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H S Jacobs

Publications and source records attributed to H S Jacobs.

At least 37 records · Page 2Linked to original sources
PubMed1998

Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome.

The aim of this study was to investigate of the relationship of ovarian stromal volume, measured using three-dimensional ultrasound, to serum androgen concentrations in patients with polycystic ovaries. Serum gonadotrophin, oestradiol and androgen concentrations and ovarian volume measurements were obtained in the early follicular phase from 100 women undergoing assisted conception treatment cycles. Group 1 contained 50 women with regular menstrual cycles and normal ovarian morphology, group 2 contained 24 women with regular menstrual cycles and polycystic ovaries seen on ultrasound scan and group 3 contained 26 women with polycystic ovary syndrome. Statistical analysis included analysis of variance, Scheffé's procedure and Pearson's correlation. Total ovarian volume (15.7-16.1 versus 11 ml, P < 0.05), stromal volume (14.5 versus 9.4 ml, P < 0.05) and thecal steroid concentrations were significantly greater in groups 2 and 3. Stromal volume was positively correlated with serum androstenedione concentrations (r = 0.45, P = 0.0019 in group 3) but was not correlated with any other endocrine parameter. It was concluded that polycystic ovaries are characterized by increased ovarian stroma with associated overproduction of theca-derived steroids, particularly androstenedione.

Adult↗
PubMed1998

Reproductive endocrinology.

The theme running through the articles in this issue on reproductive medicine is that of the safety of the medical treatments we use in this specialty. Two of the articles focus on familiar medications, such as the oral contraceptive pill and the drugs used to induce ovulation, and two focus on the benefits and potential hazards of new approaches to treatment, viz the reduction of insulin drive in women with polycystic ovary syndrome and the use of selective modulators of estrogen receptors in postmenopausal women with osteoporosis.

Endocrinology↗
PubMed1998

Implications of using follicle-stimulating hormone preparations depleted of luteinizing hormone to achieve follicular growth in in vitro fertilization.

We aimed to compare the outcome of in vitro fertilization (IVF) treatment using follicle-stimulating hormone (FSH) containing gonadotropins with human menopausal gonadotropin (hMG) containing gonadotropins for ovarian stimulation. A retrospective analysis of 82 patients undergoing IVF in a private fertility clinic was performed over a specific period of time. Eighteen women received hMG, 20 received Normegon and 44 received FSH. In addition, 17 of these patients received hMG in one cycle and FSH in the other. The main outcome measures studied were duration of treatment, dose of gonadotropins required to achieve optimum follicular growth, number and size of follicles, endometrial thickness, serum estradiol concentrations, number of oocytes retrieved, pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS). At the time of administration of human chorionic gonadotropin (hCG), the mean (+/- SD) serum estradiol concentrations in patients treated with preparations containing FSH and luteinizing hormone (LH) in a ratio of 1:1 was 10,044.3 +/- 5378.8 pmol/l compared with 6819.5 +/- 2597.9 pmol/l in patients treated with preparations with FSH and LH in a ratio of 3:1 and 7369 +/- 4300 pmol/l in patients treated with FSH. The differences between the first and the second two groups were significant (p < 0.05). Endometrial thickness in the three groups of patients were 11 +/- 1.7 mm, 11 +/- 1.5 mm and 9.7 +/- 1.5 mm, respectively (p < 0.001). Comparing cycles of treatment with hMG and FSH in the same patient, we found significantly higher estradiol levels, thicker endometrium, more developing follicles and a shorter duration of treatment in the hMG-treated cycles compared with those in FSH-treated cycles. However, there were no differences between the incidence of OHSS or the pregnancy rates between the three treatment groups. With the advent of recombinant human FSH and the shortage of LH-containing preparations, it is important to note that serum estradiol concentrations on the day of administration of hCG underrepresent the degree of follicular maturation. In the context of the use of a 'long' protocol of gonadotropin-releasing hormone (GnRH) analog therapy and LH-depleted gonadotropin preparations, serum estradiol is no longer a reliable marker of follicle development.

Adult↗
PubMed1997

Early prediction of ovarian multifollicular response during ovulation induction in patients with polycystic ovary syndrome.

