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PubMed1996

[A prospective study on causal factors of female infertility with laparoscopy and transvaginal B-ultrasound].

OBJECTIVE: To study the casual factors of female infertility with laparoscopy and B-ultrasound. METHODS: Eighty-five infertile women were evaluated by serial transvaginal B-ultrasound scans for follicular development and ovulation and by laparoscopic examinations 2 to 6 days after ovulation. RESULTS: The patterns of follicular development and ovulation detected by B-ultrasound were: (1) ovulation from normal follicle (ONF) (56.47%); (2) ovulation from two follicles at the same time (O2F) (5.88%); (3) ovulation from small follicle (OSF) (16.47%); (4) ovulation from polycystic ovaries (PCO) (3.53%); (5) luteinized unruptured follicle syndrome (LUFS) (7.06%); (6) anovulation (10.90%). Laparoscopic examinations showed that the incidence of partial and complete tubal obstruction was 32.94% and pelvic adhesions 35.29%. Pelvic tuberculosis was found in 20.00%, which was the main disease leading to pelvic adhesions (46.67%), and tubal obstruction (60.71%). Endometriosis (EMS) was discovered in 36 cases (42.35%), among them, 30 (83.33%) had patent tubes. The stigmas or/and corpus hemorrhagica were seen in 60 out of 70 patients in whom ovulation had been diagnosed by B-ultrasound. 6 cases were defined as "mechanically unruptured follicle syndrome". CONCLUSIONS: Abnormal follicular development may result in female infertility. Pelvic tuberculosis is another main causal factor of infertility. Endometriosis related infertility may rather result from other factors than tubal obstruction. Laparoscopic examinations combined with transvaginal B-ultrasound scans are very useful approaches in the etiological study of female infertility.

Adult↗
PubMed1997

Natural family planning: suitability of the CUE method for defining the time of ovulation.

The purpose of this study was to compare the CUE method for family planning with the Ovulation Detection Method for defining the fertile phase of the menstrual cycle. We evaluated 42 cycles from 10 women in Monterrey, Mexico, who were monitored by basal body temperatures, urinary LH, pelvic ultrasound, and the CUE monitor. The fertile phase of the cycle was adequately defined in all cycles using the CUE method, and in 35 cycles (83.3%) by the Ovulation Method. Using our protocol, the period of recommended abstinence with the CUE method is 9 days and with the Ovulation Method 11 days. The CUE method accurately defines the fertile phase of the menstrual cycle, thus improving the predictability of ovulation for women who use natural methods of birth control.

Adult↗
PubMedDate not supplied

New technology in natural family planning.

In recent years, several new devices have been developed to help women achieve or avoid pregnancy. These devices include computerized basal body temperature thermometers, electronic fertility monitors, and chemical and hormonal ovulation detection kits. This article describes these new fertility devices and discusses their effectiveness and impact on helping women understand and control their fertility.

Body Temperature↗
PubMed1986

Ultrasonic and endocrinologic investigation of ovarian follicle and free fluid in cul-de-sac for monitoring follicular development and ovulation.

The accuracy of ultrasound as a means of monitoring follicular development and ovulation detection was studied in 31 infertile women. The follicular diameter measured by ultrasound correlated well actual diameter found during laparotomy (r = 0.88), and estradiol-17 beta (E2) and progesterone in follicular fluid aspirated from large follicles (greater than or equal to 16 mm) indicated high levels. Furthermore, in 23 out of the 55 cycles, ultrasound examinations demonstrated free fluid in cul-de-sac at ovulation, and concentrations of E2 and progesterone (P) in peritoneal fluid by the puncture of cul-de-sac dramatically increased after ovulation. We suggested that ultrasound monitoring provided a reliable measure of follicular growth and prediction of ovulation, and a combined use of ultrasound and puncture of cul-de-sac could be developed into a new tool for the study of the mechanism of human ovulation.

Adult↗
PubMed1989

Correlation of endometrial maturation with four methods of estimating day of ovulation.

