Evaluation of anovulatory cycles and induction of ovulation.
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Amenorrhea↗
Biomedical subjects
M L Taymor
Publications and source records attributed to M L Taymor.
Emotional stress and infertility.
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Behavior↗
On the etiologic role of ureaplasma urealyticum (T-mycoplasma) infection in infertility.
Two hundred consecutive infertility patients and sixty-seven controls subjects were studied for the incidence of infection with Ureaplasma urealyticum (T-mycoplasma). On the basis of a complete infertility investigation, the infertility patients were subdivided into those with explained infertility and those with unexplained infertility. Of the patients with unexplained infertility, 55% had a positive culture for T-mycoplasma as compared with a 32% incidence of positive cultures in the control population. The differences were statistically significant. The 6-month pregnancy rate following successful antibiotic treatment in patients with unexplained infertility was 42%. The 6-month pregnancy rate in a comparable group of patients with unexplained infertility, seen during a 3-year period prior to mycoplasma culture and treatment, was 32%. The difference in pregnancy rates between the two groups was not statistically significant. No correlation was found between a poor postcoital test and the presence of T-mycoplasma infection nor between T-mycoplasma infection and poor cervical mucus. The role of T-mycoplasma infection in infertility was neither proven nor disproven by this study.
Cervix Uteri↗
The use of luteinizing-hormone-releasing hormone in gynecology.
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Amenorrhea↗
Diagnostic value of androgen measurements in polycystic ovary syndrome.
A group of 51 women with a diagnosis of polycystic ovary syndrome (PCO) were investigated. They were further classified into PCO Type I and PCO Type II based on clinical and laboratory investigations. Serum levels of unbound (free) and total testosterone, testosterone binding globulin (TBG), and androstenedione were measured in these women and compared with values in normal women. Mean levels of all these steroids were elevated in women with PCO. No difference in adrogen levels was found between women with PCO Type I and PCO Type II. Serum unbound testosterone concentrations correlated better with the presence and severity of hirsutism than did the total testosterone.
Androgens↗
Electron probe microanalysis of the chemical elemental content of human follicular fluid.
Follicular fluid samples were obtained by puncturing follicles of ovaries in situ from patients undergoing laparotomy. Sodium, potassium, chloride, magnesium, calcium, phosphorus, and sulfur concentrations measured by electron probe microanalysis were similar to those of blood, with minimal differences. This suggested that culture media in which these electrolytes are added in concentrations similar to those of serum are appropriate for culture of the human oocyte.
Calcium↗
Artificial insemination homologous and its role in the management of infertility.
Fifty-seven cases of homologous artificial insemination (AIH) were reviewed as well as the reason for performing the insemination. Three patients had AIH because of impotence, and two conceived. Twenty-nine patients whose husbands had sperm counts of less than 40 million/ml had AIH combined with split ejaculates, and seven (24.1%) became pregnant. Twenty-five patients had AIH because of persistent, unexplained, poor postcoital tests despite a normal semen picture, and eight (32%) became pregnant.
Erectile Dysfunction↗
The use of gonadotropins for the induction of ovulation in women with polycystic ovarian disease.
Ten infertile patients with polycystic ovarian disease were treated with 18 cycles of "pure" human pituitary follicle-stimulating hormone (HP-FSH) and 10 cycles of human menopausal gonadotropin (HMG) consisting of FSH and luteinizing hormone (LH) in a 1:1 ratio. Human chorionic gonadotropin was used to trigger ovulation when optimal follicular development was achieved as judged by urinary estrogen determinations. Of the 18 cycles utilizing HP-FSH, 14 were presumptively ovulatory, 2 were conceptual, and in 5 cycles ovarian enlargement was noted. Of the 10 HMG cycles, none was ovulatory, no conceptions resulted, and 6 instances of hyperstimulation were noted. Pretreatment serum LH levels were significantly higher than normal follicular phase values. These observations suggest that endogenous LH levels in patients with polycystic ovaries are quite adequate for follicular development so that the administration of exogenous LH is unwarranted. Furthermore, the data suggest that HP-FSH or low-LH-containing HMG may prove to be an additional safe and effective nonsurgical treatment modality for patients who are anovulatory because of polycystic ovaries.
Adult↗
Clinical aspects of the polycystic ovary syndrome.
One hundred and one patients with polycystic ovary syndrome (PCO) were treated during an 11-year interval. Sixty-seven cases were classified as typical PCO with enlarged ovaries of probable ovarian origin (Type I) and 34 as atypical PCO of probable adrenal origin (Type II). Fifty-five patients were treated for anovulatory infertility with clomiphene citrate or other endocrine therapy as indicated. There was a 91% ovulatory response and 51% conception rate from therapy in cases of Type I PCO. In Type II PCO, adrenal suppressive therapy resulted in a 55% ovulatory response. Our data support the concept that anovulation of ovarian origin as seen in PCO Type I responds to clomiphene therapy, while anovulation secondary to adrenal hyperandrogenization should be treated by adrenal suppressive therapy.
