Does growth hormone-releasing factor assist follicular development in poor responder patients undergoing ovarian stimulation for in-vitro fertilization?

Treatment with growth hormone-releasing factor (GRF) has been reported to improve the ovarian response to gonadotrophins in women who respond poorly to ovarian stimulation during in-vitro fertilization (IVF). The efficacy and tolerability of GRF were studied in a randomized, double-blind, placebo-controlled trial involving 196 patients. Following down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), patients were randomized to receive GRF (500 microg twice daily; n = 96) or placebo (n = 100) in addition to follicle stimulating hormone (FSH); treatment was continued until human chorionic gonadotrophin was given, or for a maximum of 14 days. GRF had no significant effect on the mean number of follicles with a diameter of >/=16 mm (GRF: 3.26 +/- 2.29; placebo: 3.27 +/- 2.30; P = 0.95), the number of FSH ampoules required to achieve ovarian stimulation (GRF: 55.2 +/- 16. 4; placebo: 54.9 +/- 17.2; P = 0.50), or on secondary measures of ovarian response and treatment outcome. There were, however, significant increases in circulating growth hormone (GH) and insulin-like growth factor (IGF)-1 concentrations. GRF was well tolerated. It is concluded that, despite producing significant increases in GH and IGF-1, concomitant treatment with GRF does not improve the ovarian response to FSH in poorly responsive women undergoing IVF.

Practice management for ovulation induction.

The use of Pergonal at a fixed dosage was evaluated in 200 women. The primary monitoring mode was vaginal ultrasonography. The overall pregnancy rate was 59% (118/200). The rates of multiple birth, hyperstimulation, spontaneous abortion and ectopic pregnancy were evaluated, also. The use of this regimen in private practice appears to be safe and effective.

Tubal reanastomosis: a comparison between microsurgical and microlaser techniques.

In order to evaluate the effect of the carbon dioxide laser as an adjunct to conventional microsurgical techniques, the authors retrospectively reviewed the charts of 53 patients who underwent tubal reanastomosis after elective sterilization. Thirty-two patients had non-laser microsurgical reanastomosis from 1981 to 1985; 21 patients had microlaser tubal reanastomosis from 1983 to 1985. All patients had unprotected intercourse for at least 1 year. In the non-laser group, 15 were known to have conceived, and in the laser group, eight had conceived; success rates were 43.7% and 42.9%, respectively. It is concluded that the carbon dioxide laser's advantages (precision, hemostasis, and the ability to preserve more normal reproductive tissue), although technically beneficial in performing microsurgical tubal reanastomosis, may not prove to be superior to conventional microsurgical technique as pregnancy rates are compared. Additional long-term studies are needed as more experience is gained to further delineate the role of the carbon dioxide laser for microsurgical tubal reanastomosis.

The effect of aqueous progesterone on operative adhesion formation.

Progesterone (P) has been shown to have antiinflammatory and immunosuppressive properties. This study was designed to evaluate these effects on operative adhesion formation. Forty guinea pigs received standardized injuries to their uterine horns. Four groups were examined. Normal saline was used as an irrigant in the first, or control, group. Aqueous P (50 mg or 1 ml) was dripped over the injured site and instilled intraperitoneally in the second group. The third group received intramuscular aqueous P (3.3 mg/kg body weight) 1 day postoperatively, the day of surgery, and either 6 or 13 days postoperatively until reexploration. In the fourth group 1 ml of 32% dextran 70 (Hyskon) was administered in the same manner as aqueous P in the second group. The animals in all groups were reexplored 1 or 2 weeks after the initial surgical procedure, and the adhesions were scored. Adhesion formation was significantly reduced (P less than 0.001) in all treatment groups when compared with the control group. Aqueous P may have a role in the prevention of adhesion formation associated with pelvic surgery and, in particular, microscopic tubal and ovarian surgery.

The effect of copper in vivo on specific progesterone binding by human endometrial cytosol.

Copper has been shown to interfere with specific progesterone binding by human endometrial and myometrial cytosol in vitro. These results suggested that one possible mode of action of the copper-bearing intrauterine devices (IUDs) is through interference with the action of progesterone at its target sites. A prospective study was carried out to determine whether the proposed mode of action of copper-bearing IUDs could be demonstrated in vivo. The results of this study revealed a significant difference in specific progesterone-binding capacity between proliferative and secretory endometria (P less than 0.001). However, when secretory endometria of the controlled subjects were compared with those of the copper-bearing IUD wearers, no significant difference was observed in the specific progesterone-binding capacity (P greater than 0.2). These data suggested that copper released from copper-bearing IUDs in vivo may not interfere with the binding of progesterone to its receptors in vitro. It is doubtful that the contraceptive effectiveness of copper-bearing IUDs could be due to the ability of copper to prevent progesterone from exerting its full effects on the endometrium.

The Sertoli cell in mixed gonadal dysgenesis.

Since 1937, over 100 cases of mixed gonadal dysgenesis have been described. Thus far, no correlation has been made between the light and electron microscopic morphology of the gonad and the appearance of the ipsilateral internal genitalia. In the case presented in this paper the presence or absence of the Sertoli cell in the ipsilateral gonad correlates with the morphology of the internal genitalia on that side.

Androgen, estrogen, and progesterone by a lipid cell tumor of theovary.

In a 64-year-old woman with a virilizing lipid-cell tumor of the left ovary, serum progesterons, androgens, estrogens, and cortisol levels in the peripheral and ovarian veins were measured. Although virilization was the only symptom of hormone production by the tumor in this patient, endocrine studies showed that several steroids were secreted by this neoplasm. Of the steroids measured, androstenedione was the principal secretory product. Pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone, and testosterone were also secreted, but in quantities which were one third to one sixth the amount of androstenedione. The tumor's pattern of hormone secretion was similar to patterns of steroid production by ovarian stromal cells found in previously reported in vitro studies. This case and a review of the literature demonstrate that androstenedione appears to be the predominant secretory product of lipid cell tumors, whereas testosterone is the predominant secretory product of hilus cell tumors.

Nonpuerperal inversion of the uterus by endometrial stromal sarcoma of the uterine fundus.

Nonpuerperal inversion of the uterus is rare; the 69th such case in the English literature is reported. Although caused most frequently by submucous leiomyoma, nonpuerperal uterine inversion may be caused by carcinoma or, as in this report, a sarcoma of the uterine fundus. For optimal therapy and to reduce surgical complications, the correct preoperative diagnosis of uterine inversion and any concomitant disease is mandatory.