Maternal plasma unconjugated oestrogens in early human pregnancy.
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Biomedical subjects
Publications and source records attributed to R F Harrison.
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Mean maternal plasma levels of testosterone, androstenedione, and 5 alpha-dihydrotestosterone were established from 4 to 16 weeks gestation from twice-weekly blood samples taken from 15 pregnant women. All three hormone levels were raised when compared with the non-pregnant state. There were significant differences in mean maternal plasma testosterone levels at 4 to 5 and 7 to 8 weeks gestation, when comparing women carrying male and female fetuses. Androstenedione levels in a twin pregnancy were increased throughout and testosterone levels were more than 1 SD above the mean from week 15. Steroid levels fell late in the two women who aborted. Hormone levels in three women being given progestogens were within normal limits.
Beta-human chorionic gonadotrophin (beta-hCG) was assayed twice weekly in plasma from 20 subjects from 4 to 16 weeks gestation; 14 of these were normal. There was an initial rise, a plateau at weeks 7 to 9, and a further rise to a maximum at week 11. Levels then dropped steadily to week 16. There was no significant difference when mean levels were subdivided and calculated according to the subsequent sex of the baby. Of the 6 abnormal subjects, the twin pregnancy initially showed normal levels but at week 11 to 13 these were at least one standard deviation above the mean. The plasma beta-hCG levels of the two subjects who aborted were more than one standard deviation below the mean at week 5. Three subjects treated with progestogen therapy had beta-hCG levels which fluctuated within normal limits. The trends of beta-hCG levels were similar to those of plasma hCG levels in the two subjects who had both assays performed but peak times were different. There was considerable within patient and also patient to patient variation in beta-hCG levels.
Three hundred sixteen pregnancies achieved in infertile couples attending Chelsea Hospital for Women, London, during a 2-year period are analysed (31% of total clinic attendance). Almost half the patients tested had ovulation defects, but in 11.4% more than one factor was present. Although 22.4% and 33.9% were apparently successfully treated for male and ovulation problems, respectively, and in 8.2% multiple therapy was undergone, in 33.4% success could not be attributed to any form of therapy. Chance of pregnancy diminish with time but seasonal fluctuation was noted in the pregnancies achieved. Eighty-three percent proceeded to live delivery.
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The relationship between colonization of pregnant women by Ureaplasma and Mycoplasma and the outcome of pregnancy in a study of 104 women is reported. There were eight abortions but no multiple births or stillbirths. Excluding abortions, the mean gestational length was 39.6 weeks and the corrected mean birth weight was 3.28 kilograms. There was no relationship between maternal colonization by genital mycoplasmas and reduction in birth weight of the offspring, but five of the eight women who aborted harbored Ureaplasma, suggesting an increased trend toward abortion in women harboring Ureaplasma.
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Four hundred cervicovaginal artificial inseminations using husband's semen were carried out for a variety of clinical indications. Before insemination, to one-half of the samples caffeine was added to a final concentration of 6 mM. Although the motility of the spermatozoa was enhanced in each case, no pregnancies were achieved. Of the four pregnancies in the series, only one could be attributed to artificial insemination.
Plasma levels of progesterone, 17-hydroxyprogesterone and 20 alpha hydroxypregn-4-en-3-one were established from 4 to 16 weeks gestation by sampling 15 normal patients twice weekly. Apart from a peak at week 5, the mean levels of progesterone remained constant at about 24 ng/ml until week 10 and then rose progressively to 40 ng/ml at week 16.20 alpha hydroxypregn-4-en-3-one remained within the 7 to 9 ng/ml range apart from a peak at week 5. A significant decrease in mean levels of 17-hydroxy-progesterone was noted from week 5 to a nadir of 3 ng/ml at week 11. It would appear that the main hormone production of progesterones in pregnancy has been taken over by the placental unit by the 10th week.
Plasma progesterone, 17-hydroxyprogesterone, 20alpha hydroxypregn-4-en-3-one levels were determined twice weekly up to 16 weeks gestation, where possible, in a twin pregnancy, in two patients who aborted spontaneously and in three patients who were treated with 'progesterone supplements' because of abnormal vaginal cytology. There was no correlation between vaginal smears and the plasms hormone levels and there was no evidence to suggest that progesterone supplements influenced clinical outcome. Compared with normal mean values the only difference was a significantly rise in progesterone and 20alpha hydroxypregn-4-en-3-one levels in the twin pregnancy after the 12th week and a precipitate fall in all hormone levels just prior to abortion. Plasma hormone levels could not be used to predict outcome.
Indirect immunofluorescent, macroagglutination and immobilizing sperm antibody estimations were performed as part of a prospective study on a representative group of 63 infertile couples. Serum from both, cervical mucus and seminal plasma were tested and the clinical use of the tests evaluated by considering the pregnancies that occurred and the causes of infertility that were discovered in the subsequent year. The indirect immunofluorescent test had the largest number of positives although more were found in seminal plasma than elsewhere. In these, both male and cervical factors were implicated and in this media there were less positives pregnant with the acrosome and midpiece patterns absent. The macroagglutination test had no positives pregnant and again more significance was attached to positives in the male. Similarly, immobilization results showed most positives in seminal plasma where the male and cervical factors featured prominently. It would, therefore, appear that if any clinical use is to be derived from the three tests in the search for antisperm antibodies as a cause of infertility, testing the male and especially seminal plasma appears to correlate best. If treatment is to be recommended, therefore, it should be concentrated on the man.
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