Cumulative Conception Rates Research Articles

The influence of semen analysis parameters on the fertility potential of infertile couples.

The objective of this study was to investigate the relationship between couples' fertility potential and several parameters of semen analysis (from a single semen sample/male partner) in a cohort of 1,055 infertile couples seen at the Texas Institute for Reproductive Medicine and Endocrinology for a total of 9,409 follow-up months. The medians of sperm concentrations (SC), total sperm counts (TSC), percent motility (MOT), motile sperm concentrations (MSC), and total motile sperm counts (TMSC) were significantly higher (P < 0.0001) in the group that achieved pregnancy. When the entire group was divided into "high" and "low" groups on the basis of the various parameters of semen analysis, the relative risk ratios for conception for the "high" groups were as follows: SC, 1.5; MOT, 8.5; TSC, 8.1; MSC, 5.8; and TMSC, 6.1. Life table analysis showed a statistically significant difference (P < 0.0001) in the initial rise and overall slope of the conception rates between the two groups for a number of the semen analysis parameters (TSC, MOT, MSC, and TMSC). This study showed that certain semen analysis parameters are positively correlated, with a high degree of statistical probability, with the time required for the occurrence of conception. The quantitative impact of the male fertility potential on conception rates was shown to correlate not solely with the SC or MOT values, but even more so with their derivatives (i.e., MSC and TMSC). Therefore, in an in vivo environment it is not only the number of sperm and their motility but also their derivatives that provide a quantitative insight into the male fertility potential. The data may provide a quantitative expression of the relative risk ratio for conception to occur and the time required until conception is achieved. Further studies will be necessary to clarify the effect of the other semen analysis parameters (i.e., morphology, velocity, linearity, and "efficient" MSC) on conception rates, cumulative conception rates, relative risk ratio for conception, and time until conception in a large population of infertile couples.

Abdominal myomectomy: results of a simple operative technique

To report a simple and safe procedure of abdominal myomectomy and our results performing this technique. The operative technique comprises the incision on the most prominent part of the myoma, the use of a hooked clamp to hold the tumor, and a surgical knife to peel it, without removing the apparent excess of myometrium or serosa. University Medical Centers and private practice. Eighty patients, 9 of whom were operated between 10 and 26 weeks of pregnancy, 3 during cesarean section, and 22 others who had infertility. Myomectomy was performed successfully in all patients for whom it was scheduled. Eight of nine pregnant patients had successful deliveries at term. The cumulative 10-year reoccurrence and reoperation rates of life-table analysis were 38% and 18%, respectively. The cumulative conception rates were 100% for otherwise unexplained infertility at 2 years, and 63% and 79% at 5 years for all infertile and all patients attempting conception after myomectomy, respectively. An age > 30 years, infertility > 3 years, and multiple fibroids negatively affected these rates, whereas the use of an absorbable adhesion barrier (Interceed; Johnson & Johnson AB, Somerville, NJ) had a positive effect. This procedure is an appropriate alternative for most women who want to preserve or enhance fertility potential, and if necessary, for pregnant women.

An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for infertility

We evaluated 81 women with adnexal adhesions and no male factor who underwent microsurgical (n = 59) and laparoscopic (n = 22) adhesiolysis for infertility. The cumulative conception rates for all 81 patients at 12 and 24 months were 41 and 44% respectively. The impact of the following variables on cumulative conception rates for all patients was examined: age, duration of infertility, type of infertility, ovulatory status, presence and stage of endometriosis, adhesion grade, adnexal status (bilateral or unilateral disease, unilateral tubal absence), history of previous surgery, history of pelvic inflammatory disease and treatment modality (microsurgical versus laparoscopic). The results of independent comparisons of subgroups within each of these variables may be biased because of the interrelationships between the variables. To overcome this problem, a stepwise Cox's proportional hazards regression analysis was employed. Our analysis showed that the single most significant variable influencing the cumulative conception rates was the duration of infertility (P < 0.005). For every additional year of infertility, the probability of pregnancy after adhesiolysis (microsurgical or laparoscopic) was reduced by approximately 20%. Cumulative conception rates at 12 and 24 months after microsurgical adhesiolysis were 36 and 40% respectively, while after laparoscopic adhesiolysis they were 57% at 12 and 24 months. When imbalances were adjusted between the two treatment groups, there was no statistically significant difference between the cumulative conception rates for microsurgical and laparoscopic adhesiolysis.

