Transvaginal sonography in the postoperative evaluation of colposuspension

Thirty-two patients with cystocele and rectocele with complaints of genuine urinary stress incontinence were subjected to complete urodynamic study, including intravaginal endosonography, before the operation and 6 weeks and 1 year after the operation. Intravaginal endosonography demonstrated the anatomic correlation of the bladder base, neck, and proximal urethra in relation to the inferior border of the symphysis pubis. In 28 patients, satisfactory correction of the bladder anatomy was achieved with operative treatment of genuine stress incontinence (GSI). Four patients presented persistent and recurrent GSI (2 in each group) after several weeks postoperatively. In addition, 2 patients had frequency-urgency syndrome, and 3 had voiding difficulties after the operation, but with no symptomatology of GSI. The patients with the symptoms described had various anatomic configurations after colposuspension. Vaginal endosonography is a simple technique with many advantages and satisfactory results in preoperative postoperative study, without radiation exposure and with minimal inconvenience to the patient.

The tap test: a simple and inexpensive method for the diagnosis of fetal pulmonary maturity

OBJECTIVE

To report our experience in the prediction of fetal lung maturity with the tap test.

METHOD

Amniotic fluid was obtained from 207 pregnant women from 17-40 weeks' gestation and the tap test compared with the phospholipid profile.

RESULTS

The predictive values for a mature tap test were 100%, 99.9% and 98.2% and for immature tap test were 45.8%, 50% and 56.4% at 2.5 and 10 min, respectively.

CONCLUSION

The tap test is a reliable, rapid, easy, inexpensive and accurate method for detection of fetal lung maturity.

Comparison between metal cup and silicone rubber cup vacuum extractor

A total of 400 primiparous patients who were delivered by vacuum extractor were studied. The patients were divided in two groups: Group A included 200 patients who were delivered by metal cup vacuum extractor and Group B consisted of 200 patients who were delivered by rubber cup vacuum extractor. There were no statistically significant differences in the mean maternal age, mean gestational age, mean neonatal birth weight, indications for operative delivery, occipital positions and head stations between the two groups. No differences were found in the rates of birth canal trauma (11% vs. 12.5%), major neonatal scalp trauma (6.5% vs. 5.5%), neonatal jaundice (15.5% vs. 13.5%) and Apgar score. From this study we can conclude that both metal and silicone cups are equally satisfactory for vacuum extraction.

Hormone levels of follicular fluids with and without oocytes in patients who received gonadotropin-releasing hormone analogues and gonadotropins in an in vitro fertilization program

BACKGROUND

Are follicles where no oocytes are retrieved "empty follicles"?

METHODS

The levels of estradiol (E2), progesterone (P), testosterone (T), cortisol (F), and prolactin (PRL) of follicular fluids (FF) aspirated individually from 34 randomly selected IVF patients in whom no oocytes were recovered were compared with the respective hormone levels of FF obtained from the same patients when oocytes were retrieved. Two FF without oocytes of a 35th patient in whom no oocytes were retrieved were analyzed.

RESULTS

Hormones did not differ significantly in the paired samples, while in the two FF of the 35th woman they were in agreement with cystic follicles.

CONCLUSIONS

It is necessary to differentiate aspirated follicles where no oocytes are retrieved from the "empty follicle syndrome," which was not observed in the IVF series studied and should be rare in IVF patients.

Secretion of alpha-immunoreactive inhibin by human pre-embryos cultured in vitro

alpha-Immunoreactive inhibin was measured using an enzyme immunoassay kit in the culture medium (Ham's F-10 medium supplemented with 14% heat-inactivated human serum) from day 3 or 4 to day 14 post-fertilization of 31 surplus pre-embryos from eight women participating in an in-vitro fertilization programme. Inhibition secretion was demonstrated in all of them from the fourth day after fertilization (mean +/- SEM: 3.0 +/- 0.7 U) and was independent of the morphological development of pre-embryos (2-4 cells, n = 4; 6-8 cells, n = 4; 8-10 cells, n = 9; 10-12 cells, n = 4; morulae, n = 5 and blastocysts, n = 4). On days 7, 10, 13 and 14 post-fertilization, mean inhibin values +/- SEM for non-disintegrated pre-embryos were respectively: 6.5 +/- 0.9 U, 12.3 +/- 2.0 U, 16.8 +/- 3.2 U and 20.2 +/- 3.7 U; however, when disintegration was noted on days 10 and 13 after fertilization, inhibin mean values were 9.0 +/- 1.4 U and 8.4 +/- 1.7 U respectively. Inhibin levels were significantly correlated with human chorionic gonadotrophin levels in the same culture media only on day 13, while correlation with pregnancy specific beta 1-glycoprotein occurred on day 7 post-fertilization. In conclusion, early human pre-embryos secrete alpha-immunoreactive inhibin before the cytotrophoblast is formed. This secretion increases significantly with time when development is continued, while disintegration is followed by a net decline in the rate of inhibin release.

