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Biomedical subjects

A Templeton

Publications and source records attributed to A Templeton.

At least 127 records · Page 7Linked to original sources
PubMed1992

Breech delivery and epidural analgesia.

OBJECTIVE: To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks). DESIGN: A retrospective study. SETTING: Data Bank, Aberdeen Maternity Hospital. SUBJECTS: 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. OUTCOME MEASURES: Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. RESULTS: Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65). CONCLUSION: Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

Adult↗
PubMed1992

Gonadotrophin surge-attenuating factor attenuates in-vitro LH secretion induced by gonadotrophin-releasing hormone from cultured ovine pituitary cells only during the breeding season.

Primary cultures of ovine pituitaries from adult ewes were used to investigate aspects of gonadotrophin surge-attenuating factor (GnSAF) bioactivity in human follicular fluid (hFF) from superovulated women. During the autumn and first half of the winter, LH secretion induced by gonadotrophin-releasing hormone (GnRH) was markedly reduced (43.5 +/- 5.2% of control GnRH-induced LH secretion) by incubation for 48 h with steroid-free hFF. For the rest of the year, treatment with the same batch of steroid-free hFF resulted in non-significant reduction or stimulation of GnRH-induced LH secretion (71.3 +/- 13.2 to 117.8 +/- 11.2% of control GnRH-induced LH secretion). Incubation of pituitary cells for 48 h with oestradiol (1 pmol/l to 1 mumol/l), progesterone (1 pmol/l to 1 mumol/l) or oestradiol and progesterone combined (1 pmol/l to 1 mumol/l) in a two-way titration for 48 h had no significant effect on GnRH-induced LH secretion (83.4 +/- 7.6 to 110.6 +/- 5.0% of control secretion). Separating hFF into fractions of different molecular mass by ultrafiltration demonstrated that GnSAF bioactivity was present in a form 10-30 kDa in size. Incubation for 48 h with these fractions had no significant effect on basal FSH secretion but significantly attenuated GnRH-induced LH secretion during the autumn. The same fractions had little effect on GnRH-induced LH secretion from pituitary cells collected during the summer. We conclude that ovine pituitaries display at least partial reduction in sensitivity to GnSAF outside the breeding season.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

The luteal phase after oocyte recovery in a spontaneous cycle.

There is disagreement as to whether follicular aspiration and oocyte recovery leads to a defective luteal phase. A group of 20 women with mild endometriosis was studied over two consecutive spontaneous cycles. Follicular aspiration and oocyte recovery was performed 32 hours after the onset of the endogenous luteinizing hormone surge during the second cycle. There was little disturbance of the luteal phase or in the pituitary gonadal relationship in the aspirated cycle. Although a significantly lower serum progesterone was noted on day 8 of post-oocyte recovery, all results were within the normal range seen in the control cycles.

Adult↗
PubMed1991

Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles.

OBJECTIVE: Assessment of follicular development and endometrial growth using transvaginal sonography in spontaneous and clomiphene citrate (CC) cycles with a spontaneous luteinizing hormone surge. DESIGN: Prospective study of a spontaneous cycle followed by a CC cycle to compare paired data. SETTING: Institutional tertiary referral infertility clinic. PATIENTS: Eighteen couples with primary unexplained infertility voluntarily recruited from the infertility clinic. INTERVENTION: Daily transvaginal sonography and endocrine monitoring. Clomiphene citrate (150 mg) was administered on days 5 to 9 of CC cycle. MAIN OUTCOME MEASURES: Leading follicular diameter and endometrial thickness. RESULTS: The growth rate of the leading follicle was similar in both study cycles, although in CC cycles the leading follicle diameter was significantly larger. Endometrial thickness was reduced in CC cycles. CONCLUSION: Follicular development and endometrial thickness are altered in CC cycles.

Adult↗
PubMed1991

Cervical mucus score and in vitro sperm mucus interaction in spontaneous and clomiphene citrate cycles.

OBJECTIVE: Assessment of the effects of clomiphene citrate (CC) on cervical mucus score and in vitro sperm mucus interaction. DESIGN: Prospective study of cervical mucus score and in vitro sperm mucus interaction in a spontaneous cycle followed by a CC cycle to compare paired data. SETTING: Tertiary institutional infertility clinic. PATIENTS, PARTICIPANTS: Twenty-two couples with primary unexplained infertility were studied in both cycles. INTERVENTIONS: Clomiphene citrate (150 mg) on days 5 to 9 in CC cycles. MAIN OUTCOME MEASURES: Cervical mucus score and sperm-mucus penetration test score. RESULTS: Mean cervical mucus score in spontaneous cycles was 9.3 (95% confidence interval [CI] 8.4 to 10.2) and in CC cycles 5.6 (95% CI 4.6 to 6.6), P less than 0.0001. Sperm-mucus penetration test score in spontaneous cycles was 11.4 (95% CI 7.6 to 15.2) and in CC cycles 3.9 (95% CI 1.17 to 6.63), P less than 0.01. CONCLUSIONS: Clomiphene citrate has an adverse effect on both cervical mucus score and sperm-mucus penetration.