Dating of maturity of the endometrium by histologic examination was correlated with four methods of ovulation detection in 13 cycling parous women. Histologic dating was assessed independently by two pathologists and correlated with the postovulatory duration as determined by daily transvaginal ultrasound scanning, serum LH measurements, basal body temperature (BBT), and subtraction of 14 days from the onset of menses. In addition, progesterone and estradiol (E2) were measured in daily serum samples. Dating of the endometrial biopsy was highly correlated (P less than .002) with the day of ovulation as determined by ultrasound, and was found to be within 2 days of the correct postovulatory day on evaluation of 25 of 26 (96.1%) of the interpretations. The accuracy of dating using the LH surge was 84.6% (22 of 26 interpretations), and with the BBT thermogenic shift was 76.9% (20 of 26 interpretations). However, dating of the endometrium was within 2 days of the correct day in only 17 of the 26 interpretations as determined by subtracting 14 days from the onset of the subsequent menses. The accuracy of dating was significantly better correlated (P less than .025) with days from ovulation as determined by ultrasound than as calculated from the onset of menses. There was a significant correlation between endometrial dating and the amount of progesterone (P less than .01) and E2 (P less than .01) secreted from the day of ovulation, as determined by transvaginal ultrasound, to the day of biopsy. These data confirm a strong correlation between endometrial dating and ovarian hormone secretion during the postovulatory phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Variations in fertility studies in The Netherlands].

OBJECTIVE: To determine how a standard infertility investigation is conducted and to determine the use of fertility tests used in such investigations in relation to WHO guidelines. DESIGN: Questionnaire survey. SETTING: Dutch medical schools. METHOD: A questionnaire survey among the heads of all 8 university and 20 non-university teaching departments of obstetrics and gynaecology or their fertility units was conducted. One non-university department failed to respond. RESULTS: The examinations recommended by the WHO (general physical examination, andrological and gynaecological examination, semen analysis, ovulation detection, tubal patency testing) in general were carried out, but general physical examination of the male as a rule was only carried out if indicated. Popular routine examinations not recommended by the WHO were the postcoital test and hysterosalpingography. Regarding the postcoital test, there was variation in the time interval after coitus and the standards for spermatozoal motility. CONCLUSION: Standard fertility investigations are usually based on empiricism and tradition, including the testing recommended by the WHO.

Fallopian Tube Patency Tests↗
PubMed1987

[Salivary LH as an ovulation indicator: comparison between salivary LH, serum LH and ultrasonic findings].

A radioimmunological method of salivary LH determination has been developed as a new non invasive approach to hormonal ovulation detection. In this study salivary LH patterns have been compared to serum LH peak and daily sonographic assessment of follicle maturation in 15 spontaneous cycles of 9 women experienced in self-observation of their cycles (NFP). The day where the mature follicle was no longer visible sonographically was labelled day 0. Serum LH peaks occurred in 11 out of 15 cycles on day -1, two times on days -2 and 0 and preceded salivary LH peaks in 8 out of 15 cycles. The latter coincided in 7 cycles with day 0 in two cycles each with days -1 and +1 and in 4 cycles with day -2. Thus 13/15 serum- and 11/15 salivary-LH peaks occurred within +/- one day of the disappearance of the mature follicle. A time lag of up to six hours between the sampling of saliva and serum might explain the difference in the respective peak days, however, more studies into the kinetics of LH transport and its circadian rhythmicity seem necessary. Nevertheless, in principle also the salivary LH peak is considered a suitable indicator of ovulation.

Adult↗
PubMed2005

Follicular cysts occur after a normal estradiol-induced GnRH/LH surge if the corpus hemorrhagicum is removed.

The pathophysiology underlying follicular cysts appears to be lack of an estradiol (E2)-induced GnRH/LH surge due to hypothalamic insensitivity to E2. In addition, progesterone (P4) can cause animals with follicular cysts to resume normal cyclicity and normal hypothalamic responsiveness to E2. We postulated that follicular cysts may be a pathological manifestation of a physiological state that cows, and possibly other species, go through during the normal estrous cycle but the rise in P4 following ovulation induces them back to normal hypothalamic responsiveness to E2. Based on this hypothesis, we expected that removal of the ovary containing the corpus hemorrhagicum would prevent the normal rise in P4 following ovulation and induce development of follicular cysts. Cows (n = 24) on day 7 of the estrous cycle were treated with prostaglandin F2alpha (PGF2alpha) and time of ovulation was detected by ovarian ultrasonography every 8 h. Immediately following detection of ovulation, cows were randomly but unequally assigned to have the ovary containing the corpus hemorrhagicum removed (TRT; n = 16) or the ovary opposite to the corpus hemorrhagicum removed (CON; n = 8). Cows were subsequently evaluated by daily ultrasound and blood sampling to determine follicular dynamics. Ovulation was detected at 93.7 +/- 4.5 h after PGF2alpha injection. All CON cows had a normal estrous cycle length (22.0 +/- 0.6 days) after ovariectomy (OVX). Half of the TRT cows became anovular (TRT-ANO; n = 8) after OVX with large anovular follicles developing on the ovary (maximal size, 25.4 +/- 1.4 mm; range, 20-32 mm). However, eight TRT cows ovulated (TRT-OV; n = 8) 7.3 +/- 0.6 days after OVX. Control cows had a normal P4 rise after ovulation. Removal of the newly formed corpus hemorrhagicum prevented the rise in circulating serum P4 in TRT-ANO cows throughout the 25-day experimental period. The TRT-OV cows had a delayed increase in circulating P4 but it was normal in relation to time of ovulation. Serum E2 concentrations were similar among groups (TRT-OV, TRT-ANO and CON cows) until 7 days after OVX. Serum E2 concentrations then decreased in TRT-OV and CON cows but remained elevated (>5 pg/ml) in TRT-ANO cows. Thus, the endogenous increase in circulating E2 that induces the GnRH/LH surge and estrus is sufficient to induce cows into a physiological state that resembles follicular cysts if it is not followed by increased circulating P4.