OBJECTIVE: To examine the association between the midfollicular FSH-LH ratio and the number of follicles, and the multifollicular ovarian response to gonadotropin stimulation in patients with polycystic ovary syndrome (PCOS) with normal basal LH and FSH levels. SUBJECT(S): Eighteen patients who had an abandoned treatment cycle because of multifollicular ovarian response. For comparison, all other completed treatment cycles in the same group of patients were used. MAIN OUTCOME MEASURE(S): The dose of hMG or FSH, daily effective dose, day 8 serum FSH and LH concentration, day 8 number of follicles > or = 8 mm, E2 and number of follicles on hCG day or day of cycle was abandoned. RESULT(S): In the abandoned cycles, day 8 serum LH concentrations were significantly lower and day 8 number of follicles and FSH-LH ratios were significantly higher compared with the completed cycles. A high predictive power (> 90%) for multifollicular response was established by using a set of two criteria: a FSH-LH ratio > or = 1.6 and the number follicles > or = 7 as the cutoff point. CONCLUSION(S): When aiming for a monofollicular response in women with PCOS and normal basal FSH and LH levels, cycles with high midfollicular FSH-LH ratios (> or = 1.6) and a high number of follicles (> or = 7) are those prone to develop a multifollicular ovarian response.

Adult↗
PubMed1997

Menopause and post-menopause.

From the endocrine point of view, menopause is considered a deficiency state and oestrogen therapy regarded as restoring the pre-menopausal endocrine milieu. Oestrogen therapy alleviates acute climacteric symptoms and also reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. Cardiovascular protection seems to be the major benefit of oestrogen replacement: it reduces morbidity and mortality from coronary heart disease by approximately 50%. The mechanisms are complex and not fully under-stood. In this review we discuss currently available data on the effects of hormone replacement therapy on serum lipids and lipoproteins, the vessel wall (endothelium dependent and endothelium independent), blood flow, cardiac function, blood pressure, haemostasis, insulin sensitivity and direct anti-atherosclerotic effect as possible mechanisms of cardioprotection. Oestrogen therapy reduces the rate of post-menopausal bone loss, increases bone mineral density (BMD) and decreases fracture rate. Recent evidence suggests that initiation of oestrogen therapy in older women produces larger increases in BMD which might provide a significant protective effect at the time when fracture is common. The incidence of Alzheimer's disease is reduced by 50% in post-menopausal women taking oestrogen replacement. Limited clinical trials of oestrogen treatment in women with this disease have documented beneficial effects on cognitive function. The results of epidemiological studies of the effects of oestrogens on breast cancer risk are conflicting but recent evidence suggests that the risk is increased in current users after 5 years of use and among older women. In contrast, increase in the risk of venous thromboembolism is most significant within the first 12 months of therapy, strongly suggesting the importance of individual susceptibility.

Adult↗
PubMed1997

New developments in postmenopausal hormone replacement therapy.

In this review we summarize background data that have steadily accumulated to help explain the beneficial actions of oestrogen replacement treatment on cardiovascular disease. The range of beneficial actions on the cardiovascular system is extraordinary, and goes far beyond the widely acknowledged effects on lipoprotein action. We also review recent reports on the beneficial actions of oestrogen treatment on Alzheimer's disease and colorectal cancer. The emphasis throughout is on understanding the mechanisms of benefit.

Alzheimer Disease↗
PubMed1996

Elective cryopreservation of all embryos in women at risk of developing ovarian hyperstimulation syndrome may not prevent the condition but reduces the live birth rate.

OBJECTIVE: Our goal was to evaluate the use of elective cryopreservation of all embryos to prevent the development of ovarian hyperstimulation syndrome in patients at risk while undergoing in vitro fertilization treatment. DESIGN: We analyzed 117 treatment cycles in which the serum E2 concentration on the day of hCG administration was > 10,000 pM and in whom > or = 15 oocytes were retrieved at ultrasound-directed follicle aspiration. The incidence of ovarian hyperstimulation syndrome, pregnancy, and live birth in 65 patients who had elective cryopreservation of all embryos and 52 patients who had fresh embryo transfer were compared. Independent t test and chi-square test (with Yates' correction) was used as appropriate. RESULTS: The clinical pregnancy (35 vs 17%; P < 0.03) and the live birth (27 vs 12%; P < 0.05) rates in patients receiving fresh embryo transfer was significantly higher than in those who had elective cryopreservation of all embryos. The incidence of moderate and severe ovarian hyperstimulation syndrome was similar in both groups (3.8 and 6.2%). CONCLUSIONS: Elective cryopreservation of all embryos does not reliably protect against the development of ovarian hyperstimulation syndrome but may reduce the clinical pregnancy and live birth rate.

