Search

Because research concerning the outcome of pregnancy for previously infertile women has produced inconsistent results, a prospective study was undertaken of all women attending a prenatal clinic in England between December 1987 and September 1989. One hundred fourteen women with histories of unexplained infertility for longer than one year (index group), and 114 age-matched pregnant women without such histories (control group), were selected. One woman in the control group underwent an elective abortion after 17 weeks' gestation because of a diagnosis of Down syndrome in the fetus. Comparisons of labor and delivery were performed for the remaining 113 pairs. The index group had a higher rate of emergency cesarean section (15 percent) than controls (6 percent), which upon analysis yielded an increased risk for this procedure of 2.43. Of all cesarean sections performed, which included both elective and emergency procedures, 22 percent were performed on the index subjects and 11 percent were carried out on the controls. Infertile women had a risk of 0.82 of a spontaneous vaginal delivery. No differences were seen between the groups in birthweight or the proportion of infants who were small for gestational age (birthweight at or below the 10th percentile). This study is the first to investigate obstetric outcomes in previously infertile women that uses age-matched controls, thus eliminating the confounding effect of greater age among infertile women. The increase in the emergency cesarean section rate for previously infertile women was not due to age or parity (number of previous children borne), but was the result of several factors, possibly involving the obstetrician's heightened awareness to events such as fetal distress. Women with histories of infertility can be reassured that their obstetric outcome is not likely to be different from women without such histories, with the exception of a higher risk for emergency cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women whose menstrual periods stop prematurely (before the age of 40) because their ovaries have ceased functioning are said to suffer from premature ovarian failure, and many require hormone replacement therapy (HRT) with female hormones to prevent disease, such as osteoporosis and atherosclerosis, and to alleviate the symptoms of estrogen deficiency, such as vaginal dryness. The effects of HRT on the endometrium (the lining of the uterus) have not been completely characterized. To learn more about this issue, 18 women with premature ovarian failure who had been on HRT for varying times were studied. Ovarian failure was idiopathic (due to unknown causes) in 10 cases, the result of chemotherapy for malignant conditions in four cases, or the result of Turner's syndrome (a chromosomal abnormality) in four cases. Hormone levels were monitored and the thickness of the uterus and endometrium were measured during two cycles of treatment with hormones. Biopsies were also taken of endometrial tissue. Results showed that all biopsy specimens showed signs of secretory activity (usually associated with the phase of the menstrual cycle that occurs after ovulation). The women with Turner's syndrome had the least developed endometrium, while the women in the other groups were similar. The results imply that women with premature ovarian failure do not represent a homogeneous group, but respond differently to HRT. Analysis of the hormone levels in these women suggests that the dose of estrogen administered according to this protocol may be too high. (Consumer Summary produced by Reliance Medical Information, Inc.)