A controlled assessment of the in vitro fertilization performance of British women of Indian origin compared with white women

To compare the reproductive performance of Indian versus white women in IVF. Controlled comparative clinical study. In vitro fertilization center based in university department in large tertiary level hospital. Results from first IVF treatment cycles in 44 Indian patients were compared with results from 88 white patients, matched by age and body mass index, over the same treatment year. The patients were selected from a prospectively collected IVF databank. Standard luteal-phase start long GnRH analogue regime. Ovarian stimulation with FSH and hMG. Transvaginal ultrasound-guided oocyte recovery. In vitro fertilization and ET following established protocols. Rates of abandoned cycles, egg retrievals, ETs, clinical pregnancies, miscarriages, and live births were compared in the first IVF treatment cycle. Cumulative pregnancy rates (PRs) over three cycles in the two groups of patients were also compared. More cycles were abandoned in the Indian than in the white group: 22.7% versus 9.1%. The Indian live birth rate per cycle was worse: 9.1% versus 22.7%. The performance of the two groups was otherwise similar: ovarian stimulation with hMG and FSH required 26.0 required 26.0 ampules in the Indian group versus 24.6 ampules in the white group, mean number of follicles on the day of egg retrieval 8.7 versus 8.7, mean number of eggs 5.9 versus 5.8, fertilization rate 82.4% versus 82.5%; ET rate 73.5% versus 82.5, mean number of embryos transferred 2.1 versus 1.8, and clinical PR per cycle started 18.2% versus 27.3%. Under the same IVF regime, Indians performed worse than whites at the stage of ovarian stimulation (higher rate of abandoned cycles for poor response) and in live birth rate. Cumulative conception and live birth rates also tended to be worse in Indians than in whites.

Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin: Tan S.-L.; Maconochie N.; Doyle P.; Campbell S.; Balen A.; Bekir J.; Brinsden P.; Edwards R.G.; Jacobs H.S. GBR Am J Obstet Gynecol 1994 171/2 (513–520)

International Journal of Gynecology & ObstetricsVolume 49, Issue 2 p. 226-226 Citations from the literature fertility and sterility Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin Tan S.-L.; Maconochie N.; Doyle P.; Campbell S.; Balen A.; Bekir J.; Brinsden P.; Edwards R.G.; Jacobs H.S. GBR Am J Obstet Gynecol 1994 171/2 (513–520) First published: May 1995 https://doi.org/10.1016/0020-7292(95)90980-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume49, Issue2May 1995Pages 226-226 RelatedInformation

Prognosis for Successful Outcome with In Vitro Fertilization Treatment

In vitro fertilization and embryo transfer (IVF-ET) are well established treatments that have helped a large number of infertile women to conceive and have resulted in the birth of thousands of normal, healthy babies. Many couples nowadays have several IVF treatment cycles and it is important that they are provided with an accurate assessment of the probability of ultimate success. This paper reviews several prognostic factors which affect the cumulative conception and livebirth rates after IVF. These include the age of the patient, the cause of infertility, the type of ovarian stimulation regimen used, and the effect of a previous successful IVF treatment on the results of a second course of treatment. Finally, since the ultimate objective of patients undergoing infertility treatment is to have a healthy, normal baby, the obstetric outcome of IVF pregnancies is compared with that of naturally conceived pregnancies.

Return of fertility following discontinuation of norplant R-II subdermal implants : ICMR task force on hormonal contraception

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal liver births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and “other reasons,” opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion. There was no association between the pregnancy rates and either duration of Norplant-II implants use or bleeding patterns during the three months prior to discontinuation of the method in this sample. However, there was a delay in return of fertility in women aged more than 30 years as compared to those who were below the age of 30 years. The study indicates that the return of fertility was not impaired in ex-Norplant-II implant users who were planning pregnancy. In addition, those women who continued with the pregnancy until term delivered full-term normal babies in all the study groups.