Animals↗
PubMed1987

The reliability of ovulation prediction by a single ultrasonographic follicle measurement.

Since ultrasonographic ovulation detection has been introduced many authors have speculated about the ovulation predictive value of this new technique. Reliable studies in this respect, however, are lacking. The present study describes ultrasonographic data of 158 spontaneously ovulating, infertile patients. Each patient contributed only one cycle to the study. To construct individual follicle growth curves serial follicular measurements were performed. A wide range existed in mean maximum diameters of the preovulatory follicles. Furthermore, the slopes of the follicle growth curves, as well as the durations of the follicle growth phases showed considerable variations. The intrinsic variability in the various characteristics of follicle growth makes a single measurement as accurate as serial measurements in predicting ovulation. A formula has been devised by means of the data of the first 100 women, which correlates follicular diameter with the time interval to ovulation. The formula was developed based on one randomly selected measurement per patient. The validity of the formula has been tested in 58 additional women, also contributing one measurement each. According to this validation the adequacy of the prediction rule was demonstrated. Ultrasound appeared to be a less sensitive method for prediction of ovulation than has been speculated by some investigators. It is, however, an improvement, compared to the prediction of ovulation based upon the length of the previous menstrual cycles. A single follicle measurement may therefore be helpful in timing post-coital tests or artificial inseminations, in addition to being an adjuvant to more reliable methods.

Female↗
PubMed1986

Cervical mucus changes and ovulation prediction and detection.

Cervical mucus can be used to predict ovulation if a woman has received adequate education in the method and is committed to careful observation of her cervical mucus changes. Many different tests have been based on the quantity, physical properties or biochemical constituents of cervical mucus. However, routine use of cervical mucus for ovulation monitoring by patients requires that the tests be more practical for accurate sample collection and more objective for the detection of cervical mucus changes.

Cervix Mucus↗
PubMed1999

Synchronization rate, size of the ovulatory follicle, and pregnancy rate after synchronization of ovulation beginning on different days of the estrous cycle in lactating dairy cows.

Recently a protocol was developed that precisely synchronizes the time of ovulation in lactating dairy cows (Ovsynch; GnRH-7d-PGF2 alpha-2d-GnRH). We evaluated whether initiation of Ovsynch on different days of the estrous cycle altered the effectiveness of this protocol. The percentage of cows (n = 156) ovulating to the first GnRH was 64% and varied (P < 0.01) by stage of estrous cycle. Treatment with PGF2 alpha was effective, with 93% of cows having low progesterone at second GnRH. The overall percentage of cows that ovulated after second GnRH (synchronization rate) was 87% and varied by response to first GnRH (92% if ovulation to first GnRH vs 79% if no ovulation; P < 0.05). There were 6% of cows that ovulated before the second injection of GnRH and 7% with no detectable ovulation by 48 h after second GnRH. Maximal diameter of the ovulatory follicle varied by stage of estrous cycle, with cows in which Ovsynch was initiated at midcycle having the smallest follicles. In addition, milk production and serum progesterone concentration on the day of PGF2 alpha affected (P < 0.05) size of the ovulatory follicle. Using these results we analyzed pregnancy rate at Days 28 and 98 after AI for cows (n = 404) in which Ovsynch was initiated on known days of the estrous cycle. Pregnancy rate was lower for cows expected to ovulate larger follicles than those expected to ovulate smaller follicles (P < 0.05; 32 vs 42%). Thus, although overall synchronization rate with Ovsynch was above 85%, there were clear differences in response according to day of protocol initiation. Cows in which Ovsynch was initiated near midcycle had smaller ovulatory follicles and greater pregnancy rates.

