Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test.

A young man with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of beta-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment.

Endometrial biopsy during a cycle of conception.

Endometrial biopsies obtained from 18 infertile women during early intrauterine pregnancy were examined histologically. The cycle date on which the biopsies were obtained was determined from the day of ovulation by basal body temperature charts and prior menstrual history. The average cycle dates of the biopsies were similar for the women who delivered at term or who had first-trimester spontaneous abortions. Among the women who delivered at term, the average histologic date assigned to the specimens was significantly earlier than the average cycle date. In contrast, among the women who had early pregnancy loss, the specimens had an average histologic date significantly later than the average cycle date. A histologic date of later than 25 days or later than the cycle date of the biopsy was associated with a poor prognosis for the pregnancy.

PIP: 18 infertile women from the Milton S. Hershey Medical Center in Pennsylvania underwent endometrial biopsy during the cycle of conception. The endometrial biopsies were examined histologically and dated by 4 different examiners within 2-day interval rates. Average cycle date on which biopsies were obtained was day 25 (range 21 to 28). 13 of the 18 women delivered at term, 4 had histologically documented 1st-trimester spontaneous abortions, and 1 was lost to follow up in the 2nd trimester. Pregnancy outcome did not correlate with day of cycle on which biopsy was taken. Overall incidence of obtaining endometrial biopsy during the cycle of conception in this group of patients was 6.2%, an incidence similar to that by Wentz but greater than that observed by others (0.05% to 4.2%). Average histologic date assigned to specimens was earlier than the average cycle date on which the biopsy was taken. Pregnancy outcome correlated with the histologic dates of the endometrium, with the number of 1st trimester abortion significantly increased among those whose endometrium was dated histologically later than the cycle date of biopsy or later than day 25.

The treatment of endometriosis at laparoscopy for infertility.

Endometriosis is found in some infertile women, and treatment by laparotomy and/or hormonal therapy is associated with subsequent pregnancy. In this study, 100 consecutive patients with mild/moderate endometriosis were treated at laparoscopy. Forty of these women achieved a pregnancy within 37 months postoperatively; 73% of these pregnancies occurred within 6 months, and 88% within 12 months of operation. Although this pregnancy rate is similar to rates obtained after treatment by laparotomy and/or hormonal therapy, the pregnancies in this study population occurred significantly earlier than after laparotomy or combined therapy. The age of the women, duration of infertility, parity, extent of endometriosis, or presence of additional treatable factors of infertility did not affect the pregnancy rate. There was no significant morbidity, and the procedure can be performed on an outpatient basis with local anesthesia. Laparoscopy offers a practicable alternative for the treatment of mild/moderate endometriosis in infertile women.

Gonadal dysgenesis in a 46,XY female mosaic for double autosomal trisomies 8 and 21.

The proband was evaluated at 19 years of age because of primary amenorrhoea and, on chromosomal analysis, was found to have a 46,XY karyotype in 75% of her cells and 48,XY, +8, +21 in 25% of her cells. She appeared normal at birth and exhibited normal intellectual and physical development until puberty when secondary sexual differentiation failed. This young women showed none of the dysmorphic features associated with either trisomy 8 or trisomy 21. Her XY gonadal dysgenesis was manifested by late developmental problems of amenorrhoea, sexual infantilism, and gonadal neoplasia.

Chromosomal abnormalities associated with infertility.

From a population of 515 subfertile couples and 119 women with amenorrhea, 38 patients were karyotyped because of specific signs and symptoms suggestive of chromosomal abnormality. The indications for karyotyping included primary amenorrhea, secondary amenorrhea with gonadal failure before 35 years of age, stature of less than 147.5 cm, azoospermia with eunuchoidism, and personal or family history of more than 2 spontaneous abortions or more than 2 severely abnormal children. In addition, 19 patients from the same subfertile population were selected randomly for karyotyping to serve as controls. Using banding techniques, chromosomal abnormalities were found in 18 of the 38 specifically selected individuals, whereas no abnormality was found among those randomly selected. Three of the 18 patients had chromosomal abnormalities not previously described; their karyotypes were 46,XY/48,XY,+8,+21; 46,X,inv dup(Xq)/q26 leads to q21); and 46,XY,t(9;20)(q22;q12).

A longitudinal analysis of artificial insemination with donor semen.

A longitudinal analysis of artificial insemination with donor semen (AID) in 114 consecutive couples revealed a 37% over-all pregnancy rate. The 45 pregnancies occurred in 39 patients, and approximately 90% of these pregnancies occurred within six cycles of AID. Pregnancy rates were higher in the age group 25 to 30, in those who received only fresh semen, and in those with a history of a previous pregnancy. Lower pregnancy rates were observed in patients age 31 or older, in those with pelvic disease, and in those randomly receiving freshly thawed semen or fresh semen. The use of a vaginal device for retaining semen, the use of patient positioning, or the duration of infertility did not appear to affect the success rate. When surgically correctable pelvic disease was treated, a pregnancy rate of 22% was obtained.

PIP: A longitudinal analysis of artificial insemination with donor semen (AID) in 114 consecutive couples revealed a 37% over-all pregnancy rate. The 45 pregnancies occurred within 6 cycles of AID. Pregnancy rates were higher in the 25-30 year age group (46.8%), in those with a previous history of pregnancy (50%), and in those who received only fresh semen (pregnancy rate decreased by 29% when fresh and frozen semen were used randomly in patients matched for age with no history of pelvic disease). Lower pregnancy rates were observed in patients aged 31 or older (18%) and in those with pelvic disease (22.2%). Use of a vaginal device for retaining semen, use of patient positioning, or duration of infertility did not appear to affect the success rate. When surgically correctable pelvic disease was treated, a pregnancy rate of 22% was obtained.