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Inhibition of ovulation by an oral contraceptive containing 100 micrograms levonorgestrel in combination with 20 micrograms ethinylestradiol.

Twenty-four healthy female volunteers with normal ovulatory cycles, aged between 20 and 34 years (27.5 +/- 4.3), were included in a single-center, non-comparative study to investigate the effect on inhibition of ovulation of an oral contraceptive containing 20 micrograms ethinylestradiol in combination with 100 micrograms levonorgestrel. At baseline, during three treatment cycles and post-treatment, ultrasonography was used to examine the ovaries, to measure follicular size, and to measure the thickness of the endometrium. Serum levels of LH, FSH, estradiol, progesterone, total testosterone, free testosterone, SHBG, and CBG were also measured. Compared with treatment cycle 1, an increase in residual ovarian activity (follicle grades 4-5) was observed in cycles 2 and 3. Mean levels of LH, FSH, 17 beta-estradiol and progesterone remained suppressed during treatment. No escape ovulation was observed during the treatment phase of the study and there were no pregnancies. Ovulation was noted to return rapidly in the posttreatment cycle. Subjective and objective tolerance of the present regimen was noted to be good. Results indicate that the monophasic oral contraceptive containing 100 micrograms levonorgestrel combined with 20 micrograms ethinylestradiol effectively inhibits ovulation, providing adequate suppression of ovarian activity.

Adult↗

Effects of initiation day of clomiphene citrate on the endometrium of women with regular menstrual cycles.

OBJECTIVE: To investigate the effects of initiation time of clomiphene citrate (CC) on the endometrium of women with regular menstrual cycles. DESIGN: Randomized, double-blind, cross-over study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. PATIENT(S): Thirty-three healthy female volunteers with regular menstrual cycles. INTERVENTION(S): The volunteers were randomized to receive either 100 mg of CC on days 1-5 and placebo on days 5-9 (study group) or placebo on days 1-5 and CC on days 5-9 (control group). After a wash-out period of 1 month of CC treatment, the medication was switched in each group. Ultrasonography was performed daily after day 10 of the cycle to detect ovulation. Ultrasonography for endometrial appearance and thickness, endometrial sampling, and blood samples obtained for determination of E(2) and P levels were performed 7 days after ovulation in both groups. MAIN OUTCOME MEASURE(S): Morphometric analysis, histologic dating, and ultrasonographic appearance and thickness of the endometrium. RESULT(S): Morphometric parameters, histologic dating, and ultrasonographic appearance and thickness of the endometrium were similar in both groups. CONCLUSION(S): Starting CC on either day 1 or day 5 of the menstrual cycle did not have any differential effects on the endometrium of women with regular menstrual cycles, particularly regarding the morphometric analysis, histologic dating, or ultrasonographic appearance.

Adult↗

Detrimental effect of endometrial biopsies on pregnancy rate following human menopausal gonadotropin/human chorionic gonadotropin-induced ovulation.

The effect of luteal phase endometrial biopsy was studied in 33 anovulatory women treated with human menopausal gonadotropins (hMG) to induce ovulation and pregnancy. Over-all, 33 of 85 ovulatory cycles resulted in pregnancy (39%). Of 50 nonbiopsied cycles, 26 resulted in pregnancy (52%) whereas only 7 of 35 biopsied cycles resulted in pregnancy (20() (P less than 0.01). Four pregnancies terminated in spontaneous first-trimester abortions, 12% in the nonbiopsied group and 14% in the biopsied group. Luteal phase endometrial biopsy significantly lowers pregnancy rates in hMG-induced ovulatory cycles, but does not change abortion rates.

Abortion, Spontaneous↗

Ultrasound in the evaluation of normal and induced ovulation.

In the past several years sonography has become an invaluable research tool for the investigation of spontaneous and induced ovulation and has added to the understanding of folliculogenesis and reproductive endocrinology. In practical terms, in ovulation induction sonography assists in the evaluation of the number and distribution of follicles, necessary for adequate interpretation of estrogen levels. Although there is no ideal size when it can be assumed that a follicle is mature, estimation of follicle size is of value and is a good guide to the timing of hCG administration. If the follicles are extremely small or there is evidence of hyperstimulation, these observations, together with the E2 levels, may be used to decide whether a further ultrasonic examination is warranted for the assessment of follicular growth or whether the treatment cycle should be abandoned. Provided follicular size is within normal limits, the diameter of the largest follicle may also be used in IVF programs to determine when the patient should be admitted to the hospital for more intensive monitoring of follicular development and the administration of hCG. Ultrasound is also valuable in patients with only one ovary accessible to laparoscopy. Even if the largest follicle is in the inaccessible ovary, the treatment cycle does not have to be abandoned, provided that several follicles are developing in the contralateral ovary. If neither ovary is accessible laparoscopically, percutaneous oocyte aspiration offers the patient the opportunity of IVF and embryo transfer.

