Healthy twins delivered after oocyte cryopreservation and bilateral ovariectomy for ovarian cancer

Anti-neoplastic treatments have significantly increased the survival of cancer patients, but female patients risk premature menopause. Oocyte cryopreservation has been proposed as a fertility-saving option. This report describes the first live birth achieved with autologous cryopreserved oocytes in an ovariectomized borderline cancer patient. A patient with a borderline ovarian tumour asked for oocyte cryopreservation after a right adnexectomy. Ovulation induction resulted in the retrieval and cryopreservation of seven mature oocytes. Thirty-nine months after a left ovariectomy, the patient asked for oocyte thawing and embryo transfer. Endometrial growth was induced using hormone replacement treatment. Three of the seven cryopreserved oocytes were thawed; they survived and, after insemination, normal fertilization took place. Three embryos were transferred into the patient's uterus. A twin pregnancy was achieved with the birth of two healthy females. Oocyte cryopreservation may be a reliable option for preserving fertility in young cancer patients who risk premature menopause due to surgery, chemotherapy or radiotherapy.     

Effects of unilateral ovariectomy on female fertility outcome

Purpose

To compare the fertility outcome among women subjected to unilateral ovariectomy and other abdominal or non-gynaecologic pelvic surgery.

Methods

In this retrospective cohort study, 113 fertile women, surgically treated between 1990 and 2001 at Sapienza University of Rome with unilateral ovariectomy (UO), appendectomy (AP) or cholecystectomy (CO) for benign disease, were analysed for fertility outcome. Patients with assessed pre-surgical fertility defects, previous abdominal or pelvic surgeries and post-surgical contraception were not included.

Results

Thirty-five women underwent UO, 39 were subjected to AP and 39 were treated with CO. After a minimum 10-year post-surgical interval, the overall number of successful pregnancies was 75. The rate of women who experienced at least one post-operative successful pregnancy was: 48.5 % in UO, 41 % in AP and 53.8 % in CO (UO vs. AP, P = 0.55; UO vs. CO, P = 0.99; AP vs. CO, P = 0.53). One patient (2.8 %) in UO, one patient (2.6 %) in AP and two patients (5.1 %) in CO underwent Assisted Reproductive Technology to become pregnant. The rate of women who reported at least one miscarriage was: 10/35 (28.5 %) in UO, 11/39 (28.2 %) in AP, 12/39 (30.8 %) in CO (UO vs. AP, P = 0.93; UO vs. CO, P = 0.89; AP vs. CO, P = 0.81). One ectopic pregnancy was reported in CO group and one stillbirth occurred in one AP patient.

Conclusions

No statistical difference in terms of post-operative fertility outcome between patients subjected to UO, AP or CO was found, thus allowing to suppose that the removal of one ovary does not significantly worsen the female fertility outcome respect to other abdominal or pelvic procedures.     

Urinary excretion, osmolarity and electrolytes after bolus-injection of fenoterol in female rabbits

The effects of bolus injections of 1.0-80.0 micrograms/kg body weight fenoterol on urinary excretion, osmolarity and electrolytes were studied in unanesthetized, water-loaded rabbits. In animals infused initially with isotonic solution over 2 h with 60 ml/h and thereafter over 10 h with 45 ml/h, urine excretion was 538 ml/12 h, sodium excretion was 65.4 mmol/12 h, and potassium excretion was 4.8 mmol/12 h. In animals injected with 5.0-80.0 micrograms/kg body weight fenoterol, a strong antidiuresis occurred, lasting for 2 (10.0 micrograms/kg) to 4 h (80.0 micrograms/kg). Due to the strong antidiuresis, urinary osmolarity was significantly elevated for 2 (10.0 micrograms/kg) to 3 h (80.0 micrograms/kg). The changes of sodium excretion after fenoterol injection were very similar to those of urine excretion. Maximum reduction of sodium excretion was found after injection of 10.0-80.0 micrograms/kg body weight fenoterol, the effect lasting for 1 h (10.0 micrograms/kg) to 4 h (80.0 micrograms/kg). Potassium excretion was significantly reduced after injection of 5.0-80.0 micrograms/kg body weight fenoterol. In contrast to all the other parameters measured, potassium excretion remained significantly reduced until the end of the infusion period in animals treated with 10.0-80.0 micrograms/kg body weight fenoterol and was not dose dependent. Our data presented in this work extend earlier findings in the rabbit in that bolus injection of fenoterol also results in a drastic decrease of urine and electrolyte excretion. The results are discussed with special reference for the management of acute fetal distress with betamimetics and to the development of pulmonary edema that has been shown to occur under therapy with betamimetics on both female rabbits and humans.     

Bilateral ovariectomy in gonadal dysgenesis with a Y chromosome]

The Authors report 4 cases of gonadal dysgenesis with a Y chromosome. Every patient underwent bilateral oophorectomy. Two cases of streak gonads, 1 case of streak gonad and gonadoblastoma and 1 case of non metastasizing bilateral gonadoblastoma with foci of dysgerminoma have been found. The Authors emphasize the importance of early bilateral gonadectomy in all cases of gonadal dysgenesis with a Y chromosome.     

The progesterone positive feedback effect in women after ovariectomy

Various ovarian substances regulate the secretion of gonadotrophins during the menstrual cycle, but there are still several unclarified issues. The aim of this study was to investigate the positive feedback effect of progesterone during the immediate period following ovariectomy. