When multiple gestational sacs are seen on ultrasound, 'take-home baby' rate improves with in-vitro fertilization

During a 5.5 year period, 309 clinical pregnancies were recorded in our in-vitro fertilization (IVF) unit. A single gestational sac was identified by early ultrasonography in 233 patients, while in 76 others, multiple gestational sacs were noted. 'Take-home baby' rate, in patients in whom multiple sacs were observed, was higher than that in patients with a single sac. Delivery of at least one live newborn occurred in only 73.8% of patients with a single sac, compared with 93.3% and 91.7% in patients with two and three gestational sacs, respectively. Conversely, the early and late abortion rates were decreased in patients with multiple sacs. Embryonic implantation rate, defined as the ratio of gestational sacs observed to the number of embryos transferred, was found to be a valuable prognostic factor for a live delivery, and can serve as a tool in assaying the prognosis of pregnancy detected by early sonography. The observation of a higher 'take-home baby' rate in cases with multiple sacs identified by ultrasound and with higher embryonic implantation rate, might be the result of a better embryo quality and/or improved uterine receptivity, promoted by a favourable hormonal milieu or by as yet unknown endometrial factors.

Uterine rupture with the use of a low-dose vaginal PGE2 tablet

BACKGROUND

Prostaglandin E2 (PGE2) vaginal tablets, suppositories and gel are increasingly being used for the induction of labor. Ease of administration and supervision are their greatest advantage, while hyperstimulation and rupture of the uterus are the main risks.

CASE

A 26-year-old woman, gravida 5, para 2, with no history of cesarean section, was induced at 40 weeks' normal gestation, because of mild pregnancy-induced hypertension. Half a tablet (1.5 mg) of PGE2 was inserted into the cervix. Three hours later, tetanic uterine contractions started. In a precipitated labor she delivered a female weighing 3,250 gr, about 20 minutes after the appearance of uterine contractions. Severe post partum hemorrhage occurred, and examination disclosed an isthmical uterine rupture. Subtotal hysterectomy was performed at laparotomy. The postoperative course was uneventful.

CONCLUSION

The use of PGE2 should be of concern in multiparous patients, or those with scarred uteri. This case highlights the risk of even a small dose of PGE2 administered into the cervix.

Pregnancy during long-term gonadotropin-releasing hormone agonist therapy associated with clinical pseudomenopause

A case of pregnancy occurring with escape of suppression from GnRH-a therapy is described. Clinical pseudomenopause had been established, and the pregnancy was exposed to depot GnRH-a for 8 weeks. Normal pregnancy outcome demonstrated that successful implantation may occur in the first escaped ovulatory cycle.

Migration sedimentation technique as a predictive test for the fertilizing capacity of spermatozoa in an in-vitro fertilization programme

The migration-sedimentation technique (MST) has been proposed as a means of separating high quality motile spermatozoa. The present study was conducted in order to evaluate whether sperm performance following separation by MST predicts their fertilizing capacity in an in-vitro fertilization (IVF) programme. Ninety semen specimens were analysed for use in an IVF-embryo transfer (ET) programme. Each specimens was divided into two parts: one was processed in the IVF programme and was used after sperm swim-up separation for insemination of human ova. The other aliquot (0.2 ml) was separated by MST, and the sperm then characterized by their concentration, motility, degree of motility and morphology. Sperm characteristics after separation by MST were then correlated with the results of the IVF-fertilization rates. In 79 of 90 IVF-ET cycles, at least one oocyte was fertilized. All post-MST sperm characteristics were significantly higher in cycles with fertilizations compared to IVF cycles without fertilization. A larger percentage of the total motile spermatozoa were recovered after MST in semen specimens with fertilization, compared to semen specimens without fertilization (39.9 +/- 3.6 and 20.6 +/- 6.6%, respectively; P < 0.05). This value was correlated with the percentage of fertilized oocytes (r = 0.24; P < 0.02). More IVF cycles with fertilizations were recorded in cases in which the recovery of motile sperm was > 25% (P < 0.005), or when more than 1.5 x 10(6) motile spermatozoa were recovered after MST (P < 0.0001). As sperm characteristics after MST correlated significantly with their fertilizing capacity, the MST test could be used in evaluation of the fertilizing capacity of spermatozoa.

