The predictive value and the management of cycles with low initial estradiol levels.

This study was undertaken to examine the predictive value of low estradiol (E2) after 5 days of human menopausal gonadotropin (hMG) stimulation response to therapy in that cycle. We further examined whether the outcome of such cycles can be improved by increasing the hMG dose. When 18 cycles in which day 8 E2 was less than or equal to 50 pg/mL were compared with 48 cycles with corresponding E2 levels of 51 to 150 pg/mL, the former showed a significantly worse response to subsequent hMG therapy.

Femoral neuropathy after laparoscopy. A case report.

Femoral neuropathy has been reported to occur after abdominal hysterectomies and has been related to nerve compression by abdominal wound retractors. We report a case of a 35-year-old woman with infertility who developed unilateral femoral nerve palsy after laparoscopy and hysteroscopy. This rare complication, secondary to extreme flexion, abduction and lateral rotation of the hip joint, can be prevented by careful preoperative patient positioning.

Ureteral injuries at laparoscopy: insights into diagnosis, management, and prevention.

The increasing use of laparoscopy as a therapeutic method mandates a reappraisal of the risks involved. Complications frequently described include injuries to the large and small bowels, bladder, and blood vessels. The world literature reports only eight cases of ureteral injury at laparoscopy.

Evidence of gonadal and gonadotropin antibodies in women with a suboptimal ovarian response to exogenous gonadotropin.

Failure to respond to human menopausal gonadotropin (hMG) with adequate ovarian stimulation is associated with a poor prognosis in subsequent cycles in women participating in an in vitro fertilization/embryo transfer program. Sera from 26 menstruating women (mean age 38 +/- 4.3 years) identified as "low responders" with either tubal or male factor infertility, mean baseline FSH values of 11 mIU/mL, and peak serum estradiol levels lower than 300 pg/mL were assessed for specific antibodies to human ovary and gonadotropins.

Luteal rescue in in vitro fertilization-embryo transfer.

The luteal phase hormone profiles of two groups participating in the Yale in vitro fertilization (IVF) program were compared. A control group (group I) consisted of 28 women (28 cycles) who received our standard ovulation induction regimen (no luteal phase support). The treatment group (group II) consisted of 40 women (42 cycles) who were prospectively studied after receiving luteal phase support with 10,000 IU human chorionic gonadotropin (hCG) 5 days after the initial hCG dose.

Manifestation of diabetes mellitus on mouse follicular and pre-embryo development: effect of hyperglycemia per se.

Animal models of diabetes mellitus during pregnancy have repeatedly suggested that maternal hyperglycemia was teratogenic during organogenesis, and thus may contribute to diabetic teratogenesis. However, little attention has been focused on the effects of hyperglycemia on pre-organogenic development. In this report, we examine the effect of hyperglycemia (950 mg glucose/dL) on the development of mouse pre-embryos in vitro.

Unsuspected leiomyosarcoma: treatment with a gonadotropin-releasing hormone analogue.

We present a case of a 46-year-old woman evaluated for abnormal uterine bleeding and an enlarged uterus, with normal endometrial sampling. Three months of leuprolide acetate injections resulted in a nonenlarging uterus and resolution of iron deficiency anemia and menorrhagia. Intraoperative examination suggested leiomyosarcoma, which was confirmed by postoperative permanent histologic sections.

Ovarian antibodies detected by immobilized antigen immunoassay in patients with premature ovarian failure.

An enzyme-linked immunosorbent assay (ELISA) was used to detect ovarian and oocyte antibodies in serum from 45 patients with premature ovarian failure (POF). Control sera were obtained from a similar group of normally cycling women without POF. A specific antibody reaction was found when POF sera were tested against human ovary (47%) or oocytes (47%).

Ovarian cysts decrease the success of controlled ovarian stimulation and in vitro fertilization.

Forty cystic structures, 16 to 60 mm, of probable ovarian origin were found in 126 cycles during an ultrasound scan on day 3 of a cycle in which in vitro fertilization was planned. The response of these patients to exogenous gonadotropin stimulation, oocyte capture, fertilization, cleavage, and pregnancy was studied. Patients with cystic change had significantly lower peak estradiol (E2) levels.

A critical assessment of the indications for in-vitro fertilization and embryo transfer.

In-vitro fertilization therapy (IVF-ET) should be considered an important and indispensable component of all comprehensive infertility treatment programmes. It is neither more, nor less important than operative laparoscopy, hysteroscopic diagnosis, a broad-based programme for ovarian stimulation and ovulation induction or even psychological counseling. Clearly, with today's technology, IVF-ET is not a panacea of infertility, but in selected cases it may provide a child where other forms of therapy have failed.

Reduced bone mass in reproductive-aged women with endometriosis.

