两种类型的特发性低促性腺激素性腺功能减退症

两例男性IHH患者性幼稚的程度不同,例1睾丸容积10ml,例2为2ml。12hLH脉冲分析表明,前者夜间入睡后出现分泌脉冲,和正常人相似,但是白天无分泌脉冲;后者白天和夜间都没有分泌脉冲。这一结果表明,睾丸大小的差别代表着两种不同类型的IHH。     

Effect of gonadotropins on human endometrial stromal cell proliferation in vitro

It has long been known that endometrial regeneration and proliferation is regulated by sex steroids, cytokines and various growth factors. The mechanisms responsible for such organized growth are still under investigation. Human chorionic gonadotropin/luteinizing hormone (hCG/LH) receptors have been found to be localized in human endometrium by immunocytochemistry. Gonadotropins have been widely used for hyperstimulation during in vitro fertilization (IVF) procedures; however, the direct effect of gonadotropin on the endometrium has not been adequately investigated yet. This study attempted to define the effect of gonadotropins on the proliferation of human endometrial stromal cells in vitro. Human endometrial stromal cells were obtained from hysterectomy specimens and cultured in serum-containing media for up to 72 h. The effects of adding 7.5, 15, 30, 150 mIU/ml of human menopausal gonadotropin (hMG) and follicle stimulating hormone (FSH), and 10, 100, 1,000, 10,000 mIU/ml of hCG on cumulative [³H]-thymidine incorporation in endometrial stromal cells were assessed. This study demonstrated that FSH and hMG induced significant inhibition in [³H]-thymidine uptake at all concentrations, respectively (P<0.05). In contrast to the above two hormones, hCG exerted inhibitory effect at concentrations of 1,000 and 10,000 mIU/ml (P<0.05). There was no evidence of dose-response correlations in all three gonadotropin experiments. These data imply that gonadotropins at the concentrations studied inhibit the proliferation of human endometrial stromal cells, at least, in short-term culture in vitro. Accordingly, we cannot negate the possibility that administered gonadotropin during ovarian hyperstimulation may directly influence the proliferation of human endometrial cells. Received: 24 September 2001 / Accepted: 18 December 2001     

Endometriosis,endometrioma, and ART results: Current understanding and recommended practices

Endometriosis and infertility are linked in a complex relationship, and a number of different pathogenetic mechanisms may associate the two. Endometriosis is diagnosed in 6–8% of women undergoing ART. Women with endometriosis appear to have similar ART outcomes compared to controls in terms of live birth rates, despite a lower oocyte quality. Laparoscopy should not be routinely performed before ART with the only aim to diagnose mild or moderate endometriosis, but if the latter is found, surgical removal can be considered, as it might improve pregnancy rates. In case of more severe forms of the disease (endometrioma and deep infiltrating endometriosis), the benefits of surgery before ART are uncertain and must be balanced against risks. Management decisions should be individualized based on patient choice, age, associated symptoms, and the risk of repeat surgery.     

Optimisation médicale du recueil de spermatozoïdes dans les azoospermies non obstructives

Medical optimisation of sperm retrieval in non-obstructive azoospermia is reviewed. Gonadotropin treatment of hypogonadotropic hypogonadism allows obtaining sperms in the ejaculate in about 90% of cases provided the duration of treatment was long enough. TESE is indicated in case of persistent azoospermia at 2 years of continuous treatment. Some publications reported a possible effect of hormonal treatments (FSH, hCG, anti-estrogens, aromatase inhibitors) in primary spermatogenic failure, but mainly in cases selected for their favourable histology and normal hormonal levels. The effect on unselected cases remains doubtful. Conversely, the effect of the treatment of varicoceles is significant. Other medical treatments or advises need further investigations.     

Ethanol Has Direct Inhibitory Effects on Steroidogenesis in Human Granulosa Cells: Specific Inhibition of LH Action

We have evaluated the direct effects of ethanol (EtOH) on the production of progesterone (P) and estradiol-17β (E₂) by cultured human granulosa cells obtained during in vitro fertilization procedures. On day 3 of culture, cells were divided into control and ethanol (20 m m ) groups and stimulated by hFSH (50 ng/ml), h lh (0–50 ng/ml), FSH+LH, 8 Br-cAMP (0.25 m m ) and androstenedione (10⁻⁷ M). Experiments were terminated on days 7 and 9 and DNA, P, and E₂ were measured. Ethanol inhibited P and E₂ secretion stimulated by LH; however, there was no significant effect of ethanol on P and E₂ production in the control group or when the cells were stimulated by FSH or cAMP. EtOH also had no effect on androstenedione stimulated E₂ production. There was no significant difference in the DNA contents of the human granulosa cells in the ethanol group as compared with the control group. These results are the first demonstration of a direct effect of ethanol on cultured granulosa-lutein cells and suggest that ethanol may inhibit action of LH on the corpus luteum. A direct selective toxic effect of EtOH on the ovary may be responsible for some of the reproductive abnormalities observed in alcoholic women.     