Embryo reduction in multifetal pregnancies using saline injection: comparison between the transvaginal and the transabdominal approach

A total of 30 patients with multifetal pregnancies, all resulting from treatment with superovulatory agents or assisted reproductive techniques, underwent embryo reduction. All patients had three or more fetuses (one sextuplet, two quintuplets, seven quadruplets and 20 triplets). The procedure was carried out using intra-embryonal injection of 0.9% sodium chloride solution. Embryo reduction was carried out via the transabdominal approach in 10 patients, performed at 11-12 weeks of gestation, and via the transvaginal route in 20 other patients, at 8-10 weeks of gestation. In the transabdominal group, one patient aborted following repeated attempts at embryo reduction while the other nine gave birth to healthy newborns (eight twins and one triplet). In the transvaginal group, four pregnancies are currently ongoing (all beyond 28 weeks of gestation), 14 pregnancies resulted in a delivery of at least one live newborn (13 twins and one singleton), one patient had a late abortion at 24 weeks' gestation and another was delivered at 27 weeks' gestation due to severe pre-eclampsia. Transvaginal ultrasound-guided needle procedures are commonly practised in most in-vitro fertilization units. The employment of this route for embryo reduction, performed at an earlier gestational age and with the use of a non-toxic substance such as 0.9% saline solution, is advocated.

Improved fertilization rate in an in vitro fertilization program by egg yolk-treated sperm

High fertilization and PRs have been achieved by using thawed donor sperm cryopreserved with medium containing EY. The aim of our study was to examine the possible effect of EY on the fertilizing capacity of fresh sperm in an IVF program. Preincubation of spermatozoa in EY for 2 hours at room temperature significantly improved fertilization (P less than 0.001) in couples who had low fertilization rates in previous cycles, whereas no effect was found concerning couples with high fertilization rates.

High initial values of beta-subunits of human chorionic gonadotropin in ovum donation pregnancies indicate better implantation

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

The predictive fertilization value of the hypoosmotic swelling test (HOST) for fresh and cryopreserved sperm

BACKGROUND

The hypoosmotic swelling test (HOST) was recommended as a predictive test for in vitro fertilization (IVF) outcome. These results, however, were controversial and the results for thawed semen were insufficient. The present study was conducted in order to clarify the predictive value of the HOST for IVF in fresh and thawed sperm.

METHODS

The hypoosmotic swelling test was performed in three groups: husband's fresh semen "subfertile" group, donor's thawed semen group, and donor's fresh semen "fertile" group.

RESULTS

No correlation was found between HOST values and sperm characteristics in fresh or thawed sperm. Fresh sperm HOST values correlated with IVF fertilizations. No such correlations were found when thawed sperm was used. HOST values were significantly higher in the fresh fertile donor group than in the fresh subfertile group (P less than 0.001). Following the freezing and thawing process, HOST values decreased dramatically. Nevertheless, the fertilization rate was still higher compared to that of the fresh subfertile group (P less than 0.001). There were significantly more IVF cycles with no fertilizations when HOST values were below 45%.

CONCLUSION

The HOST has a predictive value for fertilization of oocytes in IVF cycles when fresh semen, but not thawed sperm, is used. The freezing-thawing process affects the outer membrane of the spermatozoon and changes its characteristics, leading to a decrease in HOST values. Sperm characteristics that play a role in the fertilization process are not expressed directly by HOST values.

Vaginal injury resulting from sliding down a water chute

A 27-year-old woman was admitted to the hospital because of profuse vaginal bleeding from a vaginal laceration caused by the impact of water to the perineum after sliding down a water chute. At the time of the accident the patient was using a vaginal tampon. The potential mechanism for this trauma is discussed.