Animals↗
PubMed2000

Responsiveness to boar stimuli and change in vulvar reddening in relation to ovulation in weaned sows.

In 117 weaned sows, changes in estrous behavior and vulvar reddening were related to timing of ovulation. Detection of estrus was performed every 8 h with four levels of boar stimuli to record the change in responsiveness to these stimuli. This resulted in four overlapping phases of estrus, during which a standing response could be evoked: 1) man estrus (standing response to a back pressure test, in the absence of a boar), 2) spontaneous estrus (standing response in the presence of a boar, no back pressure test), 3) boar estrus (standing response to boar + back pressure test), and 4) detection-mating-area estrus (back pressure test in the presence of four boars). In addition to the detection of estrus, the change in reddening of the inner vulvar mucosa was recorded. Manifestation of estrus in response to the four stimuli occurred in 46, 56, 90, and 97% of the sows, respectively. Onset of the four phases occurred 24 h (SD 13 h), 23 h (SD 15 h), 34 h (SD 13 h), and 41 h (SD 12 h) before ovulation. The duration of the intervals between the various phases of estrus explained 10 to 50% of the variation in the timing of ovulation relative to the onset of the phases. However, these intervals could not be calculated for all sows because estrus was not expressed at every stimulus level by each sow. The end of vulvar reddening occurred, on average, 21 h (SD 14 h) before ovulation. Except for five sows that ceased to show vulvar reddening within 5 h after ovulation, the end of vulvar reddening occurred before ovulation, within a 70-h range. Of the sows showing boar estrus, 90% also showed vulvar reddening. For sows that showed vulvar reddening until after the onset of boar estrus (two-thirds of the sows), the end of reddening occurred within a much smaller range: from 36 h before, until 2 h after, ovulation. Onset of estrus, regardless at which stimulus level it is detected, appears too variable relative to timing of ovulation to be used as a predictor for ovulation. Duration of the different stages of responsiveness explains only some of this variation and cannot be obtained on all sows. Combining information on vulvar reddening and boar estrus can predict ovulation within a reasonable range for two-thirds of the sows.

Animals↗
PubMedDate not supplied

Presentation of polycystic ovary syndrome and its management with clomiphene alone and in combination with metformin.

BACKGROUND: This study was carried out to determine the pattern of presentation of Polycystic ovary syndrome (PCOS) in patients presenting at our unit and to compare effects of clomiphene alone and in combination with metformin in management of PCOS. METHODS: This study was conducted from Jan 2001-2003 at Military Hospital, Rawalpindi. All patients presenting with infertility were evaluated with a view to select 100 patients of PCOS with the help of history of oligomenorrhoea, hirsuitism and acne. Diagnosis was confirmed by ultrasonography and hormone analysis (LH, FSH, prolactin, testosterone along with LH:FSH>2). The 100 selected patients were divided into two equal groups. One was given combined clomiphene citrate (CC) and metformin for ovulation induction and the other CC alone. These patients were followed for six cycles for ovulation and conception. Follicle tracking on ultrasonography and day-21 serum progesterone level were used to detect ovulation while conception was confirmed by urine pregnancy test, serum B-HCG level and ultrasonography for gestational sac. RESULTS: Hirsuitism and oligomenorrhoea were the two most common clinical features of PCOS. In the first group 34 patients (68%) ovulated as compared with 18 (36%) in the second group. In the first group 18 out of 34 women (52.9%) conceived as compared with only 8 out of 18 (44%) in the second group. The difference was significant at >0.05 when ovulatory and pregnancy responses were compared among two groups. All patients tolerated metformin well and no teratogenic effects were observed in patients who conceived after treatment with metformin. CONCLUSION: A combination of metformin and clomiphene citrate significantly increases the ovulation and conception rates in these patients.

Adult↗
PubMed1996

Detailed analysis of pronucleus development in bovine zygotes in vivo: ultrastructure and cell cycle chronology.

The ultrastructural development of pronuclei and cytoplasm was studied in bovine zygotes developed in the oviducts. The timing of the morphological events was related to sonographically detected ovulation and to the progress of the cell cycle determined by double labelling (3H and 14C-thymidine) of newly synthesized DNA combined with autoradiographic detection. The onset of the S-phase occurred at 11-12 hr after the estimated time of ovulation (EO), and this phase of the cell cycle lasted for 7-9 hr. During the G1-phase, the pronuclei contained spheres of compact, electron-dense fibrillar material classified as nucleolus precursor bodies. Early in the S-phase (13 hr after EO) spherical fibrillogranular bodies containing larger rounded electron-dense components were detected in the periphery of the pronuclei as well. At 15 hr, the latter bodies had become connected through electron-dense material with spherical multivacuolated fibrillar bodies of the same electron density as the nucleolus precursor bodies. At 17 hr, similar compact spherical bodies, now presenting a single large vacuole, were observed on some occasions, while in other zygotes the morphology remained unchanged throughout the rest of the S and G2-phases.

