Search PubMed⌕ Search

Biomedical subjects

D L Olive

Publications and source records attributed to D L Olive.

At least 127 records · Page 7Linked to original sources
PubMed1989

Twenty-four-hour progesterone and luteinizing hormone profiles in the midluteal phase of the infertile patient: correlation with other indicators of luteal phase insufficiency.

The authors have further analyzed women diagnosed as having luteal phase insufficiency in hope of determining the value of specific screening tests as well as determining the degree of heterogeneity of pathophysiologic mechanisms involved in the disorder. Twelve women with the disorder were identified, 6 with two consecutive midluteal serum progesterone (P) levels less than 10 ng/ml (group 1) and 6 with two consecutive late luteal phase endometrial biopsies out of phase (group 2); 4 infertile women with normal serum P and late luteal biopsies also were studied (group 3). All underwent serum sampling for P and luteinizing hormone (LH) at 20-minute intervals for 24 hours, beginning at 9:00 A.M. of day 7 post-LH surge. No significant differences were noted among the three groups for LH area under the curve, pulse frequency, or pulse amplitude. Furthermore, no differences were ascertained for P area under the curve. However, individuals were identified who had one or more hormonal abnormalities but no abnormal biopsy, as well as patients with normal hormonal profiles but having abnormal endometrial development. Receiver Operating Characteristic curves demonstrated that pooled morning serum P levels provided optimal predictive ability of biopsy results. The authors conclude that luteal phase insufficiency is a heterogeneous disorder, and that neither endometrial biopsy nor serum hormonal analysis obviates the need for the other.

Biopsy↗
PubMed1989

Gonadotropin-releasing hormone antagonists attenuate estrogen/progesterone-induced hyperprolactinemia in monkeys.

Previous studies have documented that exogenous gonadotropin-releasing hormone (GnRH) stimulates prolactin (PRL) secretion and augments thyrotropin-releasing hormone-induced PRL release. Further, the concomitant pulsatile release of PRL and luteinizing hormone (LH) suggests that GnRH may be an important regulator of PRL release in certain physiologic states. The authors explored this possibility by evaluating the effect of a GnRH antagonist ([Ac-pClPhe1, pClPhe2, DTrp3, DAla10]-GnRH; GnRH-antagonist) on PRL secretion in monkeys with induced hyperprolactinemia. Monkeys were given estradiol (E2) benzoate 25 mg/kg intramuscularly (IM) on cycle days 1 to 28, and a 3-cm progesterone (P) silastic capsule was placed on cycle day 15 and removed on day 28. On cycle days 15 to 28, monkeys were given IM injections of 1 mg/kg GnRH-antagonist (n = 3), 2 mg/kg GnRH-antagonist (n = 3), or vehicle (n = 3). Daily blood samples were assayed for E2, P, and PRL. The degree of PRL elevation was calculated as percent increase in area under the curve for days 15 to 28 when compared with days 1 through 14 (baseline). Luteinizing hormone levels were calculated similarly. Results indicate a dose-dependent effect of GnRH-antagonist on PRL secretion, with the larger dose producing a significantly lower hyperprolactinemic response, as well as a decline in LH. Thus, GnRH-antagonist attenuates induced hyperprolactinemia in a dose similar to that which suppresses LH release. These findings suggest that GnRH is a physiologic regulator of pituitary PRL secretion. In addition, GnRH analogs may be of benefit in controlled ovarian hyperstimulation by attenuating gonadotropin-induced hyperprolactinemia, thereby reducing potential adverse effects on fertility.

Animals↗
PubMed1988

Limited hormonal responsiveness of ectopic endometrium: histologic correlation with intrauterine endometrium.

In order to assess the hormonal responsiveness of ectopic endometrium, 438 unselected endometrial implants and corresponding intrauterine endometrium from 196 patients were evaluated and classified by standard endometrial dating criteria. Only 13% of the endometrial implants were histologically synchronous with the corresponding intrauterine endometrium. Both proliferative and secretory implants were present in relatively constant proportions throughout the menstrual cycle, demonstrating a lack of correlation with cyclic endogenous hormones. A significant percentage (range, 25% to 49%) of endometrial implants displayed some form of local hemorrhage irrespective of the menstrual cycle timing. Sixty percent of the patients had evidence of hemorrhage in at least one implant. In women receiving hormonal therapy at the time of surgery, the proportion of endometrial implants that were histologically in concert with the corresponding endometrium ranged from 0% to 33%. In early pregnancy and menopause, 50% and 31% of endometrial implants were histologically similar, respectively. These data indicate that the hormonal responsiveness of endometrial implants is unpredictable and inconsistent.

Adolescent↗
PubMed1987

Treatment of endometriosis-associated infertility with CO2 laser laparoscopy: the use of one- and two-parameter exponential models.