Adult↗
PubMed1991

Infertility--epidemiology and referral practice.

A questionnaire-based study of infertility has been carried out in two age cohorts of women in a defined geographical region. Women were aged 36-40 years or 46-50 years at the time of the survey. The prevalence of infertility (no conception after 2 years of trying) was approximately 14% in both age cohorts. However, a significantly higher proportion of younger women had sought medical help. In both age cohorts there was a higher incidence of spontaneous abortion among infertile women. These findings suggest no significant increase in the prevalence of infertility over a decade but a considerable increase in the use of medical services.

Abortion, Spontaneous↗
PubMed1991

Blunted prolactin response to exogenous luteinizing hormone releasing hormone in superovulated women.

To investigate the prolactin (PRL) response to luteinizing hormone releasing hormone (LHRH) in superovulated cycles, eight normally ovulating women were studied in two cycles, i.e. a spontaneous (control) and a cycle treated with 'pure' follicle stimulating hormone (FSH) (225 IU/day). LHRH was given to the women i.v. (a single injection of 100 micrograms) in the late follicular phase of both cycles. The oestradiol levels (mean +/- SEM) at the time of the LHRH challenge were 635 +/- 31 and 1707 +/- 225 pmol/l respectively (P less than 0.001). The size of the leading follicle was similar in both cycles. Basal PRL levels (mean +/- SEM) on the day of the LHRH experiment were significantly higher in the FSH (250 +/- 31 microIU/ml) than in the spontaneous cycles (133 +/- 15 microIU/ml. P less than 0.05). In the latter cycles, LHRH induced a significant increase in serum PRL and LH levels, while the FSH cycles, the prolactin (PRL) response to LHRH was blunted and LH response markedly attenuated. We conclude that superovulation induction stimulates basal but suppresses LHRH-induced PRL release. It is suggested that basal PRL secretion is LHRH-independent and the suppressing effect is mediated via previously described paracrine interactions between the gonadotrophs and lactotrophs and/or through ovarian inhibitory substances.

Adult↗
PubMed1991

Folliculogenesis and ovulation in infertile women with mild endometriosis.

Twenty-one infertile women with laparoscopically documented minimal-mild endometriosis (AFS score 2-10) were studied during 27 cycles (six women had two cycles each) to investigate follicular development and ovulation. Of the 27 cycles studies, 24 (89%) appeared to be endocrinologically normal and ovulatory. Luteinized unruptured follicle (LUF) occurred in only one cycle (4%). One further patient exhibited abnormal endocrinology with evidence of premature ovulation over two (8%) consecutive cycles. This study indicates that the majority of women with minimal-mild endometriosis have endocrinologically normal menstrual cycles and that luteinized unruptured follicles occur infrequently.

Adult↗
PubMed1991

Prevalence and genesis of endometriosis.

A group of 1542 pre-menopausal Caucasian women were assessed prospectively to investigate the prevalence of endometriosis. The women were either having laparoscopy because of infertility (n = 654), undergoing laparoscopic sterilization (n = 598), having laparoscopy because of chronic abdominal and pelvic pain (n = 156) or undergoing abdominal hysterectomy for dysfunctional uterine bleeding (n = 134). Endometriosis was noted more frequently among women being investigated for infertility (21%) than among those undergoing sterilization (6%). Among those being investigated for chronic abdominal pain, the incidence of endometriosis was 15%, while among those undergoing abdominal hysterectomy, it was 25%. In all groups the total duration of combined pill usage was significantly higher in patients who had a normal pelvis compared to those with endometriosis. It is suggested that among susceptible women, both fertile and infertile, a prolonged period of regular spontaneous menstruation may play a causative role in the genesis of endometriosis.

Abdominal Pain↗
PubMed1991

The effects of clomiphene citrate upon ovulation and endocrinology when administered to patients with unexplained infertility.

Twenty-four couples with unexplained infertility were studied in a spontaneous cycle followed by a clomiphene citrate (CC) cycle (150 mg, days 5-9). All spontaneous cycles were ovulatory, as defined by follicular collapse determined by transvaginal sonography. In CC cycles, 6/24 (25%) cycles demonstrated luteinized unruptured follicles (LUF). In 2/6 LUF cycles there was no apparent luteinizing hormone (LH) surge. LUF cycles had significantly elevated LH levels in the follicular phase compared to ovulatory CC cycles. There was no apparent difference in serum oestradiol. In CC cycles multifollicular development occurred in 87.5% of cycles, with significantly elevated serum oestradiol. Luteinizing hormone and follicle-stimulating hormone were elevated in the follicular phase compared to spontaneous cycles. This study suggests a high incidence of LUF when CC is administered to ovulatory patients, and its use in patients with ovulatory infertility is questioned.

Clomiphene↗
PubMed1991

Attenuation of gonadotrophin release and reserve in superovulated women by gonadotrophin surge attenuating factor (GnSAF).