Discordant secretion of pregnancy specific beta 1-glycoprotein and human chorionic gonadotropin by human pre-embryos cultured in vitro

OBJECTIVE

To study and compare the secretion of pregnancy specific beta 1-glycoprotein (SP1) and human chorionic gonadotropin (hCG) by human pre-embryos, cultured in vitro, with their respective morphological development.

DESIGN

Spare human pre-embryos from randomly selected women participating in a program of in vitro fertilization (IVF) were studied prospectively.

SETTING

Pre-embryos were cultured, and hormone release was determined in academic research laboratories.

PATIENTS, PARTICIPANTS

Pre-embryos (n = 108) cultured for 14 days after fertilization in Ham's F-10 medium (GIBCO Ltd., Paisley, Scotland) were observed, and hCG and SP1 were measured in the culture media at regular intervals.

MAIN OUTCOME MEASURES

Discordant secretion of SP1 and hCG.

RESULTS

Of the 98 bipronucleate pre-embryos, 53.6% formed blastocysts, 17.3% of which hatched. Human chorionic gonadotropin was detected from day 7 after fertilization concomitantly with blastocyst formation, thereafter showing a logarithmic increase (maximum 10,650 mIU) until the first signs of embryonic disintegration. Pregnancy-specific beta 1-glycoprotein release started 3 to 4 days after fertilization independently of the morphological development and the future production of hCG, thereafter displaying a nonlogarithmic increase (maximum 41 ng).

CONCLUSIONS

Hormone secretion and morphological development are unique for each pre-embryo. Human chorionic gonadotropin and SP1 seem to have different biochemical and physiological regulation.

Intrauterine insemination as a treatment of infertility in women with antisperm antibodies

Twenty-four women with infertility caused by antisperm antibodies were treated by homologous intrauterine insemination. Initially, all the women had timed intrauterine insemination by washed spermatozoa for three cycles. The pregnancy rate per couple was 4.20%. The remaining 23 patients received a combined treatment of chlomiphene citrate and intrauterine insemination for three cycles, which did not increase the pregnancy rate per couple and per cycle (4.3% and 1.4% respectively). Thereafter, the remaining 22 patients received a combined treatment of hMG and intrauterine insemination for another three cycles which resulted in a pregnancy rate per cycle (6.1%) and per couple (18.20%) that was significantly greater (P less than 0.01). We conclude that infertile women with antisperm antibodies can benefit after a trial of induction of multiple follicular development with hMG in combination with intrauterine insemination.

Serum levels of steroid and placental protein hormones in ectopic pregnancy

The hormonal profiles of extra-uterine pregnancies (EP) were compared with the normal intra-uterine pregnancies (IUP), and threatened abortions (TA) of good outcome. In 45 cases of EP confirmed histologically, maternal serum human chorionic gonadotropin (hCG), pregnancy specific beta 1-glycoprotein (SP1), 17 beta-estradiol (E2) and progesterone (P) were measured serially before treatment by enzyme immunoassays (EIA). The same hormones were also determined in the control groups, 26 with normal IUP and 24 with TA. All four hormone levels in EP were significantly lower (P less than 0.01-P less than 0.0001) than in normal pregnancies and threatened abortions of matched gestational age except the hCG and E2 in the fifth week of pregnancy. The mean values of E2 and P were found in the normal levels of luteal phase or slightly over them (8th-9th and 9th-10th weeks, respectively). No increase in the hormonal profiles of the above two steroids was noticed between 5 and 10 weeks' gestation in EP.

IN CONCLUSION

(a) The significantly lower values of hCG and SP1 in EP were confirmed; (b) the serial and concurrent hormonal measurements assure the verification of EP and the differentiation from normal IUP and TA of good outcome; (c) the ectopic implantation of trophoblast critically reduces its vitability to hCG and SP1 synthesis and it can only partially compensate for the reduction of corpus luteum function.

