Cumulative Birth Research Articles

A hierarchical Bayesian birth cohort analysis from incomplete registry data: evaluating the trends in the age of onset of insulin‐dependent diabetes mellitus (T1DM)

Childhood diabetes is one of the major non-communicable diseases in children under 15 years of age. It requires a life-long insulin treatment and may lead to serious complications. Along with the worldwide increase in the incidence several countries have recently reported a decreasing trend in the age of onset of the disease. The aim of this study is to analyse long-term data on the incidence of the childhood diabetes in Finland from the birth cohorts perspective. The annual incidence data were available for the period 1965--1996 which translates into 1951--1996 birth cohorts. Hence the data consist of completely and partially observed cohorts. Bayesian modelling was employed in the analysis. Several different priors and cohort combinations were tried in order to determine the sensitivity of the results. The cumulative birth cohort incidence of diabetes was determined to have an increasing average annual trend of 2.5 per cent. Although the average birth cohort-specific age of onset was estimated to have decreased slightly over the years of observation, the trend could be a result of random variation.

Perimenopausal conception.

Fertility, defined as the ability to achieve a pregnancy, declines gradually over the woman's lifespan. Although this decline seems to begin from the age of 30 years, it is more obvious between 35 and 40 and increases dramatically thereafter. The age of 41 is considered to be the point when fertility stops and sterility starts. The actual menopause occurs approximately 10 years after the substantial loss of conception potential. Thus, the biological rather than the chronological age of the woman can predict more accurately her fertility potential. This decline in female reproductive potential correlates with ovarian factors, although a slight contribution from the uterus itself and from the neuroendocrine axis cannot be excluded. The ovarian reserve decreases with advancing age, while a parallel decrease in the quality of the oocytes is present, as indicated by the increased incidence of oocyte aneuploidy. The endocrine function of the ovary also declines with age, the later becoming unable to sustain its normal function in the neuroendocrine axis. Additionally, the role of the various endometrial factors remains controversial. On the other hand, exposure to toxic factors and the increased prevalence of infertility-related diseases like endometriosis and PID, may also contribute. Spontaneous conception rates are minimal in perimenopausal women, mainly due to a qualitative and quantitative loss of female gametes. In the rare case of spontaneous conception achievement, complications are more likely. The application of classic ovulation induction and IVF may serve some selected cases, where the woman's ovarian biological age does not correspond to her chronological one. However, the implantation, clinical pregnancy, and live birth rates in women of advanced age undergoing IVF treatment, show very poor results. On the other hand, preimplantation genetic diagnosis is an accurate diagnostic tool for exclusion of genetically deficient embryos prior to embryo transfer. Oocyte donation seems to be the most reliable option of the perimenopausal woman, since the cumulative birth rates after four treatment cycles is approximately 80%. Cryopreservation of ovarian tissue may be an alternative in nulliparas women <40 years of age who want to have children in the future or women with the same desire who, unfortunately, have had pelvic radiotherapy, chemotherapy, oophorectomy, or premature menopause. This technique has given encouraging results in animals, but has not achieved pregnancies in humans. In the future, the use of drugs to block oocyte depletion as well as recent techniques, such as cytoplasmic or germinal vesicle transfer, will be more widely tested and may offer an option to the perimenopausal woman who wishes to conceive.

The impact of isolated teratozoospermia on the cumulative life birth rate in IUI

Objective: No data are available on the effect of isolated teratospermia on the cumulative live birth rate (CLBR) in intrauterine insemination (IUI). This study tests the hypothesis that IUI treatment in cases with isolated teratozoospermia results in a lower CLBR compared to cases with normozoospermia.

