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PubMed1990

Buserelin. A review of its pharmacodynamic and pharmacokinetic properties, and clinical profile.

The gonadotrophin releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonist buserelin is a promising new agent in the treatment of a variety of disorders in gynaecology and andrology, paediatrics and oncology. While a single dose of buserelin stimulates the release of pituitary gonadotrophins, multiple doses produce reversible pituitary desensitisation, and this specific blockade of gonadotrophin support to the gonads provides the basis for the drug's efficacy in conditions dependent on sex hormone secretion. Thus, buserelin provides comparable efficacy to orchidectomy or high dose estrogens in the treatment of hormone-sensitive prostate cancer and exhibits a lower incidence of adverse effects. During the early phase of treatment it may be particularly useful in combination with antiandrogens. Buserelin also appears promising in hormone-sensitive premenopausal breast cancer. Extensive studies have proven the value of buserelin in endometriosis, where it produces a transient remission with gradual recurrence of the disease on cessation of treatment. Surgical intervention is necessary in severe disease after buserelin-induced involution of the lesions. In patients with uterine leiomyoma, preliminary data suggest that buserelin may be beneficial in rendering surgery more conservative by reducing fibroid size, although it appears unlikely to preclude surgical intervention. The use of buserelin to induce a state of reversible hypogonadotrophism before administration of exogenous gonadotrophins is a promising strategy in the treatment of infertility associated with polycystic ovary syndrome and other conditions of infertility with underlying ovarian dysfunction; such a strategy also clearly enhances the efficiency of in vitro fertilisation programmes. Initial studies suggest its potential usefulness as a female contraceptive when administered intermittently in conjunction with a progestogen. Buserelin represents a first-line treatment of central precocious puberty. In endometriosis the adverse effect profile of buserelin is generally favourable, with hypoestrogenic effects such as hot flushes and vaginal dryness, and decreased libido, predominating. There is no apparent detrimental effect on lipid metabolism. The potential for adverse hypoestrogenic effects on bone mineral content with long term administration remains to be clarified. Thus, the GnRH agonist buserelin represents an advance in the treatment of a variety of gynaecological and andrological as well as paediatric and oncological conditions, infertility and other sex-hormone dependent conditions, with a low incidence of adverse treatment effects.

Animals↗
PubMed1991

Enclomiphene does not alter the postpartum interval of suckled beef cows.

The objective of this study was to determine whether an antiestrogen (enclomiphene) would shorten the interval to first estrus and conception in postpartum beef cows. Sixty postpartum Angus beef cows were stratified by age, body condition, and calving date and were randomly assigned to one of two treatment groups. Group 1 cows (n = 24) received three silastic implants, each containing 150 mg of enclomiphene, on d 20 postpartum. Implants were removed on d 30 postpartum. Group 2 cows (n = 28), received empty implants and served as controls. Cows were artificially inseminated at first detected estrus. Estrus detection and ovulation were further verified by increased serum progesterone. Concentrations and pulse frequencies of LH were determined from blood samples collected at 15-min intervals for 6 h on d 20, 25, 30, and 40 postpartum. Hypothalami and pituitaries were collected from four cows in each treatment group on d 30 postpartum and analyzed for concentrations of estradiol receptors. Concentrations of total and unoccupied hypothalamic and pituitary estradiol receptors were reduced by enclomiphene. Neither concentrations nor pulse frequencies of LH differed significantly between treatment groups on any of the 4 d. Days to first estrus did not differ (P greater than .05) between enclomiphene-treated (57 +/- 6; n = 24) and control (56 +/- 4; n = 28) cows. Days to conception did not differ between treated (81 +/- 9) and control (79 +/- 8) cows. The dose of enclomiphene used in this study reduced hypothalamic and pituitary estrogen receptors but did not alter secretion of LH or days to first estrus in the postpartum beef cow.

Anestrus↗
PubMed1986

Behavior of preovulatory markers in normal and abnormal cycles.

Various ovulation markers in natural cycle (ultrasound measurement of follicular diameter, E2, progesterone, and LH assays) have been studied in 18 women. The patients were divided into two groups. Group 1: women who became pregnant during the same cycle; group 2: women who showed evidence of follicular growth, E2 and a LH midcycle rise, but low P levels in the luteal phase. A weaker increase in these parameters was found in group 2, especially the LH rise. Moreover, an asynchronicity between the endocrinological and morphological events has been observed in the suboptimal cycles. These findings suggest a process of follicular atresia at the end of the maturation phase, as is commonly found in otherwise normal women.

Female↗
PubMed1984

Ultrasound assessment of changes in the ovary and the uterus during LHRH therapy.