Laparoscopic vaporization with the carbon dioxide laser has become a popular treatment modality for endometriosis-associated infertility, yet little data exist regarding the efficacy of such an approach. The authors have applied sophisticated modeling techniques to pregnancy rates in 129 endometriosis patients following laser laparoscopy. Patients were identified for stage of disease, danazol usage before and after surgery, and identifiable infertility factors. Fertility rates were analyzed with monthly fecundity rates and a two-parameter exponential model. Results indicate monthly fecundity rates comparable to other forms of therapy for stage I and stage II endometriosis, but substantially higher than more traditional modalities for stage III disease. The two-parameter model revealed "cure" rates comparable or lower than with major conservative surgery or danazol therapy, but a "monthly" probability of pregnancy" substantially higher than with other treatments. These results indicate that, in experienced hands, laser laparoscopic vaporization of endometriosis is as efficacious as other published forms of therapy, including use in moderate and severe disease. In addition, these results suggest an immediate, transient effect upon the patient with endometriosis-associated infertility.

Actuarial Analysis↗
PubMed1987

Sperm-macrophage interaction in the mouse: a quantitative assay in vitro using 111indium oxine-labeled sperm.

The role of reproductive tract macrophages in contraception and reproductive failure has become widely recognized. However, in vitro analysis of sperm phagocytosis by macrophages has relied upon a semi-quantitative method of sperm counting that is of limited accuracy and reproducibility. We have developed an assay using murine sperm labeled with 111indium oxine, and results indicate the labeling to be rapid and efficient. Incorporation of 111indium into sperm increased the dose and sperm concentration and reached 90% maximal uptake after 15 min incubation, with maximal uptake occurring at 30 min. No decrease in sperm motility was noted with levels of oxine in excess of those required for significant labeling. Maximal labeling efficiency occurred in phosphate-buffered saline (PBS), with Dulbecco's modified Eagle's medium (DMEM) + 10% adult bovine serum (ABS) producing significantly less uptake. Label dissociation was detectable in PBS at room temperature, but at 37 degrees C in DMEM + 10% ABS, loss of label occurred at a rate of 23.5%/h. Addition of labeled sperm to murine macrophage monolayers under optimal conditions resulted in uptake of 111indium by macrophages, while free label was unincorporated. Results indicated assay specificity for macrophage-limited uptake, with insignificant label uptake by nonphagocytic murine fibroblasts and better sensitivity than sperm counting. Macrophages from Bacillus Calmette-Guerin (BCG)-infected mice resulted in a decrease in sperm uptake. Female macrophages showed greater capacity for sperm uptake than those of the male mouse. These initial studies demonstrated the utility of this model system in enhancing the understanding of sperm-macrophage interaction in the female reproductive tract.

Animals↗
PubMed1987

Contemporary evaluation of suspected ectopic pregnancy.

A retrospective review of the 119 patients with suspected ectopic pregnancy presenting to Duke University Medical Center during the two-year period ending June 30, 1983, was conducted. In order to determine significant differences between patients with and without ectopic pregnancy, the presenting complaints and physical signs were reviewed and analyzed. Significant findings in women with ectopic pregnancy were: (1) vaginal bleeding lasted longer, (2) abdominal rebound tenderness was more prevalent, and (3) abdominal pain was more prevalent in patients with ruptured ectopic pregnancy than in those with unruptured. There were no other significant differences among the signs and symptoms. Patients with and without ectopic pregnancy cannot be easily distinguished on the basis of presenting signs and symptoms. A combination of culdocentesis and quantitative human chorionic gonadotropin provides the maximal discriminative capacity when considering diagnostic laparoscopy for suspected ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1987

The nature of the intraperitoneal exudate associated with infertility: peritoneal fluid and serum lysozyme activity.

An intraperitoneal inflammatory process has been associated with infertility in women without anatomic distortion of the pelvic viscera, particularly with endometriosis. This phenomenon was investigated by measuring peritoneal fluid (PF) and serum levels of a major secretory product of the macrophage, lysozyme, in fertile and infertile women undergoing laparoscopy. Serum lysozyme levels were in the normal range and did not correlate with total PF lysozyme. Regression analysis revealed a negative correlation between adnexal adhesions and PF volume (P less than 0.05), PF leukocyte number (P less than 0.05), and total PF lysozyme (P less than 0.05). Significant correlations were found between total PF lysozyme and PF volume (r = 0.72, P less than 0.0001) and leukocyte number (r = 0.67, P less than 0.0001). These results suggest that a localized intraperitoneal inflammatory reaction is associated with infertility in the absence of anatomic distortion of the pelvic viscera.

Adnexal Diseases↗
PubMed1987

Endometriosis and mullerian anomalies.