A comparative prospective study of conventional regimen with chronic low-dose administration of follicle-stimulating hormone for anovulation associated with polycystic ovary syndrome

To compare efficiency of conventional and chronic low-dose regimens for treatment of anovulation associated with polycystic ovary syndrome (PCOS). Fifty participants divided into two equal groups. The first group was treated with urinary human FSH using a conventional stepwise protocol and the second group was treated with a regimen of chronic low-dose and small incremental rises with urinary human FSH or with recombinant human FSH for a maximum of three cycles. Tertiary referral university hospital fertility unit. Fifty infertile women with clomiphene citrate-resistant anovulation associated with PCOS. Pattern of follicular development, amount of FSH required, serum E2 concentrations, cycle fecundity, cumulative conception, and live birth rates. Multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) rates. Compared with the conventional dose protocol, the chronic low-dose regimen yielded slightly improved pregnancy rates (40% versus 24%) while completely avoiding OHSS and multiple pregnancies, which were prevalent (11% and 33%, respectively) with conventional therapy. Monofollicular development was induced in 74% versus 27% of cycles, and the total number of follicles > 16 mm and E2 concentrations were half those observed on conventional therapy. For women with PCOS, a chronic low-dose regimen of FSH eliminated complications of OHSS and multiple pregnancies while maintaining a satisfactory pregnancy rate. This modality, thus, has distinct advantages and could well replace conventional gonadotropin therapy for these patients.

Cumulative conception and live birth rates after the treatment of anovulatory infertility: safety and efficacy of ovulation induction in 200 patients

An analysis was performed on the cumulative conception rates, cumulative live birth rates and adverse effects of ovulation induction in patients with anovulatory infertility attending a single unit over an 11-year period. A total of 200 patients were included, 103 with clomiphene-resistant polycystic ovary syndrome (PCOS), 77 with hypogonadotrophic hypogonadism (HH) and 20 with weight-related amenorrhoea (WRA). Ovulation induction was performed using a number of protocols in which pulsatile luteinizing hormone-releasing hormone was administered s.c. or i.v. and gonadotrophins (human menopausal gonadotrophins or follicle-stimulating hormone) were administered i.m. The cumulative conception and live birth rates in the first course of therapy and after 12 cycles of treatment were, respectively, 73.2 and 62.4% in PCOS patients, 82.1 and 65.4% in the HH group and 95.0 and 85.3% in the WRA group. The miscarriage rates for all courses of treatment were 15.5% in PCOS patients, 22.9% in HH patients and 32.3% in WRA patients which resulted in cumulative live birth rates that were not significantly different. The median number of cycles and ovulations to achieve a pregnancy was 2 in all groups. The multiple pregnancy rate was significantly greater in women with PCOS (17.9%) than in women with HH (3.6%, P = 0.0052, 95% CI 5.12-23.36%) but not WRA (3.2%, P = 0.07, 95% CI 4.35-24.92%). The rate of multiple pregnancy fell after the introduction of monitoring by transvaginal ultrasound. Correction of anovulatory infertility by appropriately selected ovulation induction regimens results in cumulative conception and live birth rates indistinguishable from normal.

Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin

Our purpose was to compare cumulative conception and live-birth rates after in vitro fertilization with and without the use of the long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin. Life-table analysis of conception and live-birth rates in relation to ovarian stimulation regimen used in 2893 women who had one of five stimulation regimens exclusively throughout all treatment cycles, namely, human menopausal gonadotropin with or without clomiphene citrate; follicle-stimulating hormone with or without clomiphene citrate; and long, short, and ultrashort protocols of buserelin, plus follicle-stimulating hormone or human menopausal gonadotropin; and in an additional 347 women who had been administered both human menopausal gonadotropin and follicle-stimulating hormone with or without clomiphene citrate. The cumulative conception rate and cumulative live-birth rate were significantly higher in those women treated exclusively with the long buserelin regimen (59% and 55%, respectively, after three cycles) compared with those who only had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (39% and 29%, respectively, after three cycles) (p = 0.001 and p = 0.0001) or compared with those who had only short or ultrashort buserelin regimens (22% and 17% after two cycles) (p = 0.0001 and p = 0.005). The pregnancy failure rate in patients on the long buserelin regimen was 22.4% (95% confidence interval 14.8% to 30.0%) compared with 33.3% (95% confidence interval 29.6% to 37.0%) in those who had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (p = 0.03). When the probabilities of first conception and first live birth were examined by treatment regimen, after we allowed for the effects of age, cause of infertility, calendar year of treatment, and treatment cycle number (with a multiple logistic regression model), it was found that, relative to human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate, the odds of conceiving with the long buserelin regimen was 1.63 (95% confidence interval 1.31 to 2.03) (p < 0.001) and the odds of a live birth was 1.97 (95% confidence interval 1.53 to 2.54) (p < 0.001). Similarly, relative to short or ultrashort buserelin the odds of conceiving with long bureselin was 1.88 (95% confidence interval 1.39 to 2.55) (p < 0.001) and the odds of a live birth was 1.79 (95% confidence interval 1.25 to 2.56) (p = 0.001). Pituitary desensitization with the long protocol of buserelin significantly increases the probabilities of conception and live birth after in vitro fertilization.

