Lactation, nutrition and fertility and the secretion of prolactin and gonadotrophins in Mopan Mayan women.

The effect of lactation on menstrual cycles, ovulation and conception was studied in a group of non-contracepting Amerindian Mopan Mayan women. Anthropological observations of relevant events were made over a 21-month period. Blood samples were assayed to determine the plasma concentrations of prolactin, luteinising hormone, follicle stimulating hormone, human chorionic gonadotrophin, placental lactogen, oestrogen, progesterone and cortisol. The data show that: frequent and prolonged breast-feeding was associated with a marked increase in plasma prolactin concentrations to levels similar to those in lactating Gaing but higher than those in lactating Scottish women; ovulatory menstrual cycles and pregnancy occurred during frequent lactation; in lactating menstruating women there was an inverse correlation between fat weight and months post-partum. These data suggest that other factors as well as suckling account for the effects of lactation on fecundity.

PIP: Lactation, ovulation and conception were observed as part of an anthropological study of Amerindian Mopan Mayan women from the village of San Jose Hawaii in western Belize from March 1985-January 1987. Single blood samples from each subject were immunoassayed for prolactin, LH, FSH, hCG, placental lactogen, estrogen, progesterone and cortisol. Anthropomorphic data analyzed were body mass index (BMI), fat/weight percentage, total body water and lean body weight. 117 women had at least 1 child during the study; 91 were lactating; 51 reported no menstrual cycles. 50 submitted to blood testing. Almost all infants were breast fed for 18 months or longer, up to 3 years, typically at least 6 times per day and 3 times per night. Women averaged 9 live births and 8 surviving children, with a mean birth interval of 28 months. 25 of the 29 women known to be pregnant conceived while lactating. 16 lactating women were pregnant. Their culture requires them to have 3 menses before conception to nourish the fetus, yet forbids speaking about menstrual blood: women fabricated menstrual dates, but in confidence 51 of 81 stated that they did not menstruate before the last conception. Most often menses began 12 months postpartum. Lactating women had heightened prolactin levels even if supplementing their children's diet. Thus frequent lactation delayed onset of menses, but supplementation had no effect. Most of the women were within the normal range of BMI, but 13% were below normal. In lactating menstruating women there was a significant negative correlation between fat weight and postpartum month. The data suggest that the interval to conception or menstruation was inversely correlated with fat weight. Here suckling frequency rather than prolactin levels seems to postpone fertility. In this society, with 10-12 births and 9-10 children in the completed family, the largest in the world, prolonged frequent lactation has little effect on fertility. Instead, birth trauma, maternal mortality, fetal and infant mortality, and perhaps nutrition, have more effect on completed family size.

Variable effects of RU 486 on endometrial maintenance in the luteal phase extended by exogenous hCG.

