Timing Of Intercourse Research Articles

Human Seminal Plasma Hypersensitivity: An Under-Recognized Women's Health Issue

Human seminal plasma (HSP) hypersensitivity is defined as a spectrum of systemic and/or localized symptoms after exposure to specific protein components in seminal plasma. The major antigen is believed to be prostate-specific antigen, but other proteins are likely involved in this heterogenous disorder. There are no known risk factors for developing seminal plasma hypersensitivity, although women who develop systemic symptoms are more frequently atopic. Of interest, for both systemic and localized forms, symptoms can manifest after first time intercourse in up to 50% of cases. Diagnosis requires a careful history. The gold standard for diagnosing HSP is that symptoms are completely abated with the use of a condom prophylactic. Although women with HSP hypersensitivity often have difficulty conceiving due to their inability to have unprotected sexual intercourse, infertility has not been demonstrated to be related to HSP hypersensitivity. Patients with HSP hypersensitivity often elicit positive skin prick testing and/or serum-specific immunoglobulin E to whole seminal fluid or fractionated seminal plasma proteins. Treatment involves either avoidance with the use of condoms, an intravaginal graded challenge using dilutions of whole seminal fluid, or subcutaneous desensitization to relevant fractionated seminal plasma proteins obtained from the woman's sexual partner. In most cases, treatment using ≥ 1 or more of the above approaches has been very successful.

Clomiphene Citrate or Letrozole for Ovulation Induction in Women with Polycystic Ovarian Syndrome: A Prospective Randomized Trial

Objective To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome (PCOS). Design Prospective randomized trial. Setting University teaching hospital and private practice setting. Patients The study comprised a total of 438 infertile women (1063 cycles) with PCOS. Intervention Patients were randomized to treatment with 5 mg of letrozole daily (218 patients, 545 cycles) or 100 mg of clomiphene citrate daily (220 patients, 518 cycles) for 5 days starting on day 3 of menses. Timed intercourse was advised 24 to 36 hours after hCG injection. Main Outcome Measure Number of follicles, serum estradiol, serum progesterone, endometrial thickness, and pregnancy and miscarriage rates. Results The mean age, parity, and duration of infertility in both groups were similar. The total number of follicles was statistically significantly greater in the clomiphene citrate group (6.8 _ 0.3 vs 4.4 _ 0.4). Endometrial thickness at the time of hCG administration was statistically significantly greater in the CC group (9.2 _ 0.7 mm vs 8.1 _ 0.2 mm). The duration to reach a dominant follicle was statistically significantly longer in the letrozole group (12.1_1.3 vs 8.8_2.9 days). Ovulation occurred in 365 out of 540 cycles (67.5%) in letrozole group and 371 out of 523 cycles (70.9%) without a statistically significant difference. Levels of serum estradiol and progesterone were statistically significantly higher in the clomiphene citrate group. The pregnancy rate per cycle was 15.1% in the letrozole group and 17.9% in the clomiphene citrate group without statistically difference between the groups. Conclusion The results of this study did not show any advantage to the use of letrozole over clomiphene citrate as a first-line treatment for induction of ovulation in women with PCOS (Fertil Steril_2009;92:849-52. _2009 by American Society for Reproductive Medicine).

A multidisciplinary approach to fertility-sparing therapy for a rare vulvar tumor

Case report of a young woman with a rare vulvar malignancy who received treatment with a personalized multidisciplinary approach to balance management of her malignancy without compromising survival with her desire for future pregnancy. Case report. University hospital. A 33-year-old woman, gravida 2, para 1-0-1-1, who had a diagnosis of synovial cell sarcoma of the vulva and who desired future fertility. At multiple steps, treatment was planned to try to maximize fertility preservation without potentially affecting initial treatment, which included a radical hemivulvectomy with bilateral lymph node dissection, brachytherapy with interstitial needles (20 Gy), and external beam radiation therapy (50 Gy). Treatment and eradication of the malignancy and achievement of a successful subsequent pregnancy and live birth. The patient had no evidence of disease for 2 years after treatment. During that time she received preconception counseling by both a perinatologist and a reproductive endocrinologist. She conceived with the use of ultrasound monitoring to time intercourse specifically with ovulation from the contralateral ovary and had an uncomplicated pregnancy with a term delivery. By using several disciplines and subspecialists, this patient received personalized treatment for a rare cancer, focused at curing her cancer and optimizing her future fertility.

