Nonsurgical ovum transfer as a treatment for intractable infertility: What effectiveness can we realistically expect?

Using previously reported human, primate, and cattle reproductive performance data, we developed a mathematical model to predict the cumulative probability of pregnancy per woman per month theoretically obtainable by ovum transfer. We then conducted a preliminary ovum transfer clinical trial and compared the results of that trial to the results predicted by the model. Based on the nine spontaneously ovulating fertile donors and seven spontaneously ovulating infertile recipients available for the trial, the model predicted occurrence of between 0.63 and 8.65 pergnancies during the 6-month period of the study. We actually obtained two pregnancies. The model further predicted, with sufficient numbers of donors to produce one match per ovulation for each prospective patient, that the probability of that patient becoming pregnant from ovum transfer ranges from 0.05 to 0.35 per cycle.     

Intravenous terbutaline and simultaneous β1-blockade for advanced premature labor

Seventeen patients in advanced premature labor (cervical dilatation ≥3 cm and effacement ≥50%) were randomized in a double-blind protocol to receive metroprolol (a β₁-adrenergic antagonist) or a placebo in conjunction with intravenous and oral terbutaline (a β₂-agonist) in an attempt to inhibit the side effects of terbutaline. Both groups of patients had a dose-related increase in heart rate and systolic blood pressure and a decrease in diastolic blood pressure. Laboratory studies revealed significant hyperglycemia, hypokalemia, hypocalcemia, and acidosis during the intravenous terbutaline infusion, all of which normalized during oral terbutaline therapy. There were no significant differences in the cardiovascular or metabolic responses to terbutaline between the metroprolol and placebo patients. The mean delay in delivery was 5.7 days, with 59% of patients having delivery delayed for 48 hours or more. The mean prolongation time was shorter, but not statistically significant, for those patients receiving metroprolol. Despite the use of high-dose terbutaline, there were no significant complications of therapy. There was little efficacy of infusion dosages above 40 μg/min or repeated courses of intravenous tocolysis. Although recent reports do not recommend tocolysis in these patients, this study suggests that combined β-mimetics and glucocorticoids may be the optimal care for patients in advanced premature labor, in particular, those with infants of very low birth weight.     

Neonatal scalp abscess following intrapartum fetal monitoring: Prospective comparison of two spiral electrodes

During a six-month period, 929 newborn infants had continuous, direct fetal heart rate monitoring during labor. Of these, 481 were monitored with the Berkeley Bio-Electronics spiral electrode and 448 were monitored with the Corometrics spiral electrode. The over-all incidence of scalp abscess complicating fetal monitoring was 4.5 per cent. In the group monitored with the Berkeley electrode, 25 newborn infants (5.2 per cent) developed a scalp abscess; in the group with the Corometrics electrode, 17 newborn infants (3.8 per cent) developed scalp abscess. The incidence of scalp abscess was not significantly different in the two groups.     

Urodynamic effects of a vaginal pessary in women with stress urinary incontinence

The manner in which a vaginal pessary restores urinary continence is poorly understood. This report provides an explanation. Following placement of the vaginal pessary, detailed urodynamic studies in a group of 12 women with stress urinary incontinence demonstrated consistent and significant (p < 0.005) increase in urethral functional length and urethral closure pressure under varying stressful conditions, when compared with prepessary studies. Postpessary stress testing also became normal (p < 0.005). Prepessary and postpessary simultaneous voiding urethrocystometry and instrumented uroflowmetry demonstrated absence of obstruction to free flow of urine. Clinically, 10 of 12 patients became continent. Characteristic postpessary urodynamic alterations and Q-tip test changes provided an objective explanation that the vaginal pessary restored continence by stabilizing the urethra and urethrovesical junction to allow proper pressure transmission and by actively increasing urethral resistance to escape of urine under resting and stressful conditions.     

Prenatal and intrapartum high-risk screening. II. Risk factors reassessed

A method of identifying the high-risk pregnancy by a quantitative assessment of prenatal, intrapartum, and neonatal factors is presented. Calculating the probabilities of neonatal risk can be done with a hand-held calculator. The technique described provides a method of assessing the importance of perinatal variables and determining the effect of the process of health care on outcome.     

The oxytocin secretory response to breast stimulation in women during the menstrual cycle

Plasma oxytocin concentrations were measured during 12 minutes of mechanical pump stimulation in nine healthy women during the follicular and luteal phases of the menstrual cycle. In the follicular phase (and in five healthy male subjects), plasma oxytocin values did not increase above baseline levels with breast pump stimulation. In contrast, pump stimulation evoked a significant increase in plasma oxytocin levels during the luteal phase of the menstrual cycle. These observations suggest that oxytocin secretion is modulated by hormones involved in the menstrual cycle in women.     