The role of androgens in the late-premenopausal woman with adenomatous hyperplasia of the endometrium

To examine the possible role of androgens in hyperplasia of the endometrium, the concentrations of testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH), were measured in peripheral venous serum obtained from 42 premenopausal women with adenomatous hyperplasia of the endometrium (group A) and from 18 women without hyperplasia (group B). In patients with hyperplasia of the endometrium, significantly higher peripheral venous concentrations were found for all androgens (P less than 0.05) and estradiol (P less than 0.001) than in control patients. In contrast, there was no statistically significant difference in the mean serum values of SHBG as well as in gonadotropins among the population of compared groups. We conclude that apart from the increased estrogenic activity in patients with adenomatous hyperplasia of the endometrium, androgens may play a significant role.

Comparison of maternal serum estradiol and progesterone levels in pregnancies after induced and spontaneous ovulation

Maternal serum estradiol and progesterone levels during the early 6th to 15th weeks of gestation, were measured by radioimmunoassay in 140 pregnancies following induction of ovulation with gonadotropins or clomiphene citrate. The levels were compared with those observed in 79 spontaneous pregnancies. Significantly higher levels were observed in gonadotropin and clomiphene citrate induced pregnancies (both P values less than 0.001) between the 6th to 9th week of gestation as compared to spontaneous pregnancies. Steroid levels were similar in the two groups from the 9th week onwards. No statistically significant differences in steroid hormone values were observed in aborted and successful pregnancies within each group studied. We conclude that ovulation induction is associated with higher estradiol and progesterone levels until placental steroidogenesis starts.

Artificial insemination with fresh donor semen

One hundred and thirty-four patients received artificial insemination with fresh donor semen (AID). Using the life-table method of analysis, 72 pregnancies occurred, yielding a crude conception rate of 53.7%. The 134 women received an average of three inseminations per cycle for a total of 1,282 inseminations near the day of ovulation. The majority of pregnancies occurred by the seventh cycle. Forty-two pregnancies were achieved using a single donor; 30 pregnancies required changing the donor once, twice, or more. Among 42 patients who subsequently were treated with clomiphene citrate, 16 conceived. Two of these patients became pregnant after receiving hMG and hCG additionally. The life-table analysis of cumulative pregnancy rates following infertility therapy provides a relatively simple, powerful, and reliable tool for evaluating the effectiveness of therapy and its benefits. Patients should be advised that their chances of conception with AID approach that of normal fertile couples, provided that these patients persist in their treatment.

Clinical efficacy of LH-color: a new home ovulation test

In this study we evaluate the efficacy of a new home ovulation test to identify LH surge (LH-Color, Organon). Fifty-five spontaneously ovulating women were followed during their cycles with twice daily urinary LH testing as well as daily ultrasound and BBT charts. In 39 (70.91%) of the 55 patients, ovulation occurred within 24 h after the decoloration of the LH-Color. Follicular collapse as visualized by ultrasonography, took place in all patients within 36 h after the decoloration of the LH-Color. Thus a good correlation was found between urinary LH surge and ultrasound. We conclude that the rapid LH test was able to predict impending ovulation.

Combined subsequent development of intrauterine and extrauterine gestations

A case of combined subsequent development of intrauterine and extrauterine pregnancy is reported. Signs of normal pregnancy associated with abdominal pains and an adnexal mass were the most significant symptoms and the final diagnosis was verified by laparoscopy in both cases. We consider that drugs for induction of ovulation (chlomiphene citrate and menopausal gonadotropins) were the causative factors of this rare obstetric complication.

Perineal endometriosis

Four patients who developed endometriosis at the episiotomy scar are reported. The latent period varied from 6 months to 10 years before the onset of symptoms. Three of them experienced cyclic pain at the site of the lesion during their menses and one patient had bloody discharge from the scar during menstruation. All patients were managed surgically and no one had recurrence during the follow-up period which ranged from 2 to 5 years. The pathogenesis of endometriosis is discussed as a clinical entity; the literature is also reviewed.

Detection of sperm-bound antibodies in the male partners of infertile couples using the immunobead test

The aim of this investigation was to determine the incidence of sperm-bound antibodies in the male partners of an unselected infertile population using an immunologically specific test (IBT). With this method 34 out of 450 infertile men (7.55%) were positive for one or more of the immunoglobulins IgA, IgG and IgM. For IgG and IgA, the majority of antibody binding was located on the entire sperm with a minor amount bound to the head or tail. For the IgM, the majority of the binding was detected to the tail tip, and tail binding was observed only in a minority of cases.