ORIGINAL ARTICLE: Timed Sexual Intercourse Facilitates the Recruitment of Uterine CD56bright Natural Killer Cells in Women with Infertility

Problem The aim of this study was to investigate the influence of sexual intercourse on uterine NK cell subsets.Method of study Mid‐secretory endometrial samples obtained from 56 women were submitted for flow cytometric analysis. Basal body temperature was used to determine the day of ovulation. A total of 27 women had sexual intercourse before ovulation (pre‐ovulation group) and eight women had only after ovulation (post‐ovulation group) without any contraceptive devices. A total of 21 women did not have sexual intercourse during the experimental cycle (abstinence group). Endometrial NK cells were analyzed for the expression of CD16 and CD56 using 3‐color flow cytometry.Results CD16−/CD56bright cells were markedly increased in the pre‐ovulation group as compared with that of the post‐ovulation group (P < 0.01) and the abstinence group (P < 0.01). CD16+/CD56dim cells were significantly decreased in the pre‐ovulation group as compared with that of the post‐ovulation group (P < 0.01) and the abstinence group (P < 0.05).Conclusion It is suggested that seminal plasma participates in the recruitment of CD56bright NK cells into endometrium.

Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments

To model the cumulative probability of pregnancy among couples with subfertility without a definitive diagnosis, according to different treatment strategies. A beta distribution of fecundity was fitted that reproduced the cumulative probability of pregnancy in prospective studies of natural fertility, and this distribution was applied to simulated cohorts starting with one million couples each. Probabilities of pregnancy were generated for each cycle of each couple. Simulation study. Hypothetic subfertile population. After 2 or 4 years of attempting pregnancy and diagnostic evaluation to exclude anovulation, tubal obstruction, and severe male factor, simulated treatments were applied to the remaining nonpregnant couples, with treatment effects based on published literature. Simulated cumulative probability of pregnancy. Initially, the cumulative probability of pregnancy was highest for early treatment with IVF, but over time, conservative treatment or frequent intercourse approached the same cumulative probability. In couples without clear indications for IVF, the main benefit of early IVF may be to shorten time to pregnancy, a benefit that must be weighed against costs and potential adverse outcomes. Couples should be encouraged to maintain regular intercourse to maximize chances of pregnancy, even after unsuccessful treatment attempts.

Successful pregnancy following medical management of heterotopic pregnancy

We present a case of sonographic demonstration of quadruplet heterotopic pregnancy consisting of twin intrauterine (IU) pregnancy and a twin adnexal pregnancy after ovulation induction (OI) with clomiphene citrate (CC) and timed intercourse (TI). Both heterotopic pregnancy and spontaneous twinning are frequent after OI, this combination although extremely rare must be kept in mind. The role of early transvaginal sonography and serum beta human chorionic gonadotrophin after missed periods helps in early diagnosis. It gives us an opportunity for medical management, saving the patient the agony of surgery along with loss of pregnancy. The management of heterotopic pregnancy is controversial. This patient did not have a viable IU pregnancy and both the sacs in the adnexa were small. Thus, we treated her successfully by medical management with systemic methotrexate, with regular follow-up. This patient successfully conceived after 6 months with OI and TI, with ovulation occurring from the same side of the previous ectopic. She had a viable IU gestation corresponding to 12 weeks.

What is the most valid comparison treatment in trials of intrauterine insemination, timed or uninfluenced intercourse? A systematic review and meta-analysis of indirect evidence

Timed intercourse (TI), which is the usual control treatment in trials of intrauterine insemination (IUI), is not a typical coital activity and could impair fertility. This review summarizes the trials of IUI of male partner's prepared semen among subfertile couples according to whether the control group had TI or expectant management. A search of relevant databases and bibliographies until February 2008 yielded 150 citations of which 31 were potentially relevant and 11 met all criteria. The total estimates of the differences in pregnancy rates per couple were calculated with weights equal to the inverse variance. The primary analysis was a categorical meta-analysis by the type of control treatment (TI or expectant management). In 11 trials with 13 comparisons of IUI and intercourse among 1329 couples with subfertility, the average difference in pregnancy rate between IUI and controls was 6.1% in trials with TI and 3.9% in trials with expectant management, as the control. The adjusted indirect estimate of the difference between the types of control groups was 2.8% (95% CI -6.3, 10.7). The difference by type of control treatment was not significant, neither in the 11 most relevant trials (P = 0.82), nor in a broader group of 19 trials and 2512 patients (P = 0.20). The additional benefit accruing to IUI, where TI is the control, is not significant, but it is consistent with the possibility that pregnancy may be less likely in TI controls than in expectant management controls.

