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Biomedical subjects

R F Casper

Publications and source records attributed to R F Casper.

At least 127 records · Page 7Linked to original sources
PubMed1987

Psychological characteristics of in vitro fertilization participants.

Psychological characteristics of couples attending an in vitro fertilization clinic were examined. Participants completed measures of personality, family environment, life quality, coping, and emotional status. Couples seeking in vitro fertilization exhibited specific personality traits and cohesive, supportive relationships. Unexpectedly, they reported good quality of life and freedom from anxiety and depression.

Adaptation, Psychological↗
PubMed1987

Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome.

Recently, laparoscopic ovarian cautery has been described as a method of ovulation induction in women with polycystic ovarian disease. In an attempt to determine the mechanism of action, serum levels of androstenedione, testosterone, luteinizing hormone, follicle-stimulating hormone, and estradiol were determined before and after the laparoscopic ovarian cautery in six women with polycystic ovarian disease who had failed to ovulate with clomiphene citrate and human chorionic gonadotropin. Six regularly cycling women undergoing laparoscopy for investigation of infertility or tubal ligation served as controls. In patients with polycystic ovarian disease but not in controls, serum androstenedione, testosterone, estradiol, and luteinizing hormone significantly decreased to nadir levels on postoperative days 3 and 4. In contrast follicle-stimulating hormone levels rose after operation. These results resemble those reported after ovarian wedge resection. Of the six treated women, five ovulated postoperatively and four conceived. Laparoscopic ovarian cautery appears to be a promising alternative treatment for patients with polycystic ovarian disease in whom initial medical management fails.

Adult↗
PubMed1987

Beta-adrenergic receptor agonist infusion increases plasma prostaglandin F levels in pregnant sheep.

Recent evidence of a stimulatory effect of beta-adrenergic receptor agonists on prostaglandin production by human fetal membranes in vitro prompted us to investigate whether prostaglandins are increased during beta-agonist infusion in vivo. On days 120 to 125 of gestation, blood samples were drawn from the aorta and vena cava of five crossbred ewes at 15-minute intervals for 1 hour before, during, and for 1 hour after a 3-hour infusion of isoproterenol (0.16 microgram/kg/min) or normal saline solution. Plasma prostaglandin F2 alpha levels increased (177% +/- 13% SEM over baseline; p less than 0.002) in maternal aorta, while plasma 13,14-dihydro-15-keto prostaglandin F2 alpha levels increased in both aorta and vena cava (354% +/- 47% and 309% +/- 75% over baseline, respectively; p less than 0.002) during isoproterenol infusion but not during saline solution infusion. No change was seen in plasma prostaglandin E2 levels. The increase in plasma stimulatory prostaglandins in the pregnant ewe during beta-agonist infusion is compatible with the increased uterine activity observed after myometrial desensitization by continuous beta-agonist infusion.

Adrenergic beta-Agonists↗
PubMed1987

In vitro fertilization: determination of follicular maturation for timing of human chorionic gonadotropin administration.

Hyperstimulation protocols for IVF require critical timing of hCG administration to complete follicular maturation. We studied 170 IVF cycles in 142 patients and retrospectively compared ultrasound and endocrine parameters in pregnancy cycles and spontaneous LH surge cycles with nonpregnancy, non-LH surge cycles. Twenty-six of the 170 cycles resulted in a pregnancy (15.2%). Oocytes were recovered from 27 of 31 cycles in which a spontaneous LH surge occurred, and 9 of these cycles produced a pregnancy (33%). Follicle number and serum E2 on the day of ultrasound (cycle day 12 or 13) was lower in the LH surge group and pregnancy group than in the nonpregnant, non-LH surge group. In contrast, on the day of hCG administration or LH surge, serum E2 concentration per follicle greater than 1 cm in diameter was higher in the combined LH surge/pregnancy group (1219 pmol/l) than in the nonpregnancy/non-LH surge group (932 pmol/l). Our data suggest that it may be possible to individualize hCG administration at midcycle by determining the number of follicles greater than 1 cm by ultrasound on cycle day 12 or 13 and giving hCG when serum E2 levels reach 1100 to 1200 pmol/l per follicle.

Adult↗
PubMed1987

Effects of beta-adrenergic agonist infusions on myometrial activity and plasma prostaglandin levels in the nonpregnant sheep.