Animals↗
PubMed2004

Effects of a new injectable short-term release deslorelin in foal-heat mares.

Mares treated with subcutaneous deslorelin implants on the first postpartum estrus early in the breeding season had significant reductions in the number of large follicles at early pregnancy examinations and delayed return to estrus (in mares that failed to become pregnant); these adverse effects were attributed to a prolonged release of the drug from the implant. In 2003, an injectable short-term release (<24 h) deslorelin product became available. The objective of this study was to determine if this product would hasten ovulation in early foaling first postpartum estrus mares without reducing the number of large follicles at early pregnancy examination (14-15 days postovulation). Beginning 5-6 days postpartum, first postpartum estrus (foal-heat) mares were teased daily and examined thrice weekly (Tuesday, Thursday and Saturday) by transrectal ultrasonography. Mares in estrus with a follicle > or = 34 mm diameter on Tuesdays or Thursdays were alternately assigned to: Treatment 1, n = 17; 1.5 mg injectable short-term release deslorelin, or Treatment 2, n = 16; Control (no treatment). The schedule allowed accurate determination of the number of mares ovulating within 2 days of treatment (i.e., ovulations detected on Thursday or Saturday). Mares were mated on the day of treatment and at 2-day intervals until either ovulation was confirmed or until behavioral estrus ceased. Transrectal ultrasonography was done 14-15 days after ovulation to assess ovarian follicles and pregnancy status. Fewer covers were required and more mares ovulated within 2 days of treatment in deslorelin-treated versus Control mares (P < 0.01). Pregnancy rates were normal (69%) in deslorelin-treated mares. The number of large follicles 14-15 days after ovulation did not differ between deslorelin-treated and Control mares (P > 0.10), suggesting follicular suppression did not occur with this formulation of deslorelin.

Animals↗
PubMed1999

Diagnosis of subtle ovulation disorders in subfertile women with regular menstrual cycles: cost-effective clinical practice?

Serial monitoring by plasma progesterone measurement is advised in the literature for fertility work-up, to detect ovulation disturbances in women presenting with regular menstrual cycles. Three strategies to diagnose such 'subtle ovulation disorders' (SOD, defined as anovulation, inadequately timed ovulation or ovulation of a follicle of reduced size in regularly cycling women) were evaluated, in order to investigate costs of such a diagnosis. On the basis of a 'maximal', an 'ultrasound-only', and a 'preselection' strategy, total medical costs and costs including non-medical costs were calculated for each SOD diagnosis. A 'maximal' diagnostic strategy resulted in a total medical cost of ECU 9057 per diagnosis (including non-medical costs ECU 12,787); an 'ultrasound-only' strategy in ECU 4520 (ECU 6791) per diagnosis. By use of a 'preselection' strategy, 4.25% of the women were found to have an SOD, at a cost of ECU 3036 (ECU 6868) for each diagnosis. As the real significance of SOD diagnosis for the prognosis of the patient to become pregnant without treatment remains unclear, and as no randomized trials on treatment effectiveness have as yet been undertaken, it is questionable whether this approach is worthwhile.

Blood Chemical Analysis↗
PubMed1993

[Estrus synchronization and insemination results in Arabian mares in the Eskisehir stud].

An Arab broodmare herd of 30 mares age ranging from 4 to 12 years was grouped into 3 groups (group A, B, C) with 10 mares each and exposed to three different methods of cycle synchronisation. Group A mares received two PGF2 alpha injections 14 days apart. Group B mares got additionally 2,500 IU of hCG 5 days after second prostaglandin application. Group C consisted of mares which had foaled in a synchrony of one week and got a PGF2 alpha injection 3 weeks after parturition. All the mares responding to synchronisation were inseminated closely to ovulation detected by serial rectal palpations with an insemination doses of 0.5 billion of progressively motile spermatozoa. Conception control was performed on the 18th day after ovulation to be continued up to pregnancy confirmation on day 60. Synchronisation response in the different groups A, B, C was 60, 80, 80% starting first oestrus signs between 24 to 36 hours and ovulation time between 5 to 6.5 days post last PGF2 alpha application. Pregnancy rate (first cycle) was 66.7% (A), 75% (B) and 87% (C) basing on the number of mares who responded to synchronisation exposure.

Animals↗