Abruptio placentae associated with perforated appendicitis and generalized peritonitis

A primigravid woman at 35 weeks' gestation was admitted with abdominal pain, fever, and vomiting. Forceful contractions and signs of fetal distress suggested abruptio placentae. During caesarean section, seropurulent exudate and a perforated appendix were found; an appendectomy was performed. A mechanism linking appendicitis with abruptio placentae is suggested.

Atypical response to luteinizing hormone-releasing hormone (LH-RH) agonist (suprefact nasal) in induction of ovulation in in vitro fertilization (IVF)

Animal and human research has indicated the presence of receptors to luteinizing hormone-releasing hormone (LH-RH) in the ovaries. However, the role of these receptors is not yet clear. Forty-five patients were treated with Suprefact (D-Serg-Des-Gly10-GnRGH), starting in the midluteal phase of a nonstimulatory menstrual cycle. The Suprefact (300 micrograms t.i.d.) was administered as a nasal spray until the administration of human chorionic gonadotropin (hCG). On the third to fifth day of the following menstrual cycle, the patients were treated with a high dose of human menopausal gonadotropin (hMG). hCG was administered when at least two follicles reached a mean diameter of 18 mm. Five of these patients who ovulated spontaneously and had normal menstrual cycles did not respond to the stimulation with hMG. Treatment was stopped after 12 days of hMG administration. During the following cycle of the five patients, levels of gonadotropins were found to be in the normal range, and all of them responded as expected to hMG administered for 3 days only (hMG test). These findings suggest that LH-RH agonist may interfere with ovarian steroidogenesis.

Success rates in in vitro fertilization treatment and its correlation with high titer antibodies for Chlamydia trachomatis

The prevalence of specific chlamydial IgG and IgA antibodies was determined in 86 infertile women undergoing in vitro fertilization (IVF) and in 56 male partners; 32.5% of women (28 of 86) under investigation had both types of antibodies at a titer of IgG greater than or equal to 1:128 and IgA greater than or equal to 1:16; 9% of their male partners (5 of 56) who were tested were also seropositive. The prevalence of local IgA in semen was 9.6% (5 of 52). Pregnancy was later achieved by IVF in 13 of 32 seropositive and 19 of 32 seronegative women. Our data suggest that high levels of specific antichlamydial antibodies (IgG and IgA) are not correlated with the outcome of IVF-embryo transfer treatment.

Avoidance of cancellation of potential hyperstimulation cycles by conversion to in vitro fertilization-embryo transfer

OBJECTIVE

The study was undertaken to minimize the rate of ovarian hyperstimulation and to avoid cancellation of human treatment cycles in women treated with human menopausal gonadotropin (hMG) for induction of ovulation.

SETTING

Patients were treated in the fertility clinic and in vitro fertilization unit of our institution, which is a government, university-affiliated hospital.

PATIENTS

Ninety anovulatory patients were treated with hMG. Of these, 12 were at high risk for ovarian hyperstimulation. The criteria for potential ovarian hyperstimulation syndrome were rising excessive 17 beta-estradiol levels of greater than 1,500 pg/mL in the presence of multiple follicles with a mean diameter greater than 15 mm. These patients were transferred for continuation of treatment to our in vitro fertilization-embryo transfer (IVF-ET) unit.

INTERVENTIONS

The patients underwent ova retrieval by the ultrasonically guided transvaginal approach.

RESULTS

Of the 12 patients, 5 conceived (41.6%). Two patients had a mild ovarian hyperstimulation syndrome, and 1 had a moderate syndrome and was hospitalized for observation for 48 hours.

CONCLUSION

In view of the results, we suggest that IVF-ET should be considered in cases in which ovarian hyperstimulation syndrome is imminent, rather than withhold human chorionic gonadotropin and cancelling the treatment cycle.