Intrauterine contraception in nulliparas with the Dalkon shield

The small Dalkon Shield was used for intrauterine contraception in a series of 1,697 nulliparous women over a 2 year study period. Of these women 80 per cent were nulligravid. The device is well tolerated and has low expulsion and medical removal rates. The pregnancy rate of 1.2 per cent remained constant after 12 months of use. The nulliparous model Dalkon Shield is an effective and extremely acceptable means of intrauterine contraception in the nulliparous female.     

Intrauterine contraception in multiparas with the Dalkon Shield

The large Dalkon Shield was used for intrauterine contraception in a series of 2,370 multiparous women over a 24 month study period. The device is well tolerated and has low expulsion and medical removal rates. The pregnancy rate was 1.3 per cent at 12 months and increased to 1.5 per cent at 18 months; it remained constant thereafter. The multiparous model of the Dalkon Shield is an effective and extremely acceptable means of intrauterine contraception.     

Perinatal and maternal mortality in a religious group avoiding obstetric care

We investigated perinatal and maternal deaths occurring among women who were members of a religious group in Indiana; these women received no prenatal care and gave birth at home without trained attendants. Members of the religious group had a perinatal mortality rate three times higher and a maternal mortality rate about 100 times higher than the statewide rates. These findings suggest that, even in the United States, women who avoid obstetric care have a greatly increased risk of perinatal and maternal death.     

Fetal weight/placental weight ratio and perinatal outcome

The relationship of placental size to perinatal outcome was investigated in a population of low-risk infants. A trimmed and drained placenta was weighed for each of 417 low-risk infants, and for 108 infants whose intrapartum course was complicated only by compression of the umbilical cord. Tracings from intrapartum electronic fetal heart rate monitoring were analyzed by an investigator who was unaware of the fetal weight/placental weight ratio. The incidence of perinatal problems was increased in those infants whose fetal weight/placental weight ratio was greater than 11: intrapartum fetal distress, 20% (p = 0.0046); meconium-stained amniotic fluid, 28.9% (p = 0.0017); Apgar score less than 7, 11.1% (p = 0.04); and hyperbilirubinemia, 24.4% (p = 0.0008). On the basis of these data, the conclusion drawn was that there is a population of presumably low-risk infants who are at increased risk because they have outgrown their placentas.     

Fetal pericardial fluid: a normal finding of the second half of gestation

In a series of 104 consecutive pregnancies ranging from 20 to 40 weeks' gestation which were examined with real-time ultrasound, we observed 46 fetuses with pericardial fluid. High resolution makes the detection of normal pericardial fluid now feasible.     

Clinically silent polymicrobial amnionitis and intrauterine fetal death associated with a Cu-7 intrauterine contraceptive device

This article presents a case of silent polymicrobial amnionitis with subsequent intrauterine fetal death in a 34-year old woman who conceived with a Cu-7 IUD in place. There were no apparent pregnancy complications or symptoms of uterine infection during early pregnancy. At 16 weeks gestation, the patient underwent amniocentesis for cytogenetic studies. 5 different microorganisms--Corynebacterium, Staphylococcus warneri, Staphylococcus epidermidis, Streptococcus mitis, and Ureaplasma urealyticum--were isolated from the amniotic fluid. 2 week later, intrauterine fetal death was detected. U. urealyticum was at this point isolated from the cervix and placental and fetal tissues. This organism, which has been associated with chorioamnionitis, spontaneous abortion, and neonatal death, is suspected to have contributed to the fetal death in this case. U. urealyticum can invade the amniotic sac with fetal membranes intact and persist for 8 weeks without overt effects. This case illustrates the risks associated with nonremoval of an IUD after contraceptive failure.     

Pulsatile administration of gonadotropin-releasing hormone for induction of ovulation

Chronic pulsatile administration of gonadotropin-releasing hormone (GnRH) was used to induce ovulation in 12 women with various ovulatory disorders. In the first group of eight patients with normal to low baseline levels of gonadotropin, seven responded favorably to the treatment. Follicular maturation was observed in 57% of the treated cycles, and normal ovulatory cycles were induced in 24% of the patients. Two patients became pregnant. The intravenous route of administration was more effective than the subcutaneous one, possibly in response to the GnRH profile after each pulse. (The amplitude of GnRH peaks after an intravenous pulse was four times that seen after a subcutaneous one.) In contrast, follicular maturation and ovulation could not be induced in four women of a second group of patients with normal baseline levels of follicle-stimulating hormone but with high and frequent pulses of luteinizing hormone. The conclusion reached was that pulsatile administration of GnRH can be a new therapeutic tool in the treatment of ovulatory disorders in women who have an insufficient endogenous release of GnRH.