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PubMedDate not supplied

Effects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trial.

BACKGROUND: Women with oligomenorrhea and polycystic ovaries show a high incidence of ovulation failure perhaps linked to insulin resistance and related metabolic features. A small number of reports shows that inositol improves ovarian function. Futhermore, in these trials the quality of evidence supporting ovulation is suboptimal, and few studies have been placebo-controlled. The aim of this study was to use a double-blind, placebo-controlled approach with detailed assessment of ovarian activity (two blood samples per week) to assess the validity of this therapeutic approach in this group of women. METHODS: Of the 283 patients randomized, 2 withdrew before treatment commenced, 147 received placebo, and 136 received inositol (100 mg, twice a day). The women which discontined the study prematurely were more numerous in the treatment group (n = 45) than the placebo group (n = 15; P < 0.05). RESULTS: The ovulation frequency estimated by the ratio of luteal phase weeks to observation weeks was significantly (P < 0.01) higher in the treated group (23%) compared with the placebo (13%). The time in which the first ovulation occurred was significantly (P < 0.05) shorter [23.6 d; 95% confidence interval (CI), 17, 30; compared with 41.8 d; 95% CI, 28, 56]. The number of patients failing to ovulate during the placebo-treatment period was higher (P < 0.05) in the placebo group, and in most cases ovulations were characterized by normal progesterone concentrations in both groups. The effect of inositol on follicular maturation was rapid, because the circulating concentration of E2 increased only in the inositol group during the first week of treatment. Significant (P < 0.01) weight loss (and leptin reduction) was recorded in the inositol group, whereas in the placebo group was recorded an increase of the weight (P < 0.05). A significant increase in circulating high-density lipoprotein was observed only in the inositol-treated group. Metabolic risk factor benefits of inositol treatment were not observed in the morbidly obese subgroup of patients (body mass index > 37). No change in fasting glucose concentrations, fasting insulin, or insulin responses to glucose challenge test was recorded after 14-wk of inositol and placebo therapy. There was an inverse relationship between body mass of the patients and the efficacy of the treatment. CONCLUSIONS: These data support a beneficial effect of inositol in improving ovarian function in women with oligomenorrhea and polycystic ovaries.

Adult↗
PubMed1976

A.I.D.--a review of 200 cases.

2OO consecutive cases of couples referred for A.I.D. are reviewed. The reasons for referral are given and the technique and donors are discussed. It is estimated that about 85% of women who receive donor insemination will achieve pregnancy if they presevere. Infertility factors are common in women who present for donor insemination and this usually takes the form of ovarian follicular deficiency, probably with non-ovulation. It is suggested that a biphasic basal temperature record or a secretory endometrium in the luteal phase are unreliable tests for ovulation.

Evaluation Studies as Topic↗
PubMed2000

Does hypoxia impair ovarian function in Bolivian women indigenous to high altitude?

Fertility appears to be reduced in at least some high altitude populations relative to their counterparts at lower elevations. Inferring from the difficulties with reproduction of newcomers to high altitude and from animal experiments, it has been hypothesized that this apparent reduction is the result of hypoxia acting to reduce fecundity and/or increase fetal loss. In humans, however, several behavioral as well as biological factors may affect fertility levels. These many factors have been organized by demographers into a framework of seven proximate determinants that includes fecundability (the monthly probability of conception) of which successful ovulation is one component. To test whether ovarian function is impaired in women indigenous to high altitude, we measured salivary progesterone (P) in a sample (n = 20) of Quechua women (aged 19-42 years) residing at 3,100 m. It was found that mean luteal P = 179 pmol/L and mean midluteal P = 243 pmol/L, levels that fall about midway in the range of known values for several populations and are higher than some lower altitude populations. These findings suggest that hypoxia does not appear to significantly impair ovarian function in those with lifelong residence at high altitude. There are, however, several factors common to many high altitude populations that may act to reduce fecundability and fertility including intercourse patterns (affected by marriage and migration practices), prolonged lactation, dietary insufficiency, and hard labor.

Adult↗
PubMed1987

[Role of pulsatile liberation of gonadotropins in the development of amenorrhea].

