利用果蝇对美尔伊避孕注射液遗传效应的测定

用CS及Basc果蝇品系对美尔伊避孕注射液及其配伍的两种成份——醋酸甲地孕酮和雌二醇的毒性及遗传效应进行检测。Basc品系用于检测发生在X染色体上的隐性致死突变。实验结果表明,美尔伊避孕注射液及其配伍的两种成份均元毒性及有害的遗传效应。美尔伊避孕注射液可推广使用。     

残余卵巢功能的随访研究

本文报道了31例单侧或双侧残余卵巢功能随访结果,月经正常者23例(74.19％);月经紊乱者8例(25.81％);术后妊娠者,在未避孕的25例中有18例(72％).在术前卵巢功能基本正常的18例生育年龄妇女中,共随访26周期,其中正常排卵周期占50％;黄体功能不全周期占15.38％;无排卵周期为19.23％;黄素化未破裂卵泡综合征周期为7.69％;卵巢衰竭占3.85％.内分泌激素测定结果和正常生育年龄妇女比较,卵泡期FSH水平升高(P<0.05),E_2水平降低(P<0.05),黄体期P水平降低(P<0.01).本文结果提示:大多数残余卵巢功能正常,少数功能异常者可能和卵巢肿瘤的病理类型、残余卵巢皮质体积、血运和周围粘连情况有关,残余卵巢早衰倾向尚待进一步观察。     

人工流产后立刻放置宫内节育器

近年来,对人工流产后排卵情况的调查显示,人工流产后最快在2周左右卵巢恢复排卵,约半数妇女在3周恢复排卵。而流产后约有15·1%的妇女在人工流产后不足2周就开始性生活,22·7%的妇女在2~4周开始性生活。因此,在人工流产后第一次月经来潮前就有将近40%的妇女面临再次意外妊娠而接受人工流产的可能。流产后排卵恢复快,避孕知识缺乏,对人工流产的危害认识不足,是人工流产后未及时使用避孕措施造成重复流产的主要原因之一。另外,某些避孕方法的依从性及有效性不够,也是重复流产的另一主要原因。1人工流产后立刻放置宫内节育器的可行性放置宫内节…     

原发不孕与继发不孕超声监测排卵结果对比分析

目的:探讨原发不孕与继发不孕超声监测排卵结果的差异.方法:回顾分析原发不孕组50例(A组)和继发不孕组50例(B组)各100个周期超声监测排卵结果.结果:两组卵巢体积(6.01±0.20cm3,6.25 ±0.28cm3)、优势卵泡直径(1.88±0.15 cm,2.05 ±0.11 cm)、月经周期第3天窦卵泡数(CD3-AFC)(6.12 ±1.02个,6.35 ±1.15个)、排卵期子宫内膜厚度(10.6 ±1.60cm.9.36±1.65mm),比较差异无统计学意义(P0.05);两组无排卵周期率(15%,9%)、小卵泡排卵(SFO)率(10%,3%)、卵泡未破裂黄素化综合征(LUFS)(20%,3%)比较,A组明显高于B组(P0.05);无排卵和小卵泡排卵患者卵巢体积和CD3-AFC明显小于排卵正常者.结论:原发不孕患者排卵障碍发生率高于继发不孕患者;小卵泡排卵和无排卵是排卵障碍的主要类型;多数继发不孕患者自然周期有排卵,使用促排卵药物应了解卵情况,避免盲目使用,以减少医疗费用和促排卵治疗引起的各种不良后果.     

长效醋酸甲孕酮避孕针减量的可行性研究

目的:研究长效醋酸甲孕酮避孕针(DMPA)减量至100 mg对避孕效果、卵巢功能、月经的影响.方法:自愿使用DMPA避孕者随机分为常量组(150 mg DMPA)和减量组(100 mg DMPA),常量组52例,减量组40例,均用药1年.观察避孕效果、B超监测卵泡发育情况,测定血浆性激素值,观察用药后月经改变情况.结果:用药后两组均无避孕失败,两组90%以上受试对象卵巢内无卵泡或有小卵泡,最大卵泡直径≤1.5,其卵泡发育状况相当于正常育龄妇女卵泡早期水平;两组血FSH、LH维持在基础水平,卵巢分泌雌激素相当于正常育龄妇女卵泡早期水平;两组用药后月经改变相似.结论:两种剂量DMPA避孕效果一样,对卵巢抑制程度相似,月经改变相似.DMPA减量到100 mg具有可行性.     

