International Journal of Fertility最新文献

A study was designed to monitor release of ova by sonography in hMG-treated patients following hCG and to determine if failure to release ova correlates with critically low or high progesterone levels. This was a retrospective study of 292 consecutive patients treated with hMG. The requirement for treatment was that hCG be given when at least one follicle attained a 17-mm diameter with a serum estradiol level of at least 200 pg/mL per mature follicle. If the serum progesterone assay was greater than or equal to 1.8 ng/mL, then hCG would be given as long as there was at least one dominant follicle and a serum estradiol level greater than 200 pg/mL. The patients were divided into four groups for study based on the progesterone level at the time of hCG administration. There were no statistically significant differences in the ability to achieve ova release whether serum progesterone was very low or close to 2 ng/mL when hCG was given. The rise in the progesterone level prior to ovulation has been proposed to enhance egg release. However, the data presented herein do not support the necessity for a critical level of serum progesterone at the time of hCG injection in hMG-treated women.

Between October 1987 and January 1990, 60 patients with unruptured ectopic pregnancy in the ampullary portion of the tube were treated with linear salpingotomy, using the argon laser laparoscopically. In all cases, salpingotomy was performed by the "bare-fiber" technique, with a power of 3-6 watts. The same fiber was used for incision and coagulation either with a contact or a non-contact technique. There were no instrument-related intra- or postoperative complications. Twenty-four patients were evaluated by second-look laparoscopy or hysterosalpingography for tube patency and possible formation of adhesions. In all of these patients the tubes were patent. In one patient, the tube failed to close, resulting in a fistula. Four patients had filmy adhesions, covering the tube near the incision site. There were no adhesions covering the distal part of the tube.

In order to establish a series of provocation tests to evaluate the integrity of the sperm cAMP pathway, manganese (Mn), 2-deoxyadenosine (DEA) (via adenylyl cyclase), and methyl-isobutyl-xanthine (MIX) (via phosphodiesterase) were tested for their capacity to activate the progressive motility of human sperm. Optimal responses were obtained using washed sperm previously incubated for 3 hours in substrate-poor medium (Hepes-buffered saline). Longer periods of incubation required the presence in addition of an energy substrate such as glucose. Exposure of sperm to seminal plasma for 24 hours prior to washing attenuated the responsiveness of the sperm to the different activators. Preliminary studies on the activation of the progressive motility of washed sperm from four normozoospermic men under fertility investigation, prepared under identical conditions, revealed differences in the pattern of response which may have pathophysiological relevance.

Most studies of rhythms in human conception rates have used monthly total births back-dated 9 months. Such data are of little use for studying any pattern less than a few months in length. Even at that level, they are poor material for studying the possibility of altered conception rhythms in anomalous births. The high frequency of premature delivery in such births makes a simple 9-month offset simplistic and misleading. Dates of last normal menses (LMP) provide appropriate detail, but have generally been dismissed as unreliable. In a large public birth record dataset, we have identified a clear artifact of poor LMP recall, highly correlated with passage of time between conception and onset of prenatal care. The majority of the variation in daily LMP counts due to this recall artifact can be corrected statistically to yield population data suitable to more detailed analyses.

The role of catecholamine activity in the GnRH-LH system among cases of polycystic ovary syndrome was investigated by high-performance liquid chromatography using an electrochemical detector. We measured plasma levels of catecholamine metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG) and 3,4-dihydroxyphenylacetic acid (DOPAC), in relation to LH-RH administration in 23 women with polycystic ovary syndrome. MHPG concentrations were significantly higher in polycystic ovary syndrome patients than in ten control subjects in early follicular phase. The peak values of LH after LH-RH administration were significantly correlated with plasma MHPG concentrations. These data suggest that an excess of norepinephrine is present in polycystic ovary syndrome and that the hypophyseal response to LH-RH administration is correlated with catecholamine, especially norepinephrine activity.

A comparison was made of the ACTH stimulation test in the proliferative and luteal phases of the menstrual cycle in 13 subjects, each of whom served as her own control. The test yielded a 53.9% false-positive rate in the luteal phase. The study, therefore, clearly shows that from a practical, clinical point of view, the test is completely unreliable in the luteal phase, and is only valid when carried out in the follicular phase of the cycle.

Insulin appears to play an important role in regulating ovarian function in some mammals. The present study assessed the effect of insulin on progesterone production by human granulosa lutein (G-L) cells in vitro. G-L cells were isolated from individual follicles at the time of laparoscopy for oocyte retrieval in patients undergoing in vitro fertilization/embryo transfer (IVF/ET). G-L cells were purified and plated for culture. Control wells contained no additions, while insulin was added to test wells. Although G-L cells obtained from follicles which contain an oocyte that subsequently fertilizes in vitro produce more progesterone at three and six days of culture than G-L cells from follicles that contain an oocyte that does not fertilize in vitro, insulin is unable to increase further the progesterone production of G-L cells from follicles containing either fertilized or nonfertilized oocytes at days 3 and 6 in culture. Further analysis based on the stimulation protocol (follicle stimulating hormone, n = 13; clomiphene citrate/hMG, n = 19; hMG, n = 10) also failed to yield a significant difference in basal or insulin-stimulated progesterone secretion after three or six days in culture. The lack of an effect of insulin on progesterone production by G-L cells in vitro may indicate that these cells are maximally stimulated following hyperstimulation and cannot increase progesterone production further, or may signify that insulin has no effect on the in vitro luteinization of human G-L cells obtained from hyperstimulated cycles.

Laparoscopic surgery has gained wide acceptance in the treatment of ectopic pregnancy. When compared with conventional surgical techniques, the laparoscopic approach reduces perioperative morbidity, hospital costs, length of hospital stay, and recovery time. Laparoscopic surgery, however, often requires special surgical skills and expensive equipment. In this paper we review the literature on the efficacy of the laparoscopic approach to salpingectomy and report a simple technique for such a procedure. Any gynecologist who performs laparoscopic tubal sterilization by electrocautery has the necessary equipment and can develop the skills to carry out this procedure.

The strongest predictors of cardiovascular disease in women have been shown to be diabetes, high blood pressure, cigarette smoking, and, to a lesser degree, hypertriglyceridemia. The difference in risk between men and premenopausal women has been explained by the following widely held hypothesis: androgens lower plasma concentrations of high-density lipoprotein (HDL), particularly the HDL-2 subfraction, and increase plasma concentrations of low-density lipoprotein (LDL). In contrast, estrogens have the opposite effect, raising plasma concentrations of HDL, particularly HDL-2, and lowering plasma concentrations of LDL. After the menopause, it is believed that the protective effect of estrogens in women is lost and the incidence of heart disease rises to equal that in men. This paper provides a brief review of the effect of endogenous and exogenous androgens on lipoprotein metabolism in men and women, and considers the relevance of these findings to the choice of progestogens used in oral contraceptive preparations.