Idiopathic infertility: a trial of bromocriptine versus placebo.
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Biomedical subjects
Publications and source records attributed to R F Harrison.
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The relationship between colonization of pregnant women by Ureaplasma and Mycoplasma and the outcome of pregnancy in a study of 104 women is reported. There were eight abortions but no multiple births or stillbirths. Excluding abortions, the mean gestational length was 39.6 weeks and the corrected mean birth weight was 3.28 kilograms. There was no relationship between maternal colonization by genital mycoplasmas and reduction in birth weight of the offspring, but five of the eight women who aborted harbored Ureaplasma, suggesting an increased trend toward abortion in women harboring Ureaplasma.
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Indirect immunofluorescent, macroagglutination and immobilizing sperm antibody estimations were performed as part of a prospective study on a representative group of 63 infertile couples. Serum from both, cervical mucus and seminal plasma were tested and the clinical use of the tests evaluated by considering the pregnancies that occurred and the causes of infertility that were discovered in the subsequent year. The indirect immunofluorescent test had the largest number of positives although more were found in seminal plasma than elsewhere. In these, both male and cervical factors were implicated and in this media there were less positives pregnant with the acrosome and midpiece patterns absent. The macroagglutination test had no positives pregnant and again more significance was attached to positives in the male. Similarly, immobilization results showed most positives in seminal plasma where the male and cervical factors featured prominently. It would, therefore, appear that if any clinical use is to be derived from the three tests in the search for antisperm antibodies as a cause of infertility, testing the male and especially seminal plasma appears to correlate best. If treatment is to be recommended, therefore, it should be concentrated on the man.
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Bromocriptine and placebo were randomly allocated for three weeks to 52 postpartum patients requiring lactation suppression. Bromocriptine significantly lowered plasma prolactin levels and suppressed breast milk, breast pain and engorgement quicker than placebo. No side-effects were noted and rebound lactation did not occur. Menstruation appeared to re-start sooner when Bromocriptine was given.
22 patients complaining of primary menorrhagia or menorrhagia associated with an intrauterine device (I.U.C.D.) were studied in a double blind trial with crossover of ethamsylate and placebo. Acutal menstrual blood-losses were calculated from the iron content of used sanitary material during one pre-trail menstrual period and four trial menstrual periods, during which patients received ethamsylate ("Dicynene") treatment during two menstrual cycles and placebo during two cycles. During ethamsylate treatment the mean menstrual blood-loss was reduced by 50% in patients with primary menorrhagia and by 19% in patients with an I.U.C.D. This difference between the two groups is probably accounted for by the differing values of initial blood-loss which was significantly higher in the group with primary menorrhagia. Tampon usage and the duration of bleeding were not significantly altered by ethamsylate treatment. Reported side-effects, which were not serious, were equally common during ethamsylate and placebo treatment.
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The role of mycoplasmas in infertility was studied in 120 couples. During the twelve months of the study 27 couples (22-5%) conceived. T mycoplasmas were isolated from 63% of these couples, and Mycoplasma hominis from 18%, compared with 56% and 13%, respectively, in those who did not conceive. 88, with primary infertility of unascertained cause, took part in a controlled trial with doxycycline. The couples in the trial were allocated randomly to three groups: 30 received doxycycline, 28 received a placebo, and 30 couples were untreated. Although a twenty-eight-day course of doxycycline eradicated M. hominis and T-strain mycoplasmas from 27 (96%) of the 28 couples harbouring them, the rate of conception was no higher in those treated with the drug than in control groups. It is concluded that mycoplasmas are not associated with primary infertility and that, although doxycycline eradicates them, this drug is of no benefit in the treatment of primary infertility of unascertained cause.
Sixty-four women with poorly invading spermatozoa on postcoital tests (PCT's) were investigated for serum spermatozoal antibodies by the immunofluorescent technique. Control groups tested were women with explained infertility but normal PCT's, normal pregnant women, and normal previously pregnant women. A positive immunofluorescent test was obtained in 19 of 64 women with abnormal PCT's compared with 26 of 51 patients with explained infertility, including 11 of 13 who had well-identified gynecological disorders, 12 of 61 pregnant women, and one of 59 previously pregnant normal women. High titers (larger than or equal to 1/200) were found in a few patients in all groups except normal nonpregnant women. In no patient was evidence of complement fixation found. The immunofluorescent test, as carried out here, is therefore of little value in discriminating a group of patients in whom immunologic abnormalities are the primary cause of the infertility.