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Biomedical subjects

A H Balen

Publications and source records attributed to A H Balen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Polycystic ovaries and associated clinical and biochemical features in young women.

OBJECTIVE: To determine the prevalence of polycystic ovaries as identified by ultrasound in a group of young, postmenarcheal women in the normal population, and to investigate how polycystic ovaries are related to the spectrum of clinical and biochemical symptoms associated with the polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional observational study. SUBJECTS AND METHODS: Volunteers were recruited from two universities and two general practice surgeries in Oxford. 230 women aged 18-25 years participated. Information collected and measurements performed included: a menstrual history, anthropometric measurements, clinical observation of acne and hirsutism, transabdominal pelvic ultrasound, and biochemical analysis of a fasting blood sample. MAIN OUTCOME MEASURES: Prevalence of polycystic ovaries and their association with symptoms of the polycystic ovary syndrome. RESULTS: Polycystic ovarian morphology was identified in 74 (33%, 95% CI = 27-39%) of the 224 women who attended for an ultrasound scan. In the non-users of hormonal contraception, irregular menstrual cycles were 20% more common in women with polycystic ovaries than in women with normal ovaries (P = 0.07). There were no significant differences in acne, hirsutism, body mass index or body fat percentage between women with polycystic and normal ovaries. Analysis of biochemical data showed that women with polycystic ovaries had higher total serum testosterone concentrations (P = 0.03). The prevalence of PCOS in this age group was as low as 8% or as high as 26% depending on which criteria were applied to define the syndrome. Sub-group analyses of women according to ovarian morphology and features of PCOS revealed greater mean BMI in women with PCOS, and also indicated lower fasting insulin concentrations and greater insulin sensitivity in polycystic ovary and PCOS groups when compared to women with normal ovaries. CONCLUSIONS: Polycystic ovaries are very common in this age group but are not necessarily associated with other symptomatology. The prevalence of polycystic ovary syndrome varies widely according to the definition applied. Sub-group analysis of women with polycystic ovaries according to the presence or absence of features of polycystic ovary syndrome does not reveal an increasing trend for progression of endocrine abnormalities usually associated with polycystic ovary syndrome.

Adult↗
PubMed1999

The experiences of couples who have had infertility treatment in the United Kingdom: results of a survey performed in 1997.

A questionnaire was sent to 2000 members of two of the largest national infertility support organizations as part of the National Infertility Awareness Campaign (NIAC), 1997. A total of 980 questionnaires was completed and returned to the market research company, Ballington Hall. Some 69% of the respondents were aged between 30 and 39 years. One-third of the couples had been trying for a baby for more than 3 years, including one-tenth who had been trying to conceive for more than 10 years. Some 40% of respondents were successful in conceiving, although a significant proportion of these took more than 6 years. About 75% of those surveyed had been forced to pay for some or all of their infertility treatments and investigations, whereas 18% had their treatments funded fully by the National Health Service (NHS). Funding sources for the remaining 7% were unknown. Just over one-third of respondents felt that their GP provided sufficient information about the causes of infertility investigations and treatment, while the majority said that their specialists had been helpful. One in three said that they did not fully understand the medical nature of their own or their partner's infertility. A wide range of negative emotions was experienced by respondents. One in five said they experienced suicidal feelings; one in three said that infertility had strained their relationship; and just over one-quarter found that their relationship improved as a result of the treatment. Some 71% said that they would request counselling if it were offered free, but only 12% had been provided with free counselling on the NHS.

Adult↗
PubMed1998

Pretreatment with follicle stimulating hormone promotes the numbers of human oocytes reaching metaphase II by in-vitro maturation.