This study was designed to assess the features and conditions for endometrial bleeding induction with the synthetic antiprogestin and antiglucocorticoid RU 486 during hCG-induced prolongation of the luteal phase. Eighteen healthy, surgically sterilized women and another five women with an intrauterine contraceptive device (IUD) participated. All subjects received hCG which was injected daily in increasing doses (500 to 15,000 IU) from day 9 to day 15 of the luteal phase. Ten subjects received hCG alone, and groups of three to 16 subjects received hCG combined with RU 486 (25, 50, 100, 200 or 400 mg/day). RU 486 administration was commenced on day 12 following the LH surge and given either for 1, 4 or 7 consecutive days. In certain cycles, tamoxifen (20 mg/day) was given for 4 consecutive days with hCG, or with hCG and RU 486. All treatment cycles were separated by one or two resting cycles. Frequent blood samples were taken to monitor the endocrine response. Treatment with hCG alone or with the various combinations of RU 486 produced similar serum levels of oestradiol and progesterone which were equivalent to those observed during early pregnancy. With hCG alone, the onset of bleeding was on day 21-24 after the LH surge, coinciding with the drop in oestradiol and progesterone. With RU 486 doses of 50 mg/day or more, an early bleeding episode almost invariably occurred on day 14-17 after the LH surge in the presence of high circulating steroid levels. In contrast, 25 mg/day RU 486 for 4 days failed to induce this early onset of bleeding in three out of six cases.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: When administered during the luteal phase of the menstrual period, human chorionic gonadotropin (hCG) has been observed to induce a pseudopregnancy in which the functional lifespan of the corpus luteum is prolonged. On the assumption that women with hCG-induced prolongation of the luteal phase offer an ideal model for studying the in vivo action of RU-486 and other antiprogestins, 23 women (5 of whom were IUD users) were administered hCG alone. hCG, and RU-486, tamoxifen, or both RU-486 and tamoxifen. Increasing doses of hCG produced a progressive rise in estradiol and progesterone to levels compatible with early pregnancy; steroid levels declined after cessation of hCG treatment and bleeding occurred 21-24 days after the midcycle luteinizing hormone (LH) surge. This indicates that the luteal phase was prolonged by at least 8 days. RU-486 doses of 50 mg/day and above produced bleeding 14-17 days after the LH surge in the presence of high levels of circulating steroids, while a 25 mg dose of RU-486 failed to produce bleeding in 50% of cases and tamoxifen failed to induce early bleeding or to potentiate the effect of RU-486 at either dose. A 2nd bleeding episode occurred 22-24 days after the LH surge coincident with a drop in circulating steroids in 43% of cycles; a 2nd bleeding episode was significantly correlated with a lower total dose (200 and 400 mg) of RU-486. Endometrial biopsies in those with late bleeding showed a mixed proliferative and secretory pattern indicative of incomplete shedding. A total dose of 700 or 800 mg of RU-486 is recommended to produce complete shedding.

Early chorionic activity in women bearing inert IUD, copper IUD and levonorgestrel-releasing IUD.

Early chorionic activity was assessed in the premenstrual days by means of serum HCG beta-fraction. As control, a group of women with no contraceptive use was studied; early chorionic activity was detected in 31.8% of the cycles. In the group bearing an inert IUD the incidence was 20%, which did not differ from the control; while in the medicated IUD groups (Cu-IUD and LNG-IUD) the incidences were 4.8% and nil, respectively. Both medicated IUD groups showed a significant difference when compared with the control, as well as the inert IUD groups. The meaning of these findings, pointing out differences in the main mechanism of action between inert and medicated IUDs, is discussed.

PIP: Early chorionic activity was compared in 100 IUD users (inert device, copper IUD, and a levonorgestrel-releasing IUD) and 22 controls through measurement of the serum human chorionic gonadotropin (hCG) beta-fraction. In the control group, 7 (32%) of the 22 women had hCG beta-fraction values indicative of chorionic activity (i.e., 5mIU/ml). In the group of women wearing an inert IUD (Lippes Loop), 8 (20%) were positive for early chorionic activity. In contrast, the incidence of premenstrual chorionic activity signs was very low among women with medicated IUDs: 5% among acceptors of the copper IUD and zero among women in the levonorgestrel-releasing IUD group. In general, elevated premenstrual hCG values are indicative of failed implantation. The high incidence of hCG activity recorded among Lippes Loop acceptors in this study is consistent with the anti-implantation effect postulated for inert devices. In contrast, medicated IUDs appear to act by preventing rather than interrupting implantation and therefore should not be regarded as abortifacient contraceptive agents.

[New method for the early diagnosis of pregnancy]. / Nuevo método para el diagnóstico precoz del embarazo.

PIP: Performance of commercial immunoprecipitation tests for early detection of pregnancy exhibits serious limitations basically due to the excessive amounts (2000 IU) of (CG) chorionic gonadotropin that have to be cleared in the urine/day. Recent technical advances achieved by the use of solid-phase carbohydrate especific adsorbant concanavalin-A to extract human CG from different biological fluids, remarkably enhances the effective sensitivity of radioimmunoassays designed for quantitation of CG. Given the advantages of the system, a new method was conceived to extract and concentrate CG contained in 5 ml of urine. The procedure essentially requires concentration of urinary CG absorbed to agarose bound concanavalin-A; after being resuspended a fraction is collected for study in latex immunoprecipitation tests. CG levels were quantitated in a buffer solution and urine with and without concanavalin-A. Unabsorbed CG was detectable above 2000 IU/Lt, whereas extracted CG was detected above 500 IU/Lt. Crossreaction with luteinizing hormone and follicle stimulating hormone was observed up to 3000 IU/Lt. The quantitative differences of CG extracted either in buffer or urine were negligible. It is concluded that results obtained after partial purification and concentration of urinary CG and further immunoprecipitation are equally reproducible as other methods, but the sensitivity is more effective for diagnosis of early pregnancy. (author's)^ieng

[Analysis of radioreceptors of human chorionic gonadotropins: a new tool for the diagnosis and management of pregnancy]. / El analisis del radioreceptor de la gonadotropina carionica humana: Un nuevo enfoque para el diagnostico y el manejo del embarazo.

