Objective: To evaluate the hormonal response to the short protocol of gonadotropin-releasing hormone (GnRH) analog (GnRHa) in patients with polycystic ovarian disease (PCOD).
Methods: We enrolled 35 ...patients (20 infertile) with ultrasonographic and hormonal PCOD characteristics. GnRHa Suprefact was applied subcutaneously at a daily dose of 0.9 ml for 9 consecutive days starting on the 10th–15th day after induced or spontaneous bleeding. Blood sampling for follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E
2), estrone (E
1) and dehydroepiandrosterone sulfate (DHEA-S) was performed before the treatment and on days 3 and 4 of GnRHa administration. Student's
t-test was used for the analysis of differences between various mean values. All statistical analyses were performed by the computerized statistical package CSS-Statistica.
Results: Pretreatment hormonal levels (FSH 5.68 ± 1.86 IU/l, LH 14.16 ± 1.72 IU/l, E
2 0.29 ± 0.20 nmol/l, E
1 0.35 ± 0.17 nmol/l, T 3.52 ± 1.40 nmol/l, DHEA-S 7.15 ± 2.89 μmol/l) barely differed on day 3 of GnRHa administration, except for the rise in LH (17.14 ± 10.97 IU/l), which was still not significant. On day 9 of GnRHa application, significant suppression of FSH (3.16 ± 1.55 IU/l) and LH (8.05 ± 5.00 IU/l) was registered compared with pretreatment levels, without changes in the FSH:LH ratio, and in other parameters studied. Although there were no changes in ultrasound characteristics on day 9 of GnRHa administration compared with basal findings, bleeding occurred 14–18 days after the last GnRHa dose in 32 patients. There were three pregnancies out of 20 infertile patients in the treated cycles.
Conclusion: Significant suppression of FSH and LH in PCOD patients does not interfere with ovarian steroid production, which is probably maintained due to higher follicular sensitivity to normal FSH and LH levels. Alternatively it may be the consequence of the unaltered FSH:LH ratio in spite of GnRHa-suppressed absolute values. However the recommencement of menstrual bleeding and 15% of pregnancies in the investigated infertile patients suggest the occurrence of certain temporary intraovarian events, which probably continue after the cessation of GnRHa administration.
To evaluate the influence of educational intervention on the hormone replacement therapy (HRT) continuation rate in Slovenia after the publication of WHI results.
We enrolled 125 early postmenopausal ...women in a 12-month prospective, randomized, controlled, multicentric study in Slovenia. The study group women (
n
=
62) attended educational lectures; the control group women (
n
=
63) did not. Data were collected from three types of questionnaire: before starting HRT, at follow-up visits at 3, 6, 9 and 12 month, after the educational lecture (study group). The continuation rate was measured on the basis of women's self-reports. The results were analyzed according to the “intention-to-treat” principle. The Cox proportional hazard model was used for the final analysis.
A gynecologist's suggestion, climacteric symptoms and quality of life were the prevailing reasons for starting HRT. The prevailing factors affecting continuation of HRT were: no or irregular previous OC use (hazard ratio 3.7), no educational lectures (hazard ratio 2.0) and climacteric disorders as the reason for start HRT (hazard ratio 2.1).
In the women who discontinued HRT within the first 3 months, the fear of endometrial cancer, breast cancer and bleeding problems were statistically more significant than other factors (
P
=
0.034). In the women who stopped HRT use within 6–12 months, the fear of breast and endometrial cancers increased substantially (
P
=
0.002).
Previous OC use and educational lectures on menopausal problems and HRT significantly improve the HRT continuation rate. The main reason for discontinuing HRT is fear of breast cancer, intensified by media.
Elastase is a protease released by polymorphonuclear neutrophils (PMN) during the inflammatory process. Since 1987, seminal elastase-inhibitor complex (Ela/alpha1-PI) has been proposed as a marker of ...male silent genital tract inflammation. Measured by immunoassay in seminal plasma, Ela/alpha1-PI at a cut-off level of > or = 230 microg/l, is useful in the detection of genital tract inflammation. The prevalence of increased seminal Ela/alpha1-PI in infertile men is significantly higher than that observed in fertile men. The Ela/alpha1-PI level is positively correlated with other seminal fluid markers of male genital tract inflammation: reduced semen volume, citric acid, fructose, and increased albumin, complement component C3, caeruloplasmin, immunoglobulins IgG and IgA, and cytokines interleukins-8 and -6. A higher seminal Ela/alpha1-PI level is significantly associated with tubal damage in female partners. After antibiotic therapy, a decrease of Ela/alpha1-PI level is observed. The presence of tubal damage in the partner may negatively affect the response to antibiotic treatment. A higher seminal Ela/alpha1-PI is associated with lower percentage of sperm with single-stranded deoxyribonucleic acid (DNA) and better fertilization rate in in vitro fertilization. Besides infertility, the determination of Ela/alpha1-PI is useful to confirm the presence of prostate and other male accessory gland bacterial inflammation. Screening for PMN Ela/alpha1-PI is easy to perform and reproducible and is a reliable quantitative test for diagnosis and prognosis of silent genital tract inflammation of couples. Moreover, sequential determinations allow the follow-up of inflammation during and after therapy.
The growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis seems to play an important role in ovarian responsiveness. Recently IGF binding protein-3 (IGFBP-3) serum concentrations have been ...reported to be a good marker of GH/IGF-I axis activity. In view of this finding, we measured IGFBP-3 serum concentrations in 29 women undergoing in-vitro fertilization. We found a significant correlation among IGFBP-3 serum concentrations and markers of ovarian stimulation including efficacy index, serum oestradiol concentrations and the number of follicles on the day of human chorionic gonadotrophin (HCG) administration. The results of our study add additional evidence to the importance of the GH/IGF-I system in regulating ovarian responsiveness to gonadotrophin stimulation.
To evaluate the clinical role of blastocyst freezing and thawing after prolonged culturing in sequential media.
Retrospective analysis of 293 blastocyst freeze–thawing cycles.
University hospital ...infertility unit.
Nonselected couples undergoing IVF.
Blastocysts were frozen and thawed by a modified method.
Blastocyst recovery after freeze–thawing and pregnancy rates after the transfer. Evaluation of the effect of the number of transferred blastocysts, the method of IVF, and of the woman’s age on the results achieved by frozen–thawed blastocysts.
Frozen–thawed blastocysts provided a 29.5% clinical pregnancy rate per transfer. After the transfer of three blastocysts the pregnancy rate was 42.0%, and after the transfer of one or two blastocysts it was approximately the same (25.0% and 28.0%, respectively). The method of IVF did not affect pregnancy rates, but the increasing age of the woman did. Pregnancies were characterized by a low abortion rate (8.0%) regardless of the age of the woman.
A modified method for blastocyst freeze–thawing provides good clinical results. It offers the possibility for a single-thawed blastocyst transfer and represents a good alternative for older women because of its lower risk of spontaneous abortion.
To find whether plasma and follicular prorenin concentrations have any effect on the uterine arterial blood flow in women with polycystic ovarian syndrome (PCOS) compared to those with normal ...menstrual cycles (NMC).
Controlled prospective clinical study involved 55 women undergoing in vitro fertilization: 24 with PCOS and 31 with NMC. In both groups transvaginal colour Doppler assessment of uterine arterial blood flow was analysed on day 22 of the cycle, on the day of human chorionic gonadotrophin (HCG) administration and 36
h after HCG. Plasma and follicular (in the dominant follicle containing mature oocyte, and in the pooled follicles) prorenin and active renin, and serum estradiol and androstenedione concentrations were measured at these time-points. The Student's
t-test and Pearson correlation were used for the statistical analysis.
The resistance index (RI) in the NMC group decreased from 0.84
±
0.05 on the day of HCG to 0.78
±
0.08 36
h after HCG (
P
<
0.05); in the PCOS group the RI did not decrease. Follicular prorenin concentrations in the dominant follicle and in the pooled follicles were lower in the PCOS than in the NMC group (20,210
±
10,831
μU/l, 16,753
±
8634
μU/l versus 42,637
±
35,400
μU/l, 33,067
±
26,200
μU/l;
P
<
0.05).
Plasma prorenin concentrations do not affect vascular impedance to the uterine artery, but follicular prorenin do by newly formed low resistant vessels in the follicles.
a comparative analysis of the clinical effectiveness of pure FSH (Metrodin) and conventional gonadotropin (Pergonal) for ovarian stimulation was performed.
each group consisted of 30 selected ...patients with tubal infertility, practically identical by average age, duration of infertility, age at menarche, weight and height and husband's semen analysis. The average number of vials of drug used for stimulation, number of oocytes retrieved and embryos transferred was the same for both groups of patients. The failure of oocyte retrieval and fertilization was higher in the Pergonal (16.8%) than in the Metrodin group (6.8%).
in both groups there were 8 pregnancies--4 in the Pergonal and 4 in Metrodin group. All pregnancies in the pure FSH group resulted in the delivery of a healthy baby, while in the Pergonal group there were two deliveries and two spontaneous abortions.
evaluating the data we can conclude that pure FSH stimulation provides respectively lower failure and spontaneous abortion rates than Pergonal stimulation, leading to a higher take home baby rate.
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