Cervical Cup Research Articles

Cervical CUP Syndrome: Diagnosis and Therapy

In CUP syndrome (CUP = cancer of unknown primary) there are 1 or more metastases of a primary tumor that cannot be localized despite extensive diagnostics. CUP syndrome accounts for 5% of all human malignancies, making it one of the 10 most common forms of cancer. In addition to inflammatory lymph node enlargement and benign changes such as cervical cysts, lymph node metastases are among the most common cervical masses. Cervical CUP syndrome is a histologically confirmed cervical lymph node metastasis with an unknown primary tumor. In addition to anamnesis, clinical examination and histological confirmation, diagnostics include radiological imaging using PET-CT and panendoscopy with histological primary tumor search. Treatment options include surgical therapy with neck dissection and chemoradiotherapy.

Real-Life Performance of F-18-FDG PET/CT in Patients with Cervical Lymph Node Metastasis of Unknown Primary Tumor.

Background: Neoplasms in the head and neck region possess higher glycolytic activity than normal tissue, showing increased glucose metabolism. F-18-Flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can identify an unknown primary tumor (CUP). Aim: The aim of this study was to assess the real-life performance of F-18-FDG-PET/CT in detecting primary sites in patients with cervical lymph node metastasis of CUP. Methods: A retrospective data analysis of 31 patients who received FDG-PET/CT between June 2009 and March 2015 in a CUP context with histologically confirmed cervical lymph node metastasis was included. Results: In 48% of the patients (15/31), PET/CT showed suspicious tracer accumulation. In 52% of the patients (16/31), there was no suspicious radiotracer uptake, which was confirmed by the lack of identification of any primary tumor in 10 cases until the end of follow-up. FDG-PET/CT had a sensitivity of 67%, specificity of 91%, PPV of 92%, and NPV of 63% in detecting the primary tumor. Additionally, PET/CT showed suspicious tracer accumulation according to further metastasis in 32% of the patients (10/31). Conclusion: FDG-PET/CT imaging is a useful technique for primary tumor detection in patients in a cervical CUP context. Furthermore, it provides information on the ulterior metastasis of the disease.

The Valero Tip and Attachment for Cooper Surgical Rumi Uterine Manipulator

<h3>Study Objective</h3> To produce a Stainless-Steel surgical degree tip and attachment that works with uterine manipulator and allows the use of cervical cup for different types of surgeries. - Plastic pollution continue to be a serious problem for human health and environment, it's estimate that for 2030, 53 million tonnes of plastic could end up in rivers, lakes and oceans. One example of how changing consumption patterns can improve the environment is the use and disposal of plastics. The global theme of World Environment Day is "Beat Plastic Pollution". It aims to change consumer behaviour with the challenge, "If you can't reuse it, refuse it." In OR we don't have exception, for reducing Medical Waste and optimizing our ORs for the future, we design a stainless-steel surgical degree tip and attachment for the uterine manipulator. <h3>Design</h3> We produce a 3-D Model plastic tip as a prototype, subsequently a stainless-steel tip and attachment <h3>Setting</h3> Like it adapts to a uterine manipulator, patient position is lithotomy, the Tip attaches by a "ring" then allows the use of a cervical cup that adapts to the ring. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The design patent pending through the School of Medicine and Engineer, attach to the three types of uterine manipulator also it allows to use the cervical cup and provides the ability to use it in hysterectomy or other procedures without the cervical cup. Base on this we present the prototype guide and assemble. <h3>Conclusion</h3> The reestirilization of the tip allows us not promote the use of plastic waste.

Management of neck node with unknown primary - A review

Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon seen in 3-9% of all Head and neck cancers. Neck node metastasis seen around 5-10% of all patients with CUP. Metastasis in upper and middle neck occurs from head and neck cancers. Where as metastasis to lower neck is associated with cancers below the clavicles like thyroid cancer, lung cancer, colon cancer and ovarian cancer. Diagnostic set up consist clinical evaluation, panendoscopy of upper aerodigestive tract, CT &amp; MRI imaging, Biopsies (FNAB, open biopsy), molecular assay from all suspicious site. The optimal therapeutic management of patient with cervical CUP remains controversial due to absence of randomized studies comparing different treatment options. However NCCN has given a established guidelines for management of CUP. The major authors recommend surgical removal of neck disease, followed by post-operative radiotherapy alone or radio-chemotherapy.