Pregnancy and birth rates of live infants after in vitro fertilization in women with and without previous in vitro fertilization pregnancies: A study of eight thousand cycles at one center

OBJECTIVE: Our aim was to compare the cumulative conception and live-birth rates after in vitro fertilization in women undergoing their first course of in vitro fertilization treatment with those in women undergoing their second course of treatment, having previously achieved an in vitro fertilization pregnancy. This study occurred in a tertiary referral-assisted conception unit. STUDY DESIGN: The cumulative conception rates obtained by life-table analysis in 4115 women having their first course of in vitro fertilization therapy (7327 treatment cycles leading to 1123 pregnancies) were compared by means of the log-rank test with those of 331 women in their second course of treatment, having previously achieved an in vitro fertilization pregnancy (561 treatment cycles leading to 138 second in vitro fertilization pregnancies). Similarly, the cumulative live birth rates of 3824 women in their first course of treatment (7136 treatment cycles leading to 732 live births) were compared with those of 105 women in their second course of treatment, having previously achieved an in vitro fertilization live birth (205 treatment cycles leading to 33 second in vitro fertilization live births). RESULTS: The cumulative conception rates and cumulative live birth rates were significantly higher in women having their second course of in vitro fertilization treatment than in those having their first course (cumulative conception rate: p = 0.0001; cumulative live birth rate, p = 0.007). After five cycles of in vitro fertilization, the cumulative conception rates and cumulative live birth rates were 49.8% (95% confidence interval, 46.3% to 53.5%) and 39.0% (95% confidence interval, 35.4% to 42.9%), respectively, in those having their first course of treatment compared with 69.9% (95% confidence interval, 57.6% to 81.3%) and 68.6% (95% confidence interval, 46.1% to 88.5%), respectively, in those having their second course. The estimated median numbers of cycles taken to achieve a pregnancy and live birth (assuming all women could potentially undergo the same number of cycles) were six and eight, respectively, in the first course of treatment compared with only three and five in the second course. CONCLUSION: Women who have achieved a previous in vitro fertilization pregnancy have significantly higher cumulative conception rate and cumulative live birth rates compared with those of women having their first course of treatment. (AM J OBSTET GYNECOL 1994;170:34-40.)

Abnormal findings on hysterosalpingography: Effects on fecundity in a donor insemination program using frozen semen

We sought to evaluate the effect of abnormal baseline hysterosalpingography (HSG) on subsequent fecundity during the first six cycles of treatment.Hysterosalpingography was performed on 208 asymptomatic ovulatory women with no history of pelvic disease who were referred for donor insemination. The findings were categorized into five groups: 1) normal study, 2) uterine anomaly or filling defect with bilateral tubal patency, 3) normal uterine anatomy with unilateral tubal patency, 4) normal uterine anatomy with bilateral tubal blockage, and 5) normal uterine anatomy with hydrosalpinx. Subjects in groups 4 and 5 received inseminations only if patency of at least one fallopian tube was demonstrated with laparoscopy. Life-table analysis was performed to calculate the average monthly fecundity and cumulative conception rates for each group. The Mantel-Haenszel test was used to compare group fecundities.A total of 1460 donor insemination cycles were performed. The number of cycles in each group were as follows: group 1, 1173 (80%); group 2, 153 (10%); group 3, 90 (6.2%); group 4, 16 (1.1%); and group 5, 28 (1.9%). None of the patients in group 4 or 5 conceived. The cumulative conception rates in the first three groups were 46, 34, and 40%, respectively, and were not significantly different from one another (P greater than .05). Although a high incidence of uterine filling defects and unilateral tubal blockage was observed (19.2%), the incidence of an abnormal HSG finding that significantly decreased fecundity was only 2.8%.In women with no history of tubal or uterine disease, routine HSG before initiation of donor insemination is of limited value for identifying decreased treatment fecundity.