排卵时间的确定

正确判断排卵时间,对不孕症的治疗和避孕的指导均十分重要。排卵是多种激素作用的结果,故欲判断排卵时间,必须了解排卵周期激素的变动。排卵是发生在血中雌二醇(E_2)达峰值(300pg/ml以上)约2日后,血中LH峰值约36小时后。因排卵周期的颈管粘液和基础体温(BBT)的变化系源于雌激素的生理作用,故该两种指标即表明血中雌激素的消长水平。     

对月经正常妇女的排卵频度、顺序及侧别的研究

人们往往认为灵长类排卵是左右卵巢交替进行,且双侧排卵次数等同。本文对此做了研究。作者选择16例排卵正常的待人工授精(AID)妇女。尽可能在接近基础体温(BBT)最低日以实时超声扫描盆腔,每周期至少一次。BBT双相的妇女肯定有排卵,黄体期平均为14±2天。黄体中期血浆孕酮浓度≥38.4nmol/L(12ng/ml)。基于Bernolli分布进行统计学分析。假设在正常状态下,双侧卵巢各有50%的概率发生排卵。作者共观察16例90个周期,发现卵泡97个。其中7个周期(8%)中两个卵泡均在同一卵巢上。探及62个卵泡(64%)在右卵巢上,35个卵泡(36%)在左卵     

153例雌激素冲击诱导排卵和受孕

目的 探讨一次性大剂量雌二醇冲击诱导排卵和受孕的效果。方法 １５３例卵巢无排卵或黄体功能不健的内分泌失调不孕症，对其中７１例月经周期基本正常者，于月经第８￣１１天一次性肌肉注射苯甲酸雌二醇１０ｍｇ，８２例周期４０天以上、体内雌激素水平偏低者，于月经第５天起服克罗米芬５０ｍｇ，每日一次，连服５天，己烯雌酚０．２５ｍｇ，每日一次，连服１０天，Ｂ超提示生长卵泡直径达０．８ｃｍ左右时，再肌肉注射苯甲酸雌二     

GnRH-a治疗难治性排卵障碍不孕患者的初步观察

目的探讨常规诱导排卵失败后应用促性腺激素释放激素激动剂(GnRH-a)诱导排卵的临床效果.方法对常规促排卵治疗(氯米芬和HMG)失败的13例排卵障碍不孕患者,其中多囊卵巢综合症(PCOS)5例,小卵泡排卵8例.采用GnRH-a+HMG治疗,并于周期第8天开始B超监测卵泡发育并测定尿LH,当卵泡平均径线达18 mm或尿LH(+)时,给HCG诱发排卵.结果13例患者采用GnRH-a+HMG治疗19个周期,均有优势卵泡发育,其中16个周期(84.2%)卵泡平均径线达18 mm时尿LH仍为(-),给HCG诱发排卵;3个周期提前出现LH峰,取消使用HCG.36.8%的周期为单卵泡发育,75.0%为＜3个优势卵泡,8.3%为4～10个,18.8%为＞10个.妊娠率58.3%,周期妊娠率41.2%,其中单胎4例,双胎2例,4胎1例;自然流产的发生率为14.3%.结论GnRH-a可增强PCOS患者对HMG的反应性,防止内源性LH峰早现,并有良好的妊娠率及妊娠结局,可望作为治疗PCOS及小卵泡排卵患者的二线药物;低剂量HMG可使75%的治疗周期中卵泡发育数＜3个.     