The efficiency of cryopreserved semen versus fresh semen for in vitro fertilization/embryo transfer

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients underwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000-600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5 +/- 3.8 vs 70.4 +/- 3.5, P = 0.008), pregnancy rates per embryo transfer were similar--39.3 and 38.5%, respectively.

Ovulation induction with gonadotropins in women with polycystic ovary disease

Seventy-two infertile women with polycystic ovary disease (PCOD) and clomiphene citrate treatment failure underwent 220 human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) treatment cycles for ovulation induction over a period of 19 months. Forty-two patients ovulated but failed to conceive on clomiphene, and the remaining 30 failed to ovulate on clomiphene. Monitoring of treatment consisted of serum 17 beta-estradiol (E2) levels and ultrasonic assessment of follicular growth. Treatment was withheld whenever the E2 levels exceeded 1,500 pg/mL and/or when more than two follicles greater than or equal to 17 mm in diameter each were encountered on ultrasonography. Twenty-nine patients conceived (40.2%), and 23 delivered viable infants. Twenty-three of the 29 pregnancies were achieved in the 42 patients who ovulated on clomiphene, while only 6 pregnancies resulted in the 32 anovulatory patients on clomiphene. Six patients (20.6%) aborted in the first trimester. Multiple pregnancies consisted of only two sets of twins (6.9%). There were only two cases of mild hyperstimulation (2.7%) and no severe hyperstimulation. Because of the low occurrence of multiple pregnancies and hyperstimulation and the reasonable success rate, all PCOD patients should be started on this protocol.

The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixed-dose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E2) daily orally starting on day 2-6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.

A prospective randomized trial of human chorionic gonadotrophin or dydrogesterone support following in-vitro fertilization and embryo transfer

A randomized, prospective blind study was carried out to investigate the need for luteal phase support in patients undergoing in-vitro fertilization (IVF). One-hundred-and-fifty-six patients undergoing IVF in cycles stimulated with human menopausal gonadotropin (HMG) and human chorionic gonadotrophin (HCG) stimulated IVF, were divided into three different groups for luteal phase treatment. Fifty-four patients received dydrogesterone three times daily (TID) beginning on the day of embryo transfer (ET). Fifty-one patients received HCG on days 3, 6 and 10 following ET. Fifty-one patients received placebo p.o. TID beginning on the day of ET. There was no difference between the groups in pregnancy rate, rate of spontaneous abortion, proportion of normally developing fetuses or rate of chemical pregnancy. The data indicate that supplementation of the luteal phase may not improve the success rates of IVF-ET cycles.

Penetration of clindamycin, cefoxitin, and metronidazole into pelvic peritoneal fluid of women undergoing diagnostic laparoscopy

A single dose of clindamycin, cefoxitin, or metronidazole was administered to each of 30 women. The mean concentration of cefoxitin in pelvic fluid at 1 h exceeded those of the other two drugs (P less than 0.007). Cefoxitin concentrations were inferior to those of the other drugs when compared with the published MIC for 90% of Bacteroides fragilis strains.

Bacterial infection and human fetal wastage

Twenty-eight of 57 fetuses delivered after intrauterine death were found to have a variety of aerobic and facultative bacteria in the heart, anus, placenta, brain and cerebrospinal fluid. Subclinical maternal bacteremia, possibly originating in the urinary tract, appears to be a common cause of second- and third-trimester fetal demise.

The performance of primary and secondary unexplained infertility in an in vitro fertilization-embryo transfer program

The term "unexplained infertility" is applied to a couple in whom after an elaborate workup no apparent reason for infertility is found. Between August 1985 and May 1987, 435 patients underwent 720 treatment cycles in an in vitro fertilization-embryo transfer (IVF-ET) unit. Eighty-three of the patients had unexplained infertility as their indication for IVF-ET. Fifty-two (group A) had primary unexplained infertility and 31 (group B) had secondary unexplained infertility. Group A underwent 87 and group B underwent 50 treatment cycles. Forty-six ET were performed in group A and 34 in group B. Clinical pregnancies were achieved in 20 patients of group A (11.5% per treatment cycle) and 13 of group B (26.0%), for a combined rate of 16.8% per cycle. Patients with tubal infertility treated in the program had a pregnancy rate of 18.8% per treatment cycle. The performance of the secondary unexplained infertility group is significantly better than that of the primary unexplained infertility group. However, the overall results with patients with unexplained infertility are similar to those patients treated for tubal infertility.