Adult↗
PubMed1996

Induction of ovulation in clomiphene-resistant polycystic ovary syndrome with pulsatile GnRH.

OBJECTIVE: To determine the efficacy of pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins in a stepwise approach for inducing ovulation in women with clomiphene-resistant polycystic ovary syndrome (PCOS). METHODS: Eighty women with clomiphene-resistant anovulatory infertility and PCOS were given subcutaneous pulsatile GnRH (15 micrograms every 90 minutes) using a portable infusion pump. If no follicular development was seen, clomiphene citrate (100 mg/day for 5 days) was given concurrently with the hormone in the next cycle of treatment. Those who still failed to ovulate regularly were treated with combined pulsatile GnRH with intramuscular gonadotropins (one ampule per day for 5-7 days). RESULTS. Sixty-six of 131 (50%) pulsatile GnRH cycles, 94 of 142 (66%) pulsatile GnRH with clomiphene cycles, and 48 of 69 (70%) pulsatile GnRH with gonadotropin cycles were ovulatory. Monofollicular response (one follicle at least 14 mm on the day of ovulation) occurred in 80.6, 83.9, and 53.6% of cycles, and multifollicular response occurred in 4.8, 3.1, and 21.6% of cycles in the three groups, respectively. Mild ovarian hyperstimulation occurred in one of the 342 cycles. The cumulative conception rate was 30% after three cycles, 60% after six cycles, and 73% after nine cycles. The miscarriage rate was 22% (ten of 45 pregnancies), and 35 women (78%) had live births (33 singletons and two sets of twins). CONCLUSION: The use of subcutaneous pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins for induction of ovulation in clomiphene-resistant PCOS in a stepwise approach produces a high cumulative conception rate associated with a low rate of multiple pregnancy and ovarian hyperstimulation syndrome.

Adult↗
PubMed1996

Characterization of idiopathic premature ovarian failure.

OBJECTIVE: To characterize women with idiopathic premature ovarian failure (POF) by their ovarian ultrasonographic appearances to establish the prevalence of follicular activity and relationship to autoimmunity, estrogen status, and historical background. DESIGN: Retrospective analysis of clinical, endocrine, autoimmune, ultrasonographic, and bone densitometry parameters. SETTING: Reproductive Endrocrinology Clinics of The Middlesex Hospital, London, United Kingdom. PATIENTS: Data from 135 women with idiopathic POF were analyzed. A reference group of 18 women with normal ovarian function, studied in their follicular phase, was used for comparison of endocrine and ultrasound data. A reference group of 57 women with normal ovarian function was used for comparison of bone densitometry measurements. MAIN OUTCOME MEASURES: Serum E2 concentrations, autoantibody screen, ultrasonographic measures of ovarian volume, uterine cross-sectional area and endometrial thickness and dual roentgenogram bone mineral densitometry of the lumbar spine. RESULTS: The detection of ovaries by ultrasound (in 76%) and follicular activity (in 60% of patients) was associated with higher bone mineral density compared with women in whom ovaries could not be identified. Of 13 patients presenting with primary amenorrhea, ultrasonography identified ovaries in 62% and follicles in 38% whereas 38% had positive autoimmunity. Evidence of autoimmunity was found in 31% of patients overall and these were indistinguishable from the nonautoimmune remainder in every respect. CONCLUSIONS: Ovarian follicular activity, previously considered to be rare, as in the "resistant ovary syndrome," is found in the majority of women with POF using pelvic ultrasonography. Patients presenting with primary amenorrhea have a similar degree of ovarian function, determined by ultrasound, and autoimmunity as those presenting with secondary amenorrhea. The role of autoimmunity in the pathogenesis of POF is not distinguished from nonautoimmune ovarian damage by the measurements made in this study.

Adolescent↗
PubMed1996

Comparison of intravenous albumin and transfer of fresh embryos with cryopreservation of all embryos for subsequent transfer in prevention of ovarian hyperstimulation syndrome.

