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Biomedical subjects

E Kemmann

Publications and source records attributed to E Kemmann.

At least 19 recordsLinked to original sources
PubMed1992

Use of urinary luteinizing hormone immunoassays in the assessment of luteal function in infertile women.

It has been suggested that the chronologic date of an endometrial biopsy performed to evaluate luteal adequacy should be based on the date of the luteinizing hormone surge rather than the date of the next menstrual period. Sixty-four infertile women used a urinary luteinizing hormone immunoassay to identify the luteinizing hormone surge; timed serum progesterone level tests and an endometrial biopsy were then performed. An out-of-phase endometrium was identified in 26.6% of cycles dated traditionally and 28.1% of cycles dated from the luteinizing hormone surge. No relationship was identified between progesterone levels and endometrial biopsy results when the next menstrual period was used. When the luteinizing hormone surge was used no progesterone cutoff value could be identified that would reliably distinguish between in-phase and out-of-phase cycles. Use of a urinary luteinizing hormone immunoassay offers no advantage over the next menstrual period and does not lead to better agreement between histologic and chronologic dating.

Corpus Luteum↗
PubMed1992

Gonadotropin-releasing hormone agonist in a GIFT program.

The authors describe their experience with the gamete intrafallopian transfer (GIFT) procedure in the treatment of infertility. Utilization of a gonadotropin-releasing hormone agonist resulted in a 51.9 percent clinical pregnancy rate and a low cancellation rate.

Adult↗
PubMed1991

The role of superovulation with menotropins in ovulatory infertility: a review.

The risks of menotropin therapy (ovarian hyperstimulation syndrome, multiple gestation, adnexal torsion) are well known and have been previously described. Superovulation should not be considered for the indications described herein until more traditional therapies for infertility have been tried and found unsuccessful and sufficient time has elapsed for conception to occur. The cost of superovulation is high: the medications are expensive, frequent E2 monitoring and US studies are costly, and pregnancy complications relating to the higher rate of pregnancy loss and multiple gestation may add substantially to the overall cost. Yet, compared with IVF and GIFT, superovulation cycles combined with IUI cost between one third to one sixth that of an IVF cycle. Protocols involving combined CC/hMG/hCG, which reduce the total number of ampules of Pergonal needed per cycle and still provide multiple follicular development, may further reduce costs. There is a growing consensus that superovulation-IUI protocols should be attempted before GIFT and IVF in couples with normal pelvic viscera. There is little doubt that IVF and GIFT cycles are more costly, stressful, and complex. No comparative data have clearly shown IVF and GIFT to be superior to superovulation protocols in ovulatory women with normal pelvic anatomy. In the only study examining this issue published to date, Kaplan et al. retrospectively analyzed all GIFT and superovulation/IUI cycles at a single university center and found GIFT to be three times more efficient. However, the inherent limitations of a nonrandomized, nonprospective study of this kind are obvious as these authors have suggested. Therefore, it may be wise to consider the use of superovulation before assisted reproductive technologies until this issue is settled. It would be interesting to determine if the high PRs reported for couples with unexplained infertility or mild endometriosis in IVF and GIFT cycles in some centers not incorporating superovulation/IUI protocols would hold up if such an approach was routinely followed. Despite the increasing acceptance of superovulation protocols, we must be aware that many of the studies suggesting a role of hMG in treating ovulatory infertile women with normal pelvic anatomy suffer from deficiencies in experimental design. In a payor-driven system, such as in the United States, the difficulties in designing and carrying out scientifically sound clinical studies examining infertility therapies are obvious. The lack of federal or outside funding for the study of infertility issues contributes to the problem. It is our hope that better designed studies examining the role of superovulation in the treatment of ovulatory infertile women with normal pelvic anatomy will be forthcoming.

Female↗
PubMed1991

Normal pregnancy outcome after early maternal exposure to gonadotropin releasing hormone agonist. A case report.

An infertile woman was treated with leuprolide acetate in preparation for in vitro fertilization and was found to be pregnant after exposure to the gonadotropin releasing hormone agonist (GNRHa) from days 21-38 after her last menstrual period. She delivered a healthy-appearing, male infant at term. We found reports of four other pregnancies with early maternal GNRHa exposure. While no malformations have been reported, patients are advised to use barrier contraception when GNRHa therapy is initiated.

Adult↗
PubMed1990

The menopausal hot flush: symptom reports and concomitant physiological changes.