The effect of thyrotropin-releasing hormone stimulation on serum levels of gonadotropins in women during the follicular and luteal phases of the menstrual cycle

Thyrotropin-releasing hormone (TRH) can stimulate the secretion of adenohypophyseal thyroid-stimulating hormone and prolactin (PRL). The effect of TRH on gonadotropin secretion has not been well defined. This study investigated the effect of TRH administration on the peripheral levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) during the early follicular and midluteal phases of the menstrual cycle in five ovulatory, euthyroid, and normoprolactinemic women. Two hundred micrograms of TRH were administered intravenously on days 3 to 5 and on days 21 to 23 of the same cycle. LH and FSH were measured prior to and every 30 minutes for 2 hours following TRH injection. Ovulation was confirmed in all cycles by midluteal progesterone. All women had normal thyroid-stimulating hormone (TSH) and PRL responses to TRH stimulation in both cycle phases. Baseline and stimulated gonadotropin levels were analyzed by analysis of variance. Thirty minutes following TRH infusion, follicular and luteal levels of LH (mIU/ml, mean +/- standard error of the mean) significantly increased from 6.0 +/- 0.8 to 8.0 +/- 1.1 (P less than 0.005), and from 4.8 +/- 0.6 to 7.6 +/- 0.7 (P less than 0.005), respectively. Levels of FSH increased during both phases of the cycle, but the elevation was not statistically significant. These results suggest that TRH can stimulate gonadotrope secretion of LH, but not of FSH, in both the follicular and luteal phases of the cycle.

The development of an efficient ambulatory in vitro fertilization (IVF) and embryo transfer (ET) program using ultrasonically guided oocyte retrieval

Until recently most of the current in vitro fertilization and embryo transfer (IVF-ET) programs used laparoscopy for oocyte retrieval and included hospitalization in the treatment. The establishment of a successful ambulatory IVF program that uses ultrasonically guided oocyte aspiration, is described. Between August 1985 and February 1987, 384 percutaneous transvesical ultrasonically and transvaginally guided follicle aspirations were performed on 414 patients, following ovarian stimulation with hMG and hCG. Ninety two clinical pregnancies were confirmed by ultrasound. The clinical pregnancy rate was 26.8% when based on the number of embryo transfers. There were 16 multiple pregnancies (17.4%), 18 miscarriages (19.5%), and two tubal pregnancies (2.1%). The most important factors contributing toward the success of this program were rigid adherence to clinical and laboratory protocols, and the maintenance of a strict quality control. The ambulatory management was very well accepted by the patients, who during the entire period of ovarian stimulation had minimal disruption of their routine activities.

Estrone-3-glucuronide chemiluminescence immunoassay: an alternative method for monitoring induction of ovulation with human menopausal gonadotropin in an in vitro fertilization program

A simple, rapid, and sensitive solid-phase immunoassay procedure for the determination of estrone-3-glucuronide (E1-3-G), which uses chemiluminescence as the end point in unextracted morning urine, is described. Thirty-one patients undergoing induction of ovulation in an in vitro fertilization (IVF) unit participated in the study. From day 3 of the menstrual cycle until the day of hCG administration, morning blood samples and morning urine specimens were collected for the determination of serum 17 beta-estradiol (E2) and urine E1-3-G, respectively. A good correlation was noted between E2 measured by radioimmunoassay (RIA) and the E1-3-G measured by chemiluminescence immunoassay (CIA), from day 5 up to the day of hCG administration (0.6 less than r less than 0.85, P less than 0.001). It is evident from this study that the CIA measurement of E1-3-G in morning urine is an accurate and rapid (2.5 hours) method and is convenient for monitoring induction of ovulation with human menopausal gonadotropins.

