Septoplasty allows successful delivery in a primary aborter with six previous first trimester miscarriages.

Purpose: To demonstrate that septoplasty can correct a problem of recurrent miscarriage.

Methods: The patient was a primary aborter with a history of six consecutive miscarriages. Septoplasty by hysteroscopy/laparoscopy was performed.

Correction of failed fertilization despite intracytoplasmic sperm injection with oligoasthenoteratozoospermia but with acrosomes present by oocyte activation with calcium ionophore--case report.

Purpose: To determine if fertilization and embryo cleavage can be achieved by artificial oocyte activation in circumstances of repeated failed fertilization with sperm that have an acrosome.

Methods: A woman with three IVF cycles with intracytoplasmic sperm injection (ICSI) failed to fertilize any eggs. The sperm had severe oligoasthenoteratozoospermia with no sperm with normal morphology.

Advances in oocyte cryopreservation--part I: slow cool rapid thaw technique.

Purpose: The need for freezing oocytes has been established for females undergoing potential therapy that could damage their ovarian egg reserve, ethical or religious reasons (not having excess embryos frozen) or women nearing the age of lower fecundity but not married and not ready to use donor sperm. Applying the cryopreservation techniques for oocytes as used for embryos resulted in very poor pregnancy results.

Methods: Changes in methodology including fertilization by intracytoplasmic sperm injection because of zona hardness and using a sodium-deplete choline substitute freezing media are some of the changes made for the slow cool rapid thaw method.

Support for the hypothesis that successful immunotherapy of various cancers can be achieved by inhibiting a progesterone associated immunomodulatory protein.

A hypothesis was proposed that cancer cells may utilize a pre-existing mechanism that pregnant mammals use to avoid natural killer cell immune surveillance of the fetus. The hypothesis suggested that those cancer cells that are able to proliferate may have found a way to cause the expression of the immunomodulatory protein known as the progesterone induced blocking factor (PIBF). The cancer cells could find an alternate pathway to make this protein that does not require progesterone secretion, or the cancer cells may actually utilize progesterone and thus make PIBF in a similar fashion to normal pregnancy.

Improved pregnancy outcome for women with decreased ovarian oocyte reserve and advanced reproductive age by performing in vitro fertilization-embryo transfer.

Objective: To compare the pregnancy rates with IVF-ET vs non-assisted reproductive technology in women of more advanced reproductive age with decreased egg reserve as manifested by elevated day 3 serum FSH.

Methods: A retrospective evaluation was made in women aged > or = 38 with a day 3 serum FSH of degrees 15 mIU/ml with > or = 1 year of infertility. Another inclusion criterion was three cycles (unless a pregnancy occurred before that time) of either IVF-ET or non-assisted reproductive therapy which as a minimum included luteal phase support with progesterone.

Secondary amenorrhea with normal ovulatory cycles in a young virgin with normal follicle stimulating hormone levels--a case report.

Purpose: To determine if normal ovulation is possible despite amenorrhea in the absence of any obvious uterine abnormalities or adhesions.

Methods: The study was conducted on a 17-year-old virgin with normal sexual development and normal secondary sexual characteristics whose menarche was at age 12 but whose menses ceased after two menstruations. She was first treated with medroxyprogesterone acetate 10 mg x ten days and then a cycle of oral contraceptives.

A 59-year-old woman gives birth to twins--when should a fertility specialist refuse treatment?

Objective: To review cases of infertility where despite extremely low odds of success and potential risks to the woman if she became pregnant or to the fetus, the couples elected to take a chance to fulfill their dreams of having a baby.