Recent studies have reported that beta-adrenergic agonists stimulate the production of stimulatory prostaglandins (PGs) by intrauterine tissues in vitro. These drugs are used clinically to inhibit uterine contractions; consequently an increase in stimulatory PGs in vivo might have potentially adverse effects. We have, therefore, investigated whether beta-adrenergic agonists increase plasma PG concentrations in vivo. Samples of peripheral (aorta) and uterine venous enriched (vena cava) blood from nonpregnant sheep were collected at 15-min intervals for 1 h before, 3 h during, and 1 h postinfusion of either (a) the beta-adrenergic agonist isoproterenol (Isop) at a dose of 0.16 microgram.kg-1.min-1; (b) Isop at a dose of 0.08 microgram.kg-1.min-1; or (c) saline, 1 mL/h via a jugular vein catheter. The sheep were also equipped with intrauterine recording balloons to record intrauterine pressure and myometrial electromyographic (EMG) electrodes to measure EMG activity. Infusion of Isop at 0.16 microgram.kg-1.min-1 produced a significant initial inhibition of uterine activity, although contractions returned (within 60 min) despite continued administration of Isop. Plasma PGE2 (but not PGF2 alpha or 13,14-dihydro-15-keto-PGF2 alpha (PGFM] concentrations were significantly elevated during the Isop infusion. Administration of Isop at 0.08 microgram.kg-1.min-1 produced no effects on uterine contractile activity but was associated with a significant elevation in plasma PGE2 (but not PGF2 alpha or PGFM) concentrations. No changes in plasma PGE2, PGF2 alpha, or PGFM occurred during saline infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1987

The effect of luteal phase estrogen antagonism on luteinizing hormone pulsatility and luteal function in women.

Pulsatile LH secretion was studied to determine if the frequency of LH pulses was altered by the administration of clomiphene citrate (CC; 150 mg) for 5 days during the midluteal phase of the menstrual cycle. Seven normal women received CC or placebo in alternate cycles in a randomized double blind fashion. On the day after drug administration, blood samples were obtained at 15-min intervals for 8 h for serum LH determinations. Daily blood samples were also obtained throughout the luteal phase for determination of serum LH, estradiol (E2), and progesterone. LH pulse frequency increased from 2.4 +/- 0.5 (+/- SEM)/8 h after placebo to 3.9 +/- 0.6/8 h (P less than 0.01) after CC treatment, but pulse amplitude did not change. The transverse mean of serum LH was higher after CC (13.6 +/- 0.5 mIU/ml) than after placebo (8.4 +/- 0.3 mIU/ml; P less than 0.001), and luteal phase length was increased from 13.5 +/- 0.5 to 16.0 +/- 0.4 days (P less than 0.001) by administration of CC. Luteal phase levels of E2 and progesterone measured daily were significantly elevated (P less than 0.01) in CC-treated cycles. These findings suggest that CC increases the frequency of hypothalamic GnRH secretory episodes, perhaps by an action involving a decrease in endogenous opioid peptide activity. Since peripheral progesterone levels were elevated in the CC-treated cycles, E2 may play a permissive role in the ability of progesterone to increase endogenous opioid peptide activity acutely. Furthermore, since the luteal phase was significantly prolonged by an increase in endogenous LH pulse frequency, the slow frequency of LH pulses in the normal late luteal phase may contribute to the onset of luteolysis in the human.

Adult↗
PubMed1987

Objective measurement of hot flushes associated with the premenstrual syndrome.

Because the majority of women with PMS complain of sweats and chills resembling menopausal flushes, we attempted to document the physiologic changes during these episodes. A 26-year-old nulliparous woman with PMS described the occurrence of hot flush-like episodes coincident with PMS symptoms. The patient completed prospective self-rating scales for two consecutive cycles to establish the pattern and severity of PMS. On day 26 of the first cycle when PMS symptom scores were elevated, continuous monitoring of skin resistance and finger temperature and frequent blood sampling for LH were performed for 8 hours. The patient experienced five flush episodes, each of which was associated with a drop in skin resistance of up to 4000 ohms and was coincident with an LH pulse. Three of the flushes were associated with a rise in finger temperature of up to 10 degrees C. These physiologic changes are identical to those seen during menopausal flushes and suggest that PMS may be associated with neuroendocrine events typical of E withdrawal.

Adult↗
PubMed1986

Myometrial desensitization to continuous but not to intermittent beta-adrenergic agonist infusion in the sheep.