In-vivo and in-vitro studies have provided evidence that a non-steroidal ovarian factor, called gonadotrophin surge attenuating factor (GnSAF), attenuates the endogenous LH surge in superovulated women. To study the mechanism of action of GnSAF, the LH response to two i.v. pulses of GnRH (10 micrograms each, 2 h apart) was investigated in eight normally ovulating women during the late follicular phase of a spontaneous and an FSH superovulated cycle. The maximal LH increase in response to the first pulse (initial release) was considered as representing the acutely releasable pool and the delta LH area under the whole curve (integrated response) the reserve pool of LH. Both the initial release and the integrated response to GnRH were markedly attenuated in the FSH as compared to the spontaneous cycles. The response to the second pulse was significantly greater than the response to the first pulse (self-priming effect of GnRH) in both the spontaneous and the FSH cycles. However, in the FSH cycles the self-priming effect of GnRH was markedly reduced as compared to the spontaneous cycles. We conclude that during superovulation induction in women the two pools of pituitary LH are markedly attenuated. It is suggested that GnSAF attenuates both the GnRH-induced initial release of LH and the self-priming effect of GnRH on the pituitary.

Adult↗
PubMed1991

Peritoneal fluid volume and sex steroids in the pre-ovulatory period in mild endometriosis.

Twenty infertile women with laparoscopically confirmed mild endometriosis and ten women with tubal infertility underwent diagnostic laparoscopy 32 h after the onset of the endogenous luteinizing hormone (LH) surge during a spontaneous menstrual cycle. All visible peritoneal fluid was aspirated for assessment of volume and sex steroid content. There was no significant difference in peritoneal fluid volume or concentrations of oestradiol, progesterone and androstenedione between the two groups. Furthermore, in the endometriosis group there was no significant difference in peritoneal fluid volume and concentrations of sex steroids between those women who had been treated previously with danazol and those who were left untreated.

Adult↗
PubMed1991

Follicular development in spontaneous and stimulated cycles in women with minimal-mild endometriosis.

OBJECTIVE: To study follicle development in women with minimal-mild endometriosis. DESIGN: In women with endometriosis a spontaneous ovulatory cycle was compared with two subsequent cycles in which either clomiphene or clomiphene and FSH were given to stimulate folliculogenesis. Spontaneous cycles in women with tubal infertility provided a comparison group. SETTING: Infertility clinic, Aberdeen Maternity Hospital. SUBJECTS: 17 women with minimal-mild endometriosis and 10 women with tubal infertility. INTERVENTIONS: The women with endometriosis were treated with 150 mg clomiphene citrate from days 2 to 6 in one cycle and in a subsequent cycle with 150 mg clomiphene citrate on days 2 to 6 plus 75 iu FSH daily thereafter. MAIN OUTCOME MEASURES: Follicular size measured daily using ultrasound. Serum FSH estimated on days 5 and 7 and then daily. RESULTS: Spontaneous follicular growth in the women with endometriosis was similar to that in the women with tubal infertility. Follicular development began earlier in cycles with clomiphene/FSH and the leading follicle reached 16 mm 2 days sooner but the rate of growth was similar whether or not either regimen of stimulation was used. CONCLUSION: Follicular growth is not impaired by minimal-mild endometriosis. Infertility with this condition cannot be explained by altered follicular growth or responsiveness.

Adult↗
PubMed1990

The epidemiology of infertility in Aberdeen.

OBJECTIVE: To study the prevalence of infertility, both primary and secondary, outcome of pregnancy, occupation, and uptake of medical services in a total population of women from a geographically defined area. DESIGN: A postal questionnaire survey of an age cohort of women who had completed their fertility, and who were randomly selected from the Grampian Health Board's primary care register. SETTING: Aberdeen city district. SUBJECTS: 1024 Women in the age group 46-50, of whom 130 had to be excluded. Of the remaining 894 women, 766 (86%) responded to the questionnaire. MAIN OUTCOME MEASURES: Response to questionnaire on pregnancy history, the length of time taken to become pregnant each time, and whether medical advice had been sought. RESULTS: Among the 766 women contacted, 602 (79%) reported no difficulties in having children, 56 (7%) had chosen not to have children, and the remaining 108 (14%) had experienced infertility, defined as having difficulty in becoming pregnant for more than two years. In total 68 (9%) women had primary infertility, of whom 41 (5%) eventually conceived. Of the 40 (5%) with secondary infertility, 23 (3%) conceived. Overall, 52 (7%) of the population were left with an unresolved problem of infertility. Only 67 (62%) infertile women had made use of hospital services, and a further 8 (7%) had consulted their general practitioners. Among those who conceived there was no difference in the proportion who sought advice compared with those who did not. CONCLUSION: The overall prevalence of infertility was 14%, although half of these women eventually conceived. Primary infertility was more common than secondary infertility. Only 62% of infertile women attended a hospital clinic for treatment of their infertility.

Ambulatory Care Facilities↗