Polycystic ovaries and infertility: Our experience

Polycystic ovary syndrome (PCOS) is one of the most common (15-20%) endocrine disorders in women of childbearing age. Although it is a major cause of infertility, its etiology remains unknown and its treatment difficult. To evaluate the incidence, treatment and outcome of patients with PCOS. Retrospective analysis. PCOS patients (914 of the 1057) attending the outpatient department (OPD) from June 2003 to February 2008 were evaluated for this study. Of the 914 patients investigated, 814 came for treatment and these patients were studied for hormonal disturbances and their response to various modalities of treatment. Of the 2270 infertility patients, 46.50% (1057) had PCOS, out of these, 86.47% (914) were investigated and 77% (814) came for treatment. Our overall pregnancy rate was 48.40% (394/814). The pregnancy rate per cycle with timed intercourse (TI) was 44.77% (47/105), 17.09% (286/1673) with intrauterine insemination (IUI), 29.82% (51/171) with in vitro fertilization (IVF) and 22.22% (10/45) with frozen embryo transfer (FET). The maximum number of pregnancies (85.29%, 284/333) were achieved in the first three treatment cycles. The abortion rate was 19.01% (73/384) and the incidence of ectopic pregnancy was 5.47% (21/384). Complications seen were in the form of ovarian hyperstimulation (OHSS), retention cyst on day two and multiple pregnancies in 11.71% (228/1946) of the total treatment cycles. Most PCOS symptoms could be adequately controlled or eliminated with proper diagnosis and treatment. Thus, ovulation induction (OI) protocols and treatment modalities must be balanced for optimal results.

RETRACTED: Clomiphene citrate or anastrozole for ovulation induction in women with polycystic ovary syndrome? A prospective controlled trial

To compare the effects of anastrozole (1 mg) and clomiphene citrate (CC; 100 mg) used for ovulation induction in women with polycystic ovary syndrome. Prospective controlled trial. University teaching hospital and private-practice setting. The study comprised a total of 216 infertile women (469 cycles) with polycystic ovary syndrome. Patients received anastrozole (1 mg/d; 115 patients, 243 cycles) for 5 days, starting on day 3 of menses. A matched historical group of patients with polycystic ovary syndrome who were treated with CC (100 mg/d; 101 patients, 226 cycles) was used as a control group. Timed intercourse was advised 24-36 hours after hCG injection. Number of follicles, serum E(2), serum P, endometrial thickness, and pregnancy and miscarriage rates. The mean age, parity, and duration of infertility in both groups were similar, but statistically significantly more polycystic ovaries were found in the anastrozole group (odds ratio = 2.44; 95% confidence interval = 1.19-5.02). The total numbers of follicles were significantly higher in the CC group (3.8 +/- 0.6 vs. 3.4 +/- 0.5). Endometrial thickness at the time of hCG administration was significantly greater in the anastrozole group (10.1 +/- 0.22 mm vs. 8.2 +/- 0.69 mm). The duration of stimulation was similar in the two groups. Ovulation occurred in 165 (67.9%) of 243 cycles in the anastrozole group and in 150 (68.6%) of 226 cycles in the CC group without significant difference. Serum P was significantly higher in the CC group (7.1 +/- 1.11 vs. 8.1 +/- 0.88 ng/mL). The pregnancy and miscarriage rates were similar in the two groups. Anastrozole was associated with significantly fewer mature and growing follicles, thicker endometrium, and slightly higher pregnancy rate. Anastrozole may be helpful in situations in which multiple pregnancy is not desirable or the risk of ovarian hyperstimulation syndrome is high.

Bayesian selection of optimal rules for timing intercourse to conceive by using calendar and mucus

To find optimal clinical rules that maximize the probability of conception while limiting the number of intercourse days required. Multicenter prospective study. Women were followed prospectively while they kept daily records of menstrual bleeding, intercourse, and mucus symptom characteristics. In some cycles, women sought to conceive, whereas in other cycles, they sought to avoid pregnancy. Four centers providing services on fertility awareness. One hundred ninety-one healthy women using the Billings Ovulation Method. Women were invited to enroll by their instructors if they satisfied the entry criteria. We excluded cycles in which mucus was not recorded on a day with intercourse. None. Clinically identified pregnancies. There were 161 clinically identified pregnancies in 2,536 menstrual cycles from 191 women. Our approach relies on a statistical model that relates daily predictors, such as type of mucus symptom, to the day-specific probabilities of conception. By using Bayesian methods to search over a large set of possible clinical rules, focusing on rules based on calendar and mucus, we found that simple rules that are based on days within the midcycle calendar interval that also have the most fertile-type mucus symptom present have high utility. Couples can shorten their time to pregnancy efficiently by timing intercourse on days that the most fertile-type mucus symptom is observed at the vulva.

