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Risk factors for spontaneous abortion in menotropin-treated women
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Citations from the Literature
fetus and yolk sac are visualized by that time, and cardiac motion is observed. In practice, patients treated for infertility will have been monitored closely for signs of pregnancy and will likely have ultrasound studies relatively early in the first trimester. Provided with information about high multiple pregnancy at that time, the conventional management options have included continuation of pregnancy or its (elective) interruption, with the latter choice followed by further attempts to achieve singleton or twin implantation. We present a third option. selective continuation, illustrated by two cases.
The role of laparoscopy in the evaluation of candidates for steril&ation reversal Opsahl MS; Klein TA Department of Obstetric and Gynecologv. Divbion of Reproductive Endocrinology, Waiter Reed Army Medical Center, Washington, DC. USA FERTIL. STERIL.; 48/4 (546549)/1987/ An algorithm that avoids preliminary laparoscopy for steriliaation reversal (SR) candidates with previous Pomeroy, loop, Hulka clip, Irving, and single-burn cautery tubal ligation techniques was used. Anastomosis was attempted only when it could be anticipated that the final length of at least one tube would be 3 cm or more. Of 259 SR candidates evaluated according to the algorithm, 235 had SR procedures. Seven of 185 patients (3.8%) who did not undergo laparoscopy were found to have inoperable tubes at laparotomy. Four of these patients had histories of a prior unilateral salpingectomy. The authors conclude that, given their criteria for proceeding with tubal anastomosis, laparoscopy can be avoided in properly selected SR candidates. The results also indicate that patients with a history of unilateral salpingectomy should undergo preliminary laparoscopy.
Results of mlcros~~rgicalreconstruction in patients with comPatton PE; Williams TJ; Coulam CB Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA FE.RTIL. STERIL.; 48/4 (670-674)/1987/ Thirty-one patients underwent microsurgery for correction of postinflammatory occlusion of both the proximal and the distal portions of the oviduct. Preoperative staging of tuboovarian adhesions. hydrosalpinges, and sites of oviductal occlusion was completed in each patient. Laparoscopic records were reviewed to correlate laparoscopic sites of occlusion with those found at the time of microsurgery. The conception rate at 2.5 years of observation was 12%, and there were no live births. The sensitivity of laparoscopy to predict proximal and distal disease was 65.6 and 55.2%, respectively. The poor surgical outcome in these patients suggests that IVF-ET should be strongly considered and that a careful preoperative laparostopic examination is necessary for prospective counseling in these patients. Int J Gynecol Obstet 27
Risk factors for spontaneous abortion in menotropin-treated women J3ohrerM; Kemmann E Depclriment of Obstetrics and Gynecology, University of Medicine & Dent&y of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA FERTIL. STERIL.; 4814 (571-575)/1987/ Women who conceive with human gonadotropins have a high rate of spontaneous abortions. The causes for this poor outcome are unknown. In a retrospective analysis, the authors analyzed potential factors in 45 menotropin-treated patients with spontaneous first-trimester miscarriages. Data were compared with 119 menotropin-treated patients who conceived and delivered viable infants. Patient factors that were analyzed included the following: age history of past miscarriages, duration of infertility, diagnostic category, weight, body surface area, duration and weight-corrected dose of menotropin administration, maximum estradiol level, estradiol pattern, human chorionic gonadotropin (hCG) dose, presence or absence of hCG support in the luteal phase, results of postcoital testing, methods of insemination, and results of husband’s semen analysis. There was a significant difference between the miscarriage group and the control group in regard to age and weight distribution. All other characteristics were not significantly different. Patients over 81.8 kg as well as patients aged 35 years and older were both significantly (P < 0.01) at increased risk to have a spontaneous first-trimester miscarriage. The data suggest that obesity and advanced age contribute to the high miscarriage rate in menotropin-treated patients. It appears reasonable to suggest that women weighing more than 81.8 kg should make every effort to lose weight before beginning menotropin therapy. Clinkal trial of gossypol as a mate contraceptive drug. Part I. Efficacy study Liu G-Z; Ch’iu Lyle K; Cao J Population Sciences Divksion. Rockefeller Foundation, New York, NY 10036, USA FERTIL. STERIL.; 4813 (459-461)/1987/ The main objective of the research is to study the effectiveness and safety of gossypol as a male contraceptive drug. Using a double-blind, randomized, controlled study design, gossypol was found to be an effective male antifertility drug, with no adverse effects on libido nor appetite. In terms of serum potassium levels, there were no statistical differences between gossypol and placebo groups at the end of the loading phase. However, through the ensuing 12 months of maintenance phase, a statistically significant trend toward reduced serum potassium level was evident.
