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This study analyses the influence of female and male patient age and human
menopausal gonadotrophin (HMG) requirements on clinical pregnancy rates and
live birth rates with ovulation stimulation using HMG in combination with
intrauterine insemination (IUI). In this study, 363 consecutive HMG/IUI
treatment cycles in 184 patients carried out at a university fertility
centre were analysed in a retrospective fashion. The main outcomes measured
were clinical pregnancy rates and live birth rates. Increased female
partner age (> or = 35) and male partner age (> or = 40) were found
to negatively influence pregnancy rates with HMG/ IUI therapy. In addition,
this study demonstrated a critical threshold of HMG requirements beyond
which pregnancy did not occur. No pregnancies occurred in treatment cycles
requiring > 25 ampoules (1875 IU) of menotrophins to achieve follicular
maturity, irrespective of patient age. In conclusion, female partner age,
male partner age, and HMG requirements all significantly influence
pregnancy rates with HMG/IUI therapy.
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Vaginal carcinoma is an uncommon malignancy and one of the few gynecologic malignancies that is still clinically staged. Clinical staging, which can be difficult in some instances, is potentially inaccurate, as it has been shown to be in early endometrial and ovarian carcinoma. In addition, clinical staging can result in over- or undertreatment of the disease. The lack of standardization of treatment further compounds the issue, particularly for patients with small-volume disease. We report three patients with grade 2 or 3 small-volume primary squamous cell carcinoma of the vagina who underwent pelvic lymph node sampling for staging purposes. Each patient had lesions small enough to be considered for brachytherapy only. An average of 12 lymph nodes were removed with an average operative time of 72 minutes. All procedures were performed on an outpatient basis, and there were no intraoperative or postoperative complications. In one patient, teletherapy was added to the brachytherapy because a microscopic focus of squamous cell carcinoma was discovered in an obturator lymph node. Our initial experience indicates that laparoscopic sampling of lymph nodes in patients with early vaginal carcinoma may be helpful in preventing undertreatment of these women. Individualization of treatment can be accomplished quickly and safely on an outpatient basis, and initiation of treatment is not delayed. We believe further evaluation of laparoscopic staging of primary vaginal carcinoma is indicated. 相似文献
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Polycystic ovary syndrome (PCOS) is a common reproductive disorder
characterized by arrested follicular development prior to selection of a
dominant follicle. Dominant follicles produce large amounts of oestradiol
but PCOS follicles do not. With several potential aromatase (P450AROM)
inhibitors in follicular fluid, the question arises whether P450AROM is
expressed in PCOS granulosa cells, but the activity is inhibited, or
whether P450AROM is not expressed in PCOS. The purpose of the present study
was to determine whether P450AROM mRNA expression is altered in PCOS and to
correlate P450AROM mRNA expression in individual follicles with aromatase
stimulatory bioactivity and oestradiol in the follicular microenvironments.
P450AROM mRNA was measured in individual follicles from 16 PCOS and 48
regularly cycling control women by quantitative polymerase chain reaction
(PCR) and correlated with follicular fluid oestradiol concentrations and
aromatase stimulating bioactivity measured by the rat granulosa cells
aromatase bioassay. Follicular fluid oestradiol was low in all control
follicles <7 mm in diameter. Some follicles > or = 7 mm contained
elevated oestradiol values (P < 0.01) and all had an
androstenedione:oestradiol ratio of <4. Only in granulosa cells from
follicles > or = 7 mm with an androstenedione:oestradiol ratio of <4
were P450AROM mRNA levels increased (P < 0.05). These same follicles
also contained increased levels of aromatase stimulating bioactivity
whereas follicles <7 mm or with androstenedione:oestradiol ratio of
>4 contained little or no bioactivity. All PCOS follicles contained low
levels of oestradiol, P450AROM mRNA and aromatase stimulating bioactivity
similar to size- matched control follicles. These data indicate that
P450AROM mRNA expression and oestradiol production begin in developing
follicles when they reach approximately 7 mm in diameter. Oestradiol
production is low in PCOS follicles because there is insufficient aromatase
stimulating bioactivity to increase P450AROM mRNA expression.
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