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Laparoscopic surgery seems to be effective in treating endometriosis on the ovary. In a study of 366 women treated with laparoscopic surgery, only 11.7% had a recurrence in the next four years.

The present study was designed to evaluate the prognostic value of salpingoscopy in patients undergoing tubal laparoscopic surgery for infertility due to periadnexal adhesion or distal tubal occlusion. In addition, the clinical value of salpingoscopy was compared with a current classification system of adnexal adhesions and distal tubal occlusion. A total of 51 patients with either adnexal adhesions (24 patients) or hydrosalpinx (27 patients) were prospectively evaluated. Salpingoscopy was performed concomitantly with salpingo-ovariolysis or salpingoneostomy at the time of operative laparoscopy. There was no significant correlation between salpingoscopic classes and the classification system used for both the salpingo-ovariolysis and the salpingoneostomy groups of patients. The patients had a mean follow-up of 33 months. Patients with a normal tubal mucosa (salpingoscopic classes I and II) had a 71% cumulative term pregnancy rate in the salpingo-ovariolysis group and a 64% cumulative term pregnancy rate in the salpingoneostomy group. No intrauterine pregnancies were obtained in patients with intratubal damage (salpingoscopic classes III to V). There was a statistically significant correlation between the occurrence of a term pregnancy and the salpingoscopic classes, but not with the classification system used. These results suggest that patients with tubal infertility should be offered operative laparoscopy with salpingoscopy as the first step of treatment.

The present study was designed to evaluate the prognostic value of salpingoscopy in patients undergoing tubal laparoscopic surgery for infertility due to periadnexal adhesion or distal tubal occlusion. In addition, the clinical value of salpingoscopy was compared with a current classification system of adnexal adhesions and distal tubal occlusion. A total of 51 patients with either adnexal adhesions (24 patients) or hydrosalpinx (27 patients) were prospectively evaluated. Salpingoscopy was performed concomitantly with salpingo-ovariolysis or salpingoneostomy at the time of operative laparoscopy. There was no significant correlation between salpingoscopic classes and the classification system used for both the salpingo-ovariolysis and the salpingoneostomy groups of patients. The patients had a mean follow-up of 33 months. Patients with a normal tubal mucosa (salpingoscopic classes I and II) had a 71% cumulative term pregnancy rate in the salpingo-ovariolysis group and a 64% cumulative term pregnancy rate in the salpingoneostomy group. No intrauterine pregnancies were obtained in patients with intratubal damage (salpingoscopic classes III to V). There was a statistically significant correlation between the occurrence of a term pregnancy and the salpingoscopic classes, but not with the classification system used. These results suggest that patients with tubal infertility should be offered operative laparoscopy with salpingoscopy as the first step of treatment.

Eleven pituitary or urinary preparations of varying purity were assayed for FSH activity by an in vitrobioassay method, a receptor binding assay (RBA) technique and a radioimmunoassay (RIA) procedure, employing two anti-FSH sera with and without absorption with hCG. All methods were specific for hFSH, since other glycoproteins (hFSHα and hFSHβ subunits, hLH, hCG and hTSH) elicited little, if any, response. A partially purified hFSH preparation (1st IRP of Human Pituitary Gonadotrophins (FSH and LH/ICSH) for bioassay, code No. 69/104) was used as standard in all assays. In addition, potency estimates were expressed in terms of a highly purified hFSH preparation (hFSH-Kabi, Lot No. 19344) and in terms of the hMG (2nd IRP).Significant differences in the ratios of biological activity to receptor binding activity (B/R) and to immunological reactivity (B/I) were observed between preparations which were unrelated to their level of purity. The use of the 69/104 preparation as standard gave significantly higher B/R and B/I ratios than the use of the hMG (2nd IRP) and of a highly purified hFSH preparation. In addition, the use of the hMG (2nd IRP) as a standard gave significantly higher B/R ratios than that of the highly purified hFSH preparation.These results indicate that the 69/104 and hMG (2nd IRP) preparations contain significantly more biologically inactive receptor binding material than the more extensively purified hFSH preparation. Furthermore, the 69/104 preparation contains significantly more biologically inactive immunologically reactive material than both hMG reference standards and the highly purified hFSH preparation.It is concluded that, because of the presence in the 69/104 preparation of relatively large quantities of biologically inactive material which behaves in both the receptor binding assay (RBA) and radioimmunoassay (RIA) procedures as hFSH, this preparation is unsuitable as standard for the quantitation of FSH activity by methods other than bioassays. For the same reason, the relatively crude 2nd IRP (but not its replacement, the 1st IS for human urinary FSH and LH for bioassay) appears to be unsuitable as a standard for the assay of hFSH by RBA procedures. Among the limited number of preparations studied, a highly purified pituitary hFSH preparation appears to be the most satisfactory as a provisional standard for hFSH assays, although even this material contains some biologically inactive hFSH-like material.

