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This article describes the features and uses of the recently developed microhysteroscope, which offers a combination of panoramic hysteroscopy, contact hysteroscopy, and microscopy. The cervical canal can be crossed under strict visual control without traumatizing the mucosa, no premedication or anesthesia is required, and the amount of CO2 used is reduced to 40 ml. Multiple magnifications (X1, X20, X60, and X150) present new diagnostic opportunities by combining the data offered by hysteroscopy, colposcopy, and cytology. Aspects of microhysteroscopy that are common to other hysteroscopic techniques include timing, clinical history, positioning of the patient, physical exam, Pap smear, and ruling of pregnancy or infection. The technique of insertion of the microhysteroscope and the observations that can be made at different magnifications are detailed, and the various means of observation of the cervix and uterus are compared in a table. Current or recent pelvic infection is an absolute contraindication to hysteroscopy, and heavy bleeding is a relative contraindication. Few lethal complications related to hysteroscopy have been reported in the literature, and they followed faulty technique and the use of inappropriate distention in devices that delivered 1 or more liters of CO2/minute. Failure to perform microhysteroscopy because of severe postmenopausal cervical atresia occurred in 16 cases out of 680 attempted procedures. Microhysteroscopy was completely painless in 410 cases, similar to menstrual discomfort in 215, and moderately painful in 39. Microhysteroscopy allows collection of data on the normal aspects of the cervix and uterus, abnormal bleeding which is the most common indication, infertility investigation, adenocarcinoma, early antenatal diagnosis, salpingoscopy, and minor intrauterine operative procedures. Microhysteroscopy in conjunction with cytology, offers promise of better treatment of cervical cancer.
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PMID:Microhysteroscopy. 640 17

The relationship between intensity of jogging and various menstrual/reproductive factors in women were investigated. Data were collected by questionnaire from 319 women who participated in a running event that included both a 6.2-mile (10 K) run and a 26.2-mile marathon in northeastern Ohio. Findings reaffirmed the notion that scant menstrual flow, skipped menses, and menstrual irregularity are significantly related to the intensity of jogging; age at menarche, infertility, and uterine prolapse were not. Thirty-two percent of the women felt that jogging decreased their menstrual discomfort, and 44% reported better jogging performance right after or between menstrual periods.
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PMID:Intensity of jogging. Relationship with menstrual/reproductive variables. 656 14

61 couples with infertility from 1-11 years duration were instructed in the use of the cervical cup for artificial insemination using homologous semen in the privacy of their own homes. There have been 36 reported pregnancies in 32 of these couples. Among women with primary infertility, the pregnancy rate was 43%; it was 67% for those with secondary infertility and 53% overall. Sperm counts and percent motility, as well as postcoital test results, however, failed to indicate the eventual ability to conceive. Regardless, among couples with documented infertility, this method provided over 1/2 of the couples with at least 1 pregnancy. Additionally, the technique is simple, inexpensive, without significant risk or discomfort, and can be carried out by the couple at their convenience and in privacy.
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PMID:Pregnancy following use of the cervical cup for home artificial insemination utilizing homologous semen. 683 4

Gossypol is a phenolic compound isolated from the seeds, stems, and roots of the cotton plant. The chemical has been known for years as the toxic principle left in the cottonseed cake after cottonseed oil extraction. It is also present in the cold pressed cottonseed oil from which it may be removed through reactions with alkali. Extremely low birthrates in China's Hebeth province were traced to the use of crude cotton seed oil for cooking purposes. After prolonged investigation, it was determined that male infertility was related to the gossypol content of the oil. After a short period of animal studies, the Chinese in 1972 undertook widespread clinical trials of gossypol as a contraceptive agent. Over 4000 men have undergone treatment with the drug, some for as long as 4 years. Infertility resulted after 2 months of a daily dose of 20 mg and then the participants were maintained on 150-220 mg/month in divided doses. The drug apparently did not decrease libido in most test subjects and had not been reported to impair potency. Semen analysis at various intervals showed a decrease in motile sperm, malformed spermatozoa, and then a decrease in sperm count, leading to azoospermia. On discontinuation of the substance, the antifertility effect completely reversed itself within 3 months. No obvious toxic effects of pathological changes were observed in human and animal studies. Levels of luteinizing hormone and testosterone were unchanged and apparently indicated that gossypol does not affect hormonal balances. Adverse reactions reported to date include transient and reversible weakness in 10% of the test subjects on initiation of therapy. In addition, appetite changes, gastric discomfort, and nausea have been noted. A few cases of slight EKG changes and disturbances in potassium metabolism have occurred. No chromosomal changes have been observed nor have tests shown any mutagenic effects of the drug. In conclusion, preliminary data indicated that gossypol may offer an excellent new approach to contraception. Further testing is required to elucidate the drug's mechanism of action and to determine its adverse and possible toxic effects.
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PMID:Gossypol as an oral contraceptive for men. 692 15

Danazol, an interesting pharmacologic steroid 'in search of a disease', was first used by my group in the management of endometriosis because of the marked anti-endometrial effects found during clinical trials. The results in alleviating dysmenorrhoea, dyspareunia, and pelvic discomfort were surprisingly good, but more important was the 40 to 50% pregnancy rate that occurred following discontinuation of its use. In addition, because we suspected that women with unexplained infertility might be harbouring an occult or microendometriosis, a 3 month course of 200mg of danazol was tried in such patients, and proved effective in overcoming infertility in roughtly 40% of patients within 6 months after discontinuation of medication. We serendipitously found that some habitual aborters carried to term after a course of danazol. Accordingly, a trial of 100mg daily for 3 months was undertaken with a satisfactory outcome in more instances than could be attributed to chance alone. To readily appreciate the effectiveness of this agent, one must be aware that conceptions may follow the use of placebos or whatever regimen is employed in about 15 to 20% of infertile women. The unusually good results that we and other investigators in the field obtained with danazol rules out a placebo effect.
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PMID:Danazol in the treatment of infertility. 699 82