Factors influencing maintenance of sperm motiBty during in vitro processing De Ziegler D; Cedars MI; Hamilton F; et al Department of Obstetrics and Gynecology, University of California, Los Angeies School of Medicine, Los Angeles, CA, USA FERTIL. STERIL.; 4815 (816-820)/1987/
Citations from the Literature
fetus and yolk sac are visualized by that time, and cardiac motion is observed. In practice, patients treated for infertility will have been monitored closely for signs of pregnancy and will likely have ultrasound studies relatively early in the first trimester. Provided with information about high multiple pregnancy at that time, the conventional management options have included continuation of pregnancy or its (elective) interruption, with the latter choice followed by further attempts to achieve singleton or twin implantation. We present a third option. selective continuation, illustrated by two cases.
The role of laparoscopy in the evaluation of candidates for steril&ation reversal Opsahl MS; Klein TA Department of Obstetric and Gynecologv. Divbion of Reproductive Endocrinology, Waiter Reed Army Medical Center, Washington, DC. USA FERTIL. STERIL.; 48/4 (546549)/1987/ An algorithm that avoids preliminary laparoscopy for steriliaation reversal (SR) candidates with previous Pomeroy, loop, Hulka clip, Irving, and single-burn cautery tubal ligation techniques was used. Anastomosis was attempted only when it could be anticipated that the final length of at least one tube would be 3 cm or more. Of 259 SR candidates evaluated according to the algorithm, 235 had SR procedures. Seven of 185 patients (3.8%) who did not undergo laparoscopy were found to have inoperable tubes at laparotomy. Four of these patients had histories of a prior unilateral salpingectomy. The authors conclude that, given their criteria for proceeding with tubal anastomosis, laparoscopy can be avoided in properly selected SR candidates. The results also indicate that patients with a history of unilateral salpingectomy should undergo preliminary laparoscopy.
Results of mlcros~~rgicalreconstruction in patients with comPatton PE; Williams TJ; Coulam CB Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA FE.RTIL. STERIL.; 48/4 (670-674)/1987/ Thirty-one patients underwent microsurgery for correction of postinflammatory occlusion of both the proximal and the distal portions of the oviduct. Preoperative staging of tuboovarian adhesions. hydrosalpinges, and sites of oviductal occlusion was completed in each patient. Laparoscopic records were reviewed to correlate laparoscopic sites of occlusion with those found at the time of microsurgery. The conception rate at 2.5 years of observation was 12%, and there were no live births. The sensitivity of laparoscopy to predict proximal and distal disease was 65.6 and 55.2%, respectively. The poor surgical outcome in these patients suggests that IVF-ET should be strongly considered and that a careful preoperative laparostopic examination is necessary for prospective counseling in these patients. Int J Gynecol Obstet 27
Risk factors for spontaneous abortion in menotropin-treated women J3ohrerM; Kemmann E Depclriment of Obstetrics and Gynecology, University of Medicine & Dent&y of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA FERTIL. STERIL.; 4814 (571-575)/1987/ Women who conceive with human gonadotropins have a high rate of spontaneous abortions. The causes for this poor outcome are unknown. In a retrospective analysis, the authors analyzed potential factors in 45 menotropin-treated patients with spontaneous first-trimester miscarriages. Data were compared with 119 menotropin-treated patients who conceived and delivered viable infants. Patient factors that were analyzed included the following: age history of past miscarriages, duration of infertility, diagnostic category, weight, body surface area, duration and weight-corrected dose of menotropin administration, maximum estradiol level, estradiol pattern, human chorionic gonadotropin (hCG) dose, presence or absence of hCG support in the luteal phase, results of postcoital testing, methods of insemination, and results of husband’s semen analysis. There was a significant difference between the miscarriage group and the control group in regard to age and weight distribution. All other characteristics were not significantly different. Patients over 81.8 kg as well as patients aged 35 years and older were both significantly (P < 0.01) at increased risk to have a spontaneous first-trimester miscarriage. The data suggest that obesity and advanced age contribute to the high miscarriage rate in menotropin-treated patients. It appears reasonable to suggest that women weighing more than 81.8 kg should make every effort to lose weight before beginning menotropin therapy. Clinkal trial of gossypol as a mate contraceptive drug. Part I. Efficacy study Liu G-Z; Ch’iu Lyle K; Cao J Population Sciences Divksion. Rockefeller Foundation, New York, NY 10036, USA FERTIL. STERIL.; 4813 (459-461)/1987/ The main objective of the research is to study the effectiveness and safety of gossypol as a male contraceptive drug. Using a double-blind, randomized, controlled study design, gossypol was found to be an effective male antifertility drug, with no adverse effects on libido nor appetite. In terms of serum potassium levels, there were no statistical differences between gossypol and placebo groups at the end of the loading phase. However, through the ensuing 12 months of maintenance phase, a statistically significant trend toward reduced serum potassium level was evident.
Factors influencing maintenance of sperm motiBty during in vitro processing De Ziegler D; Cedars MI; Hamilton F; et al Department of Obstetrics and Gynecology, University of California, Los Angeies School of Medicine, Los Angeles, CA, USA FERTIL. STERIL.; 4815 (816-820)/1987/