The establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure

Ovarian steroid replacement therapy in the ovariectomized ewe, given in the correct sequence to mimic endogenous steroid changes in the normal ovulatory cycle, allows the development of embryos transferred in utero. A similar type of sequential therapy was designed for steroid replacement in women with primary ovarian failure. This produces the histological changes in uterine endometrial morphology and plasma oestradiol and progesterone similar to those observed in the normal ovulatory cycle. We now report that in one of these women a donated oocyte, fertilized by her husband's spermatozoa and cultured to the two-cell stage in vitro, was transferred in utero, resulting in a normal pregnancy and the delivery of a healthy child. Oestrogen therapy was withdrawn at 12 weeks and progesterone at 19 weeks gestation. This technique allows the treatment of human infertility due to primary ovarian failure.

A randomized trial of weekly cardiotocography in high-risk obstetric patients

A randomized clinical trial of once-weekly antenatal fetal heart rate monitoring in 539 high-risk patients could find no benefit of monitoring in terms of perinatal mortality, morbidity or Apgar score. The previously well-documented association between abnormal antenatal fetal heart rate traces and low Apgar score was confirmed. A detailed case review showed that in this population monitoring was irrelevant to almost all of the 13 perinatal deaths.

A controlled trial of fetal heart rate monitoring in a low-risk obstetric population

A controlled trial of fetal heart rate (FHR) monitoring in a low-risk obstetric population was carried out in 989 patients at the Mercy Maternity Hospital and Queen Victoria Medical Centre. The use of monitoring failed to demonstrate any improvement in perinatal outcome. Monitoring was associated with an increased intervention rate and a small increase in the number of babies who remained in the isolette beyond 3 days. This study does not support the view that FHR monitoring should be used in all labors. Further study in a larger sample is recommended.

The collection of human oocytes for in vitro fertilization. I. An instrument for maximizing oocyte recovery rate

An instrument has been devised specifically for the collection of mature oocytes of laparoscopy for the purpose of in vitro fertilization. The instrument was evaluated and the oocytes recovery rate was compared with that obtained with two other instruments, which had been in use previously, in a controlled trial over the same period of time. It was found that the newly devised instrument resulted in the recovery of all of the oocytes from 17 follicles in which aspiration was attempted. The oocytes recovery rate was significantly better with this instrument than with either of the two instrument previously used. It was also apparent that the finer-bore needle of the two instruments previously used was more effective for oocytes recovery. The new instrument is now in routine use for oocyte collection.

An applicator for the Hulka fallopian tube clip

Use of the Hulka spring clip has advantages over other methods of occluding the fallopian tubes. Since difficulties were experienced with clip applicators from two manufactures, an improved applicator was designed. A similar applicator for use at minilaparotomy is described also.

The reduction of the intrapartum still birth rate at the Queen Victoria Memorial Hospital

A significant reduction in intrapartum anoxic fetal deaths has occurred at the Queen Victoria Memorial Hospital over the last ten years. The possible explanations for this include a variety of factors, which may either improve the health of the population presenting to the hospital, or improve obstetric care. Epidemiological evidence suggests that the use of fetal diagnostic techniques has contributed to the reduction of intrapartum anoxic still births.

Controlled trial of fetal intensive care

A fetal intensive care unit was formed at the Queen Victoria Memorial Hospital in 1972. Because of some doubt concerning the value of fetal intensive care, a controlled clinical trial including all high-risk patients was performed. The trial clearly showed that intensive care is associated with improved neurologic and biochemical status of the neonate; however, it is possible that this improvement results from the use of fetal diagnostic tests or some other factor associated with intensive care. Sufficient evidence was gathered to warrant the continuation of fetal intensive care in this hospital, but in other contries, where funding is difficult to obtain, a controlled trial would appear justified.