Calcific constrictive pericarditis in pregnancy. A case report

A woman developed congestive heart failure after a normal delivery. The underlying disease was diagnosed as calcific constrictive pericarditis, and the patient underwent pericardiectomy.

Fistulization: an effective treatment for Bartholin's abscesses and cysts

We describe our experience with the technique of fistulization for the treatment of Bartholin's abscesses and cysts. The principal objective of this treatment is the restoration of the normal gland's function. The study group included 46 patients who underwent the procedure during a 12-year period. Eight patients had to undergo a refistulization, a recurrency rate of 17.4%. The fistulization procedure provides satisfactory results in a high percentage of cases. It is a simple procedure requiring very little surgical time and has fewer recurrences than marsupialization and other forms of drainage.

Hypotensive effect of bromocriptine in normal eyes

The effect of a single oral dose of 2.5 mg Bromocriptine on intraocular pressure over a 12 hour period in a group of 20 puerperal women with normal eyes, is reported. Intraocular pressure was significantly reduced, the maximal response being 3-4 hours after administration. Possible explanations for the reducing effect of Bromocriptine on intraocular pressure are discussed.

The effect of relaxin and prostaglandin E2 on the motility of human spermatozoa

Relaxin and prostaglandin E2 (PGE2) are present in human semen and have been shown to affect sperm motility. The authors further examined the effects of porcine relaxin and PGE2 on the motility of human spermatozoa. A dose-response study revealed that PGE2 at a concentration of 25 micrograms/ml is most effective in improving the motility of washed human sperm. Relaxin (100 ng/ml), PGE2 (25 micrograms/ml), or the two combined have no effect on the motility of spermatozoa in fresh, normal semen, suggesting that the constituents of fresh semen are optimal for motility. Relaxin and PGE2 individually improve the motility of washed spermatozoa. However, relaxin, but not PGE2, improves the motility of sperm in semen incubated at 37 degrees C for 5 hours (aged). In contrast to the individual substances, a combination of relaxin + PGE2 has no effect on the motility of washed spermatozoa or aged spermatozoa, suggesting that these two substances antagonize each other's actions on sperm motility. The presence of both relaxin and PGE2 in seminal plasma with normal motility spermatozoa suggests that other factors in seminal plasma regulate the effects of these substances on sperm motility.

Acute myocardial infarction in a young woman taking oral contraceptives. A case report

Acute myocardial infarction occurred in a 25-year-old woman. Coronary angiography performed one month after the acute illness was normal. An ergonovine test was negative. The patient's acute myocardial infarction most probably was induced by the use of oral contraceptives in combination with heavy smoking. Oral contraceptives, with their known influence on the blood coagulation system, must be considered a risk factor in precipitating coronary artery disease.

Effect of relaxin on human spermatozoa

To study its effect on the motility of human spermatozoa, relaxin was added at different concentrations to human semen samples of various qualities as well as to washed spermatozoa. Relaxin in physiologic concentrations (10-100 ng/mL) had no significant effect on sperm motility in normal semen samples. However, the addition of relaxin to semen samples with low sperm motility significantly increased the motility. Addition of relaxin similarly increased the motility of spermatozoa from normal semen samples that were either aged or washed; the treatment resulted in a decrease in motility. When sperm motility was optimal, as in normal samples, addition of relaxin did not increase motility. However, in some situations of decreased motility, addition of relaxin resulted in improvement of spermatozoan motility. Relaxin may have clinical value in the treatment of male infertility.

The use of voided urine temperature in the determination of basal body temperature

The temperature of freshly voided urine has been shown to be a reliable predictor of body temperature. This relationship was confirmed for the measurement of BBT. A method was described for patients to obtain their BBT in a way that they may find more convenient than obtaining either oral or rectal temperature. The BBT graph patterns generated from the temperature of freshly voided urine closely paralleled those generated by oral temperature.

