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Biomedical subjects

J R Coutts

Publications and source records attributed to J R Coutts.

At least 37 records · Page 2Linked to original sources
PubMed1990

Ovarian sensitivity to gonadotrophins in patients with PCO is unaffected by suppression of LH.

Infertile women with oligomenorrhoea and elevated LH concentrations (presumed polycystic ovary disease, PCO) were treated with exogenous gonadotrophins, HMG and HCG, for induction of follicular growth and ovulation, respectively. This was effected in the absence or presence of a gonadotrophin releasing hormone analogue (GnRH-A) to suppress basal LH and the positive feedback surge of LH. Analyses of the duration of HMG therapy required to attain the degree of stimulation for HCG to be administered showed no difference between those with and without LH suppression. Analyses of the ultrasound estimations of rates of follicle growth and continued recruitment during the course of HMG also failed to show any effect of LH suppression. These data show that the high sensitivity of these patients to HMG is not related to the circulating LH concentrations.

Buserelin↗
PubMed1990

Luteal phase deficiency: ultrasonic and biochemical insights into pathogenesis.

Serial ovarian ultrasound and daily assessments of plasma concentrations of pituitary and ovarian hormones were used to investigate ovarian function in 175 women with unexplained infertility. Their endocrine and ultrasound profiles were compared with similarly derived data from 43 normal volunteers. Fifty-one (29.1%) of the study group showed subnormal luteal phase rises in progesterone concentrations, described as poor progesterone surge (PPS) cycles. Within this group, 23 women (45.1%) demonstrated luteal cyst formation, a pattern not seen in any of the control cycles. High concentrations of follicle stimulating hormone (FSH) and reduced concentrations of oestradiol (E2) were observed in the follicular phases of the PPS cycles suggesting that the phenomenon is a product of abnormal follicular metabolism. An association of PPS with infertility exists, perhaps related to a combination of disturbances in the follicular micro-environment compromising oocyte quality, a failure of oocyte release, and impaired endometrial receptivity.

Adult↗
PubMed1990

Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation.

A prospective, controlled study of ovarian function using ovarian ultrasound and daily plasma hormone estimations (estradiol, progesterone [P], follicle-stimulating hormone [FSH], luteinizing hormone [LH]) was carried out on 175 spontaneously cycling patients with unexplained infertility. Forty-one (23.4%) demonstrated luteal phase cyst formation. In 21 cycles the dominant follicle reduced in size after the LH peak (cystic corpus luteum cycles), and in 20 no shrinkage was seen (luteinized unruptured follicles). Progesterone concentrations in the early luteal phase were significantly reduced in the luteinized unruptured follicle cycles. Elevation in plasma FSH was seen in the early follicular and luteal phases of both cyst forming groups and may be due to disturbances in ovarian metabolism. Follicular rupture is important for efficient P release by the corpus luteum.

Adult↗
PubMed1988

Combined gonadotropin-releasing hormone analog and exogenous gonadotropins for ovulation induction in infertile women: efficacy related to ovarian function assessment.

The ovarian function of infertile women with normal menstrual rhythm was investigated by daily plasma hormone (estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone) analyses throughout the menstrual cycle, and patients were diagnosed as showing a subnormal profile of progesterone in the early luteal phase or as showing no abnormality. Women with oligomenorrhea and elevated luteinizing hormone levels were diagnosed as having polycystic ovary syndrome primarily on the basis of endocrinology. All patients were treated with a gonadotropin-releasing hormone analog to suppress endogenous luteinizing hormone and follicle-stimulating hormone so that ovulation induction with exogenous gonadotropins could be undertaken as in patients with hypogonadotropic hypogonadism. Interference in the process of ovulation by endogenous luteinizing hormone fluctuations was eliminated and pregnancies were achieved. The pregnancy rate in the group with polycystic ovary syndrome was 77% per treatment course (six cycles) while that in the group with subnormal progesterone profiles was 61.5%. Patients showing no abnormality achieved no pregnancy, demonstrating the redundancy of interference with normal ovarian function.

Adult↗
PubMed1988

LHRH analogues for ovulation induction, with particular reference to polycystic ovary syndrome.

Infertile women with PCO have been treated with exogenous gonadotrophins (hMG/hCG) for ovulation induction either with or without LHRH-agonist treatment. Those treated without LHRH-agonist-induced LH suppression showed PL in greater than 30% of the cycles and this problem was eliminated by LHRH-agonist therapy. The pregnancy rate (approximately 80% of patients) during the combined therapy was approximately twice that of the group treated with hMG/hCG alone. The suppression of endogenous LH by the LHRH-agonist appeared to have no effect upon the profiles of follicular development in response to hMG, and a high rate of follicle recruitment characterized all PCO treatment cycles irrespective of circulating LH concentrations. These results suggest that LH suppression improves the efficacy of ovulation induction but has no influence on the primary metabolic disturbance in the PCO syndrome.

Drug Therapy, Combination↗
PubMed1988

The use of GnRH analogues in combination with exogenous gonadotropins in infertile women.

