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This study was designed to establish whether motile spermatozoa are released with pre-ejaculatory fluid and whether this fluid therefore poses a risk for unintended pregnancy. Forty samples of pre-ejaculatory fluid were examined from 27 volunteer men. Samples were obtained by masturbation and by touching the end of the penis with a Petri dish prior to ejaculation. Eleven of the 27 subjects (41%) produced pre-ejaculatory samples that contained spermatozoa and in 10 of these cases (37%), a reasonable proportion of the sperm was motile. The volunteers produced on up to five separate occasions and sperms were found in either all or none of their pre-ejaculatory samples. Hence, condoms should continue to be used from the first moment of genital contact, although it may be that some men, less likely to leak spermatozoa in their pre-ejaculatory fluid, are able to practice coitus interruptus more successfully than others.

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BACKGROUND: Many hormone and ultrasound measurements have been assessed as possible markers of ovarian reserve and to identify potential poor responders to ovulation induction. The objective of this study is to determine whether multiple biomarkers measured in blood samples collected immediately before commencement of ovulation induction for IVF can predict the outcome of ovarian stimulation. METHODS: We conducted a prospective observational study, including 356 unselected women undergoing ovulation induction/IVF at two centers. Anti-Müllerian hormone (AMH), inhibin B and FSH were measured before commencement of ovulation induction. The main outcome measures were the number of oocytes retrieved and pregnancy outcome. RESULTS: Univariate analyses showed that age, FSH, inhibin B and AMH were significant predictors for poor oocyte yield. AMH presented the highest receiver operating characteristic area under the curve (ROC(AUC)) of 0.827 indicating a good discriminating potential for predicting poor ovarian response, followed by FSH with an ROC(AUC) of 0.721. In the multivariate analysis, the variables age, FSH and AMH remained significant and the resulting model provided a high ROC(AUC) of 0.819. Women with an ovarian reserve test of <0.3 have more than a 75% chance of having their treatment cycle canceled, but a value over 0.73 indicates a 38% chance of pregnancy. Number of oocytes and oocyte yield per unit FSH administered were correlated with log model for no pregnancy (r = -0.217, P < 0.001 and r = -0.367, P < 0.001, respectively) but had limited predictive value. CONCLUSIONS: A derived estimate of ovarian reserve demonstrated superior ability for predicting oocyte yield after ovulation induction when compared with any single endocrine marker (AMH, inhibin B, FSH).

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OBJECTIVES: To identify lifestyle factors associated with subfertility (time to pregnancy >12 months) among women attending an antenatal clinic, and to determine whether this changed from 2001 to 2007. METHODS: Waiting-room surveys administered in 2001 and 2007. RESULTS: There were significant changes in lifestyle factors between 2001 and 2007, including such factors as previous contraceptive use and obesity, smoking, alcohol and caffeine intake of both partners. All changes were in the direction favourable to health and fertility. However, despite these health improvements, there was no overall decrease in the prevalence of subfertility in the antenatal population. Mathematical modelling showed that even if the entire population had improved their lifestyle this would have made little difference to the proportion of subfertile couples. CONCLUSIONS: A modest improvement in lifestyle over a period of 6 years in couples trying to conceive a pregnancy did not lead to any reduction in the incidence of subfertility and even substantial changes would not have made a significant difference.

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BACKGROUND: This study aims to explore the views of women concerning their choice of long-acting method of contraception. METHOD: Two-hundred and eighty-six women who had either been sterilised or fitted with an etonorgestrel (ETN) implant or the levonorgestrel intrauterine system (LNG IUS) were invited to take part. A response rate of 54% was achieved. Women from all three groups reported positive and negative experiences with their chosen method. RESULTS: Women frequently choose sterilisation specifically because it is irreversible, does not involve hormonal treatment, and they do not wish to retain choice of future fertility. Women incorrectly regard sterilisation as more reliable than any reversible method. Regret after sterilisation was common, even if this was preceded by full counselling. Even among patients of practices with a special interest in family planning, long-acting methods, although available, were not widely known about. CONCLUSION: This study suggests that women chose sterilisation for one of three main reasons: to avoid the possible side-effects of hormones; to avoid continually having to make decisions regarding child-bearing; and/or a lack of information regarding reversible methods. Sterilisation is often chosen by women specifically because of its irreversibility. This may explain why long-acting reversible methods have remained relatively unpopular.