17-Ketosteroids↗
A comparison between gonadotropin radioimmunoassays with the use of 48 hour and six-day incubation methods.
A double-antibody radioimmunoassay for human follicle-stimulating hormone (FSH) and human luteinizing hormone (LH) which can be carried to completion in 48 hours was compared with the conventional six-day double-antibody radioimmunoassay. The bound-over total (B/T) dose response curves for the 48 hour assay were comparable in slope and dose range with the six-day assay and the four per cent average within-assay and the nine per cent between-assay coefficients of variation for the 48 hour assay were comparable with the variation observed in the conventional six-day assay. Maximum variation among identical serum samples assayed in both systems was 15.3 per cent so that quantitative results obtained with either assay system were comparable.
Chorionic Gonadotropin↗
Modulation of pituitary responses to synthetic LH-RH by gonadal steroids in women with secondary amenorrhoea.
LH-RH stimulation tests were performed on two successive days in 25 women with secondary amenorrhoea of probable hypothalamic origin by intravenous injection of 150 mug of synthetic LH-RH. The patients were selected by exclusion of definite pituitary or ovarian disease and in the absence of clinical or laboratory evidence of androgen excess. Five women received successive LH-RH stimulation tests only without administration of steroid hormone. Twenty women were treated with gonadal steroids in addition to the double LH-RH stimulation test by intramuscular injection of the steroid 4 h after the first LH-RH injection. Of these 20, 9 received oestradiol (Oe2), 5 received progesterone (P) and 6 received Oe2 + P. Gonadotrophin responses to LH-RH in successive tests without steroid were not significantly different. Oe2 or P alone each produced suppression of LH and FSH responses to LH-RH in the second test as compared to the first. Combined Oe2 + P produced augmentation or suppression of the second gonadotrophin responses depending on the dose of Oe2 administered. The results demonstrate a direct effect of oestrogen or progesterone alone and in combination on the pituitary responsiveness to LH-RH. The effect of the combined steroids can be modified by variation in the oestrogen: progesterone ratio.
Amenorrhea↗
Cytologic features of oocytes in the adult human ovary.
A broad survey of the cytologic features of follicular oocytes from sections of adult ovaries from donors with normal menstrual cycles, from patients with polycystic ovarian disease, and from patients treated with estrogen and progesterone for gynecologic disorders with no apparent ovarian pathology has been made in this study. On the basis of light microscopic observations, four basic types of oocytes could be recognized: (1) oocytes with nuclei containing diffused or filamentous chromatin, (2) oocytes with metaphase I chromosomes or an extruded polar body, (3) oocytes with nuclei possessing massive clumps of chromatin frequently associated with the nucleolus, and (4) degenerating oocytes with no distinguishing cytologic features. The numbers of oocytes in these different groups varied with the reproductive state of the donors: 34 to 35% were type 1 during proliferative and secretory phases; mature oocytes type 2 were 3.3%, and were found only during the late proliferative phase; and 41 to 46% were type 3 during both phases of the menstrucal cycle. Large numbers of oocytes from polycystic ovaries (77%) and from ovaries of patients treated with steroids (86%) were degenerating and frequently contained massive clumps of chromatin material associated with the nucleolus.
Adult↗
The relationship between the pituitary response to luteinizing hormone-releasing hormone and the ovulatory response to clomiphene citrate.
Luteinizing hormone-releasing hormone (LH-RH), at a dose level of 10 mug, was administered intravenously to 31 patients, 9 with oligomenorrhea and 22 with secondary amenorrhea. A serum luteinizing hormone level higher than 45 mIU/ml at 30 or 45 minutes after injection was considered to be a "positive response" to LH-RH. All 9 patients in the oligomenorrheic group and 11 of the 22 patients with secondary amenorrhea had a "positive" response. The patients were then treated with increasing doses of clomiphene citrate until an ovulatory dose was reached. Eight of the nine patients with oligomenorrhea ovulated with doses of up to 150 mg of clomiphene daily for 5 days. Of the 11 patients in the group with secondary amenorrhea who had a "positive" response to LH-RH, 7 ovulated at a dose of 150 mg (or less) of clomiphene citrate, while only 1 of the 11 patients with a "negative" response ovulated while receiving a similar dosage of clomiphene. These results suggest that a simplified LH-RH test might be of value in selecting the level of therapy for ovulation induction.
Adult↗
Pituitary gonadotropin responses to synthetic luteinizing hormone-releasing hormone in patients with typical and atypical polycystic ovary disease.
