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Ovulation induction by means of the pulsatile subcutaneous administration of gonadotrophin-releasing hormone by way of an infusion pump is described. The clinical outcome in 50 courses of treatment, which totalled 116 treatment cycles, was analysed and was compared with the pregnancy rates that were obtained with the administration of human pituitary gonadotrophins. We found that the pregnancy rates for these two treatments were similar. We also have shown that for those women who ovulated as a result of such treatment the conception rates were similar to those in ovulatory women who had discontinued contraception. We conclude that gonadotrophin-releasing hormone has an important place among the ovulation-induction agents.

Whereas the dose of hMG is significantly correlated with both BMI and BW, commencing the more obese patient on higher hMG doses is not justified in view of the cancellation of cycles from over-responsiveness in the more obese patients started on higher hMG dosage regimens. If the more obese patient is slow to respond, however, a greater degree of clinical freedom may be exercised to increase the dose. The ultimate outcome of the cycle is not related to BMI, BW, or the dose of hMG used.

Reproductive medicine encompasses a variety of disorders resulting from disturbed gonadal function. Such disorders affect all age groups, and their rational therapy depends on comprehensive understanding of the physiology of the hypothalamo-pituitary-gonadal axis and of the pathophysiological disturbances which may occur. In a deliberately selective manner, this review has highlighted Australian contributions which include: new knowledge of the physiology of inhibin; approaches to the management of male infertility; the use of gonadotrophins and gonadotrophin releasing hormone in ovulation induction; new advances in our understanding of the pathophysiology and management of the polycystic ovarian syndrome; the use of superactive GnRH agonists in the management of disorders such as uterine fibroids and also the use of parenteral estradiol and testosterone replacement in women suffering from sexual dysfunction at the menopause. The contributions of Australian medicine have been significant.

Objective: To examine the relationship of baseline and preovulatory serum E2, P, and LH levels and age with pregnancy outcome in polycystic ovarian syndrome (PCOS) patients undergoing hMG ovulation induction. Design(s): Retrospective analysis of all available data over 2 years. Setting(s): Tertiary referral ovulation induction clinic. Subjects: Forty-four anovulatory PCOS patients with 25 ovulatory nonconception and 50 conception cycles after hMG ovulation induction. Main Outcome Measure(s): Ovulation (midluteal serum P > 25 nmol/L [7.86 ng/mL]); pregnancy (serum beta-hCG > 30 mIU/mL 16 days after ovulating injection); pregnancy outcome: pregnancy termination < 20 weeks' or >=20 weeks' amenorrhea. Result(s): Of the endocrine parameters considered, none was significantly different in nonconceptive and conceptive ovulatory cycles. Miscarriage was associated with low basal serum E2: median value for pregnancies ending <20 weeks, 105 pmol/L (28.6 pg/mL) for >=20 weeks 150 pmol/L (40.9 pg/mL). It was also significantly associated with age. For patients > 29.5 years of age, (29.5 years, population mean age) a baseline E2 <= 140 pmol/L (38.2 pg/mL) had sensitivity 92%, specificity 54%, positive predictive value 65%, and negative predictive value 87% for the prediction of miscarriage. The nature of the previous cycle, the day of the cycle on which therapy commenced, and a past history of miscarriage were not related either to pregnancy outcome or to basal serum E2.

The study was designed to examine (1) the effects of the luteinizing hormone releasing hormone (GnRH) agonist, buserelin, on pituitary and ovarian hormone secretion, and (2) the effect that pituitary-ovarian suppression with a GnRH agonist has on subsequent ovulation induction with exogenous gonadotrophins (hMG), in polycystic ovary syndrome (PCOS). Two protocols were studied where buserelin was administered intranasally to all patients in a dose of 200 mug, six times daily. Ten patients received buserelin until oestrogen withdrawal bleed occurred while a further 12 patients received buserelin for 4 weeks, before hMG was co-administered. Nine of the above subjects also underwent conventional ovulation induction with hMG. Blood samples were taken daily for radioimmunoassay of LH (LH-RIA), FSH , sex steroids and inhibin and for immunoradiometric assay of LH (LH-IRMA). Following buserelin administration there was an initial rise in LH-RIA, FSH, oestradiol (E2) and inhibin (P < 0.01). Fourteen days were needed for LH-RIA to return to the normal range, with both protocols resulting in a fall in LH-RIA and FSH (P < 0.01) before hMG was co-administered. Twenty-eight days of buserelin administration were needed to suppress E2 into the castrate range. Inhibin and both E2 and FSH were closely correlated throughout buserelin administration (P < 0.01). There was failure to respond to an intravenous bolus of 100 mug of GnRH from 7 days of buserelin administration onwards, despite the serum LH-RIA still being raised at 7 days. Serum samples assayed for LH by RIA using WHO Matched Reagents and by IRMA were closely correlated (r = 0.96, P < 0.01). There was no difference in the proportion of ovulations (52% vs 66%) or pregnancies (1 vs 1) in the GnRH agonist or control group. Similar amounts of hMG were needed in both groups and there was multiple follicular development (> 3 follicles > 15 mm diameter; 41% vs 38%) following hMG administration. There was a close correlation between

Objective: To determine the validity of the criteria currently used to select fertile sperm donors. Design(s): Retrospective study of the outcome of donor insemination treatment cycles over a 15-year period. Setting(s): The Reproductive Medicine Clinic of Prince Henry's Institute of Medical Research (formerly Medical Research Centre, Prince Henry's Hospital, South Melbourne, Victoria, Australia). Patient(s): Couples (1,299) presented with severe male factor infertility (azoospermia or severe oligozoospermia) and were treated by donor insemination (10,796 treatment cycles) using cryopreserved semen from 292 normal healthy men aged between 18 and 46 years as sperm donors. Main Outcome Measure(s): Semen characteristics, including volume, count, motility, motility index, normal morphology, live cells, and post-thaw motility, were analyzed by logistic regression analysis to determine which groups of factors were related independently and significantly to pregnancy rates. Result(s): The pregnancy rate for donor insemination was 8.9% per cycle. By logistic regression count, normal morphology, post-thaw motility (%), and post-thaw motility index together explained 28% of the variance of the pregnancy rates. Other factors, including prethaw motility characteristics (percent motility and motility index), donor age, weight, LH, FSH, and T levels, were not significant. Conclusion(s): The standard parameters of sperm count, morphology, and post-thaw motility are the most important factors for the selection of highly fertile donors. As most of the variability in the pregnancy rates resulted from other undetermined factors related both to the donor and the recipient, it is suggested that the pragmatic approach of discarding donors after a reasonable number of treatment failures (20 to 50) should continue.

The proportion of spermatozoa exhibiting the vigorous motility behaviour termed 'hyperactivation' (HA) has been shown to be increased following removal of seminal plasma and stimulation with chemical agents such as pentoxifylline. The aim of this study was to examine the relationship between the proportion of HA in cryopreserved semen samples from sperm donors and the corresponding pregnancy rates achieved by donor insemination. Cryopreserved samples from 20 men were incubated in the presence or absence of 3 mM pentoxifylline for 1 h and the %HA determined in each sample. The relationship between pregnancy rate, the proportion of HA spermatozoa in control and pentoxifylline-treated groups and the change in %HA following pentoxifylline treatment (DELTAHA) as well as the mean semen characteristics for each donor [sperm count, motility (%), motility index, normal morphology (%), post-thaw motility (%) and post-thaw motility index] were examined by logistic regression of the occurrence of clinical pregnancy with each insemination. Both DELTAHA and mean post-thaw motility index were significantly related to pregnancy rates and together accounted for 64% of the observed variation in pregnancy rates.