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Clomiphene citrate in the management of infertility associated with shortened luteal phases.

Repetitively short luteal phases were found in eight infertile women. The short luteal phase was defined as 10 days or less from the presumed time of ovulation (as assessed by basal body temperature recording) to the onset of menses. Clomiphene citrate (Clomid) therapy resulted in pregnancy in two patients and lengthened the luteal phase in the other six. Ultimately, seven of eight patients conceived during Clomid therapy. Clomid therapy can lengthen the luteal phase in patients with luteal temperature elevation of 10 days or less. The occurrence of short luteal phases may be associated with infertility.

Anovulation

Time relationships between basal body temperature and ovulation or plasma progestins.

The basal body temperature (BBT) curve and the estimated time of ovulation, defined by the onset of gonadotropin preovulatory discharge, were analyzed in 38 spontaneous cycles. The BBT nadir was usually located at the beginning of the luteinizing hormone surge, and the first high point was 8 hours after ovulation, which was itself usually at the time when the temperature passed 37 degrees C. This temperature rise was related to the increases in plasma progesterone and 17-hydroxyprogesterone with 24 to 36 hours' delay. The BBT was found to be an unreliable technique for precise ovulation timing but would be of use if the clinical precision required for the diagnosis of ovulation were less.

17-alpha-Hydroxyprogesterone

An automatic electronic device (Rite Time) to detect the onset of the infertile period by basal body temperature measurements.

Two trials of an electronic thermometer (Rite Time), designed to record and interpret basal body temperature (BBT) patterns in normal ovulating women, are described. A total of 140 menstrual cycles from 34 women, who used the thermal or symptothermal methods of natural family planning, were studied. Rite Time gave a signal for the start of the infertile period in 117 cycles, of which 114 (97%) appeared to have occurred at appropriate times. Further studies using hormonal and ultrasound reference points for ovulation were carried out in 21 cycles. Rite Time generally produced BBT patterns of quality acceptable for interpretation of the periovulatory BBT shift. About one-half of the volunteers said that they would be willing to replace their conventional charting methods with Rite Time.

Body Temperature

Attributes of the oral cavity as a site for basal body temperature measurements.

The thermal topography of the oral cavity of 11 women was mapped with thermocouples in early morning waking conditions. A reference thermocouple was placed in the vagina. No significant difference was found in the time required to reach a steady-state oral temperature and in the achieved steady-state temperature difference (Tv-To) in the preovulatory and postovulatory phases of the menstrual cycle. Location of the thermocouple in the oral cavity had a significant effect on steady-state temperature differences. After equilibration of oral thermometers, women breathed through their mouths for exactly five minutes. Mouths were closed and a second temperature equilibration phase was recorded. Mouth breathing had a significantly greater effect on the temperature of the anterior sublingual and dorsum of the tongue sites than on the posterior sublingual and buccal trough sites.

Adult

Reliability of urine temperature as a measurement of basal body temperature.

Natural family planning is based on the recognition of physiologic signs and symptoms that identify fertile and infertile phases of the menstrual cycle. Identification of the onset of the infertile period can be determined when the upward shift in basal body temperature (BBT) has occurred. A study was conducted to determine if the temperature of the first-morning voided urine adequately represents BBT. In 22 subjects, vaginal temperature, taken immediately upon awakening, was compared with first-morning voided urine temperature as measured continuously by thermocouples mounted in either of two flow-through devices attached to a toilet bowl. A significant correlation was found between the two temperatures. The convenience and hygiene of the method together with the reliability of urine temperature as an estimator of BBT could reduce the generally high rate of noncompliance of women choosing this natural method of family planning.

Adult

A statistical approach to the determination of the fertile period.

17 beta-Estradiol (E2), basal body temperature (BBT) and luteinizing hormone (LH), were measured in normally menstruating women. The preovulatory E2 observations were characterized by variations about a constant level during the preovula-peak. The BBT observations typically varied about a constant level during the preovulatory phase then about a higher constant level during the postovulatory phase. The change points in E2 and BBT were detected using a Bayesian detection rule and a midcycle 'fertile period' was marked off. The midcycle 'fertile periods' appear to bracket the ovulation event and the method shows promise as a natural family planning method. Several practical limitations of the method are discussed.

Bayes Theorem

Basal body temperature as a method of ovulation detection: comparison with ultrasonographical findings.

In 47 cycles with hormonal evidence of ovulation, the detection and timing of ovulation by basal body temperature (BBT) and by ultrasonographical observation are compared. The ovulation detection rate by ultrasonographical method proves to be considerably higher than by BBT criteria. The timing of the day of ovulation is evaluated, assuming that the ultrasonographical event of follicle disappearance represents ovulation. BBT criteria nadir, coverline and the eye-balling method show a very poor frequency distribution. The result of the FDHP method is a nearly symmetrical distribution, however, with a considerable range. We conclude that ovulation detection and timing by BBT are not reliable.

Body Temperature

Effects of two estradiol/norgestrel combinations on the ovulatory pattern and on sex hormone binding globulin capacity in women around forty years of age.