Cervical CUP syndrome

The term CUP syndrome (cancer of unknown primary) refers to amultifaceted clinical picture in which the affected patients have lymph node and/or distant metastases without the location of the primary tumor being known. The criteria of CUP syndrome are fulfilled if ahistologically or cytologically confirmed malignancy is present without adetectable primary tumor after completion of the primary diagnosis. Due to the usually poor prognosis and the manifold appearance, which often does not allow astandardized therapy, cervical CUP syndrome makes specific demands on clinical and imaging diagnostics. Using modern techniques such as positron emission tomography-computed tomography (PET-CT), imaging plays akey role in the detection of apossible occult primary tumor as well as in staging and prognosis assessment.

Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis

SummaryBackgroundGirls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes.MethodsIn this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845.FindingsOf 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59–84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72–46·72 (median $23·3, 145 brands).InterpretationOur review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products.FundingUK Medical Research Council, Department for International Development, and Wellcome Trust.

Insights from outside BJOG

Insights from outside BJOG

Laser Angiography with Indocyanine Green to Assess Vaginal Cuff Perfusion during Total Laparoscopic Hysterectomy: A Pilot Study

Study ObjectiveTo determine feasibility of using laser angiography with indocyanine green (ICG) to assess vaginal cuff vascular perfusion during total laparoscopic hysterectomy (TLH). DesignPilot feasibility trial (Canadian Task Force classification II-2). SettingAcademic-affiliated hospital. PatientsTwenty women undergoing TLH for benign disease. InterventionsParticipants underwent 1:1 randomization of energy method used for colpotomy (ultrasonic vs monopolar) and vaginal cuff closure suture (barbed vs nonbarbed). After intravenous administration of ICG, laser angiography was used to capture images of the vaginal cuff before and after closure. Three reviewers analyzed fluorescent images of vaginal cuffs to determine percent of cuff perimeter with adequate perfusion when open and length of vaginal cuff adequately perfused when closed. Measurements and Main ResultsICG fluorescence was visible at the vaginal cuff in all participants. Mean time to appearance of ICG in the pelvis after administration was 19.8 ± 6.8 seconds (mean ± SD) preclosure, and 26.0 ± 22.2 seconds postclosure. With ultrasonic energy 67.5% ± 17.4% of open cuff perimeter and 74.4% ± 20.5% of closed cuff length were adequately perfused, whereas with monopolar energy use 59.1% ± 17.4% of the open cuff perimeter and 66.3% ± 15.4% of closed cuff length were adequately perfused. Cuffs closed with barbed suture showed adequate perfusion along 71.5% ± 15.1% of the length, whereas those closed with nonbarbed suture showed 68.9% ± 20.9% adequate perfusion. When normalized to cervical cup circumference, ultrasonic energy required 1.0 ± .2 s/mm, whereas monopolar energy required .8 ± .3 s/mm (p = .162). Linear regression showed no association of normalized time of energy activation to percentage of perimeter of open cuff (R2 = .007) or length of closed cuff (R2 = .005) with adequate perfusion. No complications related to intravenous ICG administration occurred. ConclusionLaser angiography with ICG allows evaluation of vascular perfusion at the vaginal cuff during TLH. This technique may facilitate future prospective studies examining causes for vaginal cuff dehiscence, a complication with potential for severe morbidity.

Clinical Issues—January 2016

This MonthUse of count boardsKey words: count, retained surgical item, RSI, count board, whiteboard, dry erase board.Subtracting items from the countKey words: count, retained surgical item, RSI, subtract, remove.Counting miscellaneous items for gynecological proceduresKey words: count, retained surgical item, RSI, bulb syringe, cervical cup, vagina.RN first assistants (RNFAs) performing initial countKey words: count, retained surgical item, RSI, RNFA, first assistant.

