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Biomedical subjects

M Elstein

Publications and source records attributed to M Elstein.

At least 37 records · Page 2Linked to original sources
PubMed1994

A comparison of the effects of two monophasic low dose oral contraceptives on the inhibition of ovulation.

Fifty-three women were randomly allocated to one of two combined low-dose monophasic oral contraceptives (20 micrograms ethinyl estradiol with 75 micrograms gestodene or 20 micrograms ethinyl estradiol with 150 micrograms desogestrel). The ability of these formulations to inhibit ovulation was compared using hormonal parameters and ovarian ultrasound. The effects on three treated cycles were compared with pre- and post-treatment cycles. No ovulations occurred in either group during therapy. Twenty-one percent of women were observed to show some follicle-like structures accompanied by raised serum estradiol in at least one treatment cycle. No significant differences between the two preparations were demonstrated on residual ovarian function. The secretion of estradiol and progesterone was significantly reduced throughout all three treatment cycles. Mean LH and FSH concentrations were comparable with both treatments. A secondary analysis of cycle control and tolerance was undertaken. Significantly less bleeding was seen in the gestodene group during cycle 2 (p = 0.02). There were no differences between the two treatments with respect to the other cycle control parameters. Approximately half the women recorded intracyclic bleeding during the first treatment cycle. This improved during cycles 2 and 3. Both formulations were tolerated well.

Adolescent↗
PubMed1994

Endometrial structure after superovulation: a prospective controlled study.

OBJECTIVE: To demonstrate the effect of superovulation using a GnRH agonist (GnRH-a) and hMG and hCG on endometrial structure. DESIGN: Prospective, case-controlled study. SETTING: Tertiary referral assisted reproduction unit in an academic department. PATIENTS: Eleven women undergoing GIFT or IVF, without ET. INTERVENTIONS: All women were treated with a long stimulation regimen using the depot GnRH-a Goserelin (ICI, Macclesfield, United Kingdom) and hMG and hCG. MAIN OUTCOME MEASURES: Comparison of endometrial biopsy specimens taken 4 days after ovulation in an unstimulated cycle with specimens taken 4 days after oocyte recovery, using standard dating criteria and morphometric analysis. RESULTS: There was no difference in endometrial glandular development as assessed by either standard criteria or morphometric analysis. CONCLUSIONS: Superovulation preceded by pituitary down regulation is not associated with abnormal endometrial glandular development, even though supraphysiological levels of E2 and P are induced.

Adult↗
PubMed1994

Age related changes in the female reproductive cycle.

OBJECTIVE: To investigate the effect of age on the control of the reproductive cycle in regularly menstruating women. DESIGN: In this prospective study all women were seen regularly during both the follicular and luteal phases. Ultrasound scanning was used to confirm ovulation and measurements were taken to assess follicular development and endometrial thickness. Serum gonadotrophin levels on day 4 of the cycle, the maximum periovulatory oestradiol and progesterone on the seventh day after ovulation were measured and compared in different age groups. SUBJECTS & SETTING: Fifty-six healthy, regularly menstruating women were recruited from volunteers amongst staff of the University Hospital of South Manchester. RESULTS: Ovulation occurred later in the cycle for older women, with mean follicular phase length increasing from 13.9 days (in group 21-25 years) to 15.9 days (in group 37-45 years (P < 0.05). The mean of the maximum follicular diameter prior to rupture was significantly smaller in the older women: 16.7 mm in the 37 to 45 years old group compared with 19.6 mm, 21.6 mm and 21.3 mm in the 21 to 25, 26 to 31 and 32 to 36 years old age groups, respectively (P < 0.001). The maximum thickness of the endometrium in the luteal phase was greatest for older women: 15.9 mm in the age group 37 to 45 years compared with 12.1 mm in the age group 21 to 25 years (P < 0.001). Serum gonadotrophin concentrations during menses were higher with increased age; mean follicle stimulating hormone was 4.8 iu/l in the age group 21 to 25 years, and 8.5 iu/l in the age group 37 to 45 years (P < 0.001). Mean luteinising hormone was 4.5 iu/l in age group 21 to 25 years and 7.21 iu/l in age group 37 to 45 years (P < 0.001). Mean ovarian steroid concentrations were no different. CONCLUSIONS: These data illustrate significant age related differences in the pituitary-ovarian axis and endometrial thickness. This has implications for the management of older women in assisted reproduction and fertility control programmes.

Adult↗
PubMed1993

Training in family planning.

In spite of extensive programmes for training in family planning and extensive services in contraception in the UK, the number of unplanned pregnancies has not decreased. On the contrary it is increasing. Medical graduates are now educated in methods of contraception. There is an extensive programme for postgraduates, regulated by the Joint Committee on Contraception (JCC), which is well integrated and co-ordinated. The provision of good training opportunities at a local level will be enhanced by the establishment of consultant posts in Reproductive Health/community Gynaecology and the development of higher training programmes to meet the projected expansion of these posts. They can play a role in education in reproductive health with respect to sexuality and personal relationships, as well as in the provision of family planning services and training to all reproductive health care professionals and teachers.

Education, Medical, Graduate↗
PubMed1992

Comparison of Yuzpe regimen, danazol, and mifepristone (RU486) in oral postcoital contraception.

