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Journal of Obstetrics and Gynaecology. 1994 Mar; 14(2): p..In order to find a simple screening test to assess tubal patency among infertile women, comparison was made between the data provided by complete hysterosalpingography and that given by taking a single follow up film after 15 minutes of walking about at the end of the procedure. There was a good correlation between the follow up film and the complete hysterosalpingography. There was also a positive relationship between the follow up film and the outcome in terms of pregnancy rate. (excerpt)
London, International Planned Parenthood Federation, 1979. 58 p.This International Planned Parenthood report states the agency's policy position on management of infertility, and then briefly goes on to cover the following topics, in handbook form: 1) epidemiology of infertility; 2) etiology of infertility; 3) proper infertility counseling; 4) prevention (trauma avoidance and early treatment of diseases); 5) diagnostic techniques for the couple, man, and woman; 6) treatment of infertility in women and men; 7) use of artificial insemination, both with donor's semen and partner's semen; and 8) the place of adoption within the community of infertile couples. Prevalence of infertility is placed at an international average of 10%, though places such as Cameroon have rates as high as 40%. The factors influencing infertility are divided into 3 groups: 1) socio-cultural, 2) sexually transmitted diseases, and 3) other diseases and disorders. Causes of female infertility include: ovulation dysfunction; tubal obstruction or dysfunction; uterine actors such as fibroids, polyps, or developmental abnormalities; cervical abnormalities; vaginal factors, such as severe vaginitis or imperforate hymen; endocrine and metabolic factors, particularly thyroid disturbances, diabetes, adrenal disorder, severe nutritional disorders (anemia), or other systemic conditions; and repeated pregnancy wastage. Male causes include poor semen quality; ductal obstruction; ejaculatory disturbances (i.e., failure to deliver sperm to vagina); emotional stress (may lead to hypogonadism); and genetic factors (Klinefelter syndrome). Causes specific to the couple include lack of understanding of reproductive physiology, immunoloigcal incompatibility, nutritional deficiencies, and psychogenic factors.
Design of studies for the assessment of drugs and hormones used in the treatment of endocrine forms of female infertility.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 135-154The lack of uniformity in diagnostic selection of women for treatment of infertility, in choice of therapy, in monitoring of therapy, and in follow-up, frequently does not allow a meaningful comparison of results reported from different centers. To design studies assessing effectiveness of therapy of endocrine forms of female infertility, it is essential to consider: 1) mechanism controlling reproductive functions (e.g., process of ovulation); 2) cause(s) responsible for infertility (mechanical factors, ovarian failure, and pituitary failure); and 3) the mechanism of action of agents used for therapy (e.g., gonadotropins stimulate gonadal function, clomiphene stimulates gonadotropin secretion, and ergoline derivatives inhibit prolactin secretion). Patients selected for therapy should be grouped according to etiology: 1) hypothalamic-pituitary failure; 2) hypothalamic-pituitary dysfunction; 3) ovarian failure; 4) congenital or acquired genital tract disorder; 5) hyperprolactinemic patients with a space-occupying lesion in the hypothalamic-pituitary region; 6) hyperprolactinemic patients with no space-occupying lesion; and 7) amenorrheic women with space-occupying lesion. Ideally, an infertile couple should be diagnosed and treated as a unit.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 111-134A 6-month regimen for managing infertile men and/or women ideally forms 4 stages: 1) history and examination of the couple; 2) confirmation of ovulation, compatibility of sperm and mucus, and seminology; 3) tests for tubal patency; and 4) detailed endocrine tests for abnormalities found in Stages 1-3. Medical history should include emotional stress and work pressures, if any. Ovulation confirmation requires 2 tests combined from these 4: 1) basal body temperature; 2) endometrial biopsy; 3) blood progesterone levels; and 4) urinary pregnanediol. These procedures are outlined in detail, and figures chart body temperature variations and expected progesterone and pregnanediol levels. Assessment of cervical mucus and measurement of sperm penetration combine in vitro and in vivo tests. The Sims-Huhner test (postcoital test), though not standardized, is used to analyze sperm-mucus interaction by quantitative scoring of sperm count and motility. Other in vitro tests are the sperm-mucus match test and the fractional postcoital test (both described). Tubal patency is investigated by tubal insufflation with CO2, hysterosalpingography, endoscopy, and laparoscopy. Additional Stage 4 tests include vaginal cytology and assessment of estrogen and progesterone effects.
WHO Chronicle. 1982; 36(5):179-85.The World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction supports investigations on the safety and efficacy in developing countries of oral contraceptive (OC) methods and provides advice on the best preparations or devices for particular groups and the safety of controversial products such as injectable progestins. Comparative studies on OC dosages and preparations, interaction of OCs with parasitic diseases such as malaria, timing of IUD insertion, comparison of available types of IUDs, clinical and epidemiological studies of the safety and dosage levels of long acting progestin preparations, and a comparison of surgical sterilization techniques have been carried out. High priority is given to the development of better methods of fertility control. A simplified questionnaire to determine prevalence of primary and secondary infertility, pregnancy wastage, and infant and child mortality has disclosed some very high rates of infertility, particularly in Africa. Other studies seek to standardize the protocol for diagnosis and investigation of infertility and to evaluate commonly used treatment and evaluation procedures for infertility. The Special Programme seeks to strengthen the capability of institutions in developing countries to conduct research and collaborate in projects. 250 research and visiting scientist grants were awarded in 1980-81, and 20 research training courses were organized. A major effort was made in the standardization and quality control of laboratory procedures, and 142 laboratories in 48 countries now participate.