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Biomedical subjects

J A Vanrell

Publications and source records attributed to J A Vanrell.

At least 127 records · Page 7Linked to original sources
PubMed1988

Lack of endometriosis in patients with repeated abortion.

Laparoscopy was performed in 25 consecutive patients with two or more (range 2-6, mean 2.8) histologically documented first-trimester abortions in whom the well-established causes for recurrent miscarriages had been excluded. Endometriosis could not be diagnosed in any of the 25 women. Thus our results are against endometriosis as a cause of repeated abortion and do not support the routine inclusion of laparoscopy in the evaluation of the patient with recurrent abortions.

Abortion, Habitual↗
PubMed1987

Bilateral femoral neuropathy after microsurgical reversal of tubal sterilization: case report and analysis of contributing factors.

A case of bilateral femoral neuropathy after microsurgical tuboplasty for reversal of sterilization is reported. Although the prognosis is favourable and full recovery is usually observed, the disabling effect of the neuropathy may last for several months. This report is an attempt to alert fertility surgeons to the possible occurrence of such a complication disturbing to both patient and physician, by analysing the mechanisms of injury and possible ways of its prevention.

Adult↗
PubMed1987

Corpus luteum insufficiency and fertility: a matter of controversy.

This paper analyses different controversial aspects of luteal phase deficiency (LPD) on the basis of our own data and current clinical experience. Conceptual and diagnostic concerns include: (i) the lack of predictive value of mid-luteal plasma progesterone determinations regarding the progestational transformation of the endometrium, and (ii) the need for a minimum of two, or even three, endometrial biopsies for diagnosis of LPD. From an aetiologic point of view follicular phase determinants of LPD are emphasized and conflicting data on claimed predisposing factors of LPD are analysed. Primary therapeutic approaches to LPD and the effectiveness and significance of such therapy on fertility are discussed.

Corpus Luteum↗
PubMed1987

Endometrial cytosolic and nuclear progesterone receptors in the luteal phase defect.

Basal body temperature profiles, serial serum progesterone levels, and serial endometrial biopsies were studied in 15 infertile women during 21 ovulatory cycles. Ten cycles (in 9 women) demonstrated luteal phase defects (LPD), diagnosed by a histological lag in endometrial maturation, normal luteal phase length, and normal luteal phase serum progesterone levels. Both normal and LPD cycles had a maximum amount of endometrial cytosolic progesterone receptor (PgR) on days 13-15, with a significant decline thereafter. LPD cycles had significantly lower endometrial nuclear PgR concentrations than did normal cycles during the proliferative phase, but luteal phase endometrial nuclear PgR levels were similar in both groups. In 2 LPD women treated with dydrogesterone, normal endometrial maturation and a decline in endometrial cytosolic PgR concentrations in the late luteal phase were found. Therefore, with the exception of endometrial nuclear PgR concentrations during the proliferative phase, we found no evidence for a major abnormality in endometrial PgR levels in LPD cycles with a lag in endometrial histology.

Adult↗
PubMed1986

Luteal phase defects in repeated abortion.

Fifty women with 2 or more previous first-trimester abortions and 300 infertile patients underwent a luteal phase evaluation by basal body temperature, plasma progesterone, estradiol and prolactin determination, and endometrial biopsy (repeated in a later cycle when the first was defective). An endometrial luteal phase deficiency was detected in 15 (30%) of aborting patients. In 13 (26%) of these women the endometrial defect was associated to normal hormonal levels. This condition was only present in 36 (12%) of the infertility cases (P less than 0.01). We conclude that the possible etiologic role of luteal phase defects in repeated abortion, is by a secretory insufficiency in the endometrial pattern despite normal plasma hormonal levels.

Abortion, Habitual↗
PubMed1986

Luteal function after delayed ovulation.

Thirty-three infertile patients presenting spontaneous ovulatory cycles with long follicular phases (greater than or equal to 20 days) underwent a luteal function evaluation by basal body temperature, plasma progesterone (P), estradiol, and prolactin determination, and endometrial biopsy study. An endometrial luteal phase deficiency (LPD) was detected in 13 patients (39.4%), although in 10 of them (77%) P levels were normal. This study shows a high incidence of endometrial LPD among cycles with delayed ovulation and that in cases of LPD related to abnormal folliculogenesis, the endometrium is a better indicator than plasma P.