Synthetic luteinizing hormone-releasing hormone (LH-RH) was administered intravenously to 17 women with polycystic ovary disease (PPCO), 16 women with hypothalamic amenorrhea (HA), and nine women with normal cycles. The serum levels of follicle-stimulating hormone (FHS) and luteinizing hormone (LH) were measured at frequent intervals before and after LH-RH injection. The PCO patients were arbitrarily divided into two groups on the basis of ovarian morphology. The eight patients with large, "typical" PCO's (Type I) showed a greater LH response and a lower FSH response to LH-RH than did the nine patients with smaller, "atypical" PCO's (Type II). The LH response in Type I co was also greater than that in HA, but the FSH response in both types of PCO was significantly less than that in HA. The gonadotropin responses to LH-RH in Type I PCO were quite similar to those occurring in normal women during the two to three days prededing ovulation. The results suggest that excessive LH secretion and/or impaired FSH secretion may be etiologically significant in PCO but do not clearly differentiate whether the stimulus for this pattern of gonadortopin secretion occurs at the hypothatamic or pituitary level.
Amenorrhea↗
Induction of timed ovulation with synthetic luteinizing hormone-releasing hormone in women undergoing insemination therapy. I. Effect of a single parenteral administration at midcycle.
Synthetic LH-RH was administered by various routes to 19 patients during 37 treatment cycles in an attempt to trigger ovulation in association with insemination therapy. Thirty-five cycles were ovulatory; four pregnancies occurred, but two of them ended in spontaneous abortion. In 20 cycles, the hyperthermia response occurred one to three days after LH-RH administration, suggesting that ovulation occurred as a direct consequence of administered LH-RH. Low levels and delayed peak secretion of progesterone were found in two patients who had serial progesterone determinations during the luteal phase after LH-RH administration. Ovulation timing with LH-RH appears feasible, but efforts to ensure the availability of a mature follicle are required.
Abortion, Spontaneous↗
Sixteen years' experience with therapeutic donor insemination.
Therapeutic donor insemination was performed in 107 "normal" patients, using an intracervical technique and two inseminations per cycle on alternate days. Seventy-seven patients became pregnant (71.9%), and 103 conceptions occurred. Of these pregnancies, 72.8% occurred in the first 3 months of treatment and 95.2% occurred within 6 months. The spontaneous abortion rate was 18.4% The number of females born was slightly higher (54%) than the number of males (46%). There was one complication in this series (acute pelvic inflammatory disease), most probably due to inadvertent intrauterine (endometrial) insemination.
Abortion, Spontaneous↗
The sequence of pituitary responses to synthetic luteinizing hormone releasing hormone (LH-RH) throughout the normal menstrual cycle.
Thirty-one ovulatory women between 20 and 33 years of age were given 150 mug of synthetic LH-RH during different phases of the menstrual cycle. Five patients were studied during the early follicular phase (days 4-7); 10 patients during the late follicular phase (days 9-12); 6 patients during the "LH Surge"; 5 patients during the early luteal phase (days 14-16); 3 patients during mid-luteal phase (days 17-21); and 2 patients during late luteal phase (days 22-27). Oestrogen, progesterone, FSH and LH levels were determined from 30 min prior to LH-RH administration to 90 min thereafter in all cases. LH response to LH-RH increased progressively during the follicular phase. Enhanced pituitary responsiveness to LH-RH occurred at mid-cycle for both LH and FSH and maximum LH responses occurred during the "LH Surge" and early luteal phase. LH responses during the mid and late luteal phases were similar to late follicular phase responses. There were no significant differences between FSH responses during the early follicular, late follicular, mid-luteal and late luteal phases. Maximum pituitary responsiveness appears to occur in a gonadal steroid milieu of high oestrogen levels in association with rising but low progesterone levels. Progesterone or a crucial oestrogen: progesterone ratio may in fact potentiate pituitary release of LH during the early stages of corpus luteum formation. Pituitary responsiveness to LH-RH correlates positively with basal LH and oestrogen levels during the menstrual cycle and with the oestrogen:progesterone ratio during the luteal phase.
Adult↗
Rapid hCG-specific radioimmunoassay for menstrual aspiration.
Fifty-one women with missed periods ranging from 5 to 14 days who suspected a pregnancy underwent an aspiration curettage with a flexible soft-tipped cannula attached to a Karman-type syringe. Sera from these women were measured for human chorionic gonadotropin (hCG) by a rapid 2-hour solid phase radioimmunoassay using an antibody with a specificity for the beta subunit of hCG. The sensitivity and specificity of this assay insured detection of bCG with 100% accuracy at the time of the missed period. Of the 51 women, 33 (64.7%) were found to have hCG in their serum, and 29 (56.8%) had histologic evidence diagnostic of pregnancy.
Abortion, Induced↗