Changes in total and free concentrations of steroid hormones in the plasma of women throughout pregnancy: effects of medroxyprogesterone acetate in the first trimester.

The total (protein-bound plus free) and free concentrations of progesterone, oestradiol-17 beta and cortisol were measured serially throughout pregnancy in the plasma of two groups of women whose pregnancies went to term. Group A (n = 53) experienced an uneventful low-risk pregnancy with a spontaneous abortion rate of 8.6%. Women in group B (n = 22) were treated orally with medroxyprogesterone acetate (MPA; 80-120 mg daily) until 18 weeks gestation for threatened abortion within the first 6 weeks of pregnancy. In both groups of women the proportion of each hormone circulating in the free or unbound form remained constant despite the overall increases with occurred in total circulating hormone concentrations as pregnancy progressed. The steroid hormonal profiles in the first half of pregnancy were similar in both groups of women. However, from weeks 20 to 40 total and free progesterone concentrations were significantly (P less than 0.05 in each case) higher in group B compared with group A. Conversely, total and free oestradiol-17 beta concentrations were lower (P less than 0.005 and P less than 0.01 respectively) in group B. At this stage it is not known if these differences were attributable to the administration of MPA to women in group B or to altered placental steroidogenesis as a result of earlier uterine bleeding.

Heterotopic pregnancy from in vitro fertilization.

A case of heterotopic or combined intrauterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of five four-cell embryos. The phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with underlying tubal disease. This patient had both variables. Techniques applied at the time of embryo transfer are also implicated, namely, the use of culture medium with 50% maternal serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer.

Early luteal serum progesterone concentrations are higher in pregnancy cycles.

In a consecutive series of 167 patients reaching the stage of embryo transfer after in vitro fertilization and embryo transfer, 19 clinical pregnancies ensued. The serum progesterone (P) levels were significantly greater on the first and second (P less than 0.01) and third (P less than 0.05) postaspiration days for those who conceived. Higher circulating levels of P were achieved on days 1, 2, and 3 (P less than 0.05) by the daily injection of P, 50 mg in oil, given for 5 consecutive days, beginning immediately after follicle aspiration. Both pregnancy and nonpregnancy cycles demonstrated high circulating P levels, but the study implies that relatively higher levels are required for conception, and such levels can be achieved by the use of intramuscular P.

Progesterone, cortisol and oestradiol-17 beta in the initiation of human parturition: partitioning between free and bound hormone in plasma.

The concentrations of total and free progesterone, oestradiol-17 beta, and cortisol were measured in the plasma of 24 pregnant women from 10-17 days prepartum, during labour, and for 2-3 days postpartum. All the women were delivered vaginally, and their hormonal profiles were similar, whether they initiated labour spontaneously (n = 11) or were induced by rupture of the fetal membranes (n = 13). Before labour, the plasma concentrations of total radioimmunoassayable progesterone, oestradiol-17 beta and cortisol were 557.3 (SEM 70.3) nmol/l and 590.0 (SEM 76.7) nmol/l, 94.3 (SEM 18.7) nmol/l and 111.6 (SEM 19.8) nmol/l, and 1087.2 (SEM 103.7) nmol/l and 1020.7 (SEM 100.7) nmol/l, for the spontaneous and induced groups, respectively. During labour progesterone and oestradiol-17 beta declined in maternal plasma to around 130 nmol/l and 30 nmol/l in both groups by the end of the third stage. The free fractions of progesterone and oestradiol-17 beta remained constant throughout labour and over the entire study period at 2-3% and 1-2%, respectively. Total plasma cortisol rose to 1243.7 (SEM 83.3) nmol/l (P less than 0.02, spontaneous group) and 1247.5 (SEM 97.4) nmol/l (P less than 0.001, induced group) by the end of the first stage of labour. Concomitantly, free cortisol increased from 4.5-5.5% to 7.2-8.2% over this period so that its concentration increased by approximately 2.5-fold in both groups of women during labour. We conclude that the total and physiologically-active free concentrations of progesterone and oestradiol-17 beta in maternal plasma do not change immediately before the onset of labour.(ABSTRACT TRUNCATED AT 250 WORDS)

The application of rate dialysis to the determination of free steroids in plasma.

Rate dialysis is used to obtain the free steroid fraction in undiluted plasma at 37 degrees C. The free steroid fraction is determined from the rate at which a small amount of tritiated steroid diffuses from plasma on one side of a semipermeable membrane into an identical plasma sample on the other side which lacks radioactive steroid. The method may be generally applicable to steroids since the cell permeability constant, which is a function of the volume of the dialysis cell and the area and diffusion properties of the membrane, was similar for seven steroids tested. The method requires only 0.3 ml of plasma, is simple and economical to perform, and enables up to 120 determinations to be made in one day. The free fractions of cortisol, progesterone, and estradiol-17 beta were measured in plasma pooled from pregnant and non-pregnant women and pregnant and lactating sows. The results were compared with those obtained for the same plasma pools by centrifugal ultrafiltration.

Treatment of cryptorchidism with pulsatile luteinizing hormone-releasing hormone (LH-RH).

This preliminary report describes a new method of treating bilateral cryptorchidism that may modify the need for surgical intervention. Four of five boys (3 1/2, 3 1/2, 7, 11 and 12 1/2 years of age) given hourly subcutaneous pulses of luteinizing hormone-releasing hormone (LH-RH, 10 to 100 micrograms/day, given in a 3-min pulse every hour) showed evidence of testicular descent after 3 to 19 weeks. The battery-operated, programmable syringe driver was well tolerated by the boys, and the daily insertion of the scalp-vein needles was managed at home by their parents.

Induction of ovulation and cyclic activity in anestrous ewes with testosterone treated wethers and ewes.

An experiment was conducted to evaluate the effectiveness of wethers and ewes treated with testosterone preparations to induce ovulation and breeding activity in anestrous ewes. The testosterone was administered three times at weekly intervals. Wethers and ewes treated with 105 mg testosterone propionate and wethers treated with 100 mg testosterone from testosterone cyclopentyl propionate were as successful as vasectomised rams in inducing ovulation and cyclic activity in ewes. Seven days after the last injection the concentrations of testosterone in peripheral bloods were not significantly different from that in the vasectomised rams. By day 28 the concentrations were significantly lower than in the rams. The testosterone preparations tested are suitable for the induction of male sexual behavior and are rapidly excreted by sheep.