrs after the onset of the endogenous LH rise or 36 hrs after injection of hCG. Oocytes maturity was evaluated on the basis of the morphological appearance of the cumulus oophorus. The eggs were incubated in culture medium before insemination. The duration of delayed insemination had a marked effect on the proportion of fertilized oocytes and the development of embryos (X2 = 10.34, P = 0.05). After maturation of 1.5 to 3.5 hrs, minimal preovulatory oocytes were fertilized and developed to embryos. Maturation of 3.5 to 5.5 hrs increased the number of fertilized oocytes from 56% to 71.7% and the number of embryos from 50% to 55.1%. After 5.5 to 7.5 hrs of maturation significantly more fertilized oocytes (t = 2.4, P less than 0.02) and developed embryos (t = 2.41, P less than 0.02) were obtained. Preincubation of intermediary preovulatory or immature oocytes had no beneficial effect on the fertilization rate and the development of embryos.

[Persisting suppression of hyperprolactinemia after bromcriptine withdrawal]. / Trajna supresija hiperprolaktinemije nakon lijecenja bromokriptinom.

The 22-years old patient with secondary amenorrhea, galactorrhea and macroprolactinoma of hypophysis was observed. After the therapy with Parlodel, which lasted 34 months, her menstrual cycle became regular and the level of prolactin was normal. The quantity of Parlodel used daily for the normalization of prolactin was 20 mg at the beginning, and only 2,5 mg later on. This quantity was taken intermittently, only until the ovulation. She conceived 5 months after therapy withdrawal. During the pregnancy period, prolactin in serum was not higher then physiological value. The pregnancy did not cause any growth of tumor. After the delivery and the break of lactation, hyperprolactinemia persisted, but only 29,1-34,4% of the value before the beginning of the therapy.

[Immunoglobulins in serum and seminal fluid in patients with sperm agglutination]. / Imunoglobulini u serumu i sjemenoj tekucini Pacijenata s aglomeracijom spermatozoida.

Serum immunoglobulins and immunoglobulins in the seminal fluid were determined in 32 men with normospermia without agglutination and in 37 men with normospermia with agglutination. In the seminal fluid also secretory IgA and the secretory component were recorded. The values of serum immunoglobulins were more or less the same. So were the IgG values in the seminal plasma of both groups. IgA was found more frequently in the seminal plasma of patients with agglutination. IgM was not found at all. Secretory IgA and the secretory component were for the most part found in the seminal plasma of patients with normospermia and agglutination. The finding of secretory IgA and the secretory component gives an insight into the local synthesis of sperma-antibodies.

[Adrenogenital syndrome in an adolescent]. / Adrenogenitalni sindrom u adolescenata

A case is presented of primary amenorrhea resulting from the hyperfunction of the adrenal cortex. The condition developed in prepuberty. The mode of the establishment of the diagnosis and the effect of dexamethason treatment are discussed.