Embryonic development and blastocyst implantation following in vitro fertilization and embryo transfer

A sensitive and specific radioimmunoassay was used to measure human chorionic gonadotropin (hCG) excretion in serial overnight urine samples in women having embryo transfer, in an in vitro fertilization program. Elevated hCG excretion suggestive of blastocyst implantation was detected in 17 of 121 women studied. When the results were corrected for interference by luteinizing hormone and other immunoreactive substances, implantation was detectable 8 to 9 days after fertilization in 20% of conceptual cycles, in 80% by days 12 to 13, in 93% by days 14 to 15, and in 100% by days 16 to 17. From a life table of human embryo development in culture, it was estimated that 37% of four-cell and 43% of eight-cell embryos reached the blastocyst stage. On the basis of these estimates and the elevated hCG from implanting blastocysts, it was concluded that 60% to 65% of uterine blastocysts either failed to implant or failed to produce measurable hCG.

Evaluation of CSF shunt patency by means of technetium-99m DTPA

Evaluation of 192 cerebrospinal fluid shunts was performed using 1 mCi of technetium-99m DTPA which was injected into the shunt tubing. This was found to be a safe, simple method of evaluating shunt patency. No complications were noted with this procedure, nor was there any documented case of infection related to the injection of the isotope. The sensitivity of the test for evaluation of patency was 97%, specificity 90%, and accuracy 93%. Various patterns of tracer clearance are noted and discussed. The role on this test as an aid in making management decisions is detailed.

In vitro fertilization: the challenge of the eighties

A review of the in vitro fertilization and embryo transfer program between July 1979 and December 1980 at The Royal Women's Hospital, Melbourne, is presented. A total of 402 treatment cycles involving 186 patients have produced five pregnancies. Two pregnancies resulted from spontaneous ovulatory cycles and three from stimulated cycles. One live birth of a normal female child is reported. The protocol for both spontaneous and stimulated cycles and the problems that each produces are discussed. It is concluded that the stimulated cycle is to be preferred, because it allows higher rates of ovum recovery and embryo transfer. The fertilization and cleavage rates are the same for both methods. Associated research into in vitro blastocyst development, steroidogenesis in the corona cells, and the detection of other "early pregnancy factors" is presented and discussed. The paper concludes with a short statement on the ethical and moral problems posed by the research.

Ultrasound control of clomiphene/human chorionic gonadotropin stimulated cycles for oocyte recovery and in vitro fertilization

Three pregnancies have been achieved through in vitro fertilization (IVF) following clomiphene/human chorionic gonadotropin (hCG) stimulation monitored only with ultrasound. When the results of 120 stimulated cycles were compared with those from 213 spontaneous cycles during a one-year period, the clomiphene-ultrasound-hCG method led to a significantly higher laparoscopy rate as well as significantly better yields of mature oocytes and embryos for intrauterine transfer. The luteal phase was normal in the stimulated group. This ultrasound-monitored technique was simpler to manage and less costly and appears to be the current method of choice for obtaining oocytes for IVF.

Preovulatory follicular size: a comparison of ultrasound and laparoscopic measurements

Ovarian follicles in the immediate preovulatory period were measured with real-time or static ultrasound. Thirty-nine follicles were examined in thirty-six patients. In 29 spontaneous cycles the mean follicular diameter was 21.1 mm (range 17 to 25 mm) and the mean volume was 5.1 ml. In seven stimulated cycles the mean diameter was 18.4 mm and the mean volume was 3.5 ml. Laparoscopic needle aspiration of the follicular contents was performed within 12 hours of ultrasound examination in every case. Follicular dimensions based on the volume of aspirated fluid correlated well with the ultrasound measurements (r = 0.847; P < 0.001), which suggests that ultrasound is a useful technique for examining preovulatory follicular development.

Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms. Case report

Bilateral intracavernous internal carotid artery aneurysms are described in a 3-year-old child. The etiology was uncertain, although the aneurysms may have been mycotic. As there was clinical and radiological evidence of progressive enlargement of both aneurysms, the more conventional forms of treatment were not applicable. A direct surgical approach was made to both aneurysms with exploration of the intracavernous portion of the internal carotid artery under deep hypothermia and cardiac arrest.

Cellular immunity to lymphocyte antigens in human infertility

The leukocyte migration test was used to detect cellular immunity to HL-A antigens present on the husband's lymphocytes and spermatozoa in a group of fertile and infertile couples. Approximately 50% of the married female population appear to be sensitized. There was no difference between the fertile and infertile groups in the frequency of positive results, but a greater number of migration indices were below 0.7 and 0.6 in the infertile group. It is suggested that sperm cells are the most likely cause of immunization.

Experimental effects of steroids and steroid withdrawal on cerebrospinal fluid absorption

The authors studied the effects on cerebrospinal fluid (CSF) absorption of chronic administration and acute withdrawal of steroids in dogs. CSF absorption was measured by determining the amount of isotope (indium 111DTPA) recovered over a 4-hour period after injection into the cisterna magna. Resistance to CSF absorption was estimated by determining rates of low of Ringer's lactate infusion into the cisterna magna over a range of pressure gradients between CSF and sagittal sinus. Steroid withdrawal was associated with a marked reduction in CSF absorption and an increase in resistance to CSF flow. Dogs on steroids also showed reduced CSF absorption although the reduction was not statistically significant when compared with controls. The results are discussed in terms of possible mechanisms of action of steroids on CSF absorption, the etiology of the benign intracranial hypertension syndrome and the use of steroids and in the control of intracranial hypertension.