Management of neck metastases of unknown primary origin united in two European centers

Combined analysis of diagnostic and therapeutic management of neck metastases of carcinoma of unknown primary origin ('true CUP') in two European tertiary referral centers (University Medical Centers of Maastricht, NL and Cologne, D) to contribute to the ongoing discussion on management in CUP. Retrospective analysis of 29 (Maastricht) and 22 (Cologne) true cervical CUP syndrome patients (squamous cell carcinoma). The diagnostic and therapeutic approaches were correlated with clinical follow-up data and HPV status. In total, 48 out of 51 true CUP patients received postsurgical adjuvant radiotherapy. In eight patients from Cologne, this was combined with concomitant platin-based chemotherapy. Neither in Cologne nor in Maastricht, radiotherapy of the pharyngeal mucosa was commonly performed (n = 6, 12.5 %) The percentage of patients who were irradiated ipsilaterally or bilaterally did not differ between both institutes (N = 21/27 in Maastricht vs. 11/21 in Cologne), nor did the 5-year overall survival differ significantly. Oncogenic HPV was only found in 4 out of 51 CUPs (7, 8 %). Therefore, no relation with overall and recurrence-free survival could be detected. No occult primary tumors were revealed during follow-up despite de-escalation of therapy by abandoning irradiation of the pharyngeal mucosa in both institutes. There were no significant differences between ipsilateral and bilaterally irradiated patients regarding overall and recurrence-free survival. The occurrence of distant metastases was more often noticed in ipsilaterally treated patients as compared to bilaterally radiated patients (8 vs. 2, p = 0.099). Those patients all had been classified N2b or higher. International guidelines still are not unified and there is an urgent need for a consented therapeutic regimen. Comparison of two international strategies on the management of CUP patients is presented and further research is recommended regarding the role of radiotherapy of the pharyngeal axis, the value of unilateral and bilateral radiotherapy and the role of concomitant or induction chemotherapy in CUP patients, particularly in N2b or higher-staged neck disease. The prevalence and role of HPV in true CUP after thorough diagnostic work-up seem limited in our case series, particularly when compared to the role in oropharyngeal carcinomas.

Comparison of three cannulas for hysterosalpingography: a prospective, randomized study

OBJECTIVE: To compare three commonly used hysterosalpingogram (HSG) injection devices, the acorn cannula, the balloon catheter, and the cervical cup vacuum cannula, on the patient pain scores during and after HSG, HSG image quality, amount of contrast used, and total fluoroscopic and procedure time. DESIGN: Prospective, randomized study. MATERIALS AND METHODS: HSGs were performed by 4 reproductive endocrinologists (REs). A sample size of 100 was calculated to have 81% power to detect a 20% difference in visual analog scores (VAS), to measure pain perception. Cannula type was assigned by stratified blocked randomization. VAS, amount of contrast used, procedure and fluoroscopic time and HSG image quality scores were analyzed using Kruskall-Wallis, ANOVA and Fishers exact tests. RESULTS: 114 patients were enrolled. 90 patients were included in analysis with 32 patients in the acorn cannula group, 31 in the balloon catheter group, and 27 in the cervical cup vacuum cannula group. Median VAS, fluoroscopic time and amount of contrast used were not statistically significant between the groups. Median procedure time was statistically significant (p=0.0413). Median time for the acorn cannula was 2 minutes, while median time the balloon catheter & vacuum cup groups were 3 minutes. Modeled separately RE (p=0.0155) and cannula type (p=0.0421) were significant predictors of image quality score. Modeled together, RE remained significant (p=0.019) but cannula type was not (p=0.053). ANOVA analysis of the image quality score excluding of total number of images taken showed no difference in RE (p=0.217). CONCLUSION: There was no difference between the groups in pain scores, fluoroscopic time, and contrast used. There is a statistical difference between HSG catheters in procedural time with the acorn cannula requiring the shortest time. Image quality did not vary between technical operators or cannula type, but depended more on the number of images obtained at the time of the HSG.

Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site

Treatment methods for patients with cervical cancer of an unknown primary site (CUP) are still under discussion. The purpose of this retrospective study was to analyze the oncological follow-up of 58 patients treated for cervical CUP. From 1986 to 2006, 58 patients with cervical CUP were treated at the authors' institution. Treatment consisted of neck dissection alone in 8, irradiation or chemoradiation in 5, combined surgery and radiotherapy in 28, and surgery and radiochemotherapy in 17. The 3-year and 5-year overall survival rates for all patients were 52.9% and 40.9%, respectively. The 3-year and 5-year disease-specific survival rates were 50.9% and 39.7%, respectively. The 3-year and 5-year neck control rates were 73.7% and 67.3%, respectively. Neck dissection followed by radiochemotherapy was associated with the best 3-year and 5-year locoregional control rates. Extracapsular extension was a predictor of survival, but not of neck control. Distant metastases developed in about one third of all patients and were the most frequent cause of tumor-related death in cases of advanced neck disease. Despite the fact that regional control can be achieved in many cases, survival rates may be limited by distant metastasis, especially in patients with advanced neck disease.

Balloon catheter vs. cervical vacuum cup for hysterosalpingography: a prospective, randomized, single-blinded study

To compare the use of a balloon catheter device with the use of a cervical vacuum cup device in performing hysterosalpingography (HSG). Prospective, randomized, single-blinded study. Tertiary infertility center. Two hundred twenty-nine infertile women undergoing HSG. Subjects were randomized to undergo HSG using a cervical vacuum cup (n = 115) or a balloon catheter (n = 114). Randomization was performed according to Consolidated Standard of Reporting Trials (CONSORT) guidelines. The degree of pain experienced during and after the HSG, evaluated using a 100-mm visual analogue scale. The length of the procedure, the fluoroscopic time, the volume of contrast used, the difficulty of performing HSG, and the percentage of complications were also evaluated. Women in the cervical-cup group experienced more pain than those in the balloon catheter group during the contrast injection (median visual analogue scale pain scores, 13.0 vs. 6.5). The placement of the balloon catheter in comparison with the cervical cup was slightly easier to perform, although it required a somewhat longer time. The HSG using the cervical cup required less fluoroscopic time (median, 0.6 vs. 0.8 min). The balloon catheter appears to be better tolerated than the cervical cup, but the difference is minimal. The use of the cervical cup allows shortening of the patient radiation exposure.

Lidocaine–Prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study

The aim of our study is to evaluate the efficacy of applying lidocaine 25 mg-prilocaine-25 mg/G cream (EMLA 5%) on the uterine cervix for pain relief when performing hysterosalpingography (HSG). Eighty-two patients undergoing HSG as part of infertility evaluation were randomized into groups receiving EMLA (42) or placebo cream (40) in a double-blinded prospective study from which four women were later excluded. The cream was applied to the uterine cervix by means of a cervical cup 30 min before the HSG. Pain perception related to the HSG procedure was scored by visual analogue scale (VAS) at five predefined steps: after speculum application, after cervical instrumentation of the tenaculum and cannula, at the end of uterine filling, at completion of tubal spillage, and immediately following instrument removal. In addition, the patients were asked to retrospectively rate the pain during the entire procedure in a telephone interview the following day. Cervical instrumentation was found to be the most painful step of HSG (P < 0.001). When comparing the VAS pain scores, cervical instrumentation in the EMLA-treated patients was associated with significantly less pain than the control group: 3.3 +/- 2.9 versus 4.9 +/- 2.7, respectively (P = 0.02). Topical application of EMLA 5% cream on the uterine cervix before performing HSG significantly reduced the pain during this procedure.

