Combined gonadotropin-releasing hormone analog and exogenous gonadotropins for ovulation induction in infertile women: efficacy related to ovarian function assessment.

The ovarian function of infertile women with normal menstrual rhythm was investigated by daily plasma hormone (estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone) analyses throughout the menstrual cycle, and patients were diagnosed as showing a subnormal profile of progesterone in the early luteal phase or as showing no abnormality. Women with oligomenorrhea and elevated luteinizing hormone levels were diagnosed as having polycystic ovary syndrome primarily on the basis of endocrinology. All patients were treated with a gonadotropin-releasing hormone analog to suppress endogenous luteinizing hormone and follicle-stimulating hormone so that ovulation induction with exogenous gonadotropins could be undertaken as in patients with hypogonadotropic hypogonadism. Interference in the process of ovulation by endogenous luteinizing hormone fluctuations was eliminated and pregnancies were achieved. The pregnancy rate in the group with polycystic ovary syndrome was 77% per treatment course (six cycles) while that in the group with subnormal progesterone profiles was 61.5%. Patients showing no abnormality achieved no pregnancy, demonstrating the redundancy of interference with normal ovarian function.

Long-term hormone implant therapy--effects on lipoproteins and steroid levels in post-menopausal women.

Lipoprotein and steroid hormone levels were measured in 61 bilaterally oophorectomised women who had been treated for 3 years with implants containing either oestradiol alone or oestradiol plus testosterone. The lipoprotein levels associated with each of the two therapy regimens were compared. In addition, lipoproteins were measured in 67 untreated bilaterally oophorectomised age-matched women and compared with those of the treated women. Despite the high oestradiol levels produced by both types of implant, the only significant finding was a reduced LDL cholesterol in the oestrogen/testosterone treated group as compared with that of the untreated group.

Septic abortion in an IUCD user.

PIP: A 27-year old woman admitted to the hospital after 5 days of vaginal bleeding at 12 weeks gestation had had a copper-T IUD inserted 10 months previously. The IUD string was no longer visible at pregnancy testing. Prior to admission she had experienced lower abdominal pain, increasingly heavy vaginal bleeding, fever, malaise, chills, and vomiting. Intravenous ampicillin and metronidazole were commenced and the uterus was evacuated under a general anesthetic. The copper-T was removed from the uterine cavity. A uterine swab at operation and preoperative blood cultures grew E. coli. A moderate degree of disseminated intravascular coagulation (DIC) was indicated by a coagulation profile. The case demonstrates that the copper-T may be associated with intrauterine sepsis and DIC. In the 1st trimester the risk of abortion following removal of a device is near 30%, while the rate of abortion for women in whom the string is no longer visible is near 48%. Patients presenting with pregnancy in the presence of an IUD and symptoms of sepsis should have the uterus evacuated under suitable antibiotic cover.^ieng