妊娠滋养细胞肿瘤免疫组织化学研究

观察hCG,hPL在15例葡萄胎、17例恶性葡萄胎及15例绒毛膜癌中的分布,证实有中间型滋养细胞。hCG和hPL在IT和ST中的含量随滋养细胞肿瘤的不同而异,ST可能含hCG或hPL,IT主要含hPL,CT不含hCG,也无hPL。     

Prepubertal ontogeny of responsiveness to estradiol in female rat central nervous system

The physiological response to systemic estrogens changes dramatically during the period from birth to puberty. With the onset of puberty, the rat reaches a critical developmental plateau with regard to endocrinological responsiveness to estradiol. Since the appearance of the pubertal response pattern appears to be less a consequence of some intrinsic “trigger” than the natural continuation of a developmental sequence that begins prenatally, its ontogeny should be examined in a broad context that will take account of the impact of each of the dynamic components influencing the interactions between estradiol and the central nervous system on the functional development of the organism as a whole. The prepubertal ontogeny of endocrinological responsiveness to estradiol in the central nervous system of the female rat is examined in the context of several of the important factors that are known to influence the functional development of the hypothalamo-pituitary-gonadal circuit: the rapidly changing hormonal environment of the morphologically and physiologically immature juvenile rat, the shifting predominance of alphafetoprotein and “adult” estradiol-binding protein, sexual differentiation of the neural substrate, and the development of mature pituitary-gonadal feedback machanisms. The availability of ever more sensitive techniques for the measurement of the actions of estradiol in the central nervous system of the immature organism has necessitated a re-evaluation of existing data. This, in turn, suggests that new approaches should be applied to the examination of problems related to the development of reproductive maturity of the central nervous system.     

促排卵与宫腔内人工授精联合治疗不育症

为了比较不同的促排卵方法联合宫腔内人工授精（ＩＵＩ）治疗不育症的疗效。以排卵功能障碍、宫颈因素、免疫因素、原因不明、男方因素等导致不育的１４７对不育夫妇作为观察对象，分为３组。第一组：促性腺激素促排卵加ＩＵＩ，共５６例、６８周期；第二组：克罗米芬促排卵联合ＩＵＩ，共５０例，５６周期；第三组：自然周期加ＩＵＩ共４１例、４１周期。结果：第一组１６例妊娠，妊娠率２９％，周期妊娠率２４％；第二组３例妊娠，妊娠率６％，周期妊娠率５％；第三组妊娠３例，妊娠率与周期妊娠率均为７％。第一组与第二、第三组的妊娠率及周期妊娠率比较，差异均有显著意义，分别为Ｐ＜０．０１及Ｐ＜０．０２。结论：对难治性不育症，如选用ＩＵＩ治疗，则加用促性腺激素促排卵的妊娠率高于克罗米芬刺激排卵或不刺激周期。     

Hydatidiform mole following successful gonadotropin ovulation induction and donor artificial insemination

A case of successful gonadotropins ovulation induction and donor artificial insemination (AID) followed by a complication of hydatidiform mole is presented. A review of the published papers related to this topic are commented. The organization of a world registry of AID depending on the World Health Organization is encouraged.     

Endocrine Profile of 45 Patients with Sertoli Cell Only Syndrome

Endokrines Profil bei 45 Männern mit Sertoli-Zell-Syndrom
Bei 45 Männern mit Sertoli-Zell-Syndrom wurden die Hormonbasiswerte für FSH, LH, Prolaktin und Testosteron mit denen von Klinefelter-Paitenten, Männern mit Oligozoospermie und gesunden, fertilen Männern verglichen. Dabei ergab sich, daß die FSH- und LH-Werte bei Sertoli-Zell-Syndrom signifikant höher lagen als bei Gesunden. Die Erhöhung der Gonadotropine bei Patienten mit Sertoli-Zell-Syndrom was allerdings nicht so hoch und Testosteron nicht so herabgesetzt wie man es bei Klinefelter-Paitenten gefunden hatte. Aus dem Resultat, daß die LH-Werte erhöhte waren, während Testosteron sich im normalen Rahmen bewegte wird die Schlußfolgerung gezogen, daß hier eine kompensierte Dysfunktion der Leydigzellen bei den Patienten mit Sertoli-Zell-Syndrom vorliegt. Für Oligozoo-spermie-Patienten ließ sich keine Differenz der Hormonwerte gegenüber Gesunden feststellen.