Effects of age, gravidity and male infertility status on cumulative conception rates following artificial insemination with cryopreserved donor semen: analysis of 2998 cycles of treatment in one centre over 10 years.

The effects of age, gravidity and male infertility status on cumulative conception rates after donor insemination were investigated in an analysis of 2998 treatment cycles undertaken on 443 patients. It was found that the cumulative conception rates after 3, 6 and 12 cycles of treatment were 21, 40 and 62% respectively for patients < 30 years of age compared with 17, 26 and 44% for those aged > or = 30 years (P = 0.008). There was also a significant difference (P < 0.001) in results depending on course of treatment and the cumulative conception rates were 19% after 3 cycles, 33% after 6 cycles and 54% after 12 cycles of treatment in the first course of treatment compared with 40, 67 and 79% respectively in those who returned for subsequent courses of treatment after having achieved a donor insemination pregnancy in the first treatment course. Gravidity and male infertility status (azoospermia or oligozoospermia/asthenozoospermia) did not significantly affect the cumulative conception rates.

Ovarian function after conservational ovarian surgery: A long-term follow-up study

OBJECTIVE: To determine the long-term effects of conservational ovarian surgery on subsequent ovarian function. METHOD: Medical, surgical and menstrual records of 87 reproductive age women who have undergone pelvic surgery for indications including endometriosis, infertility, and pelvic pain between June 1982 and June 1989 were retrospectively reviewed. RESULTS: Sixty-seven patients had ovarian surgery during their procedure; 26 ovarian cystectomies (OC), 19 partial ovarian resections (OR) and 22 ovariolyses (OL). Twenty patients had no ovarian surgery (NOS). The mean follow-up period was comparable in all groups (OL 32 ± 15 months, OR 34 ± 26 months, OC 41 ± 30 months and NOS 37 ± 21 months). The mean time to onset of the first postoperative menses was not significantly different among the four groups (OL 24 ± 7 days, OR 24 ± 13 days, OC 29 ± 26 days and NOS 22 ± 6 days). The cumulative conception rates were not significantly different (OL 23%, OR 37%, OC 19% and NOS 25%). Menstrual disturbances, defined as perceived deviations from preoperative patterns, did not appear to be related to the type or extent of ovarian surgery and occurred in comparable frequencies among patients with or without ovarian surgery (OL 23%, OR 37%, OC 23% and NOS 20%). In the majority of cases, menstrual disturbances occurred either in the early postoperative months and were self-limited, or much later in which case they were related to recurrent endometriosis. Premature ovarian failure has so far occurred in one patient suggesting an incidence comparable to that in the general population. CONCLUSIONS: It is concluded that in this group of patients, conservational ovarian surgery had no significant effects on ovulatory and menstrual function over a prolonged follow-up period.

Cumulative conception and livebirth rates after in-vitro fertilisation

Cumulative conception and livebirth rates related to age and cause of infertility provide the most useful estimate of success after in-vitro fertilisation (IVF), but limited data are available. It is also uncertain whether the probability of pregnancy, livebirth, and pregnancy failure changes with repeated treatment cycles. To assess the effects of patients' age and cause of infertility on these outcomes, we studied the results of 5055 consecutive IVF cycles (773 clinical pregnancies, 518 livebirths) undertaken on 2735 patients in a single IVF unit. Cumulative conception and livebirth rates were analysed by the life-table approach and differences in rates between age-groups and between causes of infertility were measured by the log-rank test and logistic regression modelling. Both conception and livebirth rates per cycle declined with age (p<0·001), and cumulative conception and livebirth rates after five treatment cycles were about 54% and 45%, respectively, at 20-34 years, compared with 38·7% and 28·9% at 35-39 years and 20·2% and 14·4% at ≽40 years. The two rates were significantly different between causal groups (p<0·001 and p=0·02, respectively) and were lowest in patients with male infertility or multiple infertility factors. The pregnancy failure rate was higher (p=0·006) in women over the age of 34 years and there was a significant decline in the chances of pregnancy and livebirth per cycle with successive treatment cycles. The success of IVF compares favourably with that of spontaneous conception in the natural menstrual cycle. For women up to the age of 34 years, almost 55% will become pregnant and 45% will have a livebirth within five cycles of treatment.