Materials And Methods: Six cases are described: case 1, a 59-year-old woman with hyperstimulation and intramuscular fibroids compressing the uterine cavity who wanted to be a donor egg recipient; case 2, a 59-year-old woman desiring a second transfer of sibling frozen embryos who had previously conceived with donor eggs at age 57; case 3, a 33-year-old woman with a subseptated uterus and cervical abnormality from intrauterine diethilstibesterol exposure plus hemoaphilia trait, and only 25% of her liver remaining from a previous partial liver resection; case 4, a woman with an unicornuate uterus refusing reduction of her twins to a singleton; case 5, a 39-year-old woman willing to try again to have her first live born child with a history of a large macroprolactinoma that was resected but markedly enlarged in her previous pregnancy despite bromocryptine therapy; and, case 6, a woman willing to try a unique experimental therapy with extremely high thyroid stimulating immunoglobulins to inhibit severe intrauterine growth retardation and potential premature synostosis for her condition of Hashimoto's disease.

Results: Cases 2-5 all had successful outcomes.

Ovulation induction and pregnancy in a woman with premature menopause following gonadotropin suppression with the gonadotropin releasing hormone antagonist, cetrorelix--a case report.

Objective: To determine if ovulation and pregnancy could be achieved in a case of amenorrhea, estrogen deficiency, and markedly elevated serum follicle stimulating hormone (FSH) through reduction of the serum FSH by a gonadotropin releasing hormone antagonist.

Methods: A 37-year-old woman with hypergonadotropic secondary amenorrhea related to two courses of chemotherapy with alkylating agents and abdominal radiation therapy (Hodgkin's disease and breast cancer) was treated with cetrorelix in an attempt to induce ovulation by lowering elevated serum FSH and hopefully restore sensitivity of the few remaining follicles by restoring down-regulated FSH receptors. She was monitored with serum estradiol (E2), FSH, luteinizing hormone (LH), progesterone (P) levels and sonography.

Pregnancy outcome following in vitro fertilization-embryo transfer (IVF-ET) in women of more advanced reproductive age with elevated serum follicle stimulating hormone (FSH) levels.

Purpose: To present data on the chances of pregnancy following in vitro fertilization embryo transfer, according to day 3 serum FSH and age groups in women > or = age 36.

Materials And Methods: Data were analyzed according to three age groups (36-39, 40-42, > or = 43) and five serum FSH ranges (< or = 10, 11-12, 13-14, 15-16, > or = 17).

Results: No live pregnancies were found in women aged > or = 40 with serum FSH > or = 15 mlU/ml but they were seen in women aged 36-39.

In vitro fertilization is expensive: when should a couple be advised to stop trying with their own gametes and seek other options? Review of three cases.

Purpose: To describe refractory infertility cases that preserved many failed in vitro fertilization (IVF) cycles to achieve the goal of delivering a baby.

Methods: Case reports with a description of the various approaches and change in strategy that finally led to success.

Results: Factors causing repeated failures in these cases included adverse effects of the controlled ovarian hyperstimulation regimen on the uterine environment, failure to realize that the sperm from a male with a low hypo-osmotic swelling test can cause embryo implantation failure unless intracytoplasmic sperm injection is performed, and the discovery that sperm abnormalities rather than exclusively oocyte problems can lead to embryo fragmentation.

Marked improvement of intractable arthritic pain in a woman with rheumatoid arthritis with sympathomimetic amine treatment despite previous failure with standard therapy and possible implications for last trimester unexplained fetal demise--case report.

Purpose: To determine if sympathomimetic amine treatment could alleviate severe arthritic pain and fatigue associated with rheumatoid arthritis which was refractory to other medical therapy in a patient with a history of unexplained last trimester fetal demise and unexplained cessation of fetal movement and acidosis.

Methods: A 32-year-old female was treated with 10 mg of dextroamphetamine sulfate daily after failing to gain relief with standard therapy for rheumatoid arthritis.

Results: After several weeks of therapy the patient noticed fewer flare ups of arthritic pain and a marked improvement in her fatigue.

Episcleritis as a possible complication of lymphocyte immunotherapy--case report.

Introduction: Recurrent episceleritis is uncommon. Lymphocyte immunotherapy (LIT) is frequently useful in establishing successful pregnancies in women with previously failed in vitro fertilization (IVF) cycles.