Bayesian methods for searching for optimal rules for timing intercourse to achieve pregnancy

With societal trends towards increasing age at starting a pregnancy attempt, many women are concerned about achieving conception before the onset of infertility, which precedes menopause. Couples failing to conceive a pregnancy within 12 months are classified as clinically infertile, and may be recommended for assisted reproductive therapy (ART). Because many ART procedures are expensive and may convey an increased risk of adverse outcomes for the offspring, it is advantageous to decrease time to pregnancy by natural methods. One possibility is to intentionally time intercourse during the days of the menstrual cycle having the highest conception probabilities. This article proposes a Bayesian decision theoretic approach for searching for optimal rules for timing intercourse based on cycle day, secretions and other information. Good rules result in high conception probabilities while requiring minimal targeted intercourse. A biologically based statistical model is used to relate cycle day and biomarkers to the conception probability. A stochastic search procedure is then developed to search for rules with high expected utility, and the methods are applied to data from a recent Italian study.

Intrauterine Insemination versus Timed Intercourse for Cervical Hostility in Subfertile Couples

The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid "hostile" cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynecologic societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought the result of cervical mucus problems. The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive.We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), POPLINE (to June 2005), and LILACS (to June 2005). In addition, we contacted experts and searched the reference list of relevant articles and book chapters. We included randomized and quasirandomized, controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period. Participants were women with cervical hostility who failed to conceive for at least 1 year. We assessed the titles and abstracts of 386 publications and 2 reviewers independently abstracted data on methods and results from 5 studies identified for inclusion. The main outcome is pregnancy rate per couple. We did not pool the outcomes of the included 5 studies in a meta-analysis resulting from the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. None of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, and ovarian hyperstimulation syndrome. There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to recall that there is a lack of adequate studies that support that intrauterine insemination (IUI) is an effective treatment of cervical hostility, explain that the postcoital test has poor diagnostic and prognostic properties, and state that the use of both tests has no benefit on pregnancy rates. Although many assisted reproductive technology (ART) programs no longer perform postcoital tests, many perform intrauterine insemination (IUI), often with gonadotropins or clomiphene citrate, in their subfertile patients. Therefore, this review article will be of value to our readers who treat subfertile patients with IUI, whether or not they perform postcoital tests. For additional explanations of the statistical tests employed in this review, see D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, 57; Supplement 3: S35, September 2002; and D. Grimes, KF Schulz, Obstetrical and Gynecologic Survey, Supplement 2, S53-S69, September 2005.-RBJ.

Adolescent complainants of sexual assault; injury patterns in virgin and non-virgin groups

Introduction Misconceptions about the likelihood of sustaining injuries following rape or sexual assault can have a detrimental effect on the justice process. This is particularly noticeable with regard to first time intercourse. Forensic physicians have a duty to put any examination findings in context. This study sets out to compare the findings in virgin and non-virgin adolescents seen at the St Mary’s Sexual Assault Referral Centre, after an allegation of non-consensual intercourse. Methodology The records of all females aged 12–17 years old, examined in an 18 month period were reviewed. Results Two hundred and twenty-four clients fitted this group with a mean age of 14.8 years. Eighty-one were “virgins” and 97 had been sexually active prior to the assault. The virgin group took longer to present for examination then the non-virgin group (90 h compared to 44 h). Of all clients 51% had a non-genital injury. These tended to be minor. 32% of the non-virgin group had a genital injury. In the virgin group, 53% had a genital injury, however only 32% had the type of genital injury that would leave permanent evidence of penetration (i.e. if examined several weeks or more later). Alcohol use prior to assault was common. Conclusions Genital and or body injuries are not routinely found in adolescents after an allegation of rape or sexual assault even when there has not been previous sexual experience. The absence of injury does not exclude the possibility of intercourse, whether with or without consent.

