Biomedical subjects
Publications and source records attributed to F R Batzer.
The problem with applying information on progestogen potency obtained from biologic testing to clinical prescribing practices is that the changes in potency relate to more than progestogen dosage. The spectrum of progestogen activity is discussed, with an emphasis on the effects of the progestogens used in oral contraceptive therapy.
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Ectopic pregnancy was experienced by 103 women in our practice, for a total of 123 such pregnancies. These patients' histories were reviewed in an attempt to identify certain risk factors. The ectopic pregnancies were diagnosed prior to rupture in 73% of cases. Patients were followed for subsequent reproductive function. Among the 96 who were not sterilized during or after surgery for ectopic pregnancy, intrauterine pregnancy was achieved by 34, while 15 had at least one additional ectopic gestation. Risk factors were identified. Different surgical approaches to the affected tube influence future reproductive function and repeat ectopic gestation.
Ultrasound affords direct observation of anatomic changes leading to ovulation. It is useful in many clinical applications, such as monitoring ovulation induction regimens, determining the time of oocyte harvest in in vitro fertilization programs and assisting with timing artificial insemination. The specific time of ovulation cannot be predicted accurately enough using ultrasound to make it optimal for routine monthly cycle use.
The cervical cap was used in artificial insemination (husband) in the home by 63 couples. An overall pregnancy rate of 19% occurred regardless of the duration of use, and a rate of 44% was associated with use for at least six months or until pregnancy occurred. Comparison of pregnancy rates between those in the program and those who dropped out and conceived without therapy revealed no statistical difference.
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A case of long standing secondary amenorrhea with hyperprolactinemia and pregnancy success despite inability to normalize prolactin levels with high doses of bromergocryptine is presented.
Although contraceptive efficacy is the major reason for using oral contraceptives (OCs), other physiologic changes occur with them that can be beneficial to patients. The new, low-dose OCs are of particular interest in this regard.
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The Ericsson albumin filtration technique was used to collect a fraction rich in Y sperm for selective insemination in couples desiring a male infant. Of 35 conceptions in which sex was known at delivery or spontaneous abortion, there were 28 males (80%). Twelve pregnancies were achieved after separation of sperm in a Sephadex gel filtration system designed to allow for collection of a fraction enriched in X sperm. Seven pregnancies have resulted in females, two in males, and one in twins of each sex. One patient aborted, and one is still pregnant. While selection for either sex can be done electively, on the basis of sociologic preference, female selection has, as an additional indication, avoidance of male offspring to carriers of sex-linked diseases.
Prospective pregnancy evaluation through the combined use of a radioimmunoassay (RIA) for the beta-subunit of human chorionic gonadotropin (beta-hCG) and ultrasound during the first 42 days of gestation after ovulation was performed on a population asymptomatic for first-trimester spontaneous abortion. One hundred forty-six ultrasonic observations in 98 pregnancies were made with simultaneous beta-hCG RIA performed in 80 patients. The following landmarks of normal gestational growth were identified: (1) Before 26 days, beta-HCG RIA permits definitive diagnosis of growing trophoblastic tissue, and serial samples allow doubling time computation for prognosis while ultrasound shows a nonspecific increasing decidual response within the uterus; (2) between 26 and 36 days after ovulation, serial beta-hCG samples continue to give doubling time results while ultrasonic demonstration of a gestational sac is normally seen by 28 days after ovulation; (3) the lack of fetal heart motion by 42 days after ovulation or within a gestational sac with a mean diameter of greater than 30 mm was prognostic of abortion; (4) the absence of a gestational sac by 28 days after ovulation or with a beta-hCG RIA greater than 1,000 ng/ml is suggestive of an ectopic pregnancy until proved otherwise.
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The results of administration of clomiphene citrate to 507 patients in 578 pregnancy attempts were evaluated with respect to pregnancy rate, outcome, sex ratio, and life table analysis. The effect of dose and concomitant administration of human chorionic gonadotrophin (hCG) was also assessed. The overall pregnancy rate was 38% by individual patient and 43% by patient attempt. A pregnancy rate of 61% was recorded for couples in which anovulation was the only reproductive problem. The abortion rate was 23% in a population screened by serum beta subunit hCG determination within a week of the missed expected menses. Many patients had multiple adverse fertility factors and fully 29% had been treated unsuccessfully with clomiphene citrate prior to entry into the program. The discussion includes results from the literature over the past two decades.
Urinary pregnancy testing with Sensitex, a tube macroflocculation system, produced a positive test by 17 days after basal-body-temperature-timed ovulation in 59% of determinations. Data from days 18 to 21 showed that a negative test was associated with a statistically significantly increased propensity for first-trimester abortion. Freezing of the urinary specimens, but not refrigerated sm, produced a positive test by 17 days after basal-body-temperature-timed ovulation in 59% of determinations. Data from days 18 to 21 showed that a negative test was associated with a statistically significantly increased propensity for first-trimester abortion. Freezing of the urinary specimens, but not refrigerated storage for five days, adversely affected the accuracy of the test.
Prospective evaluation through the use of radioimmunoassay of the beta-subunit of human chorionic gonadotropin (beta-hCG) in blood samples obtained during the first 30 days of gestation was performed on an infertile population at high risk for pregnancy loss. Four hundred and fourteen samples in 281 pregnancies were analyzed. On the basis of single, random beta-hCG samples in asymptomatic patients, 77% of successful pregnancies and 59% of abortions were correctly identified. On the basis of beta-hCG doubling time (mean 2.2 days +/- 1.0 [2 SD]) computed from serial sampling, again in asymptomatic patients, 88% of successful pregnancies and 76% of abortions were correctly identified. beta-hCG doubling time appears to provide a reliable method of evaluating early pregnancy prognosis with significantly greater ability to identify problem pregnancies within the first 30 days of gestation than does single random hCG values.
Serial urinary beta human chorionic gonadotropin (beta-hCG) immunoassay was performed on 60 patients during early pregnancy. Results were expressed as tube dilutions positive and were compared with quantitative serum beta human chorionic gonadotropin radioimmunoassay (beta-hCG-RIA) values. The parallel rise of human chorionic gonadotropin (hCG) measured by serum beta-hCG-RIA and a macroflocculation beta-specific urinary immunoassay in early pregnancy was confirmed. The ability of each to predict abortion prior to the onset of patient symptoms or clinical signs of disturbed gestation was quantitated. Results were expressed for each method according to standard regression lines or doubling time for individuals. Utilizing either statistical method, urinary testing was as accurate as serum testing for the prediction of normal pregnancy (about 90% for each). Serum testing was 78% correct in predicting abortion; urinary testing was 63% accurate.