Peripheral plasma met-enkephalin levels in ovulatory and anovulatory human menstrual cycles.

OBJECTIVE: To test the hypothesis that met-enkephalin has a role in human ovulation and that plasma levels may differ between ovulatory and anovulatory ovarian cycles. DESIGN: This is a descriptive study comparing levels of plasma met-enkephalin, gonadotropins, and ovarian steroids in 12 ultrasonically confirmed ovulatory cycles and 12 anovulatory cycles. SETTING: The study took place in the infertility clinic of a large teaching hospital receiving primary and tertiary referrals of both private and public sector patients. PATIENTS: All patients (n = 16) had infertility greater than or equal to 3 years and normal findings on previous investigation including evidence of ovulation. INTERVENTIONS: Ovarian cycles were defined using transabdominal ultrasound scanning. Biochemical analyses were by radioimmunoassay. MAIN OUTCOME MEASURES: The differences between plasma met-enkephalin levels in the two groups of cycles were compared. RESULTS: Met-enkephalin levels are significantly higher in ovulatory cycles with a significant peak in the 2 postovulatory days (Duncan's multiple range test; P less than 0.05). CONCLUSION: Human ovulation is associated with cyclic elevation of plasma met-enkephalin. Further studies are required to elucidate causality.

FiSBoG (fetal steroid binding glycoprotein) as a fetal function test.

FiSBoG is a recently described fetal protein. It can be detected in the cord blood. It can be identified in maternal serum in late pregnancy. In this study the values in maternal serum in late pregnancy in 31 normal pregnancies were compared with 23 abnormal pregnancies: 4 twin pregnancies, 4 stillbirth, 4 cases of pre-eclampsia, 4 who had a significant antepartum haemorrhage and 7 who were small-for-dates, to assess its potential as a test of fetal well-being. FiSBoG appeared to have no significant role as a test of fetal well-being.

Nasal absorption of progesterone in women.

Absorption profiles were obtained from women following the administration of ointment containing 20, 30 and 40 mg of progesterone to the nasal mucosa. There were no significant differences in area-under-curves between groups receiving the drug in one nostril but when 40 mg doses were divided between two nostrils there was a significantly greater area-under-curve suggesting that the area of mucosa applied with the drug is more important than dosage.

PIP: An ointment containing 20, 30, or 40 mg of progesterone was administered to the nasal mucosa of 18 female study subjects to assess whether progesterone is absorbed through this route. The women were studied in the follicular phase (days 5-12) of their menstrual cycle. 16 subjects were investigated during only 1 menstrual cycle and the remaining 2 subjects were tested in 2 nonconsecutive cycles, producing a total of 20 absorption curves. No clinically significant changes were noted in biochemical or hematological parameters. There were no significant differences in area-under-curve between the 20, 30, and 40 mg group receiving the drug in 1 nostril. However, the mean area-under-curve for the group receiving 40 mg divided between the 2 nostrils was significantly higher than the values obtained in either the 20 mg or the 30 mg groups dosed in 1 nostril. It appears that the speed of absorption and blood levels obtained are not dependent on dosage, although the amount of progesterone absorbed can be increased by application to a larger mucosal area. Nasal mucosa absorption profiles peak at a much earlier time than those for rectal and vaginal administration; moreover, the nasal route is likely to be more acceptable to patients. Study subjects reported only a few minor side effects, including a transient unpleasant taste in the mouth and slight stuffiness. Overall, the results of this preliminary investigation suggest that the nasal route of administration is relatively acceptable and capable of providing therapeutically effective levels of progesterone.