Methods: A woman with recurrent episcleritis and previous splenectomy was carefully questioned to see if there was any association with having had the LIT procedure.

Evidence that progesterone receptor antagonists may help in the treatment of a variety of cancers by locally suppressing natural killer cell activity.

Purpose: To propose a novel concept that progesterone receptor antagonists, e.g., mifepristone, may prove effective in treating a variety of cancers--even those not shown to be hormonally dependent or possessing progesterone receptors.

Treatment of male infertility.

Purpose: To present various treatment options for male subfertility.

Methods: Surgical therapy for varicocele, hormonal therapy, mechanical therapy, e.g.

Mild ovarian stimulation.

Purpose: To evaluate the efficacy of using only mild ovarian stimulation protocols for in vitro fertilization. Both groups with decreased and normal ovarian reserve were evaluated.

Methods: Three different mild stimulation protocols were evaluated: natural with no exogenous follicle stimulation hormone (FSH) drugs at all, natural with a boost of low dose FSH to complete follicular maturation, and minimal stimulation with low dose (75-150IU) FSH from day 3-5 of the menstrual cycle.

Favorable pregnancy, delivery, and implantation rates experienced in embryo donation programs in the United States.

Objective: To document the numbers of donated frozen ETs performed and the pregnancy, birth, and embryo implantation rates seen in four infertility clinics and three embryo donation agencies in the United States.

Design And Setting: Case series. Four infertility clinics and three embryo donation agencies in the United States contributed data from their first year of available information through calendar year 2006.

Sympathomimetic amine therapy may improve refractory gastroparesis similar to its effect on chronic pelvic pain--case report.

Purpose: To determine if treatment with sympathomimetic amines can effectively treat gastroparesis that was refractory to other medical therapy.

Methods: After failing a water load test, a 29-year-old female was treated with 20 mg/day of dextroamphetamine sulfate.

Results: After several weeks of therapy she noted that most of her symptoms of gastroparesis subsided and she has remained symptom free for eight months.

A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization-embryo transfer.

Purpose: To determine if acupuncture performed during the follicular phase and luteal phase but not on the day of embryo transfer could improve the outcome following IVF-ET compared to controls.

Methods: Acupuncture was started biweekly from day 5 of the follicular phase through the luteal phase but not on the day of the transfer. Controls were matched according to age, same number of previous failed IVF cycles and same type of embryo transfer (fresh or frozen).

Ovulation defects despite regular menses: Part III.

Objective: To describe subtle ovulatory defects that can contribute to infertility and/or miscarriage despite regular menses with apparent ovulation.

Methods: By using follicular maturation studies and measurement of serum estradiol, progesterone, and LH certain imperfections in the ovulatory process can be ascertained.

Results: Careful evaluation of follicular maturation was able to determine infertility factors, e.

A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women.

There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system. The leakage of this fluid leads to various clinical conditions which frequently puzzle the consulting physician because despite the frequency of this condition intelligent physicians and patients are unaware of the cause of their condition. One of the most common manifestations is the inability to lose weight despite proper dieting.

Expression and modulation of progesterone induced blocking factor (PIBF) and innate immune factors in human leukemia cell lines by progesterone and mifepristone.

Progesterone (P), required for successful pregnancy, influences autoimmune, infectious, and malignant diseases via adaptive and innate immune effects. P induces NK inhibitor progesterone induced blocking factor (PIBF) in CD8+ T cells. PIBF isoforms could permit solid tumor immune escape.

A comparison of the efficacy of intracytoplasmic sperm injection (ICSI) using ejaculated sperm selected by high magnification versus ICSI with testicular sperm both followed by oocyte activation with calcium ionophore.

Purpose: To determine in a couple where the male had globozoospermia with failed fertilization despite intracytoplasmic sperm injection (ICSI) if fertilization could be achieved by using high magnification ICSI or by oocyte activation by calcium ionophore.

Methods: Twenty eggs were retrieved and divided according to source of sperm, i.e.