Experience with Allogeneic Leukocyte Immunization (Ai) for Implantation Failure in the In‐Vitro Fertilization Program

Immunological mechanisms might contribute to the repeated implantation failure in the in‐vitro fertilization program. AI might be a valuable therapeutic option in this situation. Here we summarize our extensive experience with this immunotherapy. We conducted a retrospective analysis of all couples who were referred to our outpatients department from 1996 to 1998 for AI after two or more embryo transfers (ET). Six hundred and eighty‐six couples (89%) continued IVF/ICSI and were followed up for 2–3 years. On average patients entered AI after 3–4 IVF–ET at an age of 33 years and completed IVF/ICSI treatment after another 2 ET; 2.6 embryos per ET were transferred according to the German embryo protection law. The cumulative birth rate war 38% after IVF transfer and 42% when spontaneous pregnancies were included. Until the age of 36 years the rates of viable pregnancies and birth were improved by a quarter in the first 6 months as compared to the second half year (33.3% versus 26.3%, 26.0% versus 19.6%) and to the German IVF Registry of 1998. Couples who had undergone more than three ET before AI seemed to benefit most. Our data suggest that AI is a valuable adjuvant therapy with a temporary effect when 3–4 IVF/ICSI transfers have been unsuccessful. The underlying immunomodulatory mechanisms require further investigation.

Effect of Allogeneic Leukocyte Immunization on Consecutive IVF/ICSI-Treatment for Failure in the In-Vitro-Fertilization Program

Bei wiederholtem Implantationsversagen im IVF/ICSI-Programm liegen möglicherweise immunologische Ursachen zugrunde. In ausgewählten Fällen besteht hier ein therapeutischer Ansatz in der aktiven Immunisierung (AI) der Frau mit Lymphozyten des Partners. In der vorliegenden Arbeit werden unsere umfangreichen Erfahrungen mit dieser Methode zusammengefasst.

Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles.

To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI-D). Retrospective study of all patients undergoing IUI-D between August 1st, 1990 and July 31st, 1998. University-affiliated infertility clinic. Three hundred and five couples undergoing 1131 IUI-D treatment cycles. Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3%, with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI-D: i) the first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles - more than one - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies when more than 3 mature follicles were present; iii) time of insemination after the 12th day in the cycle; iv) insemination after ovulation has occurred and; v) female age under 30 years. IUI-D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cycle day (cd) 12 with at least two million motile spermatozoa.

Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles

Objective. To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI-D). Design. Retrospective study of all patients undergoing IUI-D between August 1st, 1990 and July 31st, 1998. Setting. University-affiliated infertility clinic. Patients. Three hundred and five couples undergoing 1131 IUI-D treatment cycles. Main outcome measures. Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. Results. Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3%, with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI-D: i) the first treatment cycle– compared to the following up to six treatment cycles; ii) number of mature follicles– more than one – at the time of insemination, however, with an unacceptable high rate of multiple pregnancies when more than 3 mature follicles were present; iii) time of insemination after the 12th day in the cycle; iv) insemination after ovulation has occurred and; v) female age under 30 years. Conclusions. IUI-D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cycle day (cd) 12 with at least two million motile spermatozoa.

Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles.

To identify prognostic factors influencing the outcome of infertility treatment using homologous intrauterine inseminations (IUI-H). Retrospective study of all patients undergoing IUI-H at the Fertility Clinic, Odense University Hospital from August 1st, 1990 to July 31st, 1998. University-affiliated infertility clinic. Eight hundred and ninety-three couples undergoing 2473 IUI-H treatment cycles. Infertility diagnosis, female age, number of follicles, type of hormonal treatment, length of follicular phase, endometrial pattern, and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. Throughout the nine year period the overall clinical pregnancy rate per IUI-H cycle was 11.9% with a significant increase from 8.7% in 1990 to 14.8% in 1998. The multiple birth rate was 18.1%. The birth rate per couple was 27.2% after a mean of 2.8 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the fourth treatment cycle. Of the main outcome measures the following were positively and significantly related to a successful outcome of IUI: i) The first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles up to five - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies with more than 4 mature follicles; iii) use of CC/hMG-FSH as compared to CC only for ovarian stimulation; iv) number of motile sperms inseminated exceeding 5 million; v) time of insemination between the 13th and the 16th day in the cycle and vi) anovulatory or idiopathic infertility. IUI-H is a simple and inexpensive treatment giving acceptable pregnancy rates for up to four treatment cycles providing that at least 3 to 4 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, that insemination occurs between cycle day 13 and 16 and that at least 5 million motile sperms are available for insemination. Our results indicate that in the presence of tubal pathology or less than 5 million motile sperms, the couples should be referred directly to IVF-treatment.