The authors performed serial gonadotropin determinations of 25 patients with secondary amenorrhea. In addition repeatedly 17-beta-estradiol, prolactin, testosterone and progesterone determinations were carried out in every case, too. The cause of amenorrhea was hyperprolactinemia in 3 patients and elevated LH secretion (polycystic ovarian syndrome) in 5 other patients. In half of the remaining 18 cases the serial LH levels exhibited a decrease, as well as the physiological pulsation disappeared. Very low prepubertal estradiol secretion and negative gestagene and clomiphene tests were more likely at these patients. The medicinal treatment (Clostilbegyt, Pergonal, Choriogonin) was unsuccessful in more of half of the cases with restricted pulsatile pattern. According to the authors' the cessation of pulsatile LH activity results in the failure of ovarian function, in very low estradiol secretion and in lasting amenorrhea. The hormonal picture is similar to that observed during the prepubertal period (relatively high FSH level, low and tonic LH secretion). The insusceptibility of the adequate receptors in the hypothalamic-pituitary-ovarian system brings about often the failure of the clomiphene or gonadotropin treatment. Since the lack of endogenous gonadotropin-releasing hormone represents the basis of the disorder, the administration of luteinizing hormone-releasing hormone (LH-RH) in appropriate rhythm would be the solution for the patients.

Adolescent↗
PubMed1983

[Ovarian function in orthostatic idiopathic edema. Oral administration of progesterone and changes in capillary permeability].

The ovarian function was investigated in 30 women with postural idiopathic oedema by measuring plasma oestradiol and progesterone levels between the 21st and 23rd days of the menstrual cycle. Plasma progesterone concentrations were found to be lower than 5 ng/ml in 53% of the cases and than 10 ng/ml in 83%. The ovarian dysfunction most frequently observed was inadequate corpus luteum, i.e. progesterone deficiency with normal plasma oestradiol levels. In virtually all patients the initial disorder in capillary permeability, as evaluated by Landis' isotopic test, was fully corrected by progesterone administered orally. However, clinical improvement was less marked with treatments of short duration (2-3 consecutive cycles). In view of the complex pathogenesis of the disease, combined treatments in which progesterone might well play the major role are usually required.

Administration, Oral↗
PubMed1995

Prognostic assessment of ovarian reserve.

OBJECTIVE: To review the literature regarding diminished ovarian reserve, the screening techniques that are currently available, and their appropriate application in clinical practice. DATA RESOURCES: Directed Medline searches. RESULTS: Ovarian reserve screening identifies women with greatly diminished chances of achieving pregnancy. The screening techniques include the clomiphene citrate challenge test, basal day 3 FSH measurements, and the GnRH agonist stimulation test. All have been evaluated in assisted reproduction programs and the predictive values of an abnormal test for failing to conceive is very high. When abnormal, these tests allow physicians to counsel patients that their prognosis for conception is poor. Although the presence of a normal result does indicate better long-term chances for conception, an age-related decline in fecundity remains and patient age should still be considered when counseling patients with normal screening results. Clinicians are urged to validate the threshold values with the assay system used in their own laboratory before the application of these tests. CONCLUSION: The literature consistently demonstrates the value of diminished ovarian reserve screening.

Adult↗
PubMed1993

The significance of elevated FSH for reproductive function.

1. Women aged 40 or more with favourable hormone profiles can do well in assisted reproduction, while women of any age with basal FSH levels greater than 20 IU/litre will be poor responders to ovarian stimulation. 2. Basal FSH is an important predictor of ovarian reserve--levels over 25 IU/litre are rarely associated with ongoing pregnancy, and the best chance for pregnancy is an FSH between 10 and 20 IU/litre. 3. A basal E2 over about 50 pg/ml predicts poor ovarian reserve. 4. Age remains an important factor even when the FSH and E2 levels are known. 5. Optimal prediction involves simultaneous consideration of age, FSH, LH and E2. 6. Provocative tests of ovarian reserve are probably superior but are not as simple as static tests. 7. Defined risks of multiple pregnancy can be controlled by adjusting the number of pre-embryos transferred according to age and FSH levels. 8. Cases of otherwise unexplained infertility may be uncovered by evaluating basal FSH and E2 levels.

Adult↗
PubMed1987

Phase II trial of vinblastine in previously treated patients with ovarian cancer: a Southwest Oncology Group Study.

Sixty-eight patients with relapsing, epithelial type ovarian carcinoma were entered into a Phase II study of vinblastine. Vinblastine was administered as a continuous intravenous infusion over five days at a starting dose of 1.7 mg/m2/day every 3 weeks. There were 44 fully evaluable and 6 partially evaluable patients. Forty-one of these patients had had only one prior treatment regimen. Grade 3 or 4 leukopenia occurred in 12 patients (24%), but Grade 3 or 4 thrombocytopenia occurred in only 2 patients. There were two clinical complete responses of 18 and 36 weeks duration and one partial response of 6 weeks for an overall response rate of 7%. We conclude that vinblastine, administered in optimal dose and schedule, has little clinical activity in previously treated patients with ovarian cancer.

Drug Evaluation↗