Hot flushes are the most frequently reported menopausal symptom. The primary study goal was to develop criteria for the identification of hot flushes that ultimately could be applied independent of symptom report. Twenty-one postmenopausal women each underwent psychophysiological monitoring. Physiological activity accompanying their 93 subjective flush reports was compared with activity during nonflush periods, and a discriminant function analysis was carried out. The Physiological Flush Profile (PFP), developed on the basis of these analyses, consists of peripheral vasodilation plus an increase in skin conductance (sternal and/or palmar), both of a specified magnitude. The PFP was shown to be both a specific and a sensitive measure of hot flushes. Notably, change in sternal skin conductance was highly positively correlated with subjective flush severity ratings. Potential applications of the PFP toward delineating the role of psychological factors in the reporting of menopausal symptomatology are discussed.

Adult↗
PubMed1990

Home urinary luteinizing hormone immunoassays: clinical applications.

Home ovulation prediction kits represent a valuable advance in monoclonal antibody technology and offer patients a quick, reliable, and relatively inexpensive means to predict the day of ovulation. These kits are used widely by patients trying to conceive and are commonly recommended by physicians involved in the care of infertile couples. They provide a more accurate and practical means to prospectively predict the time of ovulation than do BBT graphs or cervical mucus exams, and can be used as presumptive evidence of ovulation. Whereas ovulation prediction kits appear to be most useful for couples in timing sexual intercourse, other possible uses exist, including timing of AI, the PCT, and the endometrial biopsy for luteal phase evaluation. Despite multiple potential applications, clinical studies which support the use of urinary LH immunoassays in the evaluation and treatment of the infertile couple are quite limited. More well-designed studies to define the clinical value of ovulation prediction kits need to be undertaken.

Female↗
PubMed1990

Risk of a second consecutive first-trimester spontaneous abortion in women who conceive with menotropins.

It is generally recognized that a spontaneous abortion rate of approximately 25% exists in human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced pregnancies. Despite this, little is known regarding the prognosis of future menotropin-induced pregnancies in women who abort in their first hMG pregnancy. We retrospectively reviewed the obstetrical outcome of women who achieved two or more menotropin pregnancies between the years 1980 and 1987. Nineteen of 40 patients (48%) whose first hMG pregnancy ended in an early spontaneous abortion went on to abort in a second hMG pregnancy, as compared with only 1 of 15 women (6.7%) whose first hMG pregnancy was successful. Age, parity, weight, height, and plasma estradiol levels at hCG administration did not differ between the two groups. From this data we conclude that women whose first hMG pregnancy results in a spontaneous abortion are at high risk for another spontaneous abortion in a subsequent menotropin conception.

Abortion, Spontaneous↗
PubMed1990

Impact of stress on objectively recorded menopausal hot flushes and on flush report bias.

The hot flush (or flash) is the most widely reported menopausal symptom. Anecdotal reports suggest that women experience more hot flushes when stressed. Although stress may actually trigger hot flushes, another possibility is that women under stress may be more aware of the physiological changes associated with flushes and, therefore, more likely to report them. The goal of this study was to test these hypotheses by investigating the association between stress and both objective (i.e., physiologically recorded) and subjective hot flushes. Twenty-one postmenopausal women who reported having frequent hot flushes each underwent psychophysiological monitoring during stressful and nonstressful laboratory sessions. Significantly more objective flushes were recorded during the stress session than during the nonstress session. The stress manipulation, however, did not affect subjects' propensity to report flushes. These results suggest that the observed association between reported hot flushes and stress is not due to changes in report bias. The physiological mechanisms through which stress may stimulate hot flushes are discussed.

Adult↗
PubMed1990

Adnexal torsion in menotropin-induced pregnancies.

Adnexal torsion of enlarged ovaries during early pregnancy is an infrequent but serious complication of menotropin therapy. Over 4 years, we encountered four cases of adnexal torsion among 648 menotropin-induced pregnancies. Multiple gestation may be a predisposing factor. The history of exogenous gonadotropin use, the acute clinical presentation, and the use of pelvic sonography facilitate the diagnosis. Although adnexectomy is well tolerated and pregnancy outcome is acceptable, future efforts should involve identifying preventive measures and more conservative means of therapy in these women.

Adnexal Diseases↗
PubMed1989

A prospective study on the lack of development of antisperm antibodies in women undergoing intrauterine insemination.