Successful pregnancy in a renal transplant recipient taking cyclosporin A: hormonal and immunological studies

A successful pregnancy following renal allotransplantation is reported. Until now azathioprine has been used as the standard immunosuppressive agent in such cases. Because of the potential teratogenicity of azathioprine, low doses of cyclosporin A, a new immunosuppressive drug, was used in our pregnant recipient. We present the management and the outcome of the pregnancy, as well as the hormonal and immunological follow up.

Vaginal fluid prolactin: a reliable marker for the diagnosis of prematurely ruptured membranes. Comparison with vaginal fluid alpha-fetoprotein and placental lactogen

The aim of this study is the evaluation of the reliability of vaginal fluid (VF) prolactin (PRL) for detecting prematurely ruptured membranes (PROM) and the comparison of this marker with vaginal fluid alpha-fetoprotein (AFP) and placental lactogen (HPL). In 21 pregnant women with recent or prolonged PROM from 20 to 41 weeks' gestation, in whom intact membranes were never found subsequently VF- and MS-PRL, -AFP and -HPL were measured by enzyme immunoassays, which are sensitive and very rapid. The same markers were also measured in MS, VF and urine samples (U) in 12 pregnant women of the same gestational age, without PROM, in whom the membranes were ruptured later during labor. In PROM, independently of prematurity and duration of PROM VF-PRL levels were significantly higher (2-10-fold) than the paired MS-PRL (p less than 0.0001) and ranged from 130 to 2315 ng/ml. In contrast, VF-PRL and urine PRL concentrations in pregnancies without PROM were very low or undetectable (range: 0-5 ng/ml and 0.15-1 ng/ml, respectively). Vaginal fluid AFP values in PROM from 20th to the 33rd week of pregnancy were significantly higher (5-50-fold) than the paired MS-AFP (p less than 0.01) and ranged from 103 to 5500 ng/ml. In PROM after the 33rd week of pregnancy, VF-AFP values were either lower (1/3), or equal to, or even higher (up to 2-fold) than MS-PRL. On the contrary in pregnancies with intact membranes, VF-AFP were always less than 9 ng/ml and urine AFP was undetectable (range: 0.2-1.1 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Culture of seminal fluid in infertile men and relationship to semen evaluation

Bacterial flora of the seminal fluid and its influence on semen quality, was examined in 225 asymptomatic unselected men. Each semen sample was cultured aerobically, anaerobically, for genital mycoplasmas, and for Chlamydia trachomatis. Semen analysis was made according to standard methods recommended by the W.H.O. All 225 semen samples had microbial isolates. All isolates had colony counts of 10(2) colony forming units (cfu/ml). Thirty-three cases had greater than 10(2) cfu/ml, 85 cases had greater than 10(3) cfu/ml and 78 cases greater than 10(5) cfu/ml. The most common organisms isolated were Ureaplasma urealyticum in 86 samples and C. trachomatis in 26 samples. The most frequent abnormal parameters were viability (117 of 212, 52%), motility (85 of 212, 40%) and number of sperm cells (74 of 225, 32.8%). No significant correlation was found between abnormal semen parameters and presence of U. urealyticum, and C. trachomatis. We concluded that asymptomatic bacteriospermia (infection) in the semen did not significantly affect the count, motility or morphologic features of the specimen.

The role of chlamydial serology in fertile and subfertile men

The incidence of serum antibodies to Chlamydia trachomatis and the possible association of a positive serology on semen parameters in 120 subfertile men were studied. The findings were compared with those of 120 fertile volunteers fathering two or more children. The two groups were divided into those without and those with a history of genito-urinary infection. There was no significant difference (p greater than 0.1) in the prevalence of antibody testing between the subgroups of fertile population. A statistically significant difference in the incidence of antibodies was found between the two subgroups of subfertile population. No significant difference was noted in the semen parameters between Chlamydia-positive and Chlamydia-negative fertile and subfertile patients.

Sexually transmitted diseases in women with urethral syndrome

Frequency of micturition and dysuria were prominent symptoms in 135 (57%) of 237 women with urethral syndrome. Ureaplasma urealyticum, Mycoplasma hominis and Chlamydia trachomatis were the principal organisms associated with the urethral syndrome (38.41%, 28.14% and 11.11%, respectively). Escherichia coli was cultured from four patients and Herepes genitalis and Neisseria gonorrhoea were isolated from five patients. Infections with more than one organism were frequent. Thirty-one of 135 patients were infected by two organisms, 27 by three and 4 patients by four microorganisms. Vaginitis due to Garnerella vaginalis, Candida spp. and Trichomonas vaginalis was discovered in 52 (39%) of 135 patients.