Comparison of active phase labor between triplet, twin, and singleton gestations

To characterize the active phase of labor in triplet pregnancies and compare it with gestational age-matched twins and singletons. Active phase rates were calculated beginning at 5 cm of dilation for women with triplet gestations longer than 24 weeks who labored and reached the second stage. Twin and singleton cohorts that also completed the first stage of labor were matched for gestational age at delivery (+/-1 week), parity, and epidural use. Intrapartum variables included oxytocin use (induction or augmentation, duration of infusion, and maximum dosage), cervical dilation at membrane rupture, and active phase dilation rate. Thirty-two triplet pregnancies met inclusion criteria between January 1994 and September 1998 and were each compared with twin and singleton cases in a 1:2 ratio. Triplet and twin active phase rates, while similar (1.8 versus 1.7 cm/hour, respectively), were significantly lower than the mean singleton dilation rate (2.3 cm/hour, P =.02). No other intrapartum variables differed between the three groups. Despite controlling for gestational age at delivery, mean birth weights were significantly higher in singletons and correspondingly lower in twins and triplets (2,493 versus 2,112 and 1,968 g, respectively; P =.001). An analysis of active phase dilation rates as a function of the cumulative birth weight per pregnancy demonstrated an inverse correlation, with slower progress in active labor associated with increasing total fetal weight (R = -.24; P =.002). Triplet and twin active phase dilation proceeds at a slower rate than that observed in singleton pregnancies. The rate of active phase dilation is inversely correlated to total fetal weight.

The effect of opioid antagonism and environmental restriction on plasma oxytocin and vasopressin concentrations in parturient gilts.

Oxytocin plays an important role at parturition due to its involvement in uterine contractions, foetal expulsion and the onset of maternal behaviour. The role of the related neurohypophysial hormone, vasopressin, is less clear; however, there is some evidence that it is also involved in maternal behaviour and its role in osmotic regulation is well established. The aim of this study was to investigate the inhibitory effects of endogenous opioids on these hormones during the expulsive phase of parturition in the pig, and to examine how opioid restraint interacts with environmental restriction. The subjects of this study were 31 Large Whitex Landrace primiparous sows (gilts). An indwelling jugular catheter was implanted under general anaesthesia at 12 days before the expected parturition day (EPD). From 5 days before the EPD 15 of the gilts were individually housed in a restrictive parturition crate without straw and 16 were individually housed in a straw-bedded pen. Blood samples were taken with increasing frequency towards and during parturition through a catheter extension to reduce disturbance. At 7.5 min after the birth of the first piglet half of the gilts in each environment received a dose of the opioid receptor antagonist naloxone (1 mg/kg, i.v.) with the remaining gilts receiving saline as a control. Overall, there was no effect of environment on either circulating oxytocin or vasopressin. However, both oxytocin and vasopressin were inhibited by endogenous opioids during the expulsive phase. The inhibitory effects of opioids on these hormones did not appear to have any adverse effects on the progress of parturition as judged by cumulative piglet birth intervals. The regulation of the opioid inhibition of oxytocin and vasopressin during parturition is discussed in relation to other neurotransmitters and whether opioid inhibition of these neurohypophysial hormones is part of the 'normal' physiological response to parturition or whether it is stress-induced.

Neuromuscular disorders in childhood: a descriptive epidemiological study from western Sweden.

A retrospective epidemiological study of neuromuscular disorders was carried out in children born between 1979 and 1994 in western Sweden. The purpose was to determine overall and specific prevalences, overall cumulative incidence and birth incidences of selected disorders. Cases were ascertained from 12 different sources and medical records, investigations and diagnosis were reviewed. We found a point prevalence in the population < 16 years of age of 63.1 x 10(-5) for all neuromuscular disorders and 53.1 x 10(-5) for inherited neuromuscular disorders. The point prevalence in children of school age was even higher. We found a higher occurrence of hereditary motor and sensory neuropathy, congenital myopathies and mitochondrial encephalo-myopathy, a slightly lower occurrence of Duchenne muscular dystrophy and spinal muscular atrophy and equal occurrence of myotonic dystrophy compared to previous studies in other countries. We conclude that neuromuscular disorders are more common in childhood than has previously been reported.