Infusion of the long-acting beta-adrenergic agonist ritodrine (3 micrograms/kg/min) caused by rapid inhibition of uterine activity in the ovariectomized, nonpregnant sheep. This inhibition could only be maintained for 6.4 +/- 0.8 hours, with high-frequency activity returning by 11.4 +/- 2.6 hours despite continuous infusion of ritodrine. Intermittent administration of ritodrine did not prolong uterine relaxation, probably as a consequence of its long half-life. Continuous infusion of the short-acting beta-agonist isoproterenol (0.16 micrograms/kg/min) initially inhibited uterine contractions but high-frequency activity returned by 50 minutes. In contrast, intermittent infusion of isoproterenol (30 minutes on and 30 minutes off) significantly inhibited the frequency of contractions during each of the infusion periods for the duration of the study (13 hours). Our data demonstrate that either continuous administration of beta-agonists or intermittent administration of the long-acting beta-agonist ritodrine resulted in myometrial desensitization in the sheep. In contrast, intermittent administration of the short-acting beta-adrenergic agonist isoproterenol prevented the onset of myometrial desensitization.

Adrenergic beta-Agonists↗
PubMed1986

Premenstrual syndrome: documentation by a linear analog scale compared with two descriptive scales.

We examined the use of a six-item linear analog scoring system comprised of three somatic and three mood-related items for the documentation of premenstrual syndrome. One hundred forty women with suspected premenstrual syndrome completed the linear analog scale, as well as the validated 36-item Self-Rating Scale for Premenstrual Tension Syndrome and the 35-item Prospective Record of the Impact and Severity of Menstrual Symptomatology calendar. Ninety patients and 20 normal control subjects completed two cycles of records. With use of clinical criteria and self-rating scale scores as the "gold standard," 73 patients were diagnosed as having premenstrual syndrome. Linear analog scale scores were highly correlated with both self-rating scale scores (r = 0.72, day 9; r = .66, day 27; p = 0.001) and prospective record scores (r = 0.74, day 9; r = 0.60, day 27; p = 0.001). Our results suggest that the linear analog scale may be a useful clinical tool in the study of premenstrual syndrome. Because of its simplicity, the linear analog scale may increase patient compliance. Because of its sensitivity to detect changes in symptom severity throughout the menstrual cycle, it may prove useful in evaluating the effects of therapy for premenstrual syndrome.

Adult↗
PubMed1986

The better prognosis in secondary infertility is associated with a higher proportion of ovulation disorders.

To determine the reason for the higher pregnancy rate in couples with secondary infertility, the authors compared 237 infertile couples who had a previous pregnancy in the current partnership (secondary infertility) with 135 infertile couples in whom the woman had been pregnant only in a previous partnership and 925 couples with primary infertility. Couples with secondary infertility had the highest proportion of ovulation disorders (36%); these couples with secondary infertility and an ovulation disorder had the shortest duration of infertility (26 months). Cumulative pregnancy rates at 36 months were 56% in secondary fertility, 44% in primary infertility, and 42% in pregnancy in a previous partnership (P = 0.001). In this study, the better prognosis in secondary infertility may be related to the higher proportion of couples with ovulation disorders, who had a shorter duration of infertility. Abortion rates in the earlier pregnancies with current or previous partners were 37% and 30%, respectively; after the period of infertility, the abortion rates were 14% and 12%, respectively.

Abortion, Spontaneous↗
PubMed1985

Prostaglandins mediate postoperative pain in Falope ring sterilization.

To test the hypothesis that prostaglandins mediate the high incidence of postoperative pain in patients undergoing mechanical tubal occlusion, we studied the effect of premedication with a prostaglandin synthetase inhibitor in patients having Falope ring sterilization. Fifty-two women were randomly divided into two groups in which 19 (study group) received a preoperative indomethacin rectal suppository (100 mg) while 33 (control group) received nothing. Postoperative narcotic analgesics were administered as required, and for persistent pain an indomethacin suppository was given in the recovery room. Twenty-four percent of the control group required a postoperative indomethacin suppository because of persisting pain compared to none of the study group (p less than 0.02). These results suggest that prostaglandins mediate, and premedication with a prostaglandin synthetase inhibitor may lessen, postoperative pain in patients having Falope ring sterilization.

Cyclooxygenase Inhibitors↗
PubMed1985

Progestins increase endogenous opioid peptide activity in postmenopausal women.

To determine the effect of administration of a progestin alone on endogenous opioid peptide activity, we infused naloxone (2 mg/h for 4 h) into seven estrogen-deficient postmenopausal women before and after oral medroxyprogesterone acetate (Provera; 20 mg) daily for 30 days. Baseline serum LH levels were significantly decreased by the Provera therapy [70.3 +/- 6.6 (+/- SE) vs. 27.5 +/- 1.7 mIU/ml; P less than 0.001]. Naloxone infusion before Provera treatment had no effect on serum LH levels. In contrast, after Provera therapy, a significant (P less than 0.001) increase in LH levels toward the pre-Provera baseline occurred with naloxone infusion. These findings suggest that progestins exert their negative feedback effects on LH at least in part through an opioid peptide-mediated mechanism and that progestin treatment alone can reestablish opiatergic control of LH.