The objective of this study was to establish whether [125I]hFSH subunits are formed during iodination of hFSH by a mild (lactoperoxidase) technique, and if so which fractionation procedure provides the best separation of [125I]hFSH from its subunits. In addition, the effect of the 125I subunits on the specificity of the hFSH radioimmunoassay technique was examined. The products of iodination of hFSH were fractionated by a number of techniques consisting of low and high resolution gel filtration procedures and adsorption on either cellulose or Concanavalin A coupled to Sepharose. The efficacy of the adsorption methods was assessed by a subsequent high resolution gel filtration procedure (Ultrogel AcA 54). Radioreceptor and radioimmunoassay methods were used to monitor the profiles of hFSH, hFSHα and hFSHβ subunits and to assess the recoveries of radioreceptor-active hFSH obtained by the different procedures.Iodination of a highly purified hFSH preparation invariably resulted in the formation of both [125I]hFSH and [125I]hFSH subunits. The proportion of radioactivity associated with the 125I subunit peak to that of the [125I]hFSH peak was 10 % when the iodination products after low resolution gel filtration were fractionated by a high resolution gel filtration procedure. The corresponding amount of subunits obtained by adsorption on cellulose and Concanavalin A was 71 % and 6 %, respectively. Thus in comparison with low resolution gel filtration there was a partial separation of [125I]hFSH from [125I]hFSH subunits on Concanavalin A while no separation was effected on cellulose. In fact, the results suggest that 125I subunits were formed during fractionation on cellulose. The recoveries of hFSH activity following fractionation on cellulose and Concanavalin A were significantly lower (27 % and 65 %) than those obtained by either low or high resolution gel filtration techniques. A marked reduction in the specificity of the RIA of hFSH was found when [125I]hFSH subunits rather than [125I] hFSH were used as tracer in the assay.It is concluded that the presence of 125I subunits in [125I]hFSH preparations used as tracer in the RIA of hFSH can diminish the specificity of the assay. The routine employment of a high resolution gel filtration procedure which provides a complete separation of 125I subunits from the intact hormone, is suitable for the elimination of this source of assay invalidity while the other fractionation procedures tested (cellulose adsorption or Concanavalin A) are not.

An in vitrobioassay method for hFSH is presented. The method is based on the principles previously described by Dorrington et al. (1976b) and involves the assay of oestradiol produced from 19-hydroxyandrostenedione by dispersed Sertoli cells of 10-day old rats when cultured in the presence of graded doses of FSH. Using the 1st International Reference Preparation for human pituitary gonadotrophins (FSH and LH/ICSH) for bioassay (code no. 69/104) as standard, the useful range of the method is from 0.5 to 32 mIU/chamber (2 to 128 mIU/ml). The sensitivity of the method is 0.5 mIU/chamber. The mean index of precision obtained from 16 multiple assays over 2 or 3 dose levels was 0.084. Parallelism was obtained between the 69/104 preparation and all preparations under study. The practicability of the proposed assay method is such that 15 preparations at 3 dose levels can be assayed by one person in 3 days. The specificity of the assay was investigated by determining the FSH activity in the following preparations: hFSHa-α and β-subunits, hLH, hCG, hTSH, ACTH, human growth hormone (hGH) human prolactin (hPRL) and luteinizing hormone-releasing hormone (LH-RH). The ACTH, hGH, hPRL and LH-RH preparations studied showed no detectable FSH activity in the assay. In the remaining preparations very low levels of FSH activity were found, corresponding to 0.004 to 0.6 % of the weight of these preparations when compared with a highly purified hFSH preparation, suggesting that the method is specific for FSH. The possible synergistic or antagonistic influence of the above preparations when assayed in the presence of the 69/104 preparation was also assessed. No evidence of a synergistic or antogonistic effect was found. The assay of the hFSH potencies of a limited number of hFSH preparations of varying purity by the proposed in vitrobioassay, an hFSH radioreceptor method and an hFSH specific radioimmunoassay technique revealed that – although the relationship of the various potencies obtained with each method showed a close agreement – the bioassays yielded the highest potency estimates, and the radioimmunoassays the lowest ones.Since the proposed bioassay method is sensitive and considered to be specific for hFSH activity, it provides a suitable basis for the assessment of the specificity of other in vitromethods (radioreceptor and radioimmunoassay) currently used for detecting low levels of FSH activity.

