[Bromocriptine in the treatment of normal prolactinemic anovulation].
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Evaluated in this paper is clinical experience recorded from 70 young women, aged between 14 and 27 years, with post-pill syndrome. The aetiology of post-pill amenorrhoea was found to be closely related to lability of cycle prior to pill-taking. Nearly 60 per cent of all patients had used Non-Ovlon. 10 patients had used Sequenz-Ovosiston. The prognosis of iatrogenic normogonadotrophic ovarian insufficiency was found to depend on the basal oestrogen level, reaction of corpus endometrium, and serum prolactin. Pregnancy was successfully induced in 53 per cent of all patients who wanted to have a child. The aboration rate accounted for 7.4 per cent. Clinical examination of the newborns did not give any clue as to accumulation of congenital malformations. Roughly 40 per cent of all patients remained to be anovulatory, in spite of intensive treatment.
A major limiting factor in the resumption of postpartum ovarian cycles in cattle is the inhibitory influence of the suckling calf on central regulatory elements controlling the release of GnRH from the median eminence. This inhibitory influence occurs only as a consequence of specifically defined behavioural interactions between the cow and calf in the presence of a maternal bond, cannot be simulated experimentally using thermal, electrical or mechanical stimuli, and is not dependent upon sensory ennervation within the udder. Indeed, the identity of the calf, either own or unrelated, appears to define the neuroendocrine events that attend the maintenance of the anovulatory state under controlled experimental conditions. Hence, new hypotheses that focus upon the relationship between physiological correlates of maternal behaviour and hypothalamic regulation of LH secretion are currently being tested. Specific aspects of these relationships remain conjectural, but are postulated to include the regulation of opioid tone, intracerebral oxytocin, and modulation of synthetic or excitatory activity of GnRH secretory neurones. Defining the role of the special senses in transduction of signals from calves that influence these neuronal processes may provide insight for developing practical intervention strategies of the future.
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OBJECTIVE: To demonstrate that folliculogenesis can be sustained with 200 IU human chorionic gonadotropins (hCG) after FSH-priming and result in pregnancy in women with estrogenic ovulatory dysfunction and risk factors for severe ovarian hyperstimulation syndrome (OHSS). DESIGN CASE REPORT: Three women with infertility associated with estrogenic ovulatory dysfunction and hyperinsulinemia who appeared to be at high risk for severe OHSS during gonadotropin therapy. INTERVENTIONS: After 10 days of receiving either 150 IU hMG or recombinant FSH, patients were switched to 200 IU hCG/day alone for 2-3 days. 5,000 IU of hCG was then administered followed by either home intercourse, intrauterine insemination or transvaginal oocyte retrieval-embryo transfer. MAIN OUTCOME MEASURES: Endovaginal ultrasound measurement of follicle number and size, serum estradiol levels, symptoms of ovarian hyperstimulation, pregnancy test, and evaluation of pregnancy by transvaginal ultrasound. RESULTS: After discontinuation of hMG or recombinant FSH, serum estradiol concentrations continued to rise, and follicles >14 mm continued to grow during low-dose hCG administration. All women conceived without developing symptoms of OHSS. Pregnancy outcomes achieved include a term singleton delivery, a term twin delivery, and triplets delivered at 31 weeks gestation. CONCLUSION: The use of low-dose hCG alone is sufficient for supporting the late stages of folliculogenesis in women with estrogenic ovulatory dysfunction. This ovulation induction regimen appears to support the follicular growth of larger follicles while decreasing the number of smaller preovulatory follicles, thereby reducing a known risk factor for OHSS. We report on the positive pregnancy outcomes in 3 women with estrogenic ovulatory dysfunction and clinically appeared to be at high risk for developing severe OHSS who safely underwent this protocol.
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