The effect of relaxin on the motility of sperm in freshly thawed human semen

In an attempt to improve the motility of thawed spermatozoa after 1 week of its being frozen, we treated ten normal semen samples with 16.7 nmol relaxin and 6 mmol caffeine. Motility and grade of forward progression were examined after thawing. Caffeine significantly improved motility of spermatozoa. Relaxin, when added to semen at the time of thawing, improved motility and grade of forward progression significantly. This effect was not seen if relaxin was added before freezing. These results suggest that the biologic activity of relaxin is adversely affected by freezing and thawing in seminal plasma. These observations may have clinical importance for the improvement of motility of frozen spermatozoan samples at the time of artificial insemination and for the possible improvement of pregnancy rates.

Relaxinlike bioactivity in pooled human pregnancy serum

The purpose of this study was to determine whether or not the immunoreactive relaxin contained in human pregnancy serum is biologically active. Relaxin was extracted from pooled serum of women in the third trimester of pregnancy. The extraction also was performed on pooled male serum and pooled serum from women in the follicular phase of the menstrual cycle. The extraction process began with delipidation of the serum followed by extraction of relaxin using 0.1% HCl per 50% acetone. Dialysis then was performed to remove low molecular weight substances (less than 3500 daltons). The partially purified extracts were applied individually to a muscle segment in the in vitro rat uterine horn bioassay for relaxin. The extracts of both male serum and female follicular-phase serum, containing no immunoreactive relaxin, resulted in tetanic contractions of the muscle segment. The extract of pregnancy serum, containing immunoreactive relaxin, produced inhibition of rat uterine horn contractility. This represents the first demonstration of relaxinlike bioactivity in human serum.

Hyperprolactinemia and associated pituitary prolactinomas

The association between serum prolactin (PRL) and the presence of pituitary tumors as determined by third generation computed tomography scan was studied in hyperprolactinemic patients. Patient charts from a four-year period were reviewed to identify those patients with elevated PRL (greater than or equal to 25 ng/mL). All patients with hyperprolactinemia underwent computed tomography scan evaluation of the pituitary gland. Hyperprolactinemia was identified in 79 patients, mean PRL 59 +/- 6.1 ng/mL SEM. Pituitary tumors were identified in 35 of these patients, mean PRL 65 +/- 11.9 ng/mL. This level was not significantly different from the level in 43 patients with normal computed tomography scans (52 +/- 5.7 ng/mL). This review found that computed tomography scan identified pituitary tumors in 44% (35 of 79) of patients with hyperprolactinemia. The likelihood of finding a pituitary tumor did not correlate with the level of hyperprolactinemia. Computed tomography scan is indicated for the diagnosis of prolactinomas in all hyperprolactinemic patients regardless of the serum PRL level.

Granulosa-theca cell tumor in a one-year-old infant

A case is presented of a 12-month-old female infant, with sexual precocity due to a Granulosa-Theca cell tumor which presented with vaginal bleeding, breast development and public hair growth. The 17 beta-estradiol levels prior to operation were 300 pg/ml. Levels of gonadotropins were undetectable. Postoperative estradiol levels were measured and found to be 10 pg/ml. This tumor is very rate in infants, and there have been only four previously reported cases in children under 2 years of age.

Typhoid fever complicating pregnancy

Typhoid fever in pregnancy may result in infection of the fetus, with consequent abortion. Currently, it is a rare complication of pregnancy in the industrially developed countries. This report documents a case of maternal typhoid fever with septic abortion, in which trans-placental infection of the fetus caused its demise.