Adolescent↗
PubMed1986

The significance of luteal phase deficiency on fertility: a diagnostic and therapeutic approach.

Luteal phase deficiency, diagnosed by endometrial biopsy, was found in 1 out of 25 control fertile women and in 46 out of 355 infertile patients, a difference that was not significant. It was also found in 19 [corrected] out of 60 patients with early recurrent abortion which was significantly higher than in controls and in infertile patients. Pregnancy outcome was evaluated in treated and untreated groups of patients diagnosed as having luteal phase deficiency. Our data suggest that treatment improved the results of pregnancy in patients with recurrent abortion, but not in infertile patients.

Abortion, Habitual↗
PubMed1986

Early luteal function following danazol therapy for endometriosis.

The luteal phase of 20 infertile women with endometriosis who were treated with danazol (600 mg daily for 6 months) was studied by basal body temperature, plasma progesterone (P), oestradiol (E2) and prolactin (PRL) determination, and endometrial biopsy, in any one of the first three cycles after discontinuation of danazol. All endometrial specimens were noted to be fundal samples and were clearly progestational after danazol therapy. Abnormal secretory phases were detected in three patients, as in the pre-danazol control cycles. Moreover, plasma levels of P, E2 and PRL in post-danazol cycles were similar to those found in control cycles and fell within the normal range in all cases except for one patient having hyperprolactinaemia. In conclusion, our study shows that endometrial inadequacy is not the cause of the increased fetal wastage previously reported among proximally conceived pregnancies after danazol therapy for endometriosis.

Abortion, Spontaneous↗
PubMed1985

The endometrial biopsy for diagnosis of luteal phase deficiency.

We studied endometrial luteal phase in specimens from 660 biopsies done in 300 patients from our infertility clinic. A minimum of two (240 women) or three (60 women) endometrial biopsy specimens from separate cycles were taken regardless of the previous histologic findings in all patients. Statistical analysis of results by the McNemar and the Cochran Q tests for the significance of changes leads us to conclude that a minimum of two, and even three, endometrial biopsy specimens are needed for diagnosis of luteal phase deficiency.

Biopsy↗
PubMed1985

Mild endometriosis and luteal function.

The luteal function of 27 patients with mild endometriosis and infertility was compared with that of 50 infertile patients without endometriosis. The incidence of endometrial luteal phase deficiency was similar in both groups of patients. Luteal phase length and plasma levels of progesterone (P), estradiol (E2) and prolactin (PRL) in infertile patients (both groups) were similar to those in a group of 10 fertile women. We conclude that luteal phase defects should not be considered as a primary cause of infertility in mild endometriosis.

Corpus Luteum↗
PubMed1984

Endometrial biopsy inadvertently taken in the cycle of conception.

Endometrial data, plasma progesterone levels and the outcome of pregnancy were analyzed in 22 infertility patients from whom endometrial biopsies had been inadvertently taken in early pregnancy. We found 22.7% (5 cases) of defective endometria in association with normal plasma progesterone levels (available in four patients). Daily plasma progesterone during the first 21st postovulatory days in the cycle of conception is reported in one of our patients. Fourteen of the 22 women delivered normal infants at term, 1 woman had a hydatidiform mole and 7 women aborted (31.8%). The relevance of endometrial biopsy in the cycle of conception and its influence on the outcome of pregnancy are discussed.

Abortion, Spontaneous↗
PubMed1983

Prolactin in the evaluation of luteal phase in infertility.

Hyperprolactinemia was detected in 15 of 130 infertile patients (11.5%) with regular menstrual cycles and no galactorrhea who underwent luteal phase evaluation by basal body temperature (BBT), plasma estradiol (E2), and progesterone (P) determination, and endometrial biopsy (repeated in a later cycle when the first was defective). Luteal phase length and plasma levels of P and E2 were similar in the hyperprolactinemic and normoprolactinemic patients. Moreover, a significantly higher incidence of inadequate luteal phase, histologically documented, was found in the normoprolactinemic group. It is concluded that the usefulness of plasma prolactin (PRL) determination in the evaluation of luteal function in infertility is scanty and that most histologically documented cases of luteal phase defects occur with euprolactinemia.