Anovulation↗

Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate.

This study was undertaken to evaluate the usefulness of measuring salivary and vaginal electrical resistance in monitoring ovulation induced by clomiphene citrate (CC). Data from 28 cycles of 12 women treated with CC were compared with those of 18 cycles of 13 women who were ovulating spontaneously. Patterns of salivary readings in CC and spontaneous cycles were similar and showed a preovulatory peak 6.2 (mean) days before the luteinizing hormone peak. The trend in vaginal readings for CC cycles differed from that of spontaneous ovulations in that the values were depressed during and shortly after CC therapy. Occurrence of the periovulatory nadir and subsequent rise was common to both groups. The rise in vaginal readings CC cycles occurred within 24 hours of the luteinizing hormone peak in 88% of cases. Retrospective analysis showed that, based on this method, artificial insemination would have been timed appropriately in 25 of 27 cycles or in every cycle, depending on the protocol used. The results indicate that the method is equally useful for predicting and confirming ovulation in cycles in which CC was used to induce ovulation as it is in spontaneous cycles.

Adult↗

Diagnostics in assisted human reproduction.

The World Health Organization (WHO) estimates that 50-80 x 10(6) couples in the world are infertile, i.e. 7-15% of all couples of reproductive age (15-45 years old). The term infertility refers to couples who have been unable to conceive children for at least 1 year of regular unprotected intercourse. Although the frequency and origin of infertility varies, approximately 40-60% of the aetiology of infertility in the population studied is due to female causes. The introduction of assisted reproduction techniques, which offer couples the best opportunities for pregnancy, has opened a vast field of knowledge in reproductive biology. The medical history must be taken meticulously, with enough time to obtain the largest possible amount of relevant information. It is recommended that both partners be included in the initial work-up. In recent decades, technological progress has been favoured with the development of a great variety of diagnostic tests. Moreover, a very valuable tool helping to solve this problem has gained strength and is available to everybody - so-called 'evidence-based medicine'. There are three categories in infertility diagnostic tests. The first category includes tests showing a well-established correlation with pregnancy, e.g. semen analysis, tubal patency with hysterosalpingography or laparoscopy, and ovulation detection. The second category includes patients whose results are not consistently related to pregnancy. Here, these tests include sperm penetration assay in the zona-free hamster oocyte, post-coital tests, sperm penetration into cervical mucus, and tests to detect anti-sperm antibodies. The third group includes patients whose tests are not correlated with pregnancy. The relevant tests include endometrial biopsy, the presence of varicocele, and Chlamydia detection tests. Tests for infertility are often expensive. Since these patients are usually anxious and eager and will do almost anything to have a child, care must be taken to avoid exploitation of their hopes with unnecessary procedures. This text now reviews and updates the procedures used to investigate infertility.

Acrosome Reaction↗

Evaluation of serum CA 125 concentration before and during hormonal induced cycles as predictor of IVF/ET outcome.

PROBLEM: To evaluate the role of CA 125 in prediction of in vitro fertilization and embryo transfer (IVF/ET) outcome. METHOD OF STUDY: Serum CA 125 concentrations were evaluated in the spontaneous and stimulated cycles of 33 patients. CA 125 was measured using a microparticle enzyme immunoassay (MEIA) (Abbott, Diagnostics, USA). Follicular growth, endometrial thickness and subendometrial blood flow were evaluated by transvaginal color Doppler ultrasound. Statistical analysis was performed by Wilcoxon rank-sum test and Friedman test. RESULTS: There was no statistically significant difference (P > 0.05) of CA 125 values between spontaneous and stimulated cycles, and between pregnant and non-pregnant patients. A CA 125 rise from the late proliferative to the early secretory phase (P < 0.05) was obtained only in the stimulated cycles. There was no relationship between CA 125, follicle number, endometrial thickness and resistance index of the subendometrial vessels. CONCLUSION: CA 125 levels are not predictive of ovarian and endometrial response. Hormonal stimulation does not effect serum CA 125 concentration. There was no influence of CA 125 levels on IVF/ET outcome in stimulated cycles.

Adult↗

Sex-sensitive tasks in men and women: a search for performance fluctuations across the menstrual cycle.

This study validated 6 cognitive and motor-skill tasks as sex-sensitive and used them to investigate whether women's performance changed across the menstrual cycle. Three putative female-advantage tasks and 3 putative male-advantage tasks were administered twice, at 6-week intervals, to young college women and men. Counterbalanced for order, women received the tests once during menstruation and once during the midluteal phase. The midluteal phase was determined by projection from day of ovulation, as verified by ovulation detection kits, and by confirmation of subsequent menstruation. Results revealed a significant sex difference for 5 of the 6 tasks. However, there was no evidence that performances differed with menstrual cycle phase. These results from younger women, combined with previous results from older women, may help establish the boundaries for hormonal influences on cognitive and motor-skill behavior.