PIP: For the past 50 years the diagnosis of early pregnancy has been based on the detection of human chorionic gonadotropin (HCG). The introduction of the analysis of the radioreceptor (ARR) of HCG, discovered by Saxena in 1974, has recently led to the greatest improvement in pregnancy tests. Since only the radioreceptor can recognize the original form of the hormone, the ARR combines the specificity of bioanalysis with the sensitivity of radioimmunoassay. The qualtitative ARR of HCG has a sensitivity of 6mIU/ml, and it is about 500 times more sensitive than the test of agglutination of hematin or of latex; the qualitative, positive or negative, ARR of HCG has a sensitivity of about 200mIU/ml, or 6 times greater than the test of agglutination of hematin or latex. The ARR of HCG can detect pregnancy 1 week after ovulation; it can also detect twin pregnancies, and trophoblastic diseases or ectopic tumors, thus allowing abortion to be performed before 6 weeks of pregnancy. The high effectiveness of ARR has been demonstrated in more than 100,000 pregnancy tests conducted at the Cornell Medical College.^ieng

[Menstrual dysfunction]. / Disfuncao menstrual.

PIP: The various types of menstrual dysfunctions are classified, their symptoms are described, and appropriate treatment is suggested. The types considered are: subfollicular, persistent follicular (subdivided into simple, macrofollicular and microfollicular or androgenic), subluteal and persistent luteal. The subfollicular type is characterized by the early onset of menopause (before age 40); the follicular type by amenorrhea and sterility (simple type), alternating amenorrhea and bleeding (macrofollicular), and amenorrhea with occasional bleeding and hirsutism (microfollicular); the subluteal type by sterility; and the luteal type by either amenorrhea or hypermenorrhea. The type of dysfunction can be detected by laboratory tests (such as urinary estrogens, pregnanediol, and gonadotropins, functional cytology, 17-ketosteroids, plasma testosterone, appearance of the endometrium, and basal temperature). The subfollicular type is treated with estrogen, with or without progesterone, the follicular type with cyclical administration of progesterone (clomiphene can also be used), the subluteal type with progesterone, 17alpha-hydroxyprogesterone, and chorionic gonadotropin, and the luteal type with high doses of progesterone.^ieng

[Post-pill syndrome]. / Sindrome pos-pilula.

PIP: In a survey of 993 patients complaining of sterility and infertility, 365 were found to suffer from ovulatory disorders, and 133 of the latter were taking oral contraceptives. The patients were subjected to the following tests: basal temperature (monophasic curve in 33.08% of the cases), cervical mucus (negative crystallization in 40.60%), endometrium biopsy (Proliferative in 45.11%), and vaginal cytology (anovulatory pattern in 16.53% of the cases). Laparoscopy was used in 35 cases and biopsy of the ovaries in 18. After treatment with various drugs (such as cyclophenyl, clomiphene, human menopausal gonadotropin, human chorionic gonadotropin, estrogen, progestogen, corticoids, oral contraceptives), improvements were obtained in 82.93% of the cases with respect to basal temperature (from monophasic to biphasic), in 90.90% for cervical mucus (positive crystallization), in 35.28% for endometrium biopsy (from proliferative to sectretory), and in 42.86% for vaginal cytology (from anovulatory to ovulatory pattern). 45 pregnancies were obtianed. It is conluded that oral contraceptives can inhibit ovulation after suspending treatment, irrespective of its duration, especially in women previously suffering from menstrual disorders. The overall incidence of this syndrome is low, and it is generally reversible. It is desirable, however, to identify the women exposed to high risk of its occurrence, should the patient desire to stop the contraceptive treatment and have more children.^ieng