自身免疫性甲状腺炎与排卵障碍相关性研究

目的 探讨自身免疫性甲状腺炎（AIT）在多囊卵巢综合征（PCOS）与非PCOS排卵障碍患者中的发生情况。方法 收集2012年1月至2013年12月在绍兴市妇幼保健院就诊的排卵障碍者,其中PCOS196例,非PCOS排卵障碍152例,同期因男方因素就诊而卵巢排卵正常者104例为对照组。比较各组甲状腺功能、甲状腺抗体与甲状腺超声检查结果。结果 PCOS组、非PCOS排卵障碍组、正常对照组中AIT的发生率分别为19.9%、7.9%及6.7%,PCOS组与其他两组间比较差异均有统计学意义（P＜0.05）;非PCOS排卵障碍组与正常对照组间差异无统计学意义（P＞0.05）。PCOS组促甲状腺素（TSH）、抗甲状腺过氧化物酶抗体（TPOAb）、抗甲状腺球蛋白抗体(TgAb)均显著高于其余两组（P＜0.05）。各组间超声阳性结果差异无统计学意义（P＞0.05）。结论 AIT在PCOS患者中的发生率高于非PCOS排卵障碍者及正常者;PCOS可能是一种与AIT相关的自身免疫性疾病。     

黄体早期服用低剂量米非司酮作为妇女常规避孕方法的初步研究

目的:探讨米非司酮用于妇女常规避孕的可行方法。方法:共74例自愿受试人员,于规律月经第15日开始,口服米非司酮5 mg,按疗程递减顺序分别为A组(研究Ⅰ期)每日1次连服4天,B组(研究Ⅱ期)每日1次连服3天,C组(研究Ⅲ期)隔日1次共服2天,观察避孕效果及月经周期改变情况,对可能月经推迟3天及以上者行尿HCG、B超等检查排除早孕。结果:A组43例受试125周期,122例次月经如期来临,3例次月经推迟6~9天,尿HCG、B超等检查阴性,有效率100.0%,月经正常率97.6%。B组68例(A组43例+新入受试25例)受试286周期,282例次月经如期来临,4例次月经推迟5~8天,尿HCG、B超等检查阴性,有效率100.0%,月经正常率98.6%。C组6例(新入受试人员)受试12周期,9例次月经推迟6~9天,尿HCG、B超等检查阴性,有效率100.0%,月经正常率25.0%。A、B两组共获411受试周期,避孕有效率均达100.0%,月经正常率98.3%;C组月经周期正常率显著低于A、B组(P0.01),研究暂时终止。A、B两组避孕效果及对月经的影响差异无统计学意义(P0.05)。结论:黄体早期(内膜分泌期早期)阶段短程、小剂量应用米非司酮有较好的避孕效果,且对月经周期无明显的影响,月经规律者可用于每月的常规性避孕。初步研究认为较佳的剂量-时效关系为米非司酮5mg/d连用3天。     

New aspects of injectable contraception

Despite the availability of efficacious and safe contraceptive agents, not all women's contraceptive needs are being met. An injectable contraceptive method offers convenience and encourages compliance, both very important aspects for women seeking ideal contraception. Depot medroxyprogesterone acetate (DMPA) is a long-acting injectable, and is highly effective; one injection provides 3 months of contraception. Drawbacks of DMPA include irregular bleeding and a slow return to fertility. A new monthly injectable contraceptive agent is medroxyprogesterone acetate/estradiol cypionate suspension (Lunelle). It provides menstrual regulation and a rapid return to fertility. The estrogen ensures a withdrawal bleed monthly; however, women with contraindications to estrogen-containing contraception are not candidates for Lunelle.     

Contraceptive efficacy of norethindrone acetate (ENTA) implant: its release rate and fertility potential