MRCOG part II model essay answer

Couples in which the man is HIV-1 positive and the women is HIV-1 negative have limited options if they wish to reproduce safely. Timed unprotected intercourse carries a 0.1–4% risk of transmitting the virus through semen to the female partner. Sperm washing is a risk-reduction treatment option in which semen is centrifuged to separate live sperm, which does not carry HIV, from seminal plasma and non-germinal cells which may carry the virus, irrespective of the man's viral load, CD4 count or antiretroviral therapy. Absence of detectable HIV should be verified using a polymerase chain reaction nucleic-acid-based sequence amplification assay before the washed sperm is used in treatment. In couples with no fertility issues, the processed semen is inseminated into the female partner at the time of ovulation during a natural cycle. If a couple have additional fertility issues, sperm washing can be combined with ovulation induction, in-vitro fertilization or intracytoplasmic sperm injection. Pregnancy rate per insemination is 12% based on published reports of over 2000 inseminations. To date, there have been no seroconversions in either mother or child following use of correctly processed sperm.

A randomized controlled trial evaluating metformin pre-treatment and co-administration in non-obese insulin-resistant women with polycystic ovary syndrome treated with controlled ovarian stimulation plus timed intercourse or intrauterine insemination

There are few data in the literature regarding the utility of metfomin before and during gonadotrophin administration in women with polycystic ovary syndrome (PCOS). The aim of the present study was to assess the effect of the pre-treatment and co-administration of metformin in infertile PCOS women treated with controlled ovarian stimulation (COS) followed by timed intercourse (TI) or intrauterine insemination (IUI). Seventy insulin-resistant primary infertile women with PCOS were randomized to receive metformin cloridrate (850 mg twice daily; group A) or placebo tablets (two tablets daily; group B) for 3 months. Three trials of COS using highly purified urinary FSH (hpFSH) plus TI/IUI were performed. Number of ampoules of gonadotrophin used, duration of the ovarian stimulation, cycle cancellation, ovulation, pregnancy, abortion, live birth, mono-ovulatory cycles, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS) rates were assessed. No difference between groups was detected in ovulation, cycle cancellation, pregnancy, abortion, live birth, multiple pregnancies and OHSS rates. The mono-ovulatory cycle rates were significantly (P = 0.002) more frequent in group A than in group B, whereas the days of stimulation for non-cancelled cycles and the number of vials of gonadotrophins used were significantly (P < 0.001) higher in group A than in group B. In insulin-resistant women with PCOS, metformin pre-treatment and co-administration with hpFSH increases the mono-ovulatory cycles.

Diminished pregnancy rates in endometriosis due to impaired uterotubal transport assessed by hysterosalpingoscintigraphy

To investigate uterotubal transport by means of hysterosalpingoscintigraphy (HSSG) in women with and without endometriosis. A prospective observational study. University Hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 350 in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles and 400 intrauterine insemination (IUI) cycles/year. Cases included 56 infertile women with laparoscopic proven endometriosis and patent fallopian tubes. Twenty-two women with partners suffering from male factor infertility served as controls. A diagnostic cycle incorporating HSSG was performed. Subsequently, patients underwent either four cycles of timed intercourse (TI) or IUI in order to achieve pregnancy. If pregnancy did not occur, IVF or ICSI was performed. Evaluation of uterotubal transport capacity in women with endometriosis and healthy controls. Patients suffering from endometriosis (group I) showed a significant reduction in physiologic uterotubal transport function: While 20 patients (36%) had ipsi- or bilateral uterotubal transport, there was pathological uterotubal transport contralateral to the dominant follicle or a complete failure of transport capacity (negative HSSG) in 36 patients (64%). In the controls (group II), transport function was significantly different: 15 of 22 patients (68%) revealed ipsi- and bilateral tubal demonstration, while 5 patients (22%) showed contralateral transport and 2 patients (10%) showed negative HSSG (P= 0.01). Twenty-three pregnancies were observed (pregnancy rate: 29%). Eleven out of 14 (79%) women with ipsi- or bilateral tubal transport function fell pregnant by means of TI or IUI. In seven of nine patients (78%) with a failure in tubal transport, pregnancy was achieved by IVF/ICSI, despite acceptable semen parameters (P= 0.01). Endometriosis is significantly associated with a reduction in physiologic uterotubal transport capacity compared with controls. This resulted in diminished pregnancy rates even in women with normozoospermic partners. Therefore, IVF/ICSI may be required even when fallopian tubes are patent or semen quality is normal.

Diagnosis and treatment of immunologically infertile males with antisperm antibodies.