Aged↗
PubMed1984

A proportional hazards analysis of the clinical characteristics of infertile couples.

Evaluated were methods of ordering the many possible predictors of infertility outcome. The clinical characteristics of infertile couples were studied with respect to the occurrence of pregnancy during follow-up, by means of the methods of survival analysis. Among 1,297 couples who were infertile for 12 months or more, the cumulative pregnancy rate at 36 months with 95% confidence limits was 49% +/- 4%. The proportional hazards analysis identified three independent predictors of the occurrence of pregnancy from the couple's history (with P values in brackets): a history of pregnancy in the partnership (0.0001); shorter duration of infertility (0.0001); and shorter length of marriage (0.005). The predictors arising from the diagnostic process (with P values in brackets) were: fewer infertility diagnoses (0.0001); a favorable primary clinical diagnosis (0.001); and the presence of any tubal disease, regardless of the primary clinical diagnosis (0.001). The analysis selected an economical set of significant predictor variables and demonstrated that a longer period of contraception was associated with a lower pregnancy rate among infertile couples. Also, three simple questions from the history were nearly equivalent to the entire diagnostic process as predictors of the outcome.

Adult↗
PubMed1984

The effects of adrenergic and cholinergic agents on progesterone production by human corpus luteum in vitro.

We investigated the effects of adrenergic and cholinergic agents on human corpus luteum production of progesterone in vitro. Luteinizing hormone (LH) (50 ng/ml), dibutyryl cyclic adenosine monophosphate (Bu2cAMP) (10(-3)M), and prostaglandin E2 (PGE2) (1 microgram/ml) significantly stimulated the production of progesterone in short-term (4-hour) cell suspensions of five early and middle luteal phase corpora lutea. The adrenergic agents isoproterenol, norepinephrine, and epinephrine, and the cholinergic agents acetylcholine and carbachol at concentrations up to 10(-4)M did not alter basal or stimulated production of progesterone. Similarly, in long-term (10-day) monolayer cultures of cells from four corpora lutea, human chorionic gonadotropin (hCG) (50 ng/ml) and PGE2 stimulated, but none of the adrenergic or cholinergic agents altered, the production of progesterone significantly, except for an inhibitory effect of norepinephrine and carbachol in the presence of 17 beta-estradiol (10(-7)M) added to the culture medium. These results differ strikingly from the consistent stimulatory effect of beta-adrenergic agents on the luteal production of progesterone in several animal species.

Animals↗
PubMed1984

Clinical factors affecting pregnancy rates among infertile couples.

In a follow-up study of 1297 couples registered at a Nova Scotia infertility clinic with a complaint of infertility of at least 12 months' duration, the cumulative pregnancy rate at 36 months, with 95% confidence limits, was found to be 49 +/- 4%. The predictors of pregnancy by univariate analysis were a favourable primary clinical diagnosis (p less than 0.001), a duration of infertility of less than 3 years (p less than 0.001), a single diagnosis for the infertility (p less than 0.001), a previous pregnancy in the partnership (p = 0.001) and a length of marriage of less than 4 years (p = 0.002). Proportional hazards analysis confirmed these variables as predictors of pregnancy. The highest cumulative pregnancy rates after 12 and 36 months of follow-up were observed in cases of ovulation deficiency, and the lowest were seen in cases of tubal defects. However, before the process of diagnosing infertility begins, useful prognostic information can be determined from the length of marriage, the duration of infertility and the partnership's history of previous pregnancy.

Adult↗
PubMed1984

The effect of increased cardiac output on luteal phase gonadal steroids: a hypothesis for runners amenorrhea.

The beta-adrenergic agonist isoproterenol was infused intravenously for 4 hours during the midluteal phase of the cycle in six normal women. A rapid increase in cardiac output occurred for the entire duration of the isoproterenol infusion and serum estrogen and progesterone levels (but not luteinizing hormone levels) decreased significantly (P less than 0.001) to a nadir of 30% and 50% of baseline levels, respectively, suggesting increased metabolic clearance of the two steroids. We hypothesize that endurance training chronically increases metabolic clearance of gonadal steroids, resulting in abnormal negative and/or positive feedback on the hypothalamic/pituitary axis leading to the menstrual irregularities commonly seen in athletes.

Adult↗