Pain Relief of Hysterosalpingography by Prior Uterine Cervical Application of Lidocaine/Prilocaine Cream

Hysterosalpingography (HSG) is commonly a painful procedure. We sought to evaluate whether application of the local anesthetic lidocaine 25 mg, prilocaine 25 mg/G cream (EMLA® 5%) on the uterine cervix before performing HSG, relieves the pain associated with this procedure. A prospective cohort study to compare the perception of pain during HSG with no analgesia to the perception of pain following pre-operative application of EMLA® 5% to the uterine cervix. During a 1 yr study-period, 79 consecutive patients underwent HSG as part of infertility investigation. All patients were evaluated for the pain related to the procedure by a zero[=no pain] to ten[=worst pain imaginable] visual analogue scale (VAS). Pain was scored at five predefined steps: speculum application as baseline, at the cervical instrumentation by the tenaculum/canula, at the end of uterine filling, at the end of tubal spillage, and immediately following removal of instruments. In addition, on the next day, the patient was asked to score retrospectively the pain of the entire HSG procedure. The pain scoring method was designed by a ratio to the pain associated with that perceived during speculum application. In the first study period, 38 women underwent HSG without any analgesic treatment (control group). In the following period, 41 women were treated by topical application of 3 mL of EMLA® 5% cream on the uterine cervix using a cervical cup, 30 min before performing the HSG. The student’s t test was used to compare the pain scores at each step in the untreated-control group and the EMLA®-treated group, a P<0.05 was considered statistically significant. There was no difference in the baseline speculum application-pain in both study’s groups. Initial analysis of the procedure pain, enables us to define only two significant steps: 1.cervical instrumentation. 2.The following steps of HSG performance (uterine filling, tubal spillage and instruments removal). The cervical instrumentation was found to be more painful then the following steps, in both study groups (P<0.001). At this step the EMLA®-treated patients reported significantly less pain then the control group: 1.9 and 2.7 times the baseline pain, respectively (P=0.01). The score given retrospectively by the patient on the day after the HSG, correlated with the less painful step in the EMLA®-treated group (r=0.8, P=0.01) while in the untreated-control group it correlated with the more painful step (r=0.8, P=0.01). Topical application of EMLA® 5% cream on the cervix before HSG performance significantly reduces the pain associated with this procedure.

Diagnosis and management of carcinoma of unknown primary in the head and neck.

Carcinoma of unknown primary is defined as the histological diagnosis of metastasis without the detection of a primary tumor. In the literature, the incidence of CUP in all patients with a malignant disease is said to be between 3% and 15%. The most frequent histopathological results of CUP metastases are adenocarcinoma, followed by undifferentiated carcinoma and squamous cell carcinoma. In this retrospective investigation the clinical records of 167 patients were studied. All patients had been admitted and treated for cervical CUP at the Department of Otorhinolaryngology of the Grosshadern Clinic from 1979 to 1998. Cervical swelling was the first noted symptom in all cases, followed by pain and dysphagia. The study group comprised 134 men and 33 women with an average age of 55 years at admission. Squamous cell carcinoma (n=123) was the predominant histopathological finding of the cervical lymph nodes. During the 10-year follow-up, a primary tumor was detected in 36 (21.5%) of the 167 initially diagnosed CUP patients. In over 90% of these cases the tumor was localized in the head and neck region. The most frequent origin of the tumor was the tonsilla palatina (n=7). Neck dissection and additional postoperative radiotherapy was performed in 118 (70.7%) of the 167 CUP patients. Primary radiotherapy was the treatment of choice in 28 patients; eight patients received combined radio-chemotherapy as the primary treatment and seven patients were treated with chemotherapy alone. Six patients had no treatment. Comparison of different treatment protocols revealed a significant difference in patient survival: in comparison with primary radiotherapy alone or neck dissection and postoperative radiotherapy, the survival rate improved significantly in patients that received a bilateral tonsillectomy in addition to neck dissection and postoperative radiotherapy. The treatment of choice in patients with cervical CUP should be a surgical procedure including (radical) neck dissection and diagnostic bilateral tonsillectomy followed by postoperative radiation of the cervical lymph drainage. Bilateral tonsillectomy is especially important and is correlated with a significant improvement of the survival rate in CUP patients. Additional postoperative radiation of the entire pharyngeal and laryngeal mucosa should also be considered in order to treat a possible small primary tumor in this region.