The contraceptive efficacy of norethindrone acetate (ENTA) implant was evaluated in a study of 79 healthy volunteers aged 19-30 years. The purpose of the study was to 1) relate the menstrual pattern to the average daily release rate of the hormone, 2) assess the concentration of NET in peripheral blood in cases of unintentional pregnancies and ascertain the risk to offspring in such cases, and 3) evaluate the fertility potential and menstrual pattern in the 1-year period after implant removal. In most subjects (59), the implant was removed between the 5th and 8th month. The average release rate was found to be 163.5 mcg/day in subjects with regular menstrual cycles (cycle interval of 25-32 days) compared with 190.9 mcg/day in those with an abnormal menstrual pattern (p0.05). The rate was 143.3 mcg/day in the 19 women who became pregnant during the trial, but this difference is not significant. 15 of the 19 pregnancies occurred between 4 and 8 months, suggesting that the contraceptive efficacy of this implant does not exceed 4-5 months. Mean NET concentration in the sera of the women who became pregnant was 122.5 pg/ml at the time of pregnancy diagnosis. Only 10 subjects complied with the recommendation that their pregnancy be terminated for medical indications. The remaining 9 subjects delivered 6 female and 3 male infants who appeared to clinically normal, despite the fact that 4 had been exposed to the steroid for over 6 weeks. 1 year follow-up was possible in 52 subjects. The menstrual pattern appeared to be regular during this period. 25 of the 44 women in this follow-up group who did not use contraceptive measures became pregnant during the 1st year after implant removal. Additionally, the 9 infants delivered to women during the study period were evaluated for 2-3 years. No adverse changes in growth and development have been observed. This finding suggests that reports associating teratogenicity and progestins in early pregnancy are exagerrated.     

A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia

Treatment with flurbiprofen (100 mg twice a day for 5 days), tranexamic acid (1.5 gm three times a day for 3 days and 1 gm twice a day for another 2 days), and an intrauterine contraceptive device releasing 20 micrograms levonorgestrel per day was compared in women with idiopathic menorrhagia. The menstrual blood loss during two control periods in 15 women subsequently treated with flurbiprofen and tranexamic acid was 295 +/- 52 ml and 203 +/- 25.2 ml in the 16 women later fitted with a levonorgestrel-releasing intrauterine contraceptive device. Menstrual blood loss was reduced by all three forms of treatment. The reduction in menstrual blood loss expressed as a percentage of the mean of two control cycles for each form of treatment was as follows: flurbiprofen, 20.7% +/- 9.9%; tranexamic acid, 44.4% +/- 8.3%; levonorgestrel-releasing intrauterine contraceptive device after 3 months, 81.6% +/- 4.5%; levonorgestrel-releasing intrauterine contraceptive device after 6 months, 88.0% +/- 3.1%; levonorgestrel-releasing intrauterine contraceptive device after 12 months, 95.8% +/- 1.2%. The reduction in menstrual blood loss achieved by the levonorgestrel-releasing intrauterine contraceptive device was greater than that recorded with flurbiprofen (p less than 0.001) and tranexamic acid (p less than 0.01), and was greater for tranexamic acid when compared with flurbiprofen (p less than 0.05). The levonorgestrel-releasing intrauterine contraceptive device was the only form of treatment to reduce mean menstrual blood loss below 80 ml per menstruation, the upper limit of normal menstrual blood loss.     

Evaluation of an injectable progestin-estrogen as a contraceptive

A study involving an injectable contraceptive regimen utilizing 2 commercially available hormonal preparations, medroxyprogesterone acetate (Depo-Provera, The Upjohn Company) and estradiol-17 beta-cyclopentylpropionate (Depo-Estradiol Cypionate, The Upjohn Company), is described. 90 multigravidas received intramuscular injections of 50 mg of medroxyprogesterone acetate and 10 mg of estradiol-17 beta-cyclopentylpropionate as a contraceptive every 5 weeks, for a total of 1155 periods. The injections were found to be safe and completely effective. In 15% of the therapeutic cycles, bleeding did not appear for a period of 30 or more days. In 14%, bleeding and/or spotting lasted for longer than 9 days during a 30 day period. The incidence of aminorrhea increased somewhat after the first 10 months of treatment. Endometrial biopsies showed a "suppressed" endometrium. Adrenal pituitary responsiveness to metyrapone was found to be normal in 17 of 21 patients tested. Although almost half of the patients presented some complaints during the study, these were mostly transient and minor in nature. Headache was the complaint most frequently observed (14%), but it was generally limited to 1 cycle. The monthly injectable contraceptive regimen may be useful in a particular population of patients who, for various reasons, cannot tolerate or cannot be relied upon to take oral contraceptives. The authors believe that because of the high incidence of alterations in the bleeding pattern while on the therapeutic regimen, as well as the frequent occurrence of aminorrhea following discontinuation of therapy, the use of such a contraceptive regimen in the general population might not be desirable.     