Twenty-seven women with secondary amenorrhoea have been treated with pulsatile subcutaneous luteinising hormone releasing hormone (LHRH). Serial ultrasonic observations of increasing follicular diameters and changes in the size of the uterus have been recorded. The rate of the increase of the diameter of dominant follicles in LHRH induced cycles is identical to that observed in women undergoing spontaneous cycles. An interesting correlation was observed between follicular diameter and uterine size. The correlation suggests that uterine size measured ultrasonically can be used as a bio-assay of follicular oestradiol production. Uterine growth continues throughout the luteal phase of conception cycles and can be used as a very early sign of pregnancy.

Adult↗
PubMed1997

An overview on the effectiveness of natural family planning.

Recent years have witnessed important developments in natural family planning (NFP), which is based on the observation of fertile and infertile periods of the menstrual cycle, so that the couple is able to know when sexual intercourse may lead to a pregnancy. A review of the main studies regarding the effectiveness of NFP showed a decrease in the Pearl Index and life table values from the early 1980s to date, indicating that progress both in the teaching and in the application of these contraception, methods has been achieved. The main cause of lack of success seems to be the misapplication of NFP rules, whereas the errors due to the method itself are few. Furthermore, it seems that the symptothermal method might give better results than the ovulation method, even though no comparative study has been carried out, and that the first studies on the lactational amenorrhea method show encouraging results. Finally, it seems that NFP is best suited for 'spacers' of pregnancies, rather than for 'limiters'. Indeed, the former are more likely to show good compliance, since the sexual abstinence periods are limited and an unwanted pregnancy is not regarded as a completely negative event.

Clinical Trials as Topic↗
PubMed1997

Fertility awareness and natural family planning.

Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the sub-fertility investigations. (2) The information is also useful when helping couples to understand how each method of family planning works--how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective observations of the alterations in cervical mucus and the basal body temperature rise are accurate indicators of the fertile phase. Research on the chances of conception on each day of the menstrual cycle, using hormonal assays to estimate the time of ovulation, was carried out in 1994 by Weinberg and Wilcox. Their results showed that the timing of sexual intercourse, in relation to ovulation, strongly influences the chance of conception. Conception only occurred during a 6-day interval that ended on the estimated day of ovulation. The chances of conception fell to zero 24 hours after ovulation. Several different methods of natural family planning are taught; some methods depend on only using one of the indicators of fertility, others are based on two or more indicators. The main indicators of fertility are: observing the cervical mucus, recording the basal body temperature, palpating the cervix and a calculation based on the cycle length. Research studies performed using a combination of the indicators of fertility show that the failure rate using a combination is less than most of the studies which use a single indicator. In each case the method failure is far lower than the user failure. (ABSTRACT TRUNCATED)

Body Temperature↗
PubMed1975

Congenital malformations in mice after gonadotropin-induced ovulation.

Virgin mice were treated with gonadotropic hormones in order to induce superovulation; at term the embryos were removed by cesarean section. This treatment induced malformations (mainly forelimb defects and to a smaller extent central nervous system anomalies) as well as an altered sex ratio in the offspring. Both phenomena were statistically significant. These hormone-induced effects on the progeny were significantly dependent on both the dosage of hormones and the time (season) of administration. Because the time of administration (before mating) of gonadotropic hormones does not coincide with the critical period during embryogenic development for the teratogenic induction of malformations in the limbs and in the central nervous system (ca. 8th-12th day of gestation), the investigated defects are interpreted as of mutagenic origin.

Abnormalities, Drug-Induced↗
PubMed1989

Profile of the Billings Ovulation Method acceptors and use-effectiveness of the method in Korea.

Data from a survey of 200 Billings Ovulation Method acceptors in Korea were used to describe a profile of these natural family planning acceptors, and to calculate use effectiveness rates for twelve months of use among women using the method for avoiding an unplanned pregnancy. The majority of acceptors were women of proven fertility who wanted to limit their family size, and many of them (79%) had previously used a family planning method. Fifty-six percent were Catholics, and those study subjects were above middle income group by Korean annual household income estimates. The mean number of living children the NFP acceptors had was 2.3 +/- 1.4 and the number of children they desired to have was 2.4 +/- 1.4. The cumulative life table rate for unplanned pregnancies at the end of 12 months of use was 7 (+/- 2.5 S.E.) per 100 women, and women ever attending the learning sessions as couples experienced relatively less unplanned pregnancies compared to those women attending the sessions alone.

Adult↗
PubMed1982

Self-selection of calcium during the rearing and early laying periods of White Leghorn pullets.

