Preovulatory rise in progesterone.
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Biomedical subjects
Publications and source records attributed to Z Bognár.
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Noradrenaline (NA), serotonin (5HT), dopamine (DA), FSH, LH and prolactin (PRL) content was determined in 104 preovulatory follicular fluids obtained from 44 patients undergoing in vitro fertilization. The patients were given human menopausal gonadotropin (HMG) for ovarium stimulation, ovulation was induced with 10000 IU human chorionic gonadotropin (HCG) 34-36 hours prior to the follicular aspiration by vaginal ultrasound. Classification of the oocytes was performed by direct microscopic evaluation differentiating three groups of oocytes: Group I.: prophase I; Group II.: metaphase I; Group III.: metaphase II. There was no significant difference in monoamine and FSH content of follicular fluid at different stage of the oocyte maturation. LH and PRL significantly increased parallel with oocyte maturation (38.9; 48.8; 56.7 IU/l and 1324; 2382; 3134 IU/l). significant negative correlation was observed in Group I. between 5HT-LH (r = -0.64); in Group II. between NA-LH (r = -0.62) and NA-PRL (r = -0.51). Significant positive correlation were found in Group I. between FSH-LH (r = 0.63), in Group II. between LH-PRL (r = 0.56), in Group III. between NA-5HT (r = 0.66), NA-DA (r = 0.80) and 5HT-DA (r = 0.66). These observations suggest that action of LH and PRL may be negatively modulated by 5HT and NA in the final stage of oocyte maturation.
In an in vitro fertilization (IVF) and embryo transfer program with human menopausal gonadotropin/human chorionic gonadotropin treatment no oocytes were recovered in 18 out of 788 cycles. Estradiol (E2), progesterone (P) and androstenedione contents of 27 follicles obtained from five of the 18 patients were radioimmunologically measured and P:E2 ratio calculated. Control values of 20 follicles were obtained from four of these five patients in subsequent IVF cycles. A total of 17 oocytes were harvested. Estradiol, progesterone and androstenedione mean +/- SEM values (nmol/l) were, respectively, 4246 +/- 1484, 3751 +/- 1768 and 1920 +/- 641 in the failed cycles and 2504 +/- 908, 13,678 +/- 4749 and 509 +/- 87 in the successful ones. P:E2 ratios were 0.88 +/- 1.03 and 5.67 +/- 1.70, respectively. The differences in these levels of progesterone, androstenedione and the ratios of P:E2 were significant (p < 0.01). It is concluded that the probable cause of 'empty follicles' is inappropriate luteinization and they are not characteristic for a given patient or for stimulation with human menopausal gonadotropin/human chorionic gonadotropin.
The authors measured the noradrenaline (NA), serotonin (5-HT) and dopamine (DA) content of 47 normally maturated and 16 cystically degenerated follicular fluid samples obtained from patients involved in the in vitro fertilisation and gamete transfer program. The patients were given human menopausal gonadotropin (HMG) as a superovulation treatment, and they were given 7500 IE human Chorionic Gonadotropin (HCG) to induce ovulation 34-36 hours prior to the follicular puncture done by laparoscope. The NA content of the normally developed preovular follicles is 11.4 +/- 8.4 micrograms/100 ml on average. For the cystically degenerated follicles the data are following: 1.1 +/- 0.7 micrograms/100 ml (p less than 0.001). 5--HT and DA for the preovulatory follicles are 14.3 +/- 8.9 micrograms/100 ml and 19.3 +/- 8.2 micrograms/100 ml respectively; at the same time for the cystically degenerated follicles they are 12.2 +/- 6.2 micrograms/100 ml, and 12.7 +/- 6.8 micrograms/100 ml respectively. They presume that the higher amount of NA in the follicular fluid might play an important role in the mechanisms of ovulation, the regulation of postovulatory tubal motility, and the release of progesterone from granulosa cells.
Due to diagnostic methods of the last decades, such as laparoscopy, ultrasonography and radioimmunoassays, early diagnosis of pregnancy and also of ectopic pregnancy became available. Management of ectopic pregnancy has been conservative tubal surgery so far. Local Methotrexate treatment of ectopic pregnancy was reported only recently. The authors treated successfully two cases of ectopic tubal pregnancy with locally administered 50 mg Methotrexate. One of the tubal pregnancies occurred after IVF, and the other one following GIFT. After local Methotrexate treatment both patients are without any complaints or symptoms. This new method in the treatment of early diagnosed ectopic pregnancy is emphasized and prosed.
On the basis of literary data and of own experience the author deals with protocols concerning hyperstimulation in the in vitro fertilization and embryonic transfer cases as well as with the endocrine monitoring of superovulatory cycles. The IVF and ET programs widen our knowledge most spectacularly in the fields of follicle maturation, cycle endocrinology, and early processes of reproduction. When discussing the theoretical and practical aspects of various superovulatory treatments, the principal differences between the natural and hyperstimulatory sexual cycles are emphasized. Because of these differences and of the nature of the IVF-ET procedure, the importance of the traditional cycle diagnostics is necessarily limited. More important diagnostic possibilities are the daily quick hormone measurements by RIA methods, the hemagglutination tests, ELISA, and ultrasound examinations.
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A population based survey of women who had spontaneous abortion in Hungary between 1971 and 1980 has been evaluated. Individual data sheets completed by specialists in obstetrical institutions were used. The ratio of spontaneous abortions was 13.1% during the whole period studied but declined during the decade. The maximum occurrence was in the fifth to eighth week of gestation, when more than 40% of all spontaneous abortions occurred. Thereafter spontaneous abortion ratios decreased gradually with duration of pregnancy. The distribution of spontaneous abortions by calendar month shows characteristic seasonal changes, the minimum values being found from April to July whereas the maximum values were from October to February. The spontaneous abortion ratios increased significantly with the age of mother, over age 40 it approached 50%. They also increased with the pregnancy order, a minimum figure being registered at the first pregnancy of women in their 20s. The risk for women with a history of spontaneous abortion was 33%.
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The following conclusions were drawn from thorough checks of anatomic, histological and clinical data as well as from palpation findings and their statistical evaluation regarding the function of ligamentum rotundum in pregnant uterus: 1. Changes of the round ligament were found to be correlated with the occurrence of various forms of labour insufficiency as well as of abnormal presentation and position. Such pathological conditions would be attributable to developmental anomalies of the round ligament, its instability, and cicatrisation following inflammation and surgery and resulting asymmetrical position of the uterus. --2. Clinical experiences obtained by the author is likely to suggest that pathological position of the round ligament would rule out spontanous labour.
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Report of a rare case of unilateral fallopian twin pregnancy in which the fetuses had been arrested in the uterine tube left in place at an earlier operation by reason of ectopic pregnancy.
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