Thirteen women aged 36-46 years (mean 43) who were seeking contraceptive advice, were monitored for 3 months with basal body temperature (BBT) and were then treated for 3 months with CyclabilR (11 tablets of 2 mg estradiol valerate (E2) followed by 10 tablets of 2 mg E2 + 0.5 mg norgestrel). This treatment was immediately followed by another 3 months with CyclabilR + 2 mg E2. BBT revealed a spontaneous ovulatory rate of 89%. Cyclabil reduced the ovulatory rate, as measured with repeated serum progesterone analyses, to 37%, and Cyclabil + 2 mg E2 resulted in a marked reduction in the number of ovulations (3%). Both types of hormonal combination resulted in relatively small changes in Sex Hormone Binding Globulin Capacity. It is concluded that the addition of 2 mg E2 to CyclabilR causes a decrease in ovulation rate to such an extent that women using this combination run a relatively small risk of conceiving. One advantage over contraceptive steroids may be that the present combination contains a natural estrogen at a relatively low concentration.

Adult

The value of the basal temperature chart in the management of infertility.

The basal temperature chart (BTC) has been used as a means of screening the ovarian function of infertile patients and for monitoring their response to ovarian stimulation. During three years in a busy infertility clinic, specifically designated for cases of functional infertility, 491 patients were seen and 96 per cent of them kept valid basal temperature charts. The use of the BTC enabled therapy to be instituted early on in the course of investigations in those cases of infertility in which there was an endocrine factor. There were 420 patients in this category; of those who received treatment a high percentage became pregnant in contrast to those who were being observed. It is recommended that the BTC should be used early and more frequently in the management of cases of infertility, since it has been shown to serve as an inexpensive and convenient parameter of ovarian function.

Anovulation

Temperature analysis.

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Body Temperature

Conditioning exercise decreases premenstrual symptoms. A prospective controlled three month trial.

Conditioning exercise decreased premenstrual symptoms during 3 months of a prospective controlled training study. Eight women with normal ovulatory menstrual cycles began a running exercise training programme while completing intensity-graded questionnaires concerning molimina. Six sedentary control women followed the same protocol for 3 months but did not exercise. Oral basal temperatures evaluated by mean temperature analysis were obtained for all cycles. Exercise distance and time, average exercise heart rate, basal and maximal heart rate and body weights were recorded prospectively and evaluated during the control (0) and 3rd month of the study. Mid-luteal phase progesterone and estrogen levels were sampled during the analyzed cycles for the exercise group. Molimina did not change over 3 months time in the control group. The exercise group, after increasing distance run to 51.0 +/- 18.1 km/cycle at 3 months, showed decreases in overall molimina (scores on a 9-point scale) 6.5 +/- 1.8 to 3.5 +/- 0.9, p less than 0.01). Breast symptoms decreased from 8.3 +/- 0.7, p less than 0.005. Fluid symptoms also decreased from 7.3 +/- 1.8 to 5.5 +/- 0.9, p less than 0.025. Menstrual cycle intervals, luteal lengths, body weights and mid-luteal estrogen and progesterone levels were normal and unchanged. Moderate exercise training without major weight, hormonal or menstrual cycle alteration significantly decreased premenstrual symptoms.

Adult

Assessment of myocardial blood flow by real-time infrared imaging.

In order to evaluate the applicability of infrared imaging for the assessment of myocardial perfusion, 10 open-chested dogs were studied by a real-time infrared imaging system. The left anterior descending coronary artery was occluded for 90 min followed by 210 min of reperfusion. During the experiment, myocardial surface temperature was mapped by an infrared imaging system with a thermal resolution power of 0.1 degree C and correlated with regional myocardial blood flow measured using radiolabeled microspheres. Following the experiment, acute myocardial injury was evaluated using triphenyltetrazolium chloride staining. After 90 min of ischemia, there was a significant correlation between myocardial blood flow and myocardial surface temperature (R = 0.694, P less than 0.001). After reperfusion, temperature did not correlate with blood flow, but there was a significant correlation between temperature and ischemic myocardial injury (R = 0.551, P less than 0.05). Temperature changes during acute regional ischemia and reperfusion may be regulated by the changes in myocardial blood flow and myocardial metabolism. Temperature analysis using real-time infrared imaging may be a useful means for the evaluation of myocardial blood flow and myocardial injury during ischemia and reperfusion.

Animals

Enzymatic and envelope-converting activities of pars recta oviductal fluid from Xenopus laevis.

Conversion of the coelomic egg envelope to the vitelline envelope of the Xenopus laevis egg is known to take place in the pars recta (PR) region of the oviduct. A method for collecting fluid generated from PR cultured in vitro was devised which enhanced the recovery of envelope-converting factors. By the criteria of melting temperature analysis, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, 125I labeling, ferritin binding, and in vitro fertilization assays, the secretions collected from PR cultured in vitro were capable of modifying the envelope in a manner analogous to that which occurred in vivo, including the limited hydrolysis of one envelope glycoprotein. Hydrolytic activities present in PR fluid were assayed with a number of peptide and carbohydrate substrates. Enzymes which hydrolyzed t-butyloxycarbonyl-Leu-Ser-Thr-Arg-methylcoumarylamide, t-butyloxycarbonyl-Phe-Ser-Arg-methylcoumarylamide, and t-butyloxycarbonyl-Val-Leu-Lys-methylcoumarylamide were found to be present in PR fluid at levels elevated by threefold or more over amounts found in a comparable volume of blood plasma.

Amino Acid Sequence