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The effect of surgically lengthening the rabbit oviduct was investigated. In the study group, a lengthened fallopian tube was created by division of the left fallopian tube at the ampullary-isthmic junction and the right fallopian tube at the uterotubal junction. The proximal left tube and the entire right tube were mobilized to the midline, and a microsurgical anastomosis was performed with 10-0 nylon. This formed a tube that was lengthened by approximately 50%, with doubling of the isthmic region. In the control group, both tubes were divided at the ampullary-isthmic junction, and the proximal left and distal right segments were joined to form a tube of normal length. The left ovary and ampulla were resected in both groups. After the animal had been bred, a second laparotomy was performed to assess adhesion formation, document tubal patency, and establish a nidation index. The median nidation index of the control group (N = 11) was 0.89, whereas that of the lengthened group (N = 7) was 0. The nidation indices of the two groups were different, with P less than 0.01.

A retrospective review was undertaken on all pediatric and reproductive-aged females who underwent cardiac surgery and required cardiopulmonary bypass from 1958 through 1986. The purpose of this study was to define the fertility of these patients after surgery and to compare their reproductive performance with that in the general population. Analysis was complete for 208 patients. These patients make up the following cardiac surgical categories: septa[ defect repairs, 92; commissurotomies, 60; valve replacements, 46; tetralogy of Fallot repairs, 6; and coronary artery bypass procedures, 4. Of 208 patients, 68 (32.7%) attempted pregnancy after surgery. Infertility was defined in five women as follows: endometriosis, 3; ovulatory dysfunction, 1; unknown, 1. A total of 64 patients conceived 121 pregnancies with the following outcomes: live births, 98; spontaneous abortion, 9; ectopic pregnancy, 2; therapeutic abortion, 12. Our results suggest that infertility is not an apparent disorder after cardiac surgery and that subsequent pregnancy outcomes are similar to those in the general population.

Between July 1, 1969, and December 31, 1983, 1774 patients were evaluated in the private infertility clinic at the University of Virginia Hospital. Homologous artificial insemination was performed in 158 patients for the following indications: male factor (75.3%), cervical factor (16.7%), sperm deposition problem (3.7%), patient's request (2.5%), and immunologic factor (1.8%). Whole-ejaculate insemination was performed in 68 patients; split ejaculates were used in 90 women. Additional fertility factors in 140 patients included endometriosis, anatomic abnormalities, and ovulatory difficulties. Of the 158 women, 23 (14.6%) had a total of 27 pregnancies (mean number of cycles, 5.7); 135 failed to conceive during treatment with homologous artificial insemination (mean number of cycles, 8.4). Most pregnancies (70.4%) occurred in those patients in whom homologous artificial insemination was used for a male factor. Among the 135 couples who failed to conceive with homologous artificial insemination, 20 (14.8%) patients subsequently had 25 pregnancies. Male factor had been the indication for homologous artificial insemination in 72% of the couples. Pregnancy outcomes were similar in all subgroups. Homologous artificial insemination may not be indicated for male factor-related infertility.

Lecithin/sphingomyelin (L/S) ratios were measured in 81 amniotic fluid specimens obtained from 41 patients with “stressed pregnancies” as evidenced by chronically low (< 2 S.D.) 24 hour urinary estriol excretion. Fourteen of the patients studied also had a positive oxytocin challenge test. The results suggest that, on the average, fetal pulmonary maturity as evaluated by L/S ratios is not accelerated in “stressed pregnancies.”

During the 9-year period ending April, 1985, 103 women had bilateral and unilateral cuff salpingostomy at the University of Virginia Hospital. Currently accepted principles of microsurgery were used as well as an "antiadhesion" regimen consisting of intravenous dexamethasone and antibiotics, intraperitoneal dextran, and postoperative hydrotubations. The postoperative tubal patency rate was 75.6% in tested patients (91.2% in patients known to have conceived). Forty women (38.8%) conceived and 26 (25.2%) have had one or more term pregnancies. Fourteen women (13.5%) had ectopic pregnancies but three of these have also had term pregnancies. Fourteen women (13.5%) had first-trimester abortions. Two of nine women who had repeat salpingostomies have carried pregnancies to term as have two of 10 women who had ampullary salpingostomies. The extent of tubal disease remains the single most important factor with regard to subsequent successful pregnancy.