OBJECTIVE: To compare the effectiveness and acceptability of three regimens of postcoital contraception. DESIGN: Randomised group comparison of ethinyloestradiol 100 micrograms plus levonorgestrel 500 micrograms repeated after 12 hours (Yuzpe method); danazol 600 mg repeated after 12 hours; and mifepristone 600 mg single dose. SETTING: Community family planning clinic. SUBJECTS: 616 consecutive women with regular cycles aged 16 to 45 years. MAIN OUTCOME MEASURES: Number of pregnancies, incidence of side effects, and timing of next period. RESULTS: The raw pregnancy rates (with 95% confidence intervals) for the Yuzpe, danazol, and mifepristone groups were 2.62% (0.86% to 6.00%), 4.66% (2.15% to 8.67%), and 0% (0% to 1.87%) respectively. Overall, these rates differed significantly (chi 2 = 8.988, df = 2; p = 0.011). The differences between the mifepristone and Yuzpe groups and between the mifepristone and danazol groups were also significant. Side effects were more common and more severe in the Yuzpe group (133 women (70%)) than in either the danazol group (58 (30%)) or the mifepristone group (72 (37%)). The Yuzpe regimen tended to induce bleeding early but mifepristone prolonged the cycle. Three women bled more than seven days late in the Yuzpe group compared with 49 in the mifepristone group. CONCLUSIONS: Mifepristone was effective in reducing expected pregnancy rates and the Yuzpe method also had a clinical effect. Danazol had little or no effect. A further multicentre trial is needed.

Adolescent↗
PubMed1992

Quantification of the in vitro activity of some compounds with spermicidal activity.

The in vitro spermicidal activity of the commonly used surfactant spermicides and the antiseptic chlorhexidine, were quantified in a statistically reproducible manner, using donor semen and image capture analysis. The spermicidal activity was expressed as the ED50 under defined assay conditions. Using these parameters, the order of spermicidal activity was: Menfegol > nonoxynol-9 approximately benzalkonium chloride > sodium docusate > chlorhexidine. These differences were statistically significant.

Benzalkonium Compounds↗
PubMed1992

Pituitary-ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility.

OBJECTIVE: To determine whether abnormalities of pituitary-ovarian function are associated with minor degrees of endometriosis in women with otherwise unexplained infertility. DESIGN: Comparison of pituitary-ovarian function in a group of 22 patients with that in a control group of 10 healthy fertile women. PATIENTS: Twenty-two women with minimal or mild endometriosis and otherwise unexplained infertility. MEASUREMENTS: Ovarian ultrasound and radioimmunoassay of pituitary and ovarian hormones. RESULTS: Abnormalities, including luteinization of unruptured follicles, broad LH surges and low concentrations of progesterone during the luteal phase, were demonstrated in 82% of study cycles. CONCLUSION: Pituitary-ovarian dysfunction appears to be associated with minimal or mild endometriosis in women with otherwise unexplained infertility but the diversity of endocrine abnormalities demonstrated suggests that endometriosis is unlikely to be an aetiological factor in their development.

Adolescent↗
PubMed1991

Undergraduate education and recruitment in obstetrics and gynaecology.

The extent and quality of exposure to obstetrics and gynaecology that is required in the undergraduate curriculum has bearing on the knowledge, clinical skills and behaviour that are expected from the student. How much involvement should clinical obstetricians and gynaecologists have in teaching human reproduction and basic physiology and related science to the undergraduate? Who should teach sexual medicine? What is the extent of practical experience which students should have? Should the student have an opportunity to study a particular area in the discipline at depth in order to encourage interest and involvement and thereby facilitate recruitment? These issues are being addressed in curricular changes in Manchester, and option teaching is considered to have the potential of enhancing interest in obstetrics and gynaecology as a definitive career.

Curriculum↗
PubMed1991

The efficacy and acceptability of a low-dose levonorgestrel intravaginal ring for contraception in a UK cohort.

The efficacy and acceptability of a levonorgestrel-releasing intravaginal ring (IVR) for contraception was assessed in a British cohort studied as part of a multicentre, multinational clinical trial performed under the auspices of the World Health Organisation. One-hundred-and-fifty women took part in the study in two UK centres and completed 1417.5 months of method use. Fifty-nine women discontinued use of the IVR before the end of one year giving an overall discontinuation rate of 39.9 per 100 woman-years. The discontinuation for pregnancy with the ring in situ, was 3.0 per 100 woman-years (life table analysis). Menstrual disturbance, vaginal problems and involuntary expulsion resulted in discontinuation rates of 8.9, 8.4 and 1.6 per 100 woman-years, respectively. This method is an acceptable and effective method of contraception for women.

Adolescent↗
PubMed1990

Extending the duration of the pill-free interval during combined oral contraception.

The effect of increasing the duration of the pill-free interval from 7 to 9 and 11 days during the first 4 months of combined oral contraceptive therapy was studied by hormonal, ovarian follicle and mucus changes. Increasing the pill-free interval allowed more follicular development and more estradiol production. In some cases, pre-ovulatory values were achieved although ovulation did not occur. No differences could be detected between different types of combined oral contraceptive, including monophasic, triphasic, levonorgestrel-containing and gestodene-containing. The variation between individuals in the group of 28 was far greater than any variation in dose.

Adult↗
PubMed1990

The effects of nafarelin and danazol on vertebral trabecular bone mass in patients with endometriosis.

Single and dual-energy quantitative computed tomography (QCT) were used to measure spinal trabecular bone mineral content in 24 women treated with either nafarelin (15 patients) or danazol (nine patients) for endometriosis. Significant loss of bone mineral (-9.6 g/l; -5.9% P less than 0.001) was demonstrated after 6 months' treatment with nafarelin. This loss was reversible with no significant difference in the bone mineral measurement made before treatment and that made at 6 months after treatment was stopped (difference -1.95 g/l, NS). A small but statistically significant (+2.2 g/l, P less than 0.05) increase in bone mineral was measured in the group of patients treated with danazol for 6 months. The dual-energy QCT gave similar results, indicating little change in trabecular fat content. A significant correlation was demonstrated between mean serum oestradiol levels during treatment with nafarelin and the change in bone mineral (r = 0.655, P less than 0.005).

Adult↗