Although numerous etiologies for endometriosis have been proposed, it is clear that retrograde menstruation and cell-mediated lymphocytotoxicity each play a significant role in the disease's development. A comprehensive theory of pathogenesis of endometriosis holds that development of the disorder depends upon amount of retrograde menstruation and the ability of the immune response to remove the debris. To test this theory, 64 women with mullerian anomalies and intra-abdominal surgery were evaluated for the presence or absence of endometriosis, patency of tubes, hematocolpos or hematometra, and outflow obstruction. Results demonstrated that endometriosis was present in ten of 13 women with functioning endometrium, patent tubes, and outflow obstruction, whereas it could be identified in only 16 of 43 women with no obstruction (77 versus 37%, P less than .01). Similarly, eight of nine women with hematocolpos or hematometra had endometriosis, while only 18 of 47 with functioning endometrium but no hematometra/hematocolpos had it (89 versus 38%, P less than .01). None of the eight women without endometrium had endometriosis. These data support the concept that an increase in retrograde menstruation will increase the likelihood of endometriosis.

Endometriosis↗
PubMed1986

Analysis of sequential treatment protocols for endometriosis-associated infertility.

The evaluation of comparative pregnancy data in clinical studies is subject to a variety of biases. One such bias, when treated patients are retrospectively compared with untreated control subjects, results from the fact that treated patients must remain infertile from time of diagnosis to time of treatment while no such requirements is maintained for untreated control subjects. This bias is also apparent when patients undergo sequential treatments and transfer from one comparison group to another. We have eliminated this problem by applying the Mantel-Byar approach for constructing and comparing modified life tables that reflect sequential changes of treatment status. To illustrate this we applied commonly used methods of analysis as well as the Mantel-Byar method to infertile endometriosis patients attempting pregnancy. One hundred thirty consecutive patients were evaluated retrospectively, with 42 undergoing expectant management only, seven experiencing a conservative surgical procedure only, and 81 having a conservative surgical procedure after a variable period of expectant management. Use of Mantel-Byar analysis revealed no significant overall increase in pregnancy rate with conservative surgical procedures versus expectant management (chi 2 = 0.225, df = 1). To further assess the potential value of conservative surgical procedures in fertility enhancement, the data were stratified by degree of endometriosis. The adjusted chi 2 was 1.621. No significant difference was noted between the two therapeutic approaches with mild disease (n = 35, chi 2 = 0.0175) or moderate endometriosis (n = 59, chi 2 = 0.424). Conservative surgical procedures appear to be therapeutic, however, in women with severe disease (n = 36, chi 2 = 5.12, p less than 0.05). These results differed substantially from those obtained with the more biased analytic methods routinely used in clinical fertility trials. This study illustrates the utility of the Mantel-Byar approach as a valuable tool in the evaluation of response time data involving transient therapeutic states and one particularly adaptable to retrospective infertility studies involving sequential treatment approaches.

Actuarial Analysis↗
PubMed1986

Association of endometriosis and spontaneous abortion: effect of control group selection.

Endometriosis has been associated with an increased incidence of spontaneous abortion, compared with the abortion rate of the general population. To assess whether a separate control group would affect these conclusions, we studied 139 consecutive infertility patients with laparoscopically proven endometriosis to determine the incidence of spontaneous abortion. Ninety-five of these patients underwent conservative surgical resection of endometriosis, and 44 patients opted for expectant management. There was no significant difference between these two groups in average age, duration of infertility, or proportion of patients with primary infertility. The average spontaneous abortion rate before diagnosis for all patients was 63.1%. After surgical treatment, the abortion rate dropped to 0% (P less than 0.000001) for all stages of disease. However, even in those patients who received expectant management only, the abortion rate fell to 16.7% and 21.4% for mild and moderate endometriosis, respectively (P less than 0.001). These results suggest that the spontaneous abortion rate in untreated endometriosis may not be as high as previously reported and may not be significantly different from the rate in the general population. The data also emphasize the need for well-defined control groups when assessing the effects of a treatment regimen.

Abortion, Spontaneous↗
PubMed1986

Reevaluation of hysterosalpingography in infertility investigation.

The hysterosalpingogram has been extensively used in infertility investigations to assess tubal patency, however, the diagnostic reliability of this technique is not known. Two hundred thirty-one consecutive hysterosalpingograms were retrospectively evaluated. Sixty-two percent (143) of the patients subsequently underwent laparoscopy. Comparison of hysterosalpingogram and laparoscopic findings revealed a 15.9% false positive tubal patency rate and a 14.9% false negative tubal patency rate. Seventy-six percent of laparoscopies revealed previously undiagnosed intraperitoneal disease. Seventeen percent of hysterosalpingograms demonstrated intrauterine pathology. There was a 0.9% major complication rate with hysterosalpingograms due to two cases of acute pelvic inflammatory disease. No significant laparoscopic complications were noted. The results suggest that laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors than hysterosalpingogram in the investigation of infertility.

Adolescent↗