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Biomedical subjects

S Grobler

Publications and source records attributed to S Grobler.

7 recordsLinked to original sources

Cost-effectiveness of gamete intrafallopian transfer in comparison with induction of ovulation with gonadotropins in the treatment of female infertility: a clinical trial.

OBJECTIVE: To compare the cost-effectiveness of gamete intrafallopian transfer (GIFT) with that of conventional infertility treatment in couples with female infertility, excluding tubal factors. DESIGN: Patients were randomly divided in two groups: receiving GIFT or conventional infertility treatment. For a period of 2 years, GIFT was compared with conventional infertility treatment in couples with endometriosis, anovulation, idiopathic infertility, cervical mucus factor, female immunologic factor, or multifactorial causes of infertility in a randomized clinical trial. SETTING: The study was performed in the Unit for Human Reproduction, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: One hundred seventy-four successive couples with female infertility were selected for the study. All couples were from the higher socioeconomic bracket. INTERVENTIONS: One group received GIFT and the other received conventional infertility treatment consisting of induction of ovulation with gonadotropins followed by intrauterine artificial insemination or normal intercourse. MAIN OUTCOME MEASURES: The results were stratified according to the specific cause of infertility. Outcome was measured by the success rate per treatment cycle, as well as the cost per pregnancy. RESULTS: Overall, GIFT proved to be successful in 26.7% of treatment cycles compared with 9.7% with conventional therapy. CONCLUSIONS: After careful analysis, the authors came to the conclusion that GIFT is more cost-effective than conventional infertility treatment in patients with endometriosis and anovulation. In patients with idiopathic infertility, immunologic infertility, a cervical mucus factor, and multifactorial infertility, induction of ovulation followed by intrauterine artificial insemination or normal intercourse proved to be more cost-effective.

Coitus

Ileal mucosal absorption of bile acid in man: validation of a miniature flux chamber technique.

A method that allows the quantitative assessment of ileal mucosal cell uptake and transport of bile acids in mucosal biopsy specimens has been validated. Viability of the tissue was confirmed by maintenance of normal cell morphology, wet weight, extracellular space, porosity to polyethylene glycol-900, lactate dehydrogenase release, and transmucosal potential difference. Using 14C-taurocholic acid, absorption was shown to be directional, capable of working against a concentration gradient, reduced by metabolic inhibitors, and sodium dependent. The system showed saturation kinetics with an estimated Km of 10 mumol/l. At a standard substrate concentration of 10 mumol/l ileal mucosal bile acid absorption was compared in patients with colorectal cancer (n = 6), ulcerative colitis (n = 10), and slow transit constipation (n = 8). There was no significant difference in tissue uptake or transport between the three groups.

Bile Acids and Salts

The SCMC test: a reliable monitor for antispermatozoal antibodies.

Seventeen couples (13%) were selected from a group of 129 infertile patients according to the following criteria: (i) unexplained infertility for 3 years and (ii) greater than 50% shaking spermatozoa during SCMC testing. The couples were tested for sperm antibodies after a complete diagnostic work-up schedule. Post-coital tests were performed during the first menstrual cycle of the wife, followed by SCMC and sperm antibody titre testing. Ten males and seven females were thus treated with 96 mg methylprednisolone. Nine (52%) of the 17 with sperm antibodies achieved a pregnancy. The results of the SCMC test were in all the cases indicative of the actual sperm antibody titre. Reduction of the antibody titre and a decrease in the percentage of shaking spermatozoa as detected by the SCMC test correlated well with the pregnancy rate amongst the patients.

Antibodies

The SCMC test: a accurate indicator for spermatozoal antibodies.

Eighteen couples (12.9%) were selected from a group of 138 infertile couples for a special study about the reliability of the SCMC test, when compared with spermantibody titres in the cervical mucus and or seminal plasma and corticosteroides as treatment for immunologic infertility. It can be demonstrated that there exists a reliability of the SCMC test as an immunologic assay for sperm antibody activity in the semen and the cervical mucus.

Adrenal Cortex Hormones

Sperm/cervical mucus contact test for sperm antibodies.

Thirteen couples with a history of primary infertility for at least 3 years were selected according to the following criteria: a positive sperm/cervical mucus contact (SCMC) test, the presence of sperm-agglutinating antibodies in the cervical mucus, and/or seminal fluid of one of the partners. Nine of the males and 4 of the 13 females were accordingly treated with high dosages of corticosteroids for 6 months. Among 4 (44%) males and 2 (50%) females a pregnancy ensued. Four (80%) of the 6 patients in whom a pregnancy was reported showed not only a decline in their sperm antibody titer but also a decrease in the percent shaking spermatozoa during SCMC testing.

Antibodies

[The treatment of sperm antibodies with corticosteroids].

Seven women whose infertility was thought to be due to sperm antibodies alone were treated with either high or low doses of corticosteroids. During the treatment period the significance of the sperm-cervical mucus contact test was evaluated as a monitor for sperm antibodies. Five women became pregnant after steroid therapy and it was considered to be an effective method of treating infertility due to sperm antibodies since none of the patients complained or suffered from any side-effects.

Antibodies

Important semen parameters during postcoital testing.

One hundred and sixty-two females who attended our infertility clinic were selected according to the quality of their cervical mucus. Only mucus of extremely high quality was used in the study to determine the influence of different semen parameters on the postcoital test results. All mucus samples were evaluated 8 h following coitus. The results of the postcoital tests were divided into group I (less than 7 spermatozoa per 400 X magnification) and group II (greater than 7 spermatozoa per 400 X magnification). The results of the statistical analysis indicated the order of importance of the different semen parameters during postcoital testing. By using the stepwise discriminant analyses, it was calculated that the sperm concentration and forward progression rate of the spermatozoa are discriminating factors between the two groups.

Cervix Mucus