The efficacy of an oxidized regenerated cellulose barrier (Interceed) in reducing postoperative adhesion formation and improving reproductive outcome after ovarian surgery was evaluated in a prospective randomized trial. Twenty-nine New Zealand White female rabbits were submitted to a mid-line laparotomy and a standardized surgical incision was made on both ovaries. At random, one ovary was entirely wrapped in a sheet of Interceed, whereas the contralateral ovary was left uncovered. Four weeks following surgery, the rabbits were mated with a male of proven fertility. Two weeks later, a second-look laparotomy was performed by a blinded observer who evaluated the incidence and score of adhesions, the number of corpora lutea in each ovary, the number of embryos in the ipsilateral uterine horn and also calculated the nidation index for each side. Adhesions were observed in 66% of Interceed-covered and in 97% of control ovaries (P < 0.0001). The adhesion score on the Interceed side was significantly lower than on the control side. The nidation index for the Interceed side was significantly higher than for the control side. The authors conclude that, in the rabbit model, Interceed significantly reduces the incidence and score of postoperative ovarian adhesions and significantly improves reproductive outcome.

Several studies have shown that previous chlamydial genital infection, reflected by serological markers, is strongly associated with tubal damage leading to tubal infertility. In 105 women undergoing laparoscopy, multiple samples were collected from the lower (urethra and cervix) and upper (endometrium, peritoneal fluid, tubal lumen) genital tract, in order to isolateChlamydia trachomatis in cell culture.

The aim of the present study was to evaluate the efficacy of low-dose versus high-dose aspirin in the prevention of postoperative adhesion formation. Forty New Zealand White rabbits were randomized into three groups: low-dose aspirin (1.7 mg/kg per day for 5 days starting on the day of surgery), high-dose aspirin (28.0 mg/kg per day), and controls. The rabbits underwent a standardized surgical injury on the ovary, uterine horn and abdominal wall on one side at laparotomy. On postoperative day 21, a second-look laparotomy was performed for the evaluation of postoperative adhesions. In five animals in each group, peritoneal fluid samples were collected at initial surgery, then through an additional 2 cm incision performed on postoperative day 3, and at second-look laparotomy. The peritoneal concentrations of thromboxane B2 and 6-keto-prostaglandin F1alpha (the stable hydrolysis product of prostacyclin) were measured by radioimmunoassay. At second-look laparotomy, the adhesion formation rate was 46% in the low-dose aspirin group, 77% in the high-dose group, and 100% in the control group. The adhesion score in the low-dose group was significantly lower (P < 0.01) than in the high-dose and control groups. Peritoneal thromboxane decreased significantly during treatment in both low-dose and high-dose aspirin groups, whereas prostacyclin decreased only in the high-dose group. Postoperative adhesion reduction observed in this study with low-dose aspirin treatment could be due to the selective inhibition of thromboxane over prostacyclin production.

From 1 July 1990 to 31 January 1994, 55 patients underwent operative laparoscopy for the excision of monolateral endometriomas. None of the patients had previously undergone surgery by laparotomy or laparoscopy. At the time of laparoscopy, the surgeon staged the disease according to the American Fertility Society classification of endometriosis. A second surgeon, blinded to the preoperative management of the patients, re-staged the disease based on a videotape review. Interobserver disagreement was between 0 and 12%. Total, endometriosis (deep and superficial) and adhesion scores were evaluated separately. These scores in patients who had previously undergone transvaginal ultrasound-guided aspiration of the cyst content (n = 13) were compared with those from patients who had not undergone this procedure (n = 42). The total and endometriosis scores were not significantly different between the two groups, whereas the adhesion score in patients who had undergone a transvaginal aspiration procedure was significantly higher than in patients who had not (mean +/- SD, 12.0 +/- 13.7 versus 5.9 +/- 4.6; P = 0.02). Therefore it is possible that transvaginal ultrasound-guided endometrioma aspiration may determine tissue trauma that enhances adhesion formation.