Contraception during perimenopause

Perimenopause marks the transition from normal ovulation to anovulation and ultimately to permanent loss of ovarian function. Fecundity, the average monthly probability of conception, declines by half as early as the mid-forties, however women during the perimenopause still need effective contraception. Issues arising at this period such as menstrual cycle abnormalities, vasomotor instability, the need for osteoporosis and cardiovascular disease prevention, as well as the increased risk of gynecological cancer, should be taken into consideration before the initiation of a specific method of contraception. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives, tubal ligation, intrauterine devices, barrier methods, hormonal injectables and implants. Recently, new methods of contraception have been introduced presenting high efficacy rates and minor side-effects, such as the monthly injectable system, the contraceptive vaginal ring and the transdermal contraceptive system. However, these new methods have to be further tested in perimenopausal women, and more definite data are required to confirm their advantages as effective contraceptive alternatives in this specific age group. The use of the various contraceptive methods during perimenopause holds special benefits and risks that should be carefully balanced, after a thorough consultation and according to each woman's contraceptive needs.     

Contraception during perimenopause.

Perimenopause marks the transition from normal ovulation to anovulation and ultimately to permanent loss of ovarian function. Fecundity, the average monthly probability of conception, declines by half as early as the mid-forties, however women during the perimenopause still need effective contraception. Issues arising at this period such as menstrual cycle abnormalities, vasomotor instability, the need for osteoporosis and cardiovascular disease prevention, as well as the increased risk of gynecological cancer, should be taken into consideration before the initiation of a specific method of contraception. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives, tubal ligation, intrauterine devices, barrier methods, hormonal injectables and implants. Recently, new methods of contraception have been introduced presenting high efficacy rates and minor side-effects, such as the monthly injectable system, the contraceptive vaginal ring and the transdermal contraceptive system. However, these new methods have to be further tested in perimenopausal women, and more definite data are required to confirm their advantages as effective contraceptive alternatives in this specific age group. The use of the various contraceptive methods during perimenopause holds special benefits and risks that should be carefully balanced, after a thorough consultation and according to each woman's contraceptive needs.     

Medical management of dysfunctional uterine bleeding.

Complaints of excessive menstrual bleeding (menorrhagia) have a substantial impact on gynaecological services and in most cases no organic pathology is identified. Up to 50% of women who present with menorrhagia have blood losses within the normal range. Medical therapy is indicated for patients who do not wish surgery, or for whom surgery is unsuitable. Nonsteroidal anti-inflammatory drugs and tranexamic acid offer a simple therapy to be taken during menses, with reductions in menstrual blood loss (MBL) of 25-35% and 50% respectively. Danazol and the gonadatrophin-releasing hormone analogues are highly effective, but their side-effects make them suitable only for short-term use. The combined oral contraceptive pill and the levonorgestrel intrauterine system give reductions in MBL of 50% and 80%, with additional contraceptive cover. Cyclical progestogens are the most commonly prescribed therapy in the United Kingdom but they are ineffective for the management of ovulatory menorrhagia unless taken at high doses (10-15 mg daily) for 3 weeks out of 4.     

Ciclo prolongado/continuado

One suggested goal of contraceptive development has always been that the method should have little or no effect on the menstrual cycle. More specifically, mimicking a normal 28-day cycle was considered desirable. Combination oral contraceptives have thus been formulated in such a way as to provide an artificial but typically regular monthly cycle. For many years, however, clinicians have used hormonal manipulation of the menstrual cycle to provide therapeutic amenorrhea in individuals with underlying medical problems. There is growing interest in the use of combined oral estrogen-progestin contraception in extended «cycles» of 3, 6 and 12 or more months. Extended cycle contraception leads to better compliance than conventional cycle contraception, thus optimizing contraceptive effectiveness. Although this type of contraception is not accepted by all women, some do prefer to have fewer menstrual cycles, minimizing menstrual-related symptoms.