Prospective assessment of early fetal loss using an immunoenzymometric screening assay for detection of urinary human chorionic gonadotropin

To develop an economical, nonradiometric immunoenzymometric assay (IEMA) for the detection of urinary human chorionic gonadotropin (hCG) in studies of early fetal loss. To be effective, the IEMA must have a sensitivity equal to the standard immunoradiometric assay (IRMA) and sufficient specificity to eliminate the need for screening most nonconceptive cycles with the expensive and labor-intensive IRMA. Two different assays were used to measure hCG in daily early morning urine samples from potential conceptive cycles. Women undergoing donor artificial insemination (AI) were evaluated in a prospective study. Ninety-two women volunteers were selected on the basis of apparent normal reproductive health. Artificial insemination with nonfrozen donor semen was performed by cervical cup twice each menstrual cycle at 48-hour intervals, and daily urine samples were self-collected throughout the menstrual cycle. An IEMA was developed to detect urinary hCG using the same antibodies as in the standard IRMA; a study was designed to determine whether this nonradiometric assay could successfully detect the early fetal loss that was detected by the IRMA. Of 224 menstrual cycles analyzed by both assays, a total of six early fetal losses were detected by the IRMA. When the tentative screening rule was set to allow all six of these losses and 95% of future losses to be detected by the IEMA, an additional 34 false-positive results were detected by the IEMA. The specificity of the IEMA with this rule was calculated to be 84%. An IEMA based on the same antibodies used for the standard IRMA can serve as an efficient screening assay for the detection of early fetal loss. When the IEMA is used in this manner, nearly 80% of screened menstrual cycles can be eliminated without further testing by the IRMA.

Pregnancy following use of the cervical cup for home artificial insemination utilizing homologous semen

Sixty-one couples with infertility from 1 to 11 years were instructed in the use of the cervical cup for artificial insemination using homologous semen in the privacy of their own homes. There have been 36 reported pregnancies in 32 of these couples. Among women with primary infertility, the pregnancy rate was 43%; it was 67% for those with secondary infertility and 53% overall. Sperm counts and percent motility, as well as postcoital test results, however, failed to be indicative of eventual ability to conceive. Regardless, among couples with documented infertility, this method provided over half of the couples with at least one pregnancy. Additionally, the technique is simple, inexpensive, without significant risk or discomfort, and can be carried out by a couple at their convenience and in privacy.

The interaction of human spermatozoa with cervical mucus in vivo

The interaction between human spermatozoa and cervical mucus was studied during 14 cycles of artificial insemination (AI) with a cervical cup. The concentration of spermatozoa in the inseminate was determined as were the percentage of motility, mean swimming speed, and sperm morphology. The percentage of motility, swimming speed, and morphology of spermatozoa in the mucus were determined at 1 hour and 48 hours after AI. The percentage of motile sperm was always higher in the cervical mucus than in the semen. In some cases, spermatozoa appeared to swim faster in the mucus than in the semen but in other cases the reverse was true. In all 14 cases some spermatozoa could be found in the mucus at 48 hours after AI. In general, the percentage of motility and swimming speeds of the cervical sperm remained unchanged over the 48-hour study interval. The percentage of spermatozoa with normal morphology was higher in the cervical mucus than in the semen. This alteration in the composition of the sperm population appeared to result from exclusion by the mucus of most classes of abnormal sperm. The morphology of the cervical sperm population was similar at 1 hour and at 48 hours after AI.

Geburtseinleitung durch lokale Prostaglandin-Applikation mittels Portio-Kappe

A total of 40 patients was treated with 1.25 mg PGE2 placed in a cup which was applied to the vaginal portion of the cervix. There were 22 patients who went into labor and in 11 patients the cervix was ripened sufficiently to allow successful induction by amniotomy on the next day. Three patients were delivered by Caesarean section, late decelerations of the fetal heart rate being the main indication in one of them. In four patients the cervical cup had to be applied more than once. No side effects were observed.