Adolescent↗

Luteal phase defect: comparison between Doppler velocimetry, histological and hormonal markers.

The aim of this prospective study was to investigate the relationship between the ultrasonographic appearance of the endometrium, histological dating by biopsy, hormonal profile and impedance within the segmental uterine and ovarian circulation for assessment of luteal phase function. A total of 61 infertile patients undergoing endometrial biopsy were studied by transvaginal B-mode and color and pulsed Doppler ultrasound. Uterine, radial, spiral, ovarian and intraovarian artery impedance throughout the natural ovarian cycle were related to histological and hormonal markers of uterine receptivity. Plasma levels of follicle stimulating hormone, luteinizing hormone (LH) and estradiol were measured on cycle days 5 and 10 and measurements were continued daily until the detection of the LH surge. Endometrial biopsy was performed 7 days after ultrasonically and hormonally detected ovulation. Progesterone levels were evaluated on the day of endometrial biopsy and 3 days later. After all the data were collected, the patients were divided into two groups, according to the histopathology: 15 patients with normal endometrial dating and 43 patients with a delayed endometrial pattern (i.e. luteal phase defect). One patient with an asynchronous endometrium and two anovulatory subjects were excluded from further evaluation. A significant difference between patients with a luteal phase defect and the control group was obtained for impedance in the uterine (p < 0.05), radial (p < 0.05), spiral (p < 0.001), ovarian (p < 0.05) and intraovarian arteries (p < 0.001) during the luteal phase. The endometrium showed secretory transformation when serum levels of progesterone were higher than 15 ng/ml. Segmental uterine and ovarian artery perfusion demonstrates a significant correlation with histological and hormonal markers of uterine receptivity. Therefore, blood flow impedance in the corpus luteum and spiral arteries may aid in assessing luteal phase adequacy.

Adult↗

In vitro fertilization. The Scripps Clinic experience.

The in vitro fertilization (IVF) program at Scripps Clinic and Research Foundation, La Jolla, California, was started in 1983. In vitro fertilization is now an accepted type of infertility treatment for many couples with a disorder of tubal origin, endometriosis, male-factor infertility, or idiopathic infertility. Successful outcome has depended on the woman's age, the cause of infertility, and the number of embryos transferred. The highest pregnancy rate has been achieved in women under age 35 with tubal-factor infertility and transfer of three or more embryos. During the first year, the program's overall pregnancy rate was 13% (5 pregnancies/38 embryo transfers) and the pregnancy rate for women under age 35 with tubal-factor infertility was 28%. The functioning of an IVF program depends on the availability of a clinical laboratory for daily hormone measurements, ultrasonography for monitoring follicle growth, an operating room that is available any time day or night, and a laboratory equipped for fertilization of retrieved ova and monitoring of embryo development. Clearly, a carefully integrated team of medical care providers is necessary for a program that draws on so many different clinical resources.

Adult↗

Physiological mechanisms associated with ovulation prediction using the CUE Ovulation Predictor.

It has been shown that monitoring of salivary electrical resistance (SR) enables prediction of ovulation several days in advance, since a peak in SR is seen 5-6 days before the LH peak. This paper explores physiological mechanisms that may account for this change. The pathway whereby oestrogen stimulates aldosterone (ALDO) secretion acting through the renin-angiotensin system was considered. It is shown that this mechanism would only result in increasing SR as oestrogen values rise during the follicular phase and therefore is not an explanation of the SR peak and declining SR 5-6 days before the LH peak. The reported trend of sodium in milk of ovulating women parallels that of SR. It is shown that these changes are most likely to be due to a similar change in aldosterone levels. A possible role for adrenocorticotrophic hormone (ACTH) in causing the changes in aldosterone is discussed and supported with data from other independent studies as well as with preliminary data obtained from two normally ovulating subjects. Peaks in ACTH, ALDO and SR were coincidental and occurred 6 days before the LH peak. The temporal relationship observed among these variables suggest that ACTH, by affecting ALDO, modifies salivary electrolytes and hence SR.

Adrenocorticotropic Hormone↗

The effect of follicle maturing drugs on side of ovulation in successive cycles.

Our previous study has demonstrated that ovulation in unstimulated cycles is random with an equal likelihood of ipsilateral or contralateral ovulation occurring in the following cycle. This study evaluated women taking ovulation-inducing drugs to see if the side of ovulation in the preceding cycle has an influence on the side of ovulation in the succeeding cycle. Ovulatory patterns in consecutive pairs of cycles in anovulatory women treated with ovulation-inducing drugs were evaluated through sonographic studies of follicular maturation. The results demonstrated that when unilateral ovulation occurred, there was an equal likelihood of ipsilateral or contralateral ovulation in the succeeding cycle. However, ovulation-inducing drugs increase the incidence of bilateral or multiple ovulation.

Clomiphene↗