Endometrial samples were obtained with the Accurette and the Vabra aspirator and were compared with samples obtained by dilation and curettage in 40 patients with postmenopausal bleeding. The degree of discomfort and patient acceptability of the two outpatient procedures, the adequacy of the samples for cytological and histological examination, and the cytological and histological diagnosis were compared. The Accurette and the Vabra aspirator could not be inserted in 5 out of 40 patients because of cervical stenosis. From approximately 30 of the remaining 35 patients, adequate samples were obtained. Six cases of endometrial hyperplasia and 3 of endometrial carcinoma were diagnosed by all the methods employed, except for 1 case of endometrial hyperplasia in which the sample obtained with the Accurette was inadequate for histological examination but was nevertheless adequate for cytological examination. Of the 5 patients in whom endometrial sampling by both the Accurette and the Vabra aspirator could not be performed because of cervical stenosis, 2 cases of endometrial carcinoma were found on uterine curettage. In patients with cervical stenosis, however, dilatation and curettage under general anaesthesia is mandatory. The Accurette has the advantage of being less expensive and more suitable for routine endometrial sampling for the detection of endometrial hyperplasia or carcinoma and dating of the endometrium in cases of infertility. Both the Accurette procedure and Vabra aspiration appeared to be reliable methods of obtaining endometrial samples.
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PMID:A comparison of endometrial sampling with the Accurette and Vabra aspirator and uterine curettage. 705 25

Over a 5-year period, 98 men (101 "cases") with immunologic infertility, as diagnosed by Kibrick and F-D sperm agglutination testing, were treated with one or more regimens of methylprednisolone (96 mg/day for 7 days). Among the 71 patients for whom complete follow-up data were obtained, 31 (44%) succeeded in achieving pregnancy in their partners within 12 months of the start of treatment. The pregnancy-achievers and nonachievers were compared with respect to their semen quality, Kibrick titers, and F-D agglutination before and after therapy. No single, clear-cut factor could be identified to explain, or predict, a successful outcome. However, some men did have improved semen quality; of these, 69% achieved a pregnancy in the partner. Furthermore, pregnancy was somewhat more likely to occur if the man had a decrease in Kibrick titer; a decrease in titer was more likely in men whose titers were higher initially. No correlation with F-D agglutination activity was found. side effects were of limited incidence; only 16% of the men had any discomfort at all, and only 2% of them had severe problems. However, all discomfort and problems were transient.
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PMID:Methylprednisolone treatment of immunologic infertility in male. 712 45

Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices. A case of otitis media attributed to this phenomenon is described. The hazards of vaginal and rectal laceration, salpingitis, tubo-ovarian abscess with resultant infertility, induced abortion, and associated complications are reviewed. In addition to sinusitis, otitis media and tympanic membrane rupture, other potential upper airway and auditory complications are enumerated.
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PMID:Medical hazards of the water skiing douche. 736 81

DNA flow cytometry was applied to fine-needle aspiration biopsy specimens from the testes of 20 oligospermic or azoospermic men under investigation for infertility. All aspirations gave sufficient material for DNA flow cytometry, and no complications occurred after aspiration. In both groups many DNA patterns deviated from those observed in control specimens. In general, abnormally small testes were associated with the greatest deviations in DNA patterns. In specimens from certain azoospermic men the DNA distributions did not deviate from those of control samples, suggesting a block in the testicular excurrent ducts. These findings also suggest that DNA flow cytometry of aspirated testicular material can be used in the classification of tubular degeneration in males. The results are obtained within a short time, are quantitative and without bias, and the aspiration causes only little discomfort to the patient. The method can therefore be recommended as a very practical means of obtaining quantitative estimates of spermatogenesis in men being evaluated for infertility.
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PMID:Deoxyribonucleic acid flow cytometry of germ cells in the investigatin of male infertility. 741 90

For the diagnostic evaluation of infertility it is crucial to obtain information on potential abnormalities of the uterus or the fallopian tubes. At present, the following diagnostic methods are available: CO2-pertubation, hysteroscopy, hysterosalpingography (HSG) and chromolaparoscopy (CLP). For the latter procedure, general anaesthesia is required. In a clinical trial 103 patients from our infertility clinic were examined for fallopian tube patency using the contrast agent SH U 454 (Echovist). The new technique hystero-contrast sonography (Hy-Co-Sy) was carried out in an outpatient setting without requiring general anaesthesia. Informed consent was obtain from all patients. A Foley catheter was inserted into the uterine cavity, the balloon was inflated and the contrast medium injected. Distribution of the contrast agent as well as the uterine cavity, the fallopian tubes as well as in the pouch of Douglas was then observed by sonography. In addition to Hy-Co-Sy, 58 patients underwent HSG or CLP. Hy-Co-Sy findings could confirmed by HSG and CLP in 90.6% and 91.6%, respectively. Patients were asked to describe their discomfort on a scale of one to hundred. The average time required for the assessment to tubal patency was 9 minutes. Within 12 months of the Hy-Co-Sy study, 23 out of 60 patients (38.3%) became pregnant. Our study shows that Hy-Co-Sy is a valuable and reliable procedure to assess the uterine cavity and the fallopian tubes in patients undergoing treatment for infertility. The procedure can be performed safely in the office without the need for general anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ambulatory contrast hysterosonography as a possibility for assessing tubal patency]. 766 62


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