Reduced incidence of ovarian hyperstimulation syndrome by prophylactic infusion of hydroxyaethyl starch solution in an in-vitro fertilization programme.

Prophylactic infusion of human serum albumin can reduce or mitigate severe ovarian hyperstimulation syndrome (OHSS) in patients at high risk. Recently, concern has been expressed in the lay press regarding the potential viral transmissions with blood constituents. Hence, we looked for a safe non-biological substitute with comparable physical properties in order to cope with this concern. One hundred patients of our in-vitro fertilization (IVF) programme with oestradiol serum concentrations > or = 11010 pmol/l on the day of human chorionic gonadotrophin injection and/or > or = 20 oocytes retrieved and/or previous severe OHSS were infused with 1000 ml 6% hydroxyaethyl starch solution at the time of oocyte collection and 500 ml 48 h later. A total of 82 IVF patients at risk without prophylactic infusions during the preceding years served as controls. Both groups were identical according to patient's age, body mass index, androgen concentrations, peak oestradiol concentrations, number of retrieved oocytes, fertilization and pregnancy rates. There were seven cases of severe OHSS in untreated patients and two cases in the treatment group (P = 0.08). In moderate OHSS a significant difference became obvious with only ten cases in the treatment group and 32 cases in the control group (P < 0.00001). Hydroxyaethyl starch solution seems to be an effective and economic alternative in reducing severe and moderate OHSS during IVF treatment.

Partial uncoupling of luteinizing hormone and prolactin pulse coincidence in hyperandrogenemic women.

A partly synchronized pulsatile secretion of luteinizing hormone (LH) and prolactin has previously been suggested as an indication of the coupling of the respective pulse generators under certain conditions. In women with hyperandrogenemic chronic anovulation, episodic LH secretion is disturbed. It was, therefore, the aim of the present study to evaluate possible changes in episodic prolactin secretion pattern and in LH/prolactin co-pulsatility, and to relate the results to the accelerated LH pulse frequencies often seen in patients with hyperandrogenemic chronic anovulation. Blood samples of 32 patients with hyperandrogenemia were taken at 10-min intervals between 10.00 and 20.00. Nine regularly cycling women with normal hormone levels served as controls. In the women with hyperandrogenemia, despite an average 41% rise of LH pulse frequency, prolactin pulse frequency decreased slightly by 14% as compared to controls; no correlation between the two parameters was found (r = 0.162). The number of coincident LH and prolactin pulses increased continuously with accelerating LH frequency. The best fitting function was a hyperbola which was limited by the maximal observed prolactin frequency. As a consequence, the fraction of LH pulses that were co-secreted with prolactin episodes decreased with higher LH pulse frequencies, while the fraction of prolactin pulses concomitant with LH pulses increased. Our data provide evidence that in women with hyperandrogenemic chronic anovulation a pathological LH pulse frequency is no longer coupled with pulsatile prolactin secretion, suggesting an isolated alteration of the central neuronal control mechanism for LH secretion.

Pattern of gonadotrophin secretion in patients with hyperandrogenaemic amenorrhoea before and after ovarian wedge resection.

The follow-up of androgen and gonadotrophin concentrations after ovarian wedge resection is reported in two patients with hyperandrogenaemic amenorrhoea. Elevated testosterone concentrations decreased immediately and androstenedione after 3 months. In a patient with polycystic ovarian disease, luteinizing hormone (LH) amplitudes were reduced in the presence of unchanged pulse frequency. Small decreases in mean LH baseline values were accompanied by increases in follicle stimulating hormone concentrations. Our data provide evidence that reduction of elevated ovarian androgen concentrations leads (directly or indirectly) to a decrease of exaggerated LH pulse amplitude in patients with hyperandrogenaemic amenorrhoea.

Effects of peritoneal fluids from patients with endometriosis on capacitated spermatozoa.

OBJECTIVE: To determine the effects of peritoneal fluid (PF) from patients with endometriosis on capacitated sperm. DESIGN: Capacitated donor sperm were allowed to migrate into straws filled with pooled PF from patients with unexplained infertility without endometriosis (n = 4) and those with mild (n = 4) and moderate-severe (n = 4) endometriosis, respectively, for 3 hours. MAIN OUTCOME MEASURES: Sperm motility, sperm membrane integrity, and acrosomal loss were determined. RESULTS: Statistically, no significant differences were found among the various sperm parameters determined. CONCLUSION: Peritoneal fluid from patients with endometriosis does not appear to adversely affect capacitated spermatozoa.

Pulsatile luteinizing hormone secretion pattern in hyperandrogenemic women.

OBJECTIVE: To elucidate changes in gonadotropin secretion pattern in patients with hyperandrogenemic chronic anovulation of various origins. DESIGN AND PARTICIPANTS: Hyperandrogenemic patients (n = 32), divided into subgroups according to certain clinical and biochemical criteria, and a control group (n = 9) of regularly cycling women with normal androgen and PRL levels were prospectively investigated. SETTING: Infertility and Biochemical Endocrinology Unit, Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany. MAIN OUTCOME MEASURES: Blood samples for radioimmunological analyses of gonadotropins and steroids were taken at 10-minute intervals for 12-hour sampling periods. In nonamenorrheic patients, investigations were performed on the 5th day of a cycle. Pulsatile LH and FSH data were analyzed by computerized peak identification programs. RESULTS: In hyperandrogenemic women, mean LH levels were higher than controls, the most elevated concentrations being observed in women with secondary amenorrhea (subgroup 5), in those selected for elevated mean LH levels (subgroup 3), and in those with elevated T and/or androstenedione (A) but normal DHEAS levels (subgroup 1). With the exception of patients with DHEAS elevations but normal T and A levels (subgroup 2), LH pulse frequency and amplitude were increased with most distinct effects occurring in subgroups 3 and 5. Highly elevated T and free T levels were observed in subgroup 5 and in overweight patients (subgroup 6). Estrone (E1) serum concentrations were highest in those subgroups (3 and 5) in which acceleration of LH pulse frequency and increments in LH pulse amplitude were most pronounced; these parameters correlated significantly with E1 levels. CONCLUSIONS: Changes in pulsatile LH release in patients with hyperandrogenemic chronic anovulation correlate primarily with elevated E1 levels, rather than with T or A serum concentrations.

Optimizing the delivery of patient and physician satisfaction: a conjoint analysis approach.

This article suggests that, in evaluating and designing health care unit programs, conjoint analysis is superior to the conventional survey-research approach. Conjoint analysis can suggest unit designs that will optimize patient (or physician) satisfaction, while still controlling for unit profitability and other constraints. This article discusses the conjoint approach and illustrates its use in the design of an obstetrical unit.