Cortical and trabecular bone masses were measured by quantitative computed tomography of the distal radius in 41 women (30 +/- 1 yr) with endometriosis documented by laparoscopy and compared to those in 35 normal women (32 +/- 1 yr). Hormonal status was assessed, and a subset of 10 women with endometriosis underwent evaluation of calcium absorption and excretion. Menstrual cycles were regular in all women, and hormonal medication had not been administered during the 3 months before evaluation.

The effect of naloxone and metoclopramide on the hypothalamic pituitary axis in oligomenorrheic and eumenorrheic swimmers.

Eight highly competitive swimmers were followed over a 9-month period during a vigorous training schedule. When compared, four oligomenorrheic (group I, greater than 60 days without menses) and four eumenorrheic (group II) swimmers were not significantly different for age, years of training, body fat, intensity of training, and baseline estradiol (E2) levels. Both groups were challenged during the peak of their training schedule with 10 mg of naloxone and 10 mg of metoclopramide.

Human chorionic gonadotropin, estradiol, and progesterone profiles in conception and nonconception cycles in an in vitro fertilization program.

In 22 consecutive in vitro fertilization cycles stimulated with purified follicle-stimulating hormone, human chorionic gonadotropin (hCG), estradiol (E2), and progesterone (P) were measured every 3 days during the luteal phase. All serum measurements were normalized to the day of hCG administration (day 0). There was a total of nine pregnancies; two were biochemical pregnancies, whereas 7 of the 22 women had clinical pregnancies (31.

Cocaine use and acute rupture of ectopic pregnancies.

The hemodynamic changes associated with ingestion of cocaine may precipitate rupture of ectopic pregnancy. Two cases are presented in which this association was suspected. We believe this to be the first report of this clinical entity, representing a risk factor that should be identified in patients with suspected ectopic pregnancy.

Pelvic trophoblastic implants after laparoscopic removal of a tubal pregnancy.

Laparoscopic removal of ectopic gestations is becoming increasingly popular. We present a case in which an early, unruptured ampullary ectopic pregnancy was identified clinically, removed during laparoscopy, and subsequently confirmed by pathology. The patient later presented with pain and with rising titers of beta-hCG.

Laparoscopic treatment of ectopic pregnancy.

Over the last decade and a half the success and safety of endoscopic surgery for ectopic pregnancy has been established. Shapiro and Adler (1973) reported laparoscopic salpingectomy using electrocoagulation followed by excision. Soderstrom (1981) followed with the snare technique of salpingectomy.

Multiple consecutive cycles of ovulation induction with human menopausal gonadotropins.

Human menopausal gonadotropins were administered in multiple repetitive cycles for ovulation induction. Ovarian response, as judged by peak E2 levels and the day of hCG administration, remained similar in 3-12 immediately successive cycles. We conclude that hMG can be administered in multiple successive cycles without clinically impairing ovarian response.

The association between chlamydial-specific IgG and IgA antibodies and pregnancy outcome in an in vitro fertilization program.

Chlamydial-specific IgG and IgA antibodies were determined by a single serovar (L2) immunoperoxidase assay (IPA) in the serum of all patients that have conceived in an in vitro fertilization and embryo transfer (IVF & ET) program (n = 106) and in a group of patients that went through the program at the same period of time and did not conceive (n = 94). The prevalence rate of elevated IPA IgG (titers greater than or equal to 1:128) and IPA IgA (titers greater than or equal to 1:16) specific to chlamydiae was significantly higher (P less than 0.001) in the IVF & ET pregnancy loss and nonconception groups ("failures") versus the IVF & ET term pregnancy group ("successes") (74 vs 47%, odds ratio = 4.

The effect of prefreeze in vitro culturing on the success of embryo freezing in mice.

There is currently a controversy as to whether the prolonged in vitro culturing of embryos before freezing has a deleterious effect on their ability to survive freezing and thawing. We compared the survival rate of frozen/thawed mouse embryos after in vitro culturing, from the two-cell stage through the eight-cell, morula, and blastocyst stages, with the survival of embryos developed in vivo to the same stages. Following induced superovulation and mating, embryos in the desired cleavage stage were flushed from the oviducts and/or uterus and either cultured in vitro or frozen immediately in sterile glass ampoules to -40 degrees C and plunged into liquid nitrogen for storage.

Hysteroscopic management of uterine bleeding.

Hysteroscopy provides a means of accurately diagnosing and treating most forms of abnormal uterine bleeding. Submucous myomas and endometrial polyps may be easily removed with the resectoscope. If the myomas are large, pre-treatment with GnRH agonists will shrink the tumours, and facilitate hysteroscopic removal.

Effect of norgestrel on development of mouse pre-embryos.

The effect of synthetic progestins found in oral contraceptives has potential implications for developing embryos in women who receive oral contraceptives during early pregnancy. We assessed the effect of the progestin norgestrel on the developing pre-embryo. B3C6F1 mice were given 5 IU PMSG followed by 5 IU hCG 48h later.