Plant, soil fauna and microbial responses to N-rich organic patches of contrasting temporal availability

A simple ( L-lysine) 15 N/ 13 C dual-labelled organic patch was added to soil microcosm units with or without Lolium perenne L. plants either as a single addition of 5 ml of 200 mM L-lysine (‘patch’ treatment) or as a series of 1 ml aliquots of 200 mM L-lysine added at 7 day intervals over 28 days (‘pulse’ treatment) thus both treatments supplied the same amount of nitrogen (N). Controls were added as 1 ml H 2O over 28 days (control pulse treatment) or as a single addition of 5 ml H 2O (control patch treatment) to planted tubes. Decomposition of the added L-lysine was rapid as shown by amounts of 13 C detected in the soil atmosphere and were greatest from the planted L-lysine pulse treatment indicating the presence of plant roots was influencing decomposition of the pulse. Plant uptake of N, as 15 N , from the added L-lysine was also rapid and detected in the shoots by day 4. However, the mean rate at which 15 N appeared in the shoots did not differ between patch or pulse treatments. No 13 C levels greater than background were detected in the plant material. Root production and mortality in the patch or pulse addition zone was measured in situ using minirhizotron tubes. Cumulative root births in the L-lysine patch treatment were greater than controls in the latter part of the experiment while instantaneous root births were greater in the L-lysine pulse treatment compared to all others at 21 d. Root death rate was faster in the L-lysine treatments than in the controls. Root and shoot dry weights at final harvest (35 d) were greater in the pulse treatments. Shoot, but not root, dry weights were also significantly greater in the L-Lysine treatments compared to controls. Total root and shoot nitrogen contents were greater in the L-lysine treatments than controls. Total N capture by the L. perenne plants from the added L-lysine was 57% (patch) and 61% (pulse) of the N added and did not differ significantly between treatments. Protozoan biomass measured at harvest was greater in the L-lysine treatments (planted and unplanted) than the planted controls. The physiological profile of the microbial community did not vary because of patch or pulse treatments although significant differences between planted and unplanted L-lysine treatments and planted and H 2O controls occurred. The response of roots and microorganisms in relation to N capture is discussed.

The responsiveness of sows to their piglets in relation to the length of parturition and the involvement of endogenous opioids

The aim of this study was to describe maternal behaviour in the pig and to investigate the effect of endogenous opioids on maternal responsiveness. The behaviour of 16 Large White×Landrace female pigs was recorded around farrowing which involved recording the pig's posture and her response when piglets were present at her nose. To determine the role of endogenous opioids, sows were injected (i.m.) with either naloxone, an opioid antagonist, (1 mg kg −1 bodyweight ( n=8)) or saline ( n=8) at 3.75 h after the birth of the first piglet. Generally the initial period following the birth of the first piglet seemed to be the most active after which the sows spent almost all of the time in lateral recumbency. The results also show that farrowing sows are generally unresponsive to their piglets during farrowing. Sows receiving naloxone became more responsive towards their piglets. The changes seen in posture and responsiveness to piglets were delayed in sows with a longer parturition suggesting some involvement of cumulative piglet births on passivity. It is proposed that opioid-mediated passivity in the pig, characterised by lateral lying and unresponsiveness to piglets, may be advantageous by maximising suckling opportunities and reducing the risk of crushing piglets and of attracting predators to the nest.

Ovarian follicular dynamics: from basic science to clinical practice

The management of low responders (LR) to ovarian stimulation in cycles of assisted reproduction (AR) is a difficult challenge. Aging of the ovary and LR are coincidental in many situations, but LR is also present in young patients undergoing AR. In fact, today it is a recognized cause of infertility. When the aged ovary is considered, there is evidence that the functioning of the granulosa cells as well as the quality of the oocytes and resulting embryos are affected. Similarly, in young LR, the production of inhibin is affected. However, there is no evidence that the quality of the oocyte and/or the resulting embryo is affected. In this study, we have retrospectively analyzed our files and observed that the quality of the oocytes and embryos was similar between younger and older LR and normal responders (NR). Studies using color Doppler vaginal ultrasound have shown that the pulsatility index (PI) and the resistance index (RI) were increased in LR as compared with NR, suggesting that there was some degree of vascular resistance to flow. Treatment of LR is also a difficult challenge. Ovum donation is a successful treatment for LR, since cumulative birth rates are >85% with four attempts of embryo transfer. The future may be promising for LR once new technologies are introduced into clinical practice. The use of recombinant gonadotropins and genetically engineered human gonadotropin derivatives may be of considerable help for LR. Similarly, non-gonadotropin hormones, such as cytokines or growth factors, may be shown to play a role in the stimulation of the ovary in the near future, and may therefore open new frontiers for treatment of LR.

Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome.

The objective of this study was to ascertain if incomplete correction leaving a residual uterine septum of < or = 1 cm affects fertility outcome. Reproductive outcome in 17 women with a residual septum of between 0.5 cm and 1 cm after hysteroscopic metroplasty was compared to that in 51 women with no residual septum or one of < 0.5 cm. Septal lysis was performed with microscissors or resectoscope. One month after operative hysteroscopy, abdominal ultrasonography was performed on all the women and those with a residual septum of > 1 cm then underwent a second operative hysteroscopy to complete the lysis. The cumulative pregnancy and birth rates were calculated and the curves compared using the log-rank test. The cumulative 18 month probability of becoming pregnant was 44.5% in the patients with residual septum and 52.7% in those with no residual septum (not significantly different), and the cumulative 18 month probability of giving birth to a child was 27.5 and 36% respectively (also not significant). The presence of a residual uterine septum of between 0.5 and 1 cm as shown by ultrasonography appears not to worsen the reproductive prognosis compared with that in women in whom the septum has been completely or almost completely corrected.

Cumulative birth rates following cryopreservation of all embryos in stimulated in vitro fertilization (IVF) cycles.

To cryopreserve all good-quality embryos available after IVF is one way to avoid an impending hyperstimulation and a more attractive alternative to a couple than cancellation of the cycle. At Sahlgrenska University Hospital this method has been practiced since 1991. The aim of this study was to assess the success rate (defined as childbirth per couple) after IVF treatment including one stimulated cycle, resulting in cryopreservation of all good-quality embryos available, followed by replacement of frozen/thawed embryos in one or more natural cycles. A cohort of 32 women undergoing one stimulation for IVF between January 1991 and December 1993 where all good-quality embryos were cryopreserved and transferred in a later spontaneous cycle were studied retrospectively. The cumulative childbirth rate per couple was calculated. A total of 28 women underwent a total of 45 transfers with frozen-thawed embryos. In 4 women no transfer has taken place so far. The clinical pregnancy rate per embryo transfer was 33% (15/45) and per patient 54% (15/28). Three spontaneous abortions occurred giving a cumulative childbirth rate per patient of 39% (11/28). In addition, 6 out of the 28 women still have embryos left in the freezer. Cryopreservation of all good-quality embryos available after IVF is a highly effective alternative to cancellation of a cycle when there is impending hyperstimulation. The use of this approach results in a cumulative childbirth rate per couple of at least 39%. Since only one stimulation was performed, it also seems to be cost effective.

Infertility: The prognosis for assisted conception treatment after unexpected failure of fertilization in vitro: a comparative study

The relative prognosis for further assisted conception treatment (without micro-injection) after initial unexpected failure of fertilization in apparently favourable couples undergoing in-vitro fertilization (IVF) treatment was assessed. After their first cycle of treatment, 481 consecutive couples were grouped according to their fertilization (including cleavage) rate per oocyte into five bands. Proportions of couples proceeding to further cycles of treatment by IVF or gamete intra-Fallopian transfer (GIFT) and resulting fertilization and pregnancy rates were compared. Pregnancy rates in the first cycle of treatment were significantly related to fertilization rate. The fertilization rate was zero in 13 couples (3%) and only 1-24% in 18 (4%). There were no significant differences between these groups in the proportions proceeding to further treatment (31, 50%) compared with others (overall 37%, including some treated by GIFT), or in their median fertilization rates (75, 60% compared with 67%--IVF cycles only), pregnancy rates (20, 38% of cycles compared with 37%--IVF or GIFT) or birth rates (20, 38% of cycles compared with 31%--IVF or GIFT). Amongst couples whose initial fertilization rate was > or = 50% there was no fertilization in 4% of subsequent IVF cycles. We conclude that in couples with well defined favourable conditions, including tests of sperm function for assisted conception treatment, who have unexpected failure of fertilization, the prognosis for further treatment remains favourable without resort to more complex investigations or micro-injection methods. Such failure occurs infrequently and generally as a random event, and should have no appreciable effect on life-table calculation of cumulative pregnancy and birth rates in this group of patients.