The ability of pullets to selectively consume calcium to meet the requirements of the rearing and early laying period was studied in White Leghorns. In the first of two experiments, 456 pullets were fed either an .89% calcium rearing diet (control) or a .35% calcium diet in combination with a separate source of 38% calcium chick-sized grit (calcium self-selection) from 35 to 126 days of age. Twenty-four pullets from each of these rearing treatments were selected for the second experiment at 112 days of age and were housed in individual laying cages. Rearing treatments were continued until 176 days of age with mash and grit consumption recorded daily for each pullet. From 177 to 225 days of age these pullets were fed a 3.50% calcium diet containing either ground limestone or oyster shell as a calcium source or a .35% calcium diet fed in combination with a separate source of oyster shell. Pullet calcium intake reflected the requirements for growth during the rearing period, calcium storage in the medullary bone 19 days prior to lay, and egg shell formation during the laying period; average calcium intake for these periods was 1.18, 2.08, and greater than 3.50%, respectively. Pullets also demonstrated the ability to compensate for rearing deficiencies by increased calcium consumption when fed oyster shell on an ad lib basis. Calcium consumption was found to be significantly higher on days when an oviposition occurred than when no eggs were laid. Mash consumption during the early laying period also reflected the reproductive status of the hen with the highest consumption on days when both oviposition and ovulation occurred, intermediate consumption when either oviposition or ovulation occurred, and lowest consumption when neither oviposition nor ovulation was detected.

Aging↗
PubMed2003

Feasibility of using paper impregnated with urine instead of liquid urine for assessing ovarian activity.

BACKGROUND: Ovarian activity should ideally be assessed by serial non-invasive methods that require simple procedures for sample collection and storage. Measurement of urinary oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide is a non-invasive method available for assessment of ovarian activity, but transport of large numbers of urine samples is cumbersome and samples need to be stored frozen. An alternative sample collection, transport and storage procedure that is easier to handle and requires no or minimal cold storage facilities will particularly benefit studies in which ovulatory activity needs to be assessed in field settings. OBJECTIVE: To evaluate the feasibility of using paper impregnated with urine as an alternative to liquid urine for the measurement of oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide concentrations in the assessment of ovarian activity. METHODS: Urine samples collected daily throughout regular menstrual cycles were stored as liquid urine at -20 degrees C, and as paper impregnated with urine, in the refrigerator for 3 to 12 months or at room temperature for 1 to 6 months. Oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide concentrations were measured in these urine samples by enzyme immunoassay. Values obtained were correlated using Spearman's correlation test. RESULTS: The pattern of oestrone-3 glucuronide and pregnanediol-3 alpha-glucuronide concentrations estimated using paper impregnated with urine followed that of liquid urine in all storage conditions used. Values obtained by two methods correlated significantly (p < 0.001 to 0.0001) though the paper impregnated with urine gave slightly higher values. CONCLUSIONS: Paper impregnated with urine can be used to facilitate sample collection, transport and storage of urine when oestrone-3-glucuronide and pregnanediol-3 alpha-glucuronide measurements are required in a large number of serial samples to assess ovarian activity.

Estrone↗
PubMed1977

Preselective sex determination.

Preselective sex determination in ten consecutive pregnancies has been achieved by means of strict control over timing and technique of coitus which was combined with acidic or alkaline douching. Eight female and two male babies were born.

Acetates↗
PubMed1980

Combination of the ovulation method with diaphragm.

A marked increase in acceptance of the ovulation method of contraception, together with promising method and user failure rates, were revealed in this study of women to whom a system of combining the ovulation method with the optional use of a diaphragm, advisedly as a menstrual seal, was offered.

Contraception↗
PubMed1999

Personal hormone monitoring for contraception.

OBJECTIVE: To determine the effectiveness and acceptability of personal hormone monitoring for contraception. DESIGN: A large prospective study was carried out on personal hormone monitoring for contraception when used with abstinence during the identified fertile days. SETTING: Three country study under the auspices of the departments of Obstetrics and Gynaecology of the Universities of Birmingham, Dublin and Dusseldorf SUBJECTS: Seven hundred and ten women, median age 30, were recruited from the general population. They were required to have regular menstrual cycles (23-35 days) and to be delaying their next pregnancy. INTERVENTIONS: Personal hormone monitoring consists of a hand held monitor and disposable test sticks which measure changes in urinary concentrations of oestrone-3-glucuronide and luteinising hormone. An algorithm estimated the fertile days which were displayed by a red light. OUTCOME MEASURES AND RESULTS: One hundred and sixty two pregnancies occurred in 7209 cycles of use, of which 67 were method related pregnancies. The 13 cycle life-table method pregnancy rate (95 per cent CI) was 12. 1 per cent (9.3-14.8). The system allowed analysis of the effect of changes to the algorithm to modify the defined fertile period. As a result the algorithm was changed to increase the median warning of the luteinising hormone surge to six days. With the revised algorithm, half of the method pregnancies would have been prevented giving a calculated method pregnancy rate of 6.2 per cent (4.2-8.3) and method efficacy of 93.8 per cent. The continuation rate after 13 cycles was 78 per cent. CONCLUSION: Personal hormone monitoring proved simple to use and will be of value to women who do not want to use other methods of contraception.

Adolescent↗