Pregnancy after unilateral oophorectomy in a woman with hyperthecosis ovarii. A case report.

Ovarian hyperthecosis has been described exclusively as bilateral. It occurs predominantly in perimenopausal women but may be seen at any age after puberty. In a young woman, stromal hyperthecosis is characterized by virilism, menstrual disorders and infertility. Ovarian suppression therapy, induction of ovulation and wedge resection of the ovaries have been ineffective, and only bilateral oophorectomy has caused regression of virilism in these patients. Conservative surgery in appropriate cases may save many young women desiring pregnancy from having bilateral oophorectomy. This case report describes a unique situation in which a young woman with ovarian hyperthecosis achieved three pregnancies after unilateral oophorectomy, indicating the possibility of unilateral ovarian hyperthecosis in our patient.

Neugebauer-Le Fort operation for vaginal prolapse. A review of 38 cases.

Thirty-eight patients with varying degrees of vaginal wall prolapse were operated on using the Neugebauer-Le Fort technique. Their ages ranged from 59 to 90 years. Grand multiparity (> 4) was relatively uncommon (26%). Symptoms were present for more than two years in over half of the women. Serious medical conditions requiring preoperative attention were present in 55% of patients. If the uterus was present, dilation and curettage (D&C) was performed prior to the operation. Intraoperative complications were virtually absent; however, minor postoperative complications occurred in 30% of the patients. None of these complications were related to surgery or altered discharge plans. There were no deaths. No recurrences of prolapse were reported among 30 patients who were followed.

Free alpha-subunit response to gonadotropin-releasing hormone in women with polycystic ovaries.

The response of glycoprotein hormone free alpha-subunit to gonadotropin-releasing hormone (GnRH) was evaluated in 12 women with polycystic ovaries (PCOs). Six of these women were premedicated for 3 days with micronized 17 beta-estradiol before receiving a 100-micrograms bolus of GnRH. In nonmedicated PCO patients, GnRH did not significantly alter basal free alpha-subunit levels. In four of the six PCO patients receiving estrogen premedication, a significant increase in free alpha-subunit was observed; these four patients had low progesterone levels at the time of the GnRH test. Among the six premedicated patients, two had elevated (greater than 4 ng/ml) progesterone levels, and the GnRH tests showed no significant effect on the levels of free alpha-subunit. The study revealed a dissociation between the free alpha-subunit responses to GnRH and the responses of luteinizing hormone; a closer relationship was observed between free alpha-subunit and follicle-stimulating hormone responses. It was concluded that the lack of a free alpha-subunit response to GnRH in PCO patients is not due to a primary inability of the pituitary gonadotroph to produce free alpha-subunit but is a consequence of an altered estrogenic milieu, and a free alpha-subunit response to GnRH may reflect the replenishment of both follicle-stimulating hormone and luteinizing hormone in the gonadotrope.

Effect of oral estriol on abnormal plasma FSH and LH concentrations in women with unexplained infertility; conception in a patient with elevated FSH and LH.

Estriol tablets in the daily dose of 0.25, 0.5 or 1.0 mg were administered for ten days prior to the expected ovulation in six women with unexplained, long-standing infertility, regular, apparently ovulatory cycles, and normal cyclic changes in estradiol and progesterone. Five of six had abnormal FSH and LH patterns contrasting with normal estradiol and progesterone secretion during the control cycle. There was an increase in the midcycle LH surge at two lower doses of estriol and at the highest dose there was a 7-9 day delay observed in the estradiol peak, LH surge and menstrual period in the patient with the normal control cycle. This contradicts previously published data that estriol does not suppress or delay ovulation at the dose as high as 6 mg/day. In four patients with persistently elevated LH and low FSH concentrations, there was little change in the pattern of FSH, LH, estradiol or progesterone secretion during treatment. In the last patient, who had during the control cycle plasma FSH and LH concentrations fluctuating between high normal and menopausal range, indicating "premature ovarian failure" and absence of ovarian follicles, essentially normal cyclic pattern of both gonadotropins with exception of few individual values appeared during treatment. The patient conceived during the last cycle of treatment (estriol 1.0 mg/day). Our study demonstrates that high concentrations of FSH and LH may not necessarily indicate the absence of oocytes and documents previously reported, but never documented occurrence of a conception during estrogen therapy in such a case.

Abnormal follicle-stimulating hormone and luteinizing hormone patterns contrasting with normal estradiol and progesterone secretion in women with longstanding unexplained infertility.

Six women with unexplained longstanding infertility and regular menstrual cycles were studied. All had luteal structures identified at laparoscopy on normal appearing ovaries and normal plasma androgen levels. Daily or every other day determinations of FSH, LH, estradiol (E2), and progesterone (P) were performed in one cycle. The results were compared to similar data obtained in five apparently normal women. All six infertile women had normal patterns of E2 secretion, with a characteristic midcycle rise, followed by a normal sustained elevation of plasma P. Contrasting with the above were grossly abnormal secretory patterns of FSH and LH in five of six patients. Two types of alterations were observed. 1) Four women had plasma LH persistently higher than FSH, with absolute LH concentrations above control levels in three. Midcycle LH surges were identifiable in all four, while a FSH surge was present in only one. The LH to FSH ratio was consistently above 2. 2) One patient had plasma FSH and LH levels fluctuating between high normal and the menopausal range. At midcycle, there was a synchronized rise of both FSH and LH though not as high as on other occasions in the same cycle. This was preceded by an E2 rise and followed by P elevation. The latter type (no. 2) of endocrine changes have been previously observed in much older women, during menopausal transition. The study indicates that normal E2 and P secretion, suggestive of normal ovarian function, may occur in the absence of characteristic FSH and LH patterns. The abnormal gonadotropin patterns may well be causally related to the patient's infertility.

Endometrial prostaglandin F content in women wearing nonmedicated or progestin-releasing intrauterine devices.

Prostaglandin F (PGF) was measured in endometrial samples from eight women wearing Lippes Loops and 14 women wearing Progestaserts after 6 months' use of the intrauterine devices (IUDs). In addition, in 37 women wearing dydrogesterone-T IUDs, endometrial PGF was measured after 1 month, 3 to 7 months, and 8 to 12 months of use. Endometrial samples were also obtained from 51 women without IUDs. The following means and standard errors of endometrial PGF, expressed in picograms per microgram of endometrial protein, were obtained in women without IUDs: early proliferative phase, 3.11 +/- 1.0; midproliferative phase, 4.1 +/- 0.7; late proliferative phase, 4.4 +/- 1.0; midluteal phase, 7.13 +/- 1.0; and late secretory phase, 6.08 +/- 1.0. The midproliferative phase mean was significantly different from the midsecretory phase mean (P is greater than 0.05). Except for one group, no differences were noted during the midproliferative and midsecretory phases among the groups of women wearing medicated and nonmedicated IUDs, when compared with values for women without IUDs. The only difference noted was during the midsecretory phase in the dydrogesterone group at 8 to 12 months. In these women, the mean endometrial PGF content was 2.8 +/- 0.8, significantly different (P is greater than 0.05) from that of women without IUDs (6.1 +/- 1.0).