The effect of age on female fecundity

To determine the relationship between age and female fecundity, 210 women were studied prospectively. The subjects had negative infertility evaluations and were receiving therapeutic donor insemination. Life-table analysis was performed on 751 donor insemination cycles. For comparison, patients were divided into five separate age groups and into two separate groups, ages 19-34 and 35-45. Monthly fecundity and cumulative conception rates were calculated for each group. A significant difference was found when all age groups were compared (P = .05) and when those at or above age 35 and those below age 35 were compared (P less than .05). Frozen semen was used in 92% of all cycles. The average monthly fecundity of all patients treated with frozen semen was 16%. This study confirms a progressive decline in fecundity with age in a completely evaluated group of women undergoing therapeutic donor insemination and demonstrates that frozen semen can yield acceptable fecundity provided sufficient numbers of motile sperm are used for each procedure.

Does minimal or mild endometriosis reduce fecundity?

SummaryFollowing laparoscopy, 31 patients with minimal or mild endometriosis (revised American Fertility Society classification, 1985) were followed up for 12 months. No treatment was given. The cumulative conception rates were calculated using the life-table method of analysis. For controls, 61 patients who had stopped oral contraception because they were desirous of a further pregnancy were used. The cumulative conception rates at 6 months and 12 months were reduced (P<0001) in the patients with endometriosis. These results show that women with minimal or mild endometriosis have reduced fecundity. The possible reasons are discussed.

The diagnosis of male infertility--prospective time-specific study of conception rates related to seminal analysis and post-coital sperm-mucus penetration and survival in otherwise unexplained infertility.

Infertile women without any inherent female infertility factors and able to secrete normal cervical mucus were studied prospectively in relation to post-coital sperm-mucus penetration (PCT) and their partner's seminal analysis, excluding men with azoospermia. Time-specific cumulative conception rates calculated as for life-table analysis were related to each measured seminal variable on routine analysis of 2-3 samples (volume, density, proportion with progressive motility, and proportion with normal morphology); to various derivatives from combinations of these variables; to seminal findings after vital staining; and to the PCT results. The best seminal predictor of fertility was the motile normal sperm density (MNSD), the 18 month conception rates being 57.4% +/- 4.6 (SE) and 30.2% +/- 5.9 (ratio 1.9, P less than 0.001) above and below a derived threshold value of 4 x 10(6)/ml. The PCT led to rates of 55.6% +/- 4.3 and 14.9% +/- 5.1 (ratio 3.73, P less than 0.001) for positive and negative results, respectively. The PCT also gave rise to a significantly distinct intermediate poor-positive sub-group (conception rate 30.6% +/- 9.0). Seminal analysis (the MNSD) did not affect the conception rate associated with a positive PCT but helped to discriminate further with a negative PCT (conception rates 22.5% +/- 8.7 with an MNSD above 4 x 10(6)/ml versus 5.6% +/- 4.8 below, P less than 0.05). The PCT was the single best predictor of fertility but seminal analysis (the MNSD) was of additional value after a negative PCT.

Return of fertility following discontinuation of an injectable contraceptive — Norethisterone oenanthate (NET EN) 200mg dose

The return of fertility following discontinuation of norethisterone oenanthate (NET EN) 200 mg injectable contraceptive after use for a minimum period of six months or more was studied in 69 women who discontinued the method for planning pregnancy. Former users of copper intra-uterine device (CuT 200) were enrolled as a control group. Another 161 women who had discontinued NET EN due to other reasons (e.g. amenorrhoea, excessive bleeding or personal reasons) were also studied for return of fertility after ensuring that they were not using any other method of contraception and were exposed to the risk of pregnancy. The subjects from both groups were followed for a period of one year. The cumulative conception rates at one year were 72.5 and 83.6 per 100 subjects for ex-NET EN and ex-CuT 200 users who had discontinued the method for planning pregnancy and this difference was not statistically significant (P > 0.05). The median time for conception for ex-NET EN users was 7.8 months as compared to 3.7 months in ex-CuT 200 users but the cumulative conception rates at the end of one year show that future return of fertility in NET EN users does not appear to be adversely affected. In 51 subjects who had discontinued NET EN due to amenorrhoea, the return of fertility was predictably slower and less. The return of fertility in subjects who discontinued NET EN for other reasons (e.g. excessive bleeding and other personal reasons) was similar to ex-NET EN and ex-CuT 200 users.

Prognostic value of the postcoital test: prospective study based on time-specific conception rates.

Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6-18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.