Body Temperature↗
PubMed1983

Dehydrogesterone treatment of endometrial luteal phase deficiency after ovulation induced by clomiphene citrate and human chorionic gonadotropin.

Twenty infertile patients being treated with clomiphene citrate (CC) and human chorionic gonadotropin (hCG) for induction of ovulation, with a defective endometrial secretory pattern despite normal plasma levels of progesterone, estradiol, and prolactin, were entered into treatment plans on a random basis involving the following: CC-hCG plus dehydrogesterone (group 1), and CC-hCG (group 2). Success rates were similar in both groups (20% and 30%, respectively), based on a corrected endometrial defect during the second treated cycle. It is concluded that progestational agents are of low therapeutic value in endometrial luteal phase deficiency induced by CC.

Adult↗
PubMed1983

Luteal phase evaluation after clomiphene-chorionic gonadotrophin-induced ovulation.

Fifty infertile patients treated with clomiphene and hCG for induction of ovulation were studied with plasma progesterone measurement and endometrial histology. Five patients (10%) presented defective endometria and low plasma progesterone in spite of biphasic BBT charts with normal luteal phase length. Forty-five patients (90%) had significantly higher plasma progesterone concentrations than those found in a control group of fertile women, but a defective endometrial secretory pattern occurred in 19 of these 45 patients (42.3%). These data suggest the need for monitoring the response to clomiphene by endometrial histology in addition to BBT and plasma progesterone, or for supplemental therapy to overcome the endometrial luteal phase deficiency in clomiphene-treated cycles.

Adult↗
PubMed1982

Dehydrogesterone versus vaginal progesterone in the treatment of the endometrial luteal phase deficiency.

Forty-four infertile patients with inadequate luteal phase histologically documented in at least two separate cycles and normal plasma levels of progesterone (P), estradiol (E2), and prolactin (PRL) were entered into treatment plans on a random basis involving at least 3 months of each of the following: P vaginal suppositories, dehydrogesterone, and no treatment. Success rates were similar for P (62.5%) and dehydrogesterone (68.7%), based on a corrected endometrial defect during the fourth treated cycle or when a term pregnancy was achieved. However, these figures are significantly different (P less than 0.001) when compared with 16.6% of the control group. In ten additional infertile patients with normal luteal function as assessed by endometrial histologic study and hormone measurements, a second biopsy was performed in a consecutive cycle under dehydrogesterone administration. In no case was the normal secretory pattern impaired. It is concluded that (1) both P and dehydrogesterone can be used to advantage in the treatment of luteal phase defects, and (2) therapy with dehydrogesterone does not alter the normal pattern of endometrial secretion.

Administration, Oral↗
PubMed1982

Luteal phase in infertility: problems of evaluation.

This study was undertaken to examine the endometrial data in 200 infertile women whose three progesterone estimations per cycle totaled over 15 ng/ml when taken from 11 to 4 days preceding menstruation. Forty-three patients (21.5%) showed defective endometria in two separate cycles. No difference was found when plasma progesterone concentrations in this group were compared with those of the remaining 157 infertile patients with normal endometria. Further, plasma progesterone in infertile women (both groups) was similar to a control group of 12 fertile women with normal secretory endometria. Endometrial biopsy is essential in the evaluation of luteal function in infertility and cannot be totally replaced by the use of plasma progesterone in three samples during the luteal phase since it failed to detect as much as 21.5% of abnormal secretory phases.

Adult↗
PubMed1981

Abortion may sensitize the mother to HLA antigens.

The incidence of cytotoxic antibodies in relation to histories of abortions was analyzed in sera from 474 nulliparous pregnant women. In patients with previous spontaneous abortions, there is a higher incidence of positive sera than in primigravidae. Furthermore, patients with two or more prior abortions show a greater incidence of cytotoxic activity in their sera than women who have had only one abortion.

Abortion, Spontaneous↗