The objective of this study was to investigate the effect of follicle stimulating hormone (FSH) priming on the in-vitro maturation (IVM) of human oocytes from healthy ovaries using a chemically defined culture system. Seventeen patients donating oocytes for research received a truncated course of 600 IU FSH over 5 days and a further control group of nine patients received no FSH treatment. Mid-follicular phase cumulus-enclosed oocytes (n = 160) were aspirated from follicles < or =4 mm diameter under transvaginal ultrasound guidance and were cultured for 48 h in microdrops of medium containing 10 mIU/ml FSH and 100 mIU/ ml human chorionic gonadotrophin (HCG). The results demonstrated that human oocytes will efficiently undergo IVM under serum-free conditions. After mild FSH stimulation, a greater number of cumulus-enclosed oocytes was collected, and following culture, a lower rate of degeneration was observed. Significantly more oocytes completed nuclear maturation to metaphase II following FSH stimulation (71.1 versus 43.5%). In conclusion, a truncated course of FSH stimulation in vivo improved the oocyte maturation rate in vitro, giving a mean of 4.8+/-0.7 metaphase II oocytes per patient compared with only 2.1+/-0.7 from control patients, thus yielding more mature oocytes for future IVF treatment.

Adult↗
PubMed1998

Survey of the diagnosis and management of antisperm antibodies.

A questionnaire was sent to all Human Fertilization and Embryology Authority-registered reproductive medicine centres throughout the UK to survey their policy for the diagnosis and management of antisperm antibodies. Forty-eight responses were received from the 74 units that use husbands' spermatozoa for treatments (65%). Most centres use at least one test to detect antibodies, although a minority perform no tests on the basis that their clinical practice would be unaltered if antibodies were present. Positive tests are classed as clinically significant at levels varying from > or = 10% to > or = 50% for direct sperm binding tests (mixed antiglobulin reaction, immunobead test), and ranging from any positive reaction to > or = 1:32 for the microtitre tests (gelatin and tray agglutination tests, microimmobilization test). Strategies for managing affected patients include no intervention, artificial insemination and intrauterine insemination (IUI) using spermatozoa prepared by various techniques, in-vitro fertilization (IVF) with or without increased insemination concentration, and intracytoplasmic sperm injection. Criteria for the latter are diverse, some centres managing all antibody-positive patients this way, while others resort to it only in severe cases or after other treatments have failed. Half of the respondents occasionally or regularly employ steroids, either alone or in conjunction with IUI or IVF. Overall, it appears that much confusion exists as to how best to manage couples presenting with antibody-related infertility.

Adult↗
PubMed1996

Hypogonadotropic patients with ultrasonographically detected polycystic ovaries: endocrine response to pulsatile gonadotropin-releasing hormone.

To characterize the endocrine response during induction of ovulation in patients with hypogonadotropic hypogonadism and ultrasound findings of polycystic ovary, we performed a retrospective analysis of 22 treatment cycles with pulsatile gonadotropin-releasing hormone (GnRH) in such patients and of 17 treatment cycles in similar patients with ultrasonographically normal ovaries. Of the 21 patients studies, 11 had an ultrasound finding of polycystic ovaries and ten had ovaries that appeared normal. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol levels, number of follicles of diameter > 12 mm (by ultrasound), and ovulation and conception rates were measured. Patients with hypogonadotropic hypogonadism and ultrasound-diagnosed polycystic ovary had pretreatment endocrine status similar to those with normal ovaries, but had much higher baseline ovarian volume. Ovulation induction with pulsatile GnRH induced much higher serum LH concentrations in the former group despite similar FSH levels. This difference preceded any change in estradiol levels. The former group consistently recruited significantly more follicles during pulsatile GnRH treatment. However, ovulation and conception rates were (non-significantly) higher in the latter group. In conclusion, this study characterized a subgroup of hypogonadotropic patients with ovarian morphology, volume and response to ovulation induction similar to in patients with polycystic ovary syndrome. When treated with pulsatile GnRH, those with polycystic ovary significantly hypersecreted LH before their estradiol level changed significantly. The primary lesion in polycystic ovary syndrome seems to be in the ovary, with pituitary hypersecretion of LH secondary to disturbed ovarian feedback signalling.

Estradiol↗
PubMed1995

Characterization of a rat anterior pituitary cell bioassay.

