Intrauterine devices Wang S.S Cu 380 as compared to ML Cu 375, Nova T, T Cu 300, 7 Cu 200, Lippes Loop and Ohta Ring: clinical / physiopathological parameters.
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Biomedical subjects
Publications and source records attributed to W G Karow.
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A series of 26 in vitro fertilization (IVF) cycles was studied for changes of serum progesterone levels before and after injection of human chorionic gonadotropin (hCG) by a comparison of the number of follicles punctured, number of oocytes recovered, morphological features of oocytes, fertilization rate, cleavage rate, and quality of embryos before their transfer. Subjects were further divided into three groups according to their pregnancy outcome. Five pregnancies were generated and reached the stage of clinical confirmation of live baby delivery or live fetus by ultrasound scanning of the uterine contents. Six patient cycles that had a prolonged luteal phase and beta-hCG levels greater than 40 MIU/ml were described as biochemical pregnancies. Fifteen patient cycles showed no sign of pregnancy. The significant finding of this study is related to the serum progesterone level increase from 20 to 34 hr after hCG injection. The nonpregnancy group yielded a 1.2-fold increase compared with the biochemical pregnancy and pregnancy groups, which had a 3-fold increase. The usage of this multiple effect of progesterone may aid in the prediction of the "high-quality embryo" that might result from a given treatment cycle, indicate the completion of luteinization, the proper timing of hCG to induce final oocyte maturation, and the necessary length of preincubation, and aid in the prediction as to whether or not a pregnancy is likely to result.
The first case of a genetic abnormality in a 3-year in vitro fertilization and embryo transfer program was diagnosed after routine amniocentesis of a 38-year-old patient. The G-banded karyotype analysis gave 47, XY, +21, which constitutes an abnormal chromosome pattern consistent with Down syndrome.
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The hormonal effects of danazol and of a long-acting gonadotropin-releasing hormone analogue (GnRH-a) were studied in women with endometriosis and those with oophorectomy. During danazol treatment, total serum concentrations of estrone and estradiol, and free, dialyzable estradiol were reduced to the low follicular phase range for premenopausal women. Corresponding estrogen levels were suppressed to a significantly greater degree (P less than .02) at the end of GnRH-a administration, to concentrations which were twofold to fourfold lower than with danazol therapy and similar to values in the oophorectomized women. Sex hormone binding globulin was markedly suppressed (P less than .001) throughout danazol treatment, resulting in a threefold elevation (P less than .01) of free testosterone. These data suggest that danazol may affect endometriosis by mechanisms other than by inducing a pseudomenopause. The increased tissue availability of testosterone may be responsible for acne and hirsutism observed in some women during danazol treatment and may inhibit proliferation of the ectopic endometrium. Medical oophorectomy using GnRH-a may have improved effects on endometriosis without the androgenic side effects of danazol.
Prednisone treatment for infertility and subsequent pregnancy maintenance in humans resulted in a significant decrease in the birth weight of full-term infants and a marked increase in the percentage of newborn infants weighing 2500 grams or less, that is, "light for dates" in comparison to control offspring. A parallel experiment with mice indicated that the reduction of birth weight was caused by exposure to corticosteroids rather than to maternal disease or malfunction.
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Blood samples were obtained from 5 women during the menstrual cycle in which they had conceived. Although neither the women nor their physicians were clinically aware that conception had occurred, one or more of the blood specimens from each woman contained human chorionic gonadotropin (hCG), as measured by a specific radioimmunoassay. Each patient underwent a spontaneous abortion with 4 of the 5 women describing a delayed, but otherwise normal, menses. The fifth noted an unusually abundant amount of vaginal bleeding. Immunologic urinary pregnancy slide tests were negative in the 4 women on whom the tests were performed. The levels of hCG in the serum of these women were abnormally low for the estimated length of gestation, suggesting that defective trophoblastic function may be important in the pathogenesis of this phenomenon. These examples illustrate that some women may conceive and abort so early that the pregnancy and the abortion may remain subclinical. Therefore, it is likely that the true incidence of spontaneous abortions during the first trimester is greater than the presently accepted incidence of 15%.
Seventy-nine previously infertile women were studied during the first 9 weeks of their pregnancies. Pregnancy had occurred either without any specific therapy or following treatment with clomiphene, prednisone, or human chorionic gonadotropin, singly or in various combinations. Serum levels of progesterone, 17 alpha-hydroxyprogesterone, and estradiol were measured at 2-week intervals. A profile of early pregnancy in terms of these hormones is presented and discussed with regard to its significance for corpus luteum function. Aspects of the hormonal profile predictive of the pregnancy outcome are noted. Ovarian over-stimulation was directly related to the dosage of clomiphene, and the increased levels of 17 alpha-hydroxyprogesterone thus produced persisted into the seventh week of pregnancy. This hormonal excess probably derives from multiple corpora lutea which may also account for the increased incidence of multiple pregnancy associated with clomiphene therapy.
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Various sperm preparation techniques, swim-up and Percoll gradient, and the newly developed Wang's tube system, were evaluated for their ability to recover normal-chromatin sperm. Twenty human semen samples, collected by masturbation, were studied simultaneously with the three methods. Analysis by Acridine orange fluorescence test was performed on all samples. Pretreated semen contains 58 +/- 22% green sperm (fertile/normal). Treatment with Wang's tube system resulted in 99 +/- 1.0% green sperm; Percoll gradient, 78 +/- 11%; and swim-up technique, 72 +/- 15%. It would appear that Wang's tube system yields a high-quality sperm preparation with enough concentration, very active forward progression, and greatly improved sperm morphology, while containing normal-chromatin, double-stranded DNA.