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Ultrasound imaging can be used to assess the endometrium in a number of ways. In particular, time-lapse video recordings can show that the lining of the uterus undergoes rhythmical contractions that vary in strength and intensity throughout the ovarian cycle. These contractions appear to assist in sperm transport at the time of ovulation, but can decrease the chances of a fertilized egg implanting in the uterus if they persist later in the cycle. They are also the cause of ectopic pregnancies occurring in IVF treatment cycles. In order to reduce these uterine contractions and therefore increase the chances of a successful uterine pregnancy, IVF treatment cycles should incorporate minimal stimulation so as to make them as close to natural cycles as possible.

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BACKGROUND: The use of nonabsorbable skin sutures after daycase laparoscopic surgery is said to give better cosmetic results but the need for the patient to return for subsequent removal negates some of the advantages of daycase surgery. We therefore devised a skin stitch tied like half a shoelace, which could be removed at home by the patients themselves, but we needed to assess whether patients were willing and capable of removing their own sutures. METHODS: Between May 2003 and August 2004 a qualitative study using in-depth interviews investigated 89 women undergoing elective laparoscopic daycase surgery and using our "slip knot" suture. RESULTS: Patients were initially anxious about removing their own sutures but very few practical problems were encountered with most welcoming the use of the same stitch on a subsequent occasion. A strong finding was the positive feeling that patients had about participating in their own care. CONCLUSIONS: The slip knot stitch is a simple, effective form of skin closure, improving time management for both staff and patients and empowering patients with decisions about their own care. It is popular with patients.

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OBJECTIVE: To evaluate the association patterns and quantify the effects of lifestyle on time to pregnancy (TTP). DESIGN: Observational study. SETTING: Teaching hospitals in Hull, United Kingdom. PATIENT(S): Two thousand and one hundred twelve consecutive pregnant women. INTERVENTION(S): A questionnaire inquiring about TTP, contraceptive use, pregnancy planning, previous subfertility/pregnancies, age, and lifestyle characteristics of either partner. MAIN OUTCOME MEASURE(S): We compared TTP, conception rates, and relative risk of subfecundity between subgroups with different lifestyle characteristics. RESULT(S): We found that TTP was significantly longer if the woman or partner smoked >15 cigarettes/day (P<.001 and.04, respectively), the partner consumed >20 alcohol units/week (P<.001), the woman's body mass index was >25 kg/m(2) (P<.001), their coffee and/or tea intake was >6 cups/day (P=.04), or if they were socially deprived (P<.001). Each of these effects remained unchanged after adjusting for the potential confounders. The relative-risks of subfecundity with each of these variables ranged between 1.4 to 1.9 (1.4 to 3.6 after adjustment). The effects of coital frequency and recreational drug use were insignificant. Couples who had >4 negative lifestyle variables had a sevenfold longer TTP; their conception probabilities fell by 60%, and they were 7.3-fold more likely to be subfecund than those without negative variables. CONCLUSION(S): Lifestyle has a significant and cumulative impact on fecundity. Dose-dependent effects occur with smoking, alcohol, and tea/coffee consumption. Appropriate counseling could result in substantial reductions in the referrals for fertility investigations and treatments.

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OBJECTIVE: To evaluate the effect on fertility of the appearance of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome. DESIGN: Case-control study. SETTING: Teaching hospitals in Hull, United Kingdom. PATIENT(S): Women with the appearance of polycystic ovaries on ultrasound and women with normal ovaries. INTERVENTION(S): A questionnaire about previous subfertility, pregnancies, menstrual pattern, features of polycystic ovary syndrome, gynecological history, and individual lifestyle factors. MAIN OUTCOME MEASURE(S): Time to pregnancy (TTP) and relative risk (RR) of subfertility in symptomatic and asymptomatic subgroups of both groups. RESULT(S): Women with PCOs took longer TTP and were significantly less fertile if they were obese (RR = 2.6), had menstrual disturbances (RR = 4.6), hirsutism (RR = 2.5), and/or acne (RR = 2.7). Further reductions in fecundity occurred with an increasing number of symptoms (threefold, sevenfold, and 10-fold longer TTP with two, three, and four symptoms, respectively). The TTP of women with no symptoms was not significantly longer and they were not more likely to be subfertile than women with normal ovaries. These symptoms were not associated with significantly reduced fecundity in women with normal ovaries. CONCLUSION(S): The appearance of polycystic ovaries has been shown to have no significant impact on fertility in women with no symptoms. Appearances alone do not reflect the pathological features of polycystic ovary syndrome, and additional diagnostic criteria should be considered. Obesity, menstrual disturbances, and/or hyperandrogenism are factors associated with subfertility in women with polycystic ovaries.

