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PubMedDate not supplied

The effect of treatment on pregnancy among couples with unexplained infertility.

Our objective was to determine the effect of treatment on the likelihood of pregnancy among couples with unexplained infertility. We used a nonrandomized, prospective, multicentered cohort analytic study, with mean follow-up time of 14.5 months (range, 0.5-46 months). The subjects were 470 couples who attended infertility clinics affiliated with medical schools in Canada, in whom no abnormality was found after investigation. They were drawn from a total of 2,106 couples registered from April 1, 1984 to March 31, 1987. Of these, 130 couples were selected for treatment at the discretion of the care givers; 340 couples were not treated. Selection for treatment resulted in imbalance between the groups: the treated couples had a longer mean duration of infertility (48 vs. 36 months), and were more likely to have had a laparoscopy as part of the investigation (72% vs. 48%). No specific protocol of treatment was used. Treatments most commonly used were clomiphene (87); gonadotropins (31); intrauterine insemination (20); IVF or GIFT (16); bromocriptine (12); 43 couples had two treatments, and 11 had three treatments. The only important determinants of treatment (logistic regression) were time under observation and laparoscopy status. Duration of infertility was only a minor determinant of treatment. Crude, unadjusted pregnancy rates were 25% for the treated group and 34% for the untreated group. The early occurrence of pregnancy in the untreated couples accounted for much of this difference. After adjustment for baseline differences between the groups and times to and under treatment with proportional hazards analysis, the cumulative probability of pregnancy is 2.0 (95% CI 1.3 to 3.1) times as high with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Human reproductive technologies and the law: a select committee report.

The House of Commons Science & Technology Committee has reviewed the Human Fertilisation and Embryology Act. It considered a) the balance between legislation, regulation and reproductive freedom; b) the role of Parliament in human reproductive technologies; and c) the foundation, adequacy and appropriateness of the ethical framework for legislation. It also considered the Act itself and the workings of the Human Fertilisation and Embryology Authority. Its report is written from a very liberal perspective, but is a very thorough overview of current issues and debate in the field. There follow, slightly abridged, the conclusions and recommendations of the 200-page report.

Advisory Committees↗
PubMed1991

[Changes in coagulability and fibrinolytic activity in the patients with ovarian hyperstimulation syndrome].

Ovarian hyperstimulation syndrome (OHSS) is occasionally seen following hMG-hCG treatment in combination with a GnRH agonist. Increased coagulability and decreased renal perfusion may be life threatening in some severe cases. In order to evaluate coagulo-fibrinolytic activity, several related factors in the general circulation were examined for approximately 2 weeks after admission in 11 patients with severe OHSS. The results are as follows. 1. Fibrinopeptide A (FPA) was increased during the initial stage of OHSS followed by a gradual decrease. However, the level remained slightly higher than normal for 2 weeks after the onset of severe OHSS. 2. Fibrinopeptide B beta 15-42 (FPB beta 15-42) showed grossly similar patterns to those of FPA. 3. D-dimer levels were constantly higher than normal from the initial to the late stages of OHSS. 4. Thrombin-Antithrombin III complex (TAT) was markedly increased on the days of admission followed by a gradual decrease during the following week. 5. Antithrombin III (ATIII), plasminogen and alpha 2 plasmin inhibitor (alpha 2PI) showed only minimal decreasing patterns throughout blood samplings. 6. Increases in FPA, FPB beta 15-42 and D-dimer were greater in the cases with severe hemoconcentrations. Our present data suggest that severe OHSS brings on hypercoagulability resulting in microthrombosis. In order to avoid development of coagulopathy, prophylactic treatment should be considered for patients with OHSS.

Adult↗
PubMedDate not supplied

Therapy of immunologic infertility.

Infertility afflicts 10-15% of the couples and the incidence is progressively increasing. There are many possible causes for infertility, but immunological factors are among the most recently proposed causes. Once have ascertained that couple's infertility problem is due to sperm antibodies, the next obvious step is to attempt some form of therapy. In this paper we review the various classic and up-to-date methods of management of immunologic infertility.

Adrenal Cortex Hormones↗
PubMed1991

[Other indications: tubal sterilization, medically assisted procreation, salpingitis, fibromas].

Tubal sterilization is now commonly performed by laparoscopy. Among the available techniques, clips are easy to install and have a low failure rate. Laparoscopy is of considerable value in salpingitis for the diagnosis and treatment of tubo-ovarian abscesses. In medically assisted procreation, laparoscopy is less and less necessary. GIFT and, chiefly, ZIFT are still performed by laparoscopy in case of infertility with normal Fallopian tubes. Laparoscopic myomectomy is a more recent technique, but further experience is needed to assess its value compared with laparotomy.

Female↗
PubMed1991

GIFT triplets and management problems--a case report.

Pregnancies conceived through assisted reproduction can present considerable management problems to the obstetric and paediatric staff. Multiple pregnancies are common. The complication of prematurity increases the morbidity and mortality rates of the neonates.

Adult↗
PubMedDate not supplied

[Results of the IVF/GIFT program in Maribor].

The results of the IVF/GIFT programme for 1989 in Maribor are presented. During this period 4 clinical pregnancies were attended by the IVF procedure and one by GIFT and ZIFT each. In the IVF procedure the highest percentage of pregnancies was obtained in the group of women with the tubal factor of infertility (n = 34) where 4 clinical pregnancies on 22 ET were registered (18.1%). Cycle synchronisation with contraceptives, followed by stimulation with CC-HMG proved to be the most successful protocol for the cycle stimulation. With this protocol, pregnancy was attained in 4 of 19 stimulated cycles (21.0%). In the spontaneous cycles (n = 17) no pregnancy was registered.

Adult↗
PubMed1991

[Infertility and a mild degree of endometriosis].

Laparoscopy of barren women in whom no other causes of impaired fertility can be demonstrated frequently reveals minimal areas of endometriosis. This review of the literature on infertility and mild endometriosis shows that there is no convincing study of the effectiveness of either surgical or specific forms of medical therapy for infertility and mild endometriosis. Continual treatment with gestagen may be tried. If this does not succeed the GIFT method may be applied.

Endometriosis↗
PubMed1991

A satellite system for assisted reproductive technologies: an evaluation.

The University of North Carolina at Chapel Hill (UNC) Satellite System for Assisted Reproductive Technologies (ART) was initiated in 1984, and now serves most of North Carolina and parts of two adjoining states. The system was established to enhance the care of infertile couples at the community level, to assure a sufficiently large volume of patients at UNC Hospitals to support appropriate quality control measures, and to allow couples undergoing ART to have most of their care in their own community. This paper reports an assessment of the outcome of this program. Neither pregnancy rates, nor any other measurable result of the program differed between patients managed in the satellites and those cared for at UNC Hospitals.

Delivery of Health Care↗