We have described the protocols and characterization of a pituicyte culture, which became established as a reliable and reproducible bioassay for the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The bioassay was used to measure the bioactivity of factors that inhibit and stimulate gonadotrophin secretion. The protocol that was used involved the culling of female Wistar rats (200 to 250 g weight), at random stages of their cycle, and dispersal of their pituicytes in a concentration of 0.4 x 10(6) cells.ml-1.well-1 in serum-free medium (Dulbecco's modified Eagle's medium/Ham's F12 mixture, supplemented with insulin and transferrin) in Falcon 3047 24-well culture plates. After 24 h of pre-culture, the medium was changed and the cells cultured for a further 48 h. The supernatant was removed and assayed for basal secretion of FSH and LH. The cells were then stimulated with 10(-8) M GnRH for 4 h and the supernatant assayed for gonadotrophin-releasing hormone (GnRH)-stimulated FSH and LH secretion. All samples were assayed as pairs of duplicates (i.e. quadruplicate samples) which were randomly added to the plates to minimize plate effects. Random number tables were used to achieve this randomization.

Animals↗
PubMed1995

Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients.

The criteria for the diagnosis of the polycystic ovary syndrome (PCOS) have still not been agreed universally. A population of 1741 women with PCOS were studied, all of whom had polycystic ovaries seen by ultrasound scan. The frequency distributions of the serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin and the body mass index, ovarian volume, uterine cross-sectional area and endometrial thickness were determined and compared with the symptoms and signs of PCOS. Obesity was associated with hirsutism and an elevated serum testosterone concentration and was also correlated with increased rates of infertility and cycle disturbance. The rates of infertility and cycle disturbance also increased with serum LH concentrations > 10 IU/l. A rising serum concentration of testosterone [mean and 95th percentiles 2.6 (1.1-4.8) nmol/l] was associated with an increased risk of hirsutism, infertility and cycle disturbance. The ovarian volume was correlated with serum concentrations of testosterone, LH and the body mass index, which was also correlated with the uterine area. This descriptive data from the largest reported series of women with PCOS enables the development of a management-orientated approach to the syndrome. Women who are overweight can expect an improvement in their symptoms if they lose weight. An elevated concentration of LH (> 10 IU/l) is associated with infertility and treatment should be chosen accordingly. If the serum testosterone concentration is > 4.8 nmol/l, other causes of hyperandrogenism should be excluded.

Adolescent↗
PubMed1995

In vitro bioactivity of gonadotrophin surge attenuating factor is not affected by an antibody to human inhibin.

The effect of anti-inhibin antibodies on gonadotrophin surge attenuating/inhibiting factor (GnSAF/GnSIF) and its effect on gonadotrophin secretion in a pituitary cell bioassay were determined by culturing rat pituitary cells in a serum-free medium to which inhibin and a partially purified preparation of gonadotrophin surge inhibiting factor (GnSIF) were added. The samples were treated with an anti-inhibin antiserum and basal and GnRH-stimulated FSH and LH secretion were measured by radioimmunoassay of the culture supernatant. Inhibin had a dose-dependent inhibitory effect on both basal and GnRH-stimulated FSH secretion and also on GnRH-stimulated LH secretion. Anti-inhibin antibody blocked the inhibition of FSH secretion, except at the highest two doses of human inhibin (1.25 ng ml-1, P = 0.04; 2.5 ng ml-1, P = 0.0004). The GnSIF preparation inhibited basal and GnRH-stimulated FSH and GnRH-stimulated LH secretion and was not affected by the anti-inhibin antibody. The novel hormone, GnSIF, is different from inhibin.

Animals↗
PubMed1994

A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome.

OBJECT: To assess the efficacy of unilateral laparoscopic ovarian diathermy in the induction of ovulation in anti-estrogen-resistant polycystic ovary syndrome (PCOS). DESIGN: A prospective randomized study was performed to compare unilateral with bilateral ovarian diathermy. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS: Ten patients with anti-estrogen-resistant PCOS. INTERVENTIONS: Randomization to unilateral (4 patients) or bilateral laparoscopic ovarian diathermy (6 patients). MAIN OUTCOME MEASURES: Rate and side of ovulation and change in endocrine profiles after ovarian diathermy. RESULTS: Unilateral ovarian diathermy resulted in ovulation from both ovaries. Fifty percent of the patients responded to diathermy and those who responded had a significantly greater fall in serum LH concentrations than those who failed to respond. CONCLUSIONS: The mechanism of action of laparoscopic ovarian diathermy is via a correction of disturbed ovarian-pituitary feedback. Hypersecretion of LH appears to be the most significant endocrine disturbance in these patients.

Adult↗