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OBJECTIVE: To evaluate the effect of men's age on time to pregnancy (TTP) using age at the onset of pregnancy attempts, adjusting for the confounding effects of women's age, coital frequency, and life-style characteristics. DESIGN: Observational study. SETTINGS: Teaching hospital in Hull, United Kingdom. PATIENT(S): Two thousand one hundred twelve consecutive pregnant women. INTERVENTION(S): A questionnaire inquiring about TTP, contraceptive use, pregnancy planning, previous subfertility, previous pregnancies, age, and individual life-style characteristics of both partners. MAIN OUTCOME MEASURE(S): Time to pregnancy, conception rates, and relative risk of subfecundity for men and women's age groups. RESULTS: As with women's age, increasing men's age was associated with significantly rising TTP and declining conception rates. A fivefold increase in TTP occurred with men's age >45 years. Relative to men <25 years old, those >45 years were 4.6-fold and 12.5-fold more likely to have had TTP of >1 or >2 years. Restricting the analysis to partners of young women revealed similar effects of increasing men's age. Women >35 years were 2.2-fold more likely to be subfertile than women <25 years. The results were comparable, whether age at conception or at the onset of pregnancy attempts was analyzed, and they remained unchanged after adjustment for the confounding factors. CONCLUSION(S): Evidence for and quantification of the decline in men's fertility with increasing age is provided.

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OBJECTIVE: The purpose of this study was to compare cycle control and tolerability of the NuvaRing (NV Organon, Oss, The Netherlands), a novel combined contraceptive vaginal ring, with a standard combined oral contraceptive pill. STUDY DESIGN: Healthy women aged 18 to 40 years who requested contraception received either NuvaRing or a combined oral contraceptive containing 30 microg ethinyl estradiol and 150 microg levonorgestrel for 6 cycles in 3 similarly designed studies. Each cycle comprised 3 weeks of ring or pill use, followed by 1 ring- or pill-free week. RESULTS: Two hundred forty-seven women began the studies, 121 women with NuvaRing and 126 women with the combined oral contraceptive. Withdrawal bleeding occurred in virtually all cycles in both groups. In the NuvaRing groups, the incidence of irregular bleeding was < or =5% in all cycles; this was lower than the combined oral contraceptive groups (5.4%-38.8%). Furthermore, the incidence of a normal intended bleeding pattern was significantly higher in the NuvaRing groups than in the combined oral contraceptive groups (P <.01). Both contraceptives were well tolerated. CONCLUSION: NuvaRing has excellent cycle control and is well tolerated.

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OBJECTIVE: To test the hypothesis that, in couples with unexplained infertility, tubal flushing with an oil-soluble media (lipiodol) would increase the pregnancy rate within 6 months compared with expectant management. DESIGN: A prospective, randomized, controlled study in which couples were allocated to either a single treatment with lipiodol or no further action. SETTING: Two tertiary referral centers for assisted reproduction. PATIENT(S): Couples with a diagnosis of primary or secondary unexplained infertility based on a normal semen analysis according to World Health Organization criteria, patent fallopian tubes at hysterosalpingography or laparoscopy, and ovulatory menstrual cycles based on midluteal phase progesterone levels or ultrasonic follicle tracking. INTERVENTION(S): In those patients randomized to lipiodol, a single treatment was performed. MAIN OUTCOME MEASURE(S): Biochemical (i.e., positive pregnancy test) and clinical (i.e., fetal heart on ultrasound scan) pregnancy rates. RESULT(S): Seventeen couples were randomized to lipiodol and 17 to expectant treatment. The higher pregnancy rate after lipiodol was statistically significant. There were no complications after lipiodol treatment. CONCLUSION(S): There was a statistically significantly higher pregnancy rate in couples with unexplained infertility randomized to a single tubal flush with lipiodol compared with no treatment.

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