To test the hypothesis that intrauterine insemination with washed spermatozoa induces antisperm antibody formation, we measured serum antisperm antibody levels by the Immunobead technique in a population of women receiving exogenous gonadotropins. Antibody levels were measured before therapy (baseline) and then serially during subsequent stimulation cycles, for a maximum of six cycles. Twenty-eight patients underwent intrauterine insemination; each patient served as her own control. An additional 25 patients were treated with exogenous gonadotropins but did not undergo intrauterine insemination; they served as external controls. Antisperm antibody levels in women who underwent concomitant intrauterine insemination were compared with levels in those who did not. Of the 53 enrolled patients, 18 completed six treatment cycles, and 35 achieved pregnancy before six cycles. Forty-five patients (85%) had less than 10% Immunobead binding, six (11%) had binding between 10% and 25% (mean 16%, range 14% to 20%), and two had binding greater than 25% (28% and 42%, respectively). Mean binding was similar (less than 10%) in the intrauterine insemination and external control groups. Eighteen patients conceived in the intrauterine insemination group and seventeen in the control group. Of patients who conceived, all but one had less than 10% Immunobead binding at the time of conception (mean 1.6 months). In patients who did not conceive, there was no difference in Immunobead binding between control and intrauterine insemination groups after 6 months of therapy. Our data do not support the hypothesis that serum antisperm antibody levels, as detected by Immunobead binding, will increase in menotropin-stimulated women undergoing intrauterine insemination over a prolonged treatment period.

Adult↗
PubMed1989

The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination.

Semen parameters of raw and prepared (post-swim-up) specimens from 451 cycles of intrauterine insemination (IUI) were analyzed in relation to cycle fecundity in 232 patients undergoing ovarian stimulation with sequential clomiphene citrate/menotropin therapy. Pregnancy occurred in 42 cycles, resulting in an overall pregnancy rate of 17.7%, and a cycle fecundity of 9.3%. Cycle fecundity was positively correlated with the parameters of post-swim-up log sperm density (r = 0.994), and with log total motile sperm inseminated (r = 0.964; inseminates were limited to a maximum of 20 million total motile sperm). Post-swim-up motility did not correlate (r = 0.308) with cycle fecundity; however, most specimens had a motility of greater than 40% post-swim-up. Only one pregnancy occurred when less than 1 million motile sperm were inseminated (38 cycles), which resulted in a cycle fecundity of 2.6% for these cycles. This may represent the threshold of effectiveness for IUI in this setting. Highest cycle fecundity was obtained with an inseminate containing approximately 10 million or more motile sperm. Parameters of raw samples correlated less well with cycle fecundity than did prepared specimens. Analysis of post-swim-up semen parameters can provide useful prognostic information for women undergoing IUI with ovarian stimulation; this information is helpful in counseling patients regarding their chances of success with this therapy.

Adult↗
PubMed1979

Hyperprolactinemia and primary amenorrhea.

Four women with primary amenorrhea and hyperprolactinemia are presented. These patients started thelarchal and pubarchal development but never had a spontaneous menses. Hypothyroidism was not demonstrable in these patients. The causes for hyperprolactinemia in these patients and the clinical follow-up are discussed. In the authors' experience, hyperprolactinemia is seen in about one third of women with normogonadotropic primary amenorrhea, and primary amenorrhea is seen in about 3% of women with hyperprolactinemia.

Adolescent↗
PubMed1977

Plasma prolactin changes during the administration of human menopausal gonadotropins in nonovulatory women.

Plasma prolactin concentrations were determined in 16 nonovulatory women during treatment with human meonpausal gonadotropins (hMG). In eight patients with initially normal prolactin levels of less than 20 ng. per milliliter, a significant rise was noted at the end of hMG administration, this is thought to be a response to increased endogenous estrogen concentrations. A similar rise in plasma prolactin levels was seen in some but not all of the eight patients with initially elevated "basal" prolactin concentrations. Three of these hyperprolactinemic patients had radiographic evidence of a pituitary lesion--either a pituitary adenoma or a "microadenoma"--but the variance in prolactin response could not be explained on this basis. The two groups of normo- and hyper-prolactinemic patients showed no significant difference in the required dosage and duration or hMG treatment, plasma estradiol-17 beta response, and ovulatory and pregnancy outcome.

Adult↗
PubMed1977

Gonadal karyotyping in women with and without ovarian activity.

Results of gonadal karyotyping on 26 patients with cyclic or acyclic ovarian activity and hypogonadotropic or hypergonadotropic hypogonadism are presented. Gonadal culture growth, with the exception of tissue from polycystic ovaries, was usually successful. With one exception, leukocytic and gonadal karyotypes were concordant. Normal ovarian function did not appear to be limited to ovaries of the 46,XX karyotype.

Adolescent↗