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Increasing numbers of young women with ovarian failure and women of advanced reproductive age (> 40 yrs) utilize oocyte donation to treat their infertility. In both groups, women who become pregnant frequently experience multiple gestation, occurring in up to 30% of pregnancies. Advanced maternal age and high-order multiple gestations are associated with an increased risk for obstetric complications. We reviewed the pregnancies of patients with high-order multiple gestations (> or = 3 gestational sacs) with respect to their antepartum course and neonatal outcomes. Mothers were divided into two groups according to age at conception; Group I (> or = 40 yr, n = 20) and Group II (< 40 yr, n = 10). These 30 high-order multiple gestations were found among 127 successful oocyte donation cycles (23.6% of all pregnant patients). Data regarding pregnancy outcomes were gained by chart review and telephone interview. Results demonstrated spontaneous reductions in the number of implantation sites were similar between groups (Group I: 21.4% vs. Group II: 17.6%). Multifetal pregnancy reduction (MFPR) was more often chosen by older women (Group I: 45% vs. Group II: 10%; P < 0.05). Antenatal complications were commonly experienced by both groups (> 80%) as were operative deliveries (> 85%). However, neonatal outcomes were generally good, with only one death occurring in the 79 delivered infants (1.3%). We conclude transferring supernumerary embryos to women undergoing ovum donation places patients at great risk for high-order multiple gestations. These pregnancies are associated with increased antenatal and neonatal complications. Although advanced maternal age is normally an added risk factor, well-screened older patients carrying high-order multiple gestations experienced similar outcomes as younger mothers.

Misoprostol is a prostaglandin analogue which has uterotonic properties. Administered vaginally, it is an effective agent for induction of second trimester abortions. This study was undertaken to determine if the vaginal administration of misoprostol is effective for inducing first trimester abortions. Fifty-eight women with pregnancies less than 10 weeks gestation who desired pregnancy termination received varying dosages of vaginal misoprostol, either alone or in combination with laminaria or tamoxifen. The overall success rate for a complete abortion was 61%. The use of laminaria or tamoxifen did not affect success rates. Abortions occurred within 24 hours of administration of misoprostol. Side effects were minimal. There were no significant differences in any of the following between those who had a successful abortion and those who did not: gravidity, parity, prior elective abortion, age, gestational age of the pregnancy, and level of human chorionic gonadotropin. Although not as successful as other combination regimens, misoprostol alone is readily available, easy to administer, and without major side effects. The use of this agent could eliminate the need for about two-thirds of surgical abortions in the first 10 weeks of gestation.

Prior evaluations of carbohydrate metabolism in Norplant implant users, using the oral glucose tolerance test, have shown mild but clinically insignificant deterioration of insulin sensitivity. Using the more sensitive insulin tolerance test, the effects of the Norplant implant system on insulin sensitivity was studied in normal women. Insulin tolerance tests were performed before Norplant implant insertion in ten ovulatory female volunteers and repeated after 12 weeks of use. Both fasting glucose and fasting insulin values were similar before and after the use of Norplant implants. There was no significant difference in either the Kitt glucose value or the Kitt insulin value at baseline and at 3 months of use. Furthermore, the insulin-to-glucose ratio did not differ before and after the use of Norplant implants. There was a significant correlation with BMI and Kitt glucose value (r = -0.45, p < .05), as well as between fasting insulin and BMI (r = 0.6, p = 0.006). In the first three months of use, the levonorgestrel-containing implant system, Norplant, does not affect sensitivity to insulin or glucose in normal, nondiabetic women.

In an attempt to establish whether nidation elicits a measureable systemic immunologic response in vivo, levels of interleukin-2 receptor (IL-2R) have been determined in serum drawn from 34 pregnant patients (IUP) immediately before embryo/gamete transfer, and 7 and 14 days later. For comparison, these same values were determined for 41 subjects who did not conceive, and for 18 who spontaneously aborted (SAB) during the first trimester of gestation. Serum IL-2R values were near 320 U/ml and did not differ between days within outcomes, or within days between outcomes. Furthermore, levels of IL-2R and beta-hCG in serum were not interrelated on days 7 or 14 of pregnancy (SAB or IUP). Serum IL-2R levels did not change during the menstrual cycle. The present results appear to traverse presumptive elements of existing hypotheses of "placental immunotropism."

In an attempt to track the proliferation/demise of trophoblastic tissues in women following gamete transfer (GT) or in vitro fertilization/embryo transfer (IVF/ET), we have measured levels of human chorionic gonadotropin (hCG) in serum of 180 patients on days 7 and 14 following oocyte pickup (OPU). Serum hCG levels were measured by immunoassay and by a bioassay based on the capacity of the sample to stimulate testosterone secretion by cultured mouse Leydig cells. Based on determinations of bioactive and immunoactive hCG in serum from 18 of 180 patients who subsequently delivered (12 of 73 GT, 6 of 107 IVF/ET; P less than 0.05) and classification of patients in accord with their compliance or noncompliance with these ranges of values, about 70% of all patients in the present study were classified as "pregnant" 7 days following OPU. Based on these same criteria, about 23% were pregnant 7 days later. Biochemical pregnancy rates on days 7 and 14 following GT (near 73 and 27%, respectively) were not different from the respective values following IVF/ET (near 68 and 20%, respectively; P greater than 0.05). The luteotropin bioassay described is highly sensitive to hCG (to 0.02 mIU/ml serum) and appears appropriate to the characterization of proliferation/demise of embryonic tissues during the 14 days after gamete/embryo transfer. In addition, through its representation of the cumulative luteotropic properties of human serum and its insensitivity to biologically inactive hCG subunits, this bioassay appears more appropriate than hCG immunoassay in the monitoring of early embryonic signalling following assisted (or spontaneous) conception in the woman.