GnRH analogues suppress LH fluctuations and produce a condition of hypogonadotropic hypogonadism. This action combined with treatment with human menopausal gonadotropins (hMG) has been exploited in programmes of induction of follicular growth in infertile women for both in vivo and in vitro fertilisation. There is improved clinical control over the process of ovulation and the phenomenon of premature luteinization in women with polycystic ovary disease has been eliminated.

Drug Therapy, Combination↗
PubMed1987

'Unexplained infertility' results of secondary investigations in 95 couples.

Abnormalities of in-vitro sperm-mucus penetration, ovarian hormone deficiency, specifically poor progesterone surge, and luteal cyst formation were assessed prospectively in 95 couples with fully investigated primary infertility of greater than or equal to 3 years duration. Abnormal sperm-mucus penetration was found in 22, half of whom could have been identified on semen assessment alone. Ten other males had recurrent oligospermia but with normal motility and mucus penetration. Twenty-one patients had a poor progesterone surge and seven of them demonstrated retained luteal phase cysts. Endocrine and mucus penetration abnormalities did not coincide, demonstrating that they are distinct and unrelated phenomena. A significant number of couples were found for whom the term 'unexplained infertility' was no longer applicable and appropriate management could be considered.

Adult↗
PubMed1986

Induction of multiple follicular growth in normally menstruating women with endogenous gonadotropin suppression.

Patients with normal menstrual rhythm and normal luteinizing hormone were treated with exogenous gonadotropins to induce multiple follicular development. This was effected in the absence (34 cycles in 12 patients) or with concurrent suppression of endogenous gonadotropin levels with a gonadotropin-releasing hormone analog (84 cycles in 18 patients). In the absence of the analog, "premature" luteinization occurred in 51% of cycles before the ultrasonic visualization of a follicle with a diameter of 20 mm. In the analog-treated cycles, premature luteinization was almost totally eliminated and progesterone elevations were delayed until after administration of human chorionic gonadotropin. Follicular estrogen production was unaffected by the analog treatment, compared with hypogonadal patients treated with exogenous gonadotropins. The characteristics of follicular development showed that two to three follicles of mature size were induced with this technique, and the capacity for the induction of a larger number of follicles was evident.

Buserelin↗
PubMed1985

Effects of LH suppression in polycystic ovary syndrome.

A LH-releasing hormone (LHRH) analogue was administered to subjects with elevated circulating LH concentrations and elevated androgens (polycystic ovary syndrome, PCO) and also to a control group with normal menstrual rhythm and normal LH and androgens. In both groups circulating LH concentrations were reduced to low and indistinguishable concentrations. Oestradiol, oestrone, androstenedione and testosterone levels were all reduced by treatment in both groups. However, the reduction in androgen concentrations was less marked in the patients with PCO. The oestrogen/androgen ratios remained relatively unaltered, but the testosterone levels remained slightly elevated in the PCO patients after treatment. The results suggest that patients with PCO syndrome show a disorder of androgen metabolism independent of elevated LH concentrations.

Adult↗
PubMed1985

Successful treatment of infertile women with oligomenorrhoea using a combination of an LHRH agonist and exogenous gonadotrophins.

Eight oligomenorrhoeic patients with increased luteinizing hormone (LH) and androgen levels who had failed to conceive during prolonged anti-oestrogen therapy received a new treatment. Large doses of an LH-releasing hormone (LHRH) analogue (HOE 766) were used to suppress circulating gonadotrophin concentrations and block the positive feedback gonadotrophin surge. Ovulation was induced during continued LHRH analogue treatment with exogenous gonadotrophins without interference from the patient's own pituitary. Seven of eight patients conceived rapidly without premature luteinization and without excessive ovarian enlargement. These complications had occurred in control treatment cycles using exogenous gonadotrophins in the absence of the LHRH analogue.

Adult↗
PubMed1984

The effect of exogenous hormones on the resistance of the early pregnant human cervix.

The force required to dilate the cervix to a diameter of 8 mm (cervical resistance index) has been measured in 355 patients undergoing suction termination in the first trimester of pregnancy. The cervical resistance index (CRI) was significantly lower in multigravid patients compared with primigravid patients. Prior treatment with prostaglandin E2 pessaries produced a consistent reduction in CRI in multigravidae but not in primigravidae. The effect of the prostaglandin was more pronounced on the compliance of the cervical tissue than on the diameter of the cervical canal. Treatment with pessaries of oestradiol, progesterone and medroxy-progesterone acetate produced no changes in the CRI.

Cervix Uteri↗
PubMed1983

Pregnancy-associated changes in the physical and microscopic characteristics of the ovine cervix.

Ovine cervices were obtained at slaughter from 18 sheep comprising six groups of three--cycling ewe lambs, non-pregnant, and four groups of pregnant animals of progressively longer gestation PI to PIV. Physical and microscopic analyses carried out on these cervices showed consistent results throughout any individual tissue. A number of factors changed with increasing gestational age and some of these changes were noted from early gestation. No significant change in water content was observed through pregnancy. With increasing length of gestation the cervix increased in length and width, there were relative increases in fibroblasts, smooth muscle and softening of the tissue, and relative decreases in collagen and fibrocytes. An increased vascularity was observed in the tissues from late gestation sheep, and a change in the nature of the epithelial secretion, from neutral to acidic mucins, was also associated with late pregnancy.

Animals↗