Use of follicle-stimulating hormone alone (urofollitropin*) to stimulate the ovaries for assisted conception after pituitary desensitization

Analyse outcome of FSH therapy alone after pituitary desensitization for assisted conception to compare with published results of conventional hMG. Descriptive study of complete series of patients undergoing IVF-ET or GIFT treatment using the chosen drug protocol without exception. University private IVF-ET clinic within a comprehensive fertility service. All couples (n = 773), including 10% > or = 40 years old, treated by IVF-ET or GIFT (1,097 cycles started and 1,012 attempted egg recoveries) for mainly tubal pelvic infective damage (36% of cycles), endometriosis (16%), sperm disorders (14%) and prolonged unexplained infertility (34%) during 3 calendar years, 1990 to 1992. Ovarian stimulation using FSH alone (urofollitropin, Metrodin; Serono Laboratories Limited, Welwyn Garden City, United Kingdom) after pituitary desensitization using buserelin acetate nasal spray (Suprefact; Hoechst, Hounslow, United Kingdom) from the previous midluteal phase, monitored by ultrasonography and serum E2 measurements, followed by standard IVF-ET or GIFT treatment methods limited to the transfer of no more than three embryos or eggs. Rates per cycle started of cancellation of egg recovery, failure of egg recovery, clinical pregnancy (ultrasound detection of sac), livebirths, and cumulative pregnancy rates (PR) and birth rates. In women < 40 years old and men with favorable sperm (77% of couples and 84% of cycles) the cycle cancellation rate of egg recovery was 7%; attempted egg recovery was successful in every case. For IVF-ET the clinical PR per started cycle and the livebirth rate were 27% and 23%, respectively, and for GIFT 39% and 33%, respectively. The four-cycle cumulative PR by either treatment was 77% and livebirth rate 68%. In women > 40 years old, the cycle PR and birth rate were 14% and 8%, respectively. In cases of sperm disorder the rates in women < 40 years old were 17% and 14%, respectively, and > 40 years old were 18% and 0, respectively. By comparison with the best worldwide results of assisted conception employing pituitary desensitization, the findings demonstrate that FSH alone to stimulate the ovaries is fully effective and highly successful, and supplementation with LH is not needed.

Hysteroscopic metroplasty.

Between February 1990 and June 1993 40 patients underwent hysteroscopic metroplasty for septate uterus. Twenty-six patients had previous miscarriages (65%) and fourteen were infertile (35%). Hysteroscopic section of uterine septa was performed by means of Hamou resectoscope with sorbitol-mannitol solution as distending medium. Surgical outcome was excellent without intraoperative and postoperative morbidity. After 40-60 days the uterine cavity was completely epithelialized without intrauterine adhesions in all the cases. One patient had incomplete septum section that required a second procedure. Postoperative reproductive outcome was evaluated in 26 patients: the cumulative pregnancy and birth rate was 73% and 86%, respectively. Five patients delivered by cesarean section (39%). In the infertile group the pregnancy and birth rate was much lower (44% and 75%, respectively) than in previous miscarriage group (88% and 91%, respectively). Infertile patients do not seem to be cured by hysteroscopic metroplasty; however, in these cases the endoscopic operation should be performed, because it may prevent subsequent miscarriage. Hysteroscopic metroplasty by means of Hamou resectoscope is a very successful, quick, simple and safe procedure that may replace abdominal metroplasty.

Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis

To evaluate reproductive prognosis after hysteroscopic metroplasty. The cumulative proportions of women who became pregnant and gave birth, subdivided according to previous obstetric history, were calculated by the product limit method and compared using the log rank test. Outpatient infertility clinic of Milan University. One hundred two consecutive patients with complete (n = 23) or partial septate uterus (n = 79) referred because of infertility or repeated abortion. Hysteroscopic metroplasty performed by microscissors (n = 80), argon laser (n = 10), or electroresectoscope (n = 12). Postoperative cumulative pregnancy and birth rates. At 36 months the cumulative pregnancy and birth rates were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. Reproductive prognosis after hysteroscopic metroplasty was favorable and not influenced by the malformation subclass.