The presence of antisperm antibodies (ASA) can reduce fecundity in both males and females. The present review describes a strategy, established by investigations of the diverse inhibitory effects of ASA on fertility, for the appropriate diagnosis and treatment of infertile males with ASA. For infertile males with ASA, diagnosis using the direct-immunobead test (D-IBT), the postcoital test (PCT) and the hemizona assay (HZA) should be carried out as the basis for decision-making. If the patient with ASA has an abnormal hemizona index, it seems reasonable to advise selecting intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a primary treatment. However, it has been shown that some immunologically infertile males with normal fertilizing ability established pregnancy by timed intercourse (TI) or intrauterine insemination (IUI). In such patients with ASA having normal hemizona index, TI or IUI can be selected based on the PCT result. Therefore, the treatment strategy for males with ASA is similar to that for infertile males with oligozoospermia or asthenozoospermia. In conclusion, it should be emphasized that a diversity of ASA exists and their effects on fertility in infertile males. Although there is an argument that routine testing for ASA in males is not always necessary, one should be aware that in some cases of failed IUI or IVF, ICSI is selected afterward because of the diagnosis of ASA. (Reprod Med Biol 2005; 4: 133-141).

Reduced Fertilization Rates in Older Men When Cervical Mucus Is Suboptimal

Cervical mucus is vital in the regulation of sperm survival and transport through the reproductive tract. The goal of this study is to assess whether the lowered fertility for men in their late 30s and early 40s is related to the nature of cervical mucus on the day of intercourse. In a prospective study of 7 European family planning centers, 782 couples not using birth control recorded daily observations of intercourse and the nature of cervical mucus. Using data from 1,459 menstrual cycles, 342 ending in pregnancy, we estimate day-specific conception probabilities in relation to mucus and male and female age. On days where cervical mucus was not evident, intercourse for men in their late 30s and early 40s was 50% less likely to result in a clinical pregnancy, adjusting for intercourse timing and female age. As secretions become more conducive to sperm transport, the effect of male age diminishes steadily from 21% on days with damp secretions, to 11% on days with thick mucus, to only 4% on days with most fertile-type mucus. The effect of male age on fecundability can be minimized by timing intercourse on days with optimal secretions. II-2.

In vivo distribution of a vaginal gel: MRI evaluation of the effects of gel volume, time and simulated intercourse

A microbicide is designed to coat the vaginal epithelium and prevent transmission of HIV. Complete coverage is desired for optimal protection. In vivo factors affecting coverage have not yet been studied. This randomized crossover trial evaluates the effect of gel volume and patient activity upon vaginal epithelial coating. Gynol II gel was mixed with a magnetic resonance imaging (MRI) contrast agent. Ten women self-inserted, on separate visits, 3 or 5 mL of gel and underwent serial MRI scanning both before and after simulated intercourse. Gel spread was dependent upon time and volume. There was modest spread during the first hour and greater spread 6 h after insertion. Five milliliters of gel resulted in statistically significantly greater coverage immediately following insertion, within the first 30 min and at 6 h after insertion. Simulated intercourse greatly enhances gel spread. After simulated intercourse, the distribution of the gel at each volume was similar. Less leakage of gel was reported with the smaller volume.

Males With Subnormal Hypo‐Osmotic Swelling Test Scores Have Lower Pregnancy Rates Than Those With Normal Scores When Ovulation Induction and Timed Intercourse Is Used as a Treatment for Mild Problems With Sperm Count, Motility, or Morphology

This study was designed to evaluate the effectiveness and clinical usefulness of the hypo-osmotic swelling (HOS) test in predicting successful conception in couples in which men with mild male-factor infertility criteria were undergoing a timed vaginal inter-course protocol. One hundred couples, in which mild male infertility was the only abnormality, were included in the study. Semen was analyzed according to standard World Health Organization (WHO) criteria and subjected to the HOS test. Patients were divided into 2 groups: group 1 (n=39) with normal HOS test and group 2 (n=61) with abnormal HOS test. All women underwent three consecutive cycles of follicular growth ultrasound monitoring and timed intercourse. Ten couples were exclude from the study. Ten clinical pregnancies were achieved in group 1 with a pregnancy rate per patient and per cycle of 28.5% and 9.5%, respectively. In group 2, 6 pregnancies were achieved, with a pregnancy rate per patient and per cycle of 10.9% and 3.6%, respectively. Both pregnancy rates per patients and per cycle was significantly higher (P <.05) in group 1 than in group 2. The HOS test may be considered an easy and reliable test in identifying among subfertile men those who have a greater possibility of causing pregnancy.