The effect of an anti-insulin antiserum on human sperm motility

Inhibition of sperm motility by anti-relaxin antiserum has been previously reported. This effect may be secondary to a nonspecific effect of immunoglobulins binding to sperm or to a specific inhibition of relaxin activity at the sperm surface. The current investigation demonstrates that an anti-insulin antiserum does not inhibit sperm motility in the same system in which an anti-relaxin antiserum results in inhibition. This supports the hypothesis that the anti-relaxin antiserum effect is specific.

Effect of prolactin and relaxin on in vitro rat uterine contractions and prolactin interaction with relaxin

The balance between relaxin and prolactin has been suggested to be significant in the control of uterine activity during pregnancy. The current study was designed to determine the effect of rat prolactin on rat uterine horn segment contractility and its interaction with relaxin. Rat uterine segments mounted on a smooth muscle transducer were treated sequentially with prolactin and relaxin, and stimulated electrically. No stimulatory effect of prolactin was noted. Relaxin-inhibited uterine horn segment activity was not altered by prolactin. The reported stimulatory effect of prolactin may have been a pharmacologic effect of human prolactin on rat uterine horn segments, or may have resulted from contaminants in the preparations used.

Stimulation of human sperm cervical mucus penetration in vitro by relaxin

The effect of relaxin, a peptide hormone present in seminal plasma, on the penetration of cervical mucus by washed human sperm in vitro was studied. Penetration was analyzed by two methods. The total number of sperm per 100 X field at the 10-mm, 20-mm, and 30-mm points along a mucus-filled capillary tube was counted and the farthest distance 100 sperm and 5 sperm/100 X field penetrated the capillary tube was measured. These measurements were made at 30, 60, and 90 minutes. Treating washed sperm with physiologic concentrations of relaxin resulted in significantly increased sperm penetration as compared with sperm treated with albumin or buffer. Replacing seminal plasma to washed sperm resulted in equivalently increased penetration. The findings strongly suggest that relaxin is necessary for proper penetration of cervical mucus by human sperm.

The effect of in vivo progesterone administration on relaxin-inhibited rat uterine contractions

Progesterone pretreatment in vitro was previously shown to sensitize myometrium to the inhibiting effect of relaxin. The following experiments were performed to control for possible artifacts of the in vitro system and to place these studies on a more physiologic basis. Immature rats were treated with estrogen and either progesterone or vehicle only. Uterine horn segments were isolated and mounted in a muscle bath. After a baseline contraction pattern was established by means of electrical stimulation, porcine relaxin was added to the bath. At all dose levels of relaxin, greater inhibition of contraction amplitude occurred in uterine segments of progesterone-treated animals. Since both progesterone and relaxin are present in the circulation from the time of the missed menses in human pregnancy, this interaction suggests a physiologic synergism in the maintenance of early human pregnancy.

Amniotic fluid embolism and disseminated intravascular coagulation complicating hypertonic saline-induced abortion

Amniotic fluid embolism (AFE) associated with disseminated intravascular clotting (DIC) is usually fatal. Such a combination generally occurs at the term of pregnancy or in the immediate postpartum period. A case of AFE with DIC following a hypertonic-saline-induced abortion, is reported. The patient was in the midtrimester with a live fetus. Prompt recognition and treatment of her condition ensured her complete recovery. Such a case has not, to our knowledge, been previously reported.

Paradoxical hypersecretion of growth hormone in patients with endometrial atypical hyperplasia and carcinoma. Effect of hysterectomy

Paradoxical hypersecretion of human growth hormone (HGH) followed a glucose load in patients with endometrial cancer and atypical hyperplasia of the endometrium. All patients had normal fasting plasma glucose and serum HGH concentration with a normal glucose tolerance curve. Their urinary estrogen concentrations were within the normal postmenopausal range. 6 months after abdominal total hysterectomy and bilateral oophorectomy, the glucose load was repeated. Following surgery all patients showed a normal suppression of HGH secretion during the hyperglycemic period. These findings suggest the existence of a HGH-releasing factor in the neoplastic and preneoplastic endometrial tissue. This factor might be related to the abnormal HGH responses observed.