Introduction: We set out to determine the seroprevalence of hepatitis B and hepatitis C viruses among human immunodeficiency virus infected individuals and its impact on pattern of presentation. Methodology: A serological study for hepatitis B and hepatitis C viruses was performed on 260 HIV-positive individuals. These patients were tested for the presence of hepatitis B surface antigen and anti-hepatitis C virus (HCV) antibody. Results: Thirty (11.5%) patients tested positive for hepatitis B surface antigen, six (2.3%) tested positive for anti-hepatitis C virus antibody, four (1.5%) were positive for both hepatitis B surface antigen and anti-hepatitis C virus and the overall prevalence was 15.4% . Individuals younger than 40 years of age were more affected, and the odds ratio of a female being co-infected was 1.2, 25% versus 75% p value = 0.03. The prevalence of HIV and hepatitis co-infection rises with age except for hepatitis C. There was no significant difference in the mean levels of liver enzymes (AST, ALT) among the various groups. The groups differ significantly in their mean CD4 count: it was lowest for those coinfected with hepatitis B and hepatitis C; 106 cells/mm 3 , 171 cells/mm 3 for those with HIV alone; and the highest value of 260cells/mm 3 was obtained in those who tested positive for anti-HCV. Scarification marks and multiple blood transfusions were more common among those infected. There was no case of intravenous drug abuse identified. Conclusion: This low frequency of HIV/HCV co-infection is probably due to the uncommon intravenous drug abuse in this population. Coinfection with hepatitis B virus is common among our HIV-infected patients and should be a major consideration in the initiation and choice of therapy.

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The objective of this long-running study was to determine whether the addition of low-dose aspirin to a standard hormone replacement therapy (HRT) protocol improved uterine perfusion during assisted conception. A total of 99 women scheduled for frozen embryo replacement were studied. Endometrial preparation was with a standard buserelin/HRT protocol. Uterine perfusion was assessed by Doppler ultrasound and classified as impaired or normal. In their first attempts, those with impaired perfusion (group I, n = 37) received low doses of aspirin [150 mg (n = 26) or 300 mg daily (n = 11)], starting from day 13 of HRT. Women with normal perfusion (group II) did not receive aspirin. In subsequent attempts, those from group I were arbitrarily allocated to start aspirin on day 1 or day 13 of HRT, and 10 women from group II were arbitrarily selected to receive aspirin from day 1 of HRT. In group I, the cancellation (46 versus 36%) and pregnancy rates (15 versus 25%) in those who received 150 or 300 mg aspirin daily were similar. In those with cancelled first attempts, good perfusion was achieved in 82 versus 20% (P < 0.02) of subsequent attempts using aspirin from day 1 versus day 13 of HRT. Higher pregnancy rates (47 versus 17%) were achieved in those taking aspirin from day 1 of HRT. In group II, pregnancy rates were not statistically different in those who did or did not receive aspirin during their subsequent attempts (10 versus 35%). The addition of low-dose aspirin to a standard HRT protocol in women with impaired uterine perfusion is associated with improved blood flow and satisfactory pregnancy rates.

Objectives To analyse the incidence and factors associated with the ovarian hyper‐stimulation syndrome (OHS) in our IVF/GIFT programme before and after the introduction of a strategy to cryopreserve all embryos from women judged to be at risk. Design Two hundred forty‐one consecutive IVF/GIFT cycles from January to December 1989. Setting Specialist fertility unit, Manchester, UK. Interventions Pituitary suppression was effected by a daily subcutaneous injection of buserelin (500 μg) beginning 7 days before the expected menses. The ovarian stimulation was with variable amounts of human menopausal gonadotrophin. Ovulation was induced with 10 000 i.u. human chorionic gonadotrophin (hCG). From January to May (period A), gametes/embryos were replaced and 2000 i.u. hCG given, irrespective of the serum oestradiol (E2) concentration. From June to December (period B), all the embryos from women with an E2>3500 pg/ml on the day of ovulatory trigger were electively cryopreserved. Main outcome measures Serum E2, features of moderate or severe OHS, clinical pregnancies. Results The OHS occurred in 10/105 (9.5%) and 12/136 (8.8%) cycles in periods A and B, respectively. Fewer women (6% versus 60%, P<0.05) who had their embryos cryopreserved developed severe OHS compared with women with an E2 >3500 pg/ml who became pregnant after gamete/embryo transfer in period A. The main factors associated with the development of OHS were serum E2 concentrations >3500 pg/ml, whether gamete/embryos were replaced and the additional hCG given, the occurrence of a pregnancy and the presence of polycystic ovary disease. Conclusion The elective cryopreservation of all embryos from women with high E2 levels reduced the severity, but not the incidence of symptomatic OHS.

Objective To compare the outcome of in vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) cycles in women with or without ultrasound features of polycystic ovary syndrome (PCOS). Design A consecutive series from January to December 1989. Subjects Twenty‐five women with PCOS scheduled for assisted conception. The controls were 139 women with normal ovaries. Setting A single centre specialist fertility unit, Manchester, UK. Interventions Pituitary desensitisation was with buserelin. In the PCOS group ovarian stimulation was with 1 ampoule (75 iu FSH) of hMG/day in 12 women (Group I) and two ampoules/day in 13 (Group II). The controls (Group III) were given two ampoules of hMG daily. Human chorionic gonadotrophin (hCG; 10 000 iu) was given when three follicles measured 20 mm diameter. Main outcome measures Serum oestradiol (E2) concentrations, number of follicles, clinical pregnancies, features of the ovarian hyperstimulation syndrome (OHS). Results Women with PCOS (Groups I or II) had more follicles 14 mm diameter on the day of the hCG injection (P<0.005), higher serum E2 concentrations on the day after the hCG (P<0.05) and more oocytes retrieved (P<0.05) than the controls. The OHS was more prevalent in those with PCOS (32% versus 6.5%; P<0.05). The clinical pregnancy rate per embryo transfer (27% versus 22%) or gamete transfer (25% versus 39%) and the rate of spontaneous miscarriage (33% versus 12%) were not statistically different. Conclusions The pregnancy rate and outcome of pregnancy following IVF or GIFT in women with or without PCOS are similar. Women with PCOS are at a higher risk of developing OHS.