OBJECTIVE: To compare the efficacy of administration i.v. albumin to prevent severe ovarian hyperstimulation syndrome (OHSS) in patients undergoing ovarian stimulation for IVF with a standard policy of cryopreserving all embryos and to assess the impact of the two methods of treatment on pregnancy rates (PRs). DESIGN: Prospective randomized study. SETTING: A tertiary referral center for assisted conception. PATIENTS: Twenty-six patients undergoing IVF treatment cycles who were considered to be at high risk of developing severe OHSS on the basis of their serum E2 concentrations on the day of hCG administration and the number of oocytes collected. INTERVENTION: In group 1 (n = 13) all the generated embryos were cryopreserved to be transferred subsequently in hormonally manipulated cycles. In group 2 (n = 13) patients received IV infusions of albumin on the day of oocyte retrieval and 5 days later. Patients in group 2 had transfers of fresh embryos. MAIN OUTCOME MEASURES: The total dosage of hMG used, total number of follicles developed, number of follicles > 14 mm in diameter, serum E2 concentrations and endometrial thickness on day of hCG administration, number of oocytes retrieved, number and quality of embryos generated, PRs per cycle commenced, and onset and degree of any OHSS developed. RESULTS: There were no significant differences in the above parameters between the two groups, except for PRs that were significantly higher in patients who had all embryos cryopreserved (38.6% versus 0%). CONCLUSION: The policy of cryopreserving all generated embryos appears as effective as the administration of i.v. albumin in preventing OHSS in high-risk patients and produces significantly higher PRs.

Adult↗
PubMed1996

Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI-1) activity in lean women with and without the polycystic ovary syndrome.

OBJECTIVE: Hyperinsulinaemic women with the polycystic ovary syndrome (PCOS) may be at increased risk of vascular disease later in life, mediated by blood pressure or lipid abnormalities or by elevated plasma levels of plasminogen activator inhibitor-1 (PAI-1) activity. PAI-1 may also be involved in ovarian follicle development and ovarian connective tissue remodelling. We measured plasma PAI-1 activity and 24-hour ambulatory blood pressure records in women with and without PCOS. DESIGN: Cross-sectional study of three groups. PATIENTS: Twenty-four non-obese women with a classic ovarian ultrasound appearance of PCO and extreme menstrual disturbance (Group 1), 26 matched controls with a normal menstrual cycle and an ultrasound appearance of PCO (Group 2) and 10 matched controls with a normal menstrual cycle and normal ovarian ultrasound (Group 3). MEASUREMENTS: Twenty-four hour ambulatory blood pressure recordings (Spacelabs 90207), ovarian ultrasonography, fasting plasma insulin and glucose, plasma PAI-1 activity, HDL and total cholesterol, triglycerides, gonadotrophins and testosterone. Family history of premature vascular disease. RESULTS: Median fasting plasma insulin was significantly higher in Group 1 (45.8 pmol/l, range 12.9-161.9) than in Group 2 (28.1 pmol/l; range 13.6-91; P < 0.05) or Group 3 (26.0 pmol/l; range 13.5-63.3; P < 0.05). There were no differences between groups in 24-hour, daytime or night-time ambulatory blood pressure measurements, and no relation between plasma insulin and any blood pressure variable. Mean plasma PAI-1 activity was higher in Group 1 (10.0 +/- 7.1 AU/l) than in Group 2 (6.0 +/- 4.6 AU/l; P < 0.05) or Group 3 (5.1 +/- 3.5 AU/l; P = 0.06). There was a significant independent direct relation between fasting plasma insulin and PAI-activity (r = 0.41, R2 = 0.154; F1,59 = 11.38; P = 0.001). Groups did not differ in parental history of premature vascular disease, or in mean HDL or fasting triglyceride levels. CONCLUSIONS: The only measurable vascular risk factor associated with hyperinsulinaemia and menstrual disturbance in non-obese women with PCOS is an elevated plasma PAI-1 activity. These women did not differ from controls in ambulatory blood pressure profiles, lipid measurements or in a parental history of premature vascular disease. PAI-1 and plasminogen are involved in ovarian follicle maturation and the present finding suggests a biologically plausible link between hyperinsulinaemia, anovulation and vascular risk in PCOS.

Adult↗