Evaluation of serum prolactin levels in patients with endometriosis and infertility.

The aim of this study was to clarify the significance of serum prolactin concentrations in patients with infertility and endometriosis. Forty patients with infertility and laparoscopically proven endometriosis were recruited into the study. Basal serum prolactin levels and prolactin levels after TRH administration were measured. The mean basal serum prolactin concentrations were 12.5, 16.5, 19.5, and 26.5 ng/ml and those after thyrotropin-releasing hormone (TRH) administration were 88.3, 114.2, 125.3 and 138.8 ng/ml in patients with stages I, II, III and IV endometriosis, respectively. A statistically significant relationship was found between the basal serum prolactin levels as well as those after TRH injection and the stage of the endometriosis. The patients were divided in two groups. Group I consisted of 20 patients who did not receive any treatment, while group II consisted of 20 patients who were initially treated with GnRH analogues for 24 week and subsequently with several therapeutic schemes in order to improve their fecundity. The pregnancy rate was not different between the two groups. The patients, however, who did not become pregnant had higher serum prolactin concentrations after TRH administration as compared to those who conceived. We conclude that occult hyperprolactinemia may be a cause of infertility in patients with endometriosis.

Role of serum ceruloplasmin and its ferroxidase activity on preterm labor.

The role of serum ceruloplasmin and its ferroxidase activity on preterm labor with or without rupture of the membranes was studied. Thirty-seven primigravid women between 31 and 35 weeks of gestation were investigated. Our material is divided into 3 groups. Group A consisted of 12 patients with premature rupture of the membranes; group B consisted of 10 patients with preterm labor but intact membranes, and group C consisted of 15 non-laboring patients. Patients with rupture of the membranes presented with statistically significantly higher serum ceruloplasmin levels compared to those with preterm labor but intact membranes (p < 0.05) as well as to non-laboring patients (p < 0.01). On the contrary, the mean ferroxidase activity level or ceruloplasmin was 518.2+/-183.42, 460.9+/-198.8 and 517.5+/-142.01 micromol/l/min in groups A, B and C, respectively. These values were not significantly different. Our results show a loss of ferroxidase activity of ceruloplasmin in patients with rupture of the membranes and probably suggest a defect in the maternal defense mechanisms.

Results of the colposuspension operation in pre and postmenopausal incontinent women.

OBJECTIVE: To compare the results of Burch colposuspension in premenopausal and postmenopausal women with urinary stress incontinence (USI). METHODS: A total of 85 women with urodynamic diagnosis of genuine urinary stress incontinence were divided into two groups, according to their menstrual status (premenopausal and postmenopausal group). All of them underwent the Burch colposuspension procedure. Clinical and urodynamic data were compared preoperatively and postoperatively and between the two groups. RESULTS: Cure rate was significantly higher after Burch colposuspension in the premenopausal as compared to the postmenopausal patients (90.9 vs 73.1%, respectively, P < 0.01). A significant reduction of the diurnal and nocturnal frequency and urgency was noted in both groups postoperatively. The reduction of urgency was more prominent in the premenopausal women (P < 0.001). There were no statistically significant differences between the preoperative and postoperative values of bladder capacity, residual volume, maximal voiding pressure, peak flow rate, absolute urethral length, functional urethral length, urethral pressure and maximum urethral closure pressure both preoperatively and postoperatively within the groups and between the two groups. Comparing the two groups postoperatively, the pressure transmission ratios in the postmenopausal women were found to be significantly lower in the middle two quarters of the urethra as compared to the premenopausal patients (P < 0.001). CONCLUSION: Burch colposuspension for urinary stress incontinence has better cure rate in premenopausal than in postmenopausal women. Nevertheless, the above procedure remains an acceptable method for treatment of USI in postmenopausal patients.

Treatment of idiopathic oligozoospermia with an alpha-blocker: a placebo-controlled double-blind trial.

OBJECTIVE: To evaluate the efficacy of terazosin, an alpha-blocker, for the treatment of idiopathic oligozoospermia. PATIENTS AND METHODS: Thirty couples with infertility whose only detectable abnormality was male idiopathic subfertility entered the study. The diagnosis of idiopathic subfertility in all males studied, aged 26 to 38 years (mean 28.2 years), was confirmed after exclusion of any iatrogenic, systemic, congenital, infectious, autoimmune or endocrinological cause. In order to start with a baseline value before the study, at least three semen samples were evaluated in accordance with the WHO recommendation. Before initiation of treatment, blood samples were drawn for measurement of FSH, LH, testosterone, prolactin, dihydrotestosterone, and estradiol. Fifteen randomly selected patients (Group A) received 2 mg/d of alpha-blocker (terazosin), while another 15 (Group B) were administered an identically packed placebo tablet. Both groups received therapy for 6 months. RESULTS: The mean seminal volume changed insignificantly between the two groups (4.15 +/- 1.95 vs. 4.10 +/- 1.95). There was a statistically significant increase of the sperm concentration in patients who received the alpha-blocker compared to those receiving placebo (24.76 +/- 9.45 vs. 13.15 +/- 11.55 millions/mL; P < .001). No improvement of the mean percentage of abnormal spermatozoa was observed in the treated patients, nor a statistically significant difference of sperm motility in the treated group compared to the placebo group. Side effects were not observed in the patients receiving terazosin treatment, or were so minimal that therapy was continued. The pregnancy rates did not differ between the two groups to a statistically significant degree. CONCLUSION: The administration of terazosin to patients with idiopathic oligozoospermia has a demonstrably positive effect, especially on sperm concentration.

Gonadotropin-releasing hormone analogue plus hormone replacement therapy for the treatment of endometriosis: a randomized controlled trial.

OBJECTIVE: The aim of this study was to determine whether or not continuous combined HRT used with GnRH-a for the treatment of endometriosis can prevent hypoestrogenic side effects associated with GnRH-a. METHODS: Forty premenopausal women with laparoscopically proven endometriosis entered the study. The patients were randomized into two groups. Group I (n = 19) received 3.75 mg i.m. leuprolide acetate (LA) every 4 weeks for 24 weeks. Group II (n = 21) received 3.7 mg LA combined with 1.25 mg oral conjugated equine estrogen (CEE) and 5 mg oral medroxyprogesterone acetate (MA). RESULTS: Total revised AFS score as well as total pelvic pain scores decreased significantly (P < .001) in both groups. However, a statistically significant difference of hot flushes and sweating was reported by women receiving LA + HRT as compared to those treated with LA alone (P < .001). Furthermore, the bone loss at the lumbar spine was 4.2% in group I compared to 0.9% in group II at the end of the study. CONCLUSIONS: This study suggests that 1.25 mg CEE + 5 mg MA is effective in preventing hypoestrogenic side effects caused by GnRH-a, while the treatment of endometriosis is not impaired.

Evaluation of the hypothalamic-pituitary axis in uremic males using dynamic tests. The possible role of testicular inhibin: a preliminary report.

Two dynamic tests (Gn-RH i.v. and clomiphene citrate-CC p.o.) were used to evaluate the hypothalamic-pituitary axis in hemodialysis patients and renal transplant recipients (recipients). In the Gn-RH test the gonadotropin secretion was maximally decelerated in hemodialysis patients while it was normal in recipients. During the CC test a decrease of gonadotropin secretion, chronically and quantitatively identical for both group, was found; while on the following test days an increase was noted, which was more accelerated in male recipients. In cases with uremia a strong negative feedback dominates at the pituitary level probably owing to testicular inhibin. The estrogenic feedback in uremia was intact, while the antiestrogenic feedback at the level of hypothalamus is partly impaired, owing to altered opioid metabolism.

Amniotic fluid hormone profiles during normal and abnormal pregnancy.

Amniotic fluid (AF) and maternal serum (MS) chorionic gonadotropin (HCG), placental lactogen (HPL), pregnancy-specific beta 1-glycoprotein (SP1), total estrogens (ET), alpha-fetoprotein (AFP) and prolactin (PRL) were measured by enzyme-immunoassays, in 50 normal (A) and in 37 abnormal (B) pregnancies, from 16th to 40th weeks. A: the proteins HCG, AFP and PRL showed a similar decreasing trend after the 20th week, while HPL and SP1 rose progressively throughout the 2nd trimester, thereafter remaining constant. On the contrary ET showed an increasing pattern until term. Chorionic gonadotropin HPL and SP1 in MS were higher than in AF, while AF values of AFP and PRL were higher than in MS, but the ratio MS/AF of all hormone values increased significantly from the 2nd to the 3rd trimester (p < 0.005-p < 0.000001). Estrogens had about the same concentration in AF and MS during the 2nd trimester, but at term of pregnancy, their AF values were double those of MS. B: in polyhydramnios, elevated AF placental hormones were found, while PRL was very low. In erythroblastosis and diabetes, AFP was very low, but placental hormones, PRL and ET were both high and low. In toxemia, SP1, hCG and PRL were elevated, while HPL and ET were very low. In anencephaly and hydrocephaly with spina bifida, AFP was markedly elevated and ET were very low, but in simple hydrocephalus, very low AFP was found. In chromosomal anomalies very high placental hormones and very low AFP and ET were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Peritoneal fluid volume parameters in infertile patients.

The peritoneal fluid volume (PFV) and its cellular and acellular components have been repeatedly associated with infertility. The PFV from 88 infertile women was analyzed in relation to endometriosis, pelvic adhesions, tubal patency, luteinization, endometrial cells and macrophages. The independent existence of parameters such as the onset of luteinization, the increased population of macrophages and the presence of endometriosis increase statistically significantly the PFV. In the presence of peritoneal adhesions or/and obstructed tubes the PFV was significantly decreased.

[Ingestion of diethylstilbestrol during pregnancy. Its responsibility in the testicular feminization syndrome]. / Prise de diéthylstilbestrol pendant la grossesse. Sa responsabilité dans le syndrome du testicule féminisant.

We report the cases of two women who had testicular feminization with remnants of Müllerian ducts and whose mothers had received diethylstilbestrol (DES) during the first trimester of pregnancy. At laparotomy, masses were removed which had the microscopic appearances of testes and Fallopian tubes, and were confirmed as such at histology. There were three possible explanations for these genetic abnormalities: deficient antimüllerian hormone (AMH) secretion (or lack of sensitivity of Müllerian ducts to AMH); early testicular descent with regression of Müllerian ducts beyond the efficacy margin of AMH; exposure to DES in utero during the first trimester of pregnancy. In these two women, the most likely explanation seems to be the last one.

Vaginal fluid prolactin: a reliable marker for the diagnosis of prematurely ruptured membranes. Comparison with vaginal fluid alpha-fetoprotein and placental lactogen.

The aim of this study is the evaluation of the reliability of vaginal fluid (VF) prolactin (PRL) for detecting prematurely ruptured membranes (PROM) and the comparison of this marker with vaginal fluid alpha-fetoprotein (AFP) and placental lactogen (HPL). In 21 pregnant women with recent or prolonged PROM from 20 to 41 weeks' gestation, in whom intact membranes were never found subsequently VF- and MS-PRL, -AFP and -HPL were measured by enzyme immunoassays, which are sensitive and very rapid. The same markers were also measured in MS, VF and urine samples (U) in 12 pregnant women of the same gestational age, without PROM, in whom the membranes were ruptured later during labor. In PROM, independently of prematurity and duration of PROM VF-PRL levels were significantly higher (2-10-fold) than the paired MS-PRL (p less than 0.0001) and ranged from 130 to 2315 ng/ml. In contrast, VF-PRL and urine PRL concentrations in pregnancies without PROM were very low or undetectable (range: 0-5 ng/ml and 0.15-1 ng/ml, respectively). Vaginal fluid AFP values in PROM from 20th to the 33rd week of pregnancy were significantly higher (5-50-fold) than the paired MS-AFP (p less than 0.01) and ranged from 103 to 5500 ng/ml. In PROM after the 33rd week of pregnancy, VF-AFP values were either lower (1/3), or equal to, or even higher (up to 2-fold) than MS-PRL. On the contrary in pregnancies with intact membranes, VF-AFP were always less than 9 ng/ml and urine AFP was undetectable (range: 0.2-1.1 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Clearance pattern of maternal serum pregnancy specific beta 1-glycoprotein after treatment in active and regressed tubal pregnancy.

The clearance pattern of maternal serum pregnancy specific beta 1-glycoprotein (SP1) was studied in 16 cases of tubal pregnancy (9 active and 7 regressed) after 12, 24, 48, 72, 96, 120 and 192 h following surgery. The mean values of the hormone in both groups showed a statistically highly significant difference in all measurements before and after treatment (P less than 0.001), but they followed the same exponential regression pattern. The half-life of SP1 in active tubal pregnancies after salpingectomy was 36.2 h and in regressed tubal pregnancies after salpingostomy was 37.5 h.

hCG regression after treatment in active and regressed extrauterine pregnancies.

The regression of hCG levels was studied in the maternal serum of 15 cases of tubal pregnancies (6 regressed and 9 active). Measurements of the hCG values were made before the operation and after 12, 24, 48, 72, 96, 120 and 192 hours. The mean hCG values in the groups of the regressed and active cases, before treatment, were 479.4 +/- 266.4 mIU/ml and 6334.0 +/- 932.1 mIU/ml, and after 192 h 4.8 +/- 0.4 mIU/ml and 115.8 +/- 37.9 mIU/ml, respectively. The hCG mean values in both groups showed the same exponential regression pattern and the percentage decrease in the hormone level in the period of time between 0 and 192 h was 98%. The mean values of the hormone in both groups showed significant differences (p less than 0.001) during the whole time interval observed.

Dysgerminoma. A report of five cases.

We analyzed five cases of pure dysgerminoma following the same schedule for the treatment, which were studied during the period of 1971 to 1983. The age of patients during the period of histological examination ranged from 15 years and 6 months to 28 years. All five patients had already had their "first menstruation". The above cases examined according to the clinical findings, the symptoms, the stage of the disease; the sort of treatment the place, the period and kind of therapy in case of reappearance of the disease and final survival.