Monitoring gonadotropin-releasing hormone administration by measurement of urinary steroid conjugates.

The use of measuring urinary steroid conjugates in nontimed, randomly collected morning urine samples expressed as a function of creatinine concentration was assessed to monitor ovarian response to pulsatile administration of gonadotropin-releasing hormone in ambulatory patients. This method of evaluating ovarian steroid production provided a convenient, inexpensive, and noninvasive means of monitoring responses to gonadotropin-releasing hormone treatments and documents that clomiphene-resistant amenorrheic patients can be induced to ovulate with appropriate gonadotropin-releasing hormone therapy. Different ovarian responses in the same woman to similar doses and frequencies of gonadotropin-releasing hormone indicate that discrete adjustments of individual doses may be required to facilitate consistent ovulatory responses. The strategy presented here allows for subsequent gonadotropin-releasing hormone therapy in the individual patient to be determined by an objective and quantifiable ovarian response to an initial treatment.

Magnetic resonance imaging of the pelvis: evaluation of ovarian masses at 0.15 T.

Seventeen patients with suspected ovarian masses were evaluated by magnetic resonance imaging (MRI). MRI findings were confirmed by surgery (13 patients) or sonography and clinical follow-up (four). The study evaluated MRI characteristics of ovarian lesions using recently developed multislice and multiecho pulse techniques for a 0.15-T system. T1 and T2 relaxation times were calculated in 12 patients and although a range of values was obtained in several disease categories, diagnostic accuracy was frequently improved. MRI appearances tended to vary considerably with different pulse sequences and were particularly complex in patients with endometriosis and cystic ovarian tumors. Shortest calculated T1 and T2 values were found in hemorrhagic cysts in patients with endometriosis. Benign tumors with thick fibrous pseudocapsules had longer T1 values. Inflammatory masses and malignant ovarian tumors had significantly longer T1 and T2 values and relaxation times in a patient with mucinous cystadenoma varied within the complex mass.

Changes in the LH response to GnRH in the ovine fetus and neonate.

The in vivo responsiveness of the ovine fetal and neonatal pituitary was investigated using acute and chronic preparations. Several studies were performed on six fetuses and six lambs from 112 days' gestation through 5 weeks after birth. Ten micrograms of gonadotropin-releasing hormone (GnRH) was injected intravenously into each fetus and lamb, and serial blood samples were collected from the fetus, ewe and lamb. The luteinizing hormone (LH) content of each sample was determined by species-specific radioimmunoassay. Both the fetus and the neonate showed a response to GnRH. A significant elevation of LH was found in all animals by 15 minutes. There was no response in the ewe when GnRH was injected into its fetus. Great variability in response was noted among various age groups and between animals, with the maximum individual LH response reaching 33.7 ng/ml. The maximum LH response of the neonate during the first week of life was significantly depressed (p < 0.05) as compared to that of the fetus and the older neonate.

46,XX hernia uterus inguinale and vaginal agenesis.

The first reported case of hernia uterus inguinale in a chromosomally normal 46,XX female is presented. The diagnosis should be suspected in patients presenting with primary amenorrhea, a normal hair pattern, and an inguinal mass.

Endometrial estrogen and progesterone receptors in a uterus didelphys.

A 23-year-old woman with a uterus didelphys and a totally occluded left tube had a hysterectomy one year after having a child. Endometrial estrogen and progesterone receptors, both cytoplasmic and nuclear, were determined in five longitudinal sections of each horn. The amount and distribution of these receptors were normal, but the receptor content of the right horn was higher than that of the left.

PIP: A 23-year-old white woman was admitted with a complaint of increasing dysmenorrhea since the birth of her child 1 year before. She was diagnosed as having a uterus didelphys and a totally occluded left tube, and hysterectomy was performed. 5 longitudinal sections of each uterine horn was examined for both progesterone and estrogen endometrial nuclear and cytoplasmic hormone receptors. Cytoplasmic receptor values were in the expected normal range, and in general descended from the fundus to the cervix as in normal uteri. Nuclear receptor values were also in the expected range for secretory nuclei and their distrubtion was as seen in normal uteri. Both receptors (estrogen + progesterone; cytoplasmic + nuclear) however, were higher in the right horn vs. the left horn; this difference is ascribed to the woman's earlier pregnancy.

The choice of sterilizing procedure according to its potential reversibility with microsurgery.

Twenty-seven women were evaluated for reversal of previous tubal sterilization in the 2-year span beginning January 1, 1976. Of the thirteen who came to surgery, only seven were able to undergo reanastomosis. Five of these seven had had Pomeroy type ligations and two had ahd "one-burn" electrocoagulation. Six patients who had had "two- or three burn" electrocoagulation did not have sufficient length of fallopian tube remaining. Tubal patency was achieved in 87.5% of those who underwent reanastomosis. The pregnancy rate was 37.5%, with no ectopic pregnancies. Electrocoagulation is not recommended in healthy young women.

PIP: The type of tubal ligation originally performed affects subsequent ability to achieve successful reversal of sterilization procedure. Unfortunately, too little attention has been given to the potential reversibility of a sterilization procedure. This study (spanning 2 years) evaluates 3 groups of women (N=27) for reversal of previous tubal ligation by the Dept. of Obstetrics and Gynecology of the University of Florida. The women were assigned to 3 groups based on the outcome of evaluation (of fertility potential) and surgical procedure performed. Group 1 was comprised of women who came for evaluation but did not have any surgical procedure, while Group 2 consisted of women who had laparoscopic findings precluding any type of reanastomosis; Group 3 consisted of women who had had reanastomosis of at least one tube. The technique described by Winston, with minor modifications, was the microsurgical technique used for reanastomosis. Of the 13 who requested surgery, only 7 underwent reanastomosis; 5 of these had had Pomeroy-type ligations, and 2 had had "1-burn" electrocoagulation. 6 patients who had had "2-or-3 burn" electrocoagulation did not have adequate tubal length. 87.5% of those who were reanastomosed achieved tubal patency. Pregnancy rate was 37.5%, and there were no ectopic pregnancies. Electrocoagulation should be advised for patients with medical indication for permanent sterilization or those who are over 35 years of age. All other cases should utilize techniques with potential for reversibility, while ensuring sterility. Minilap with resection of a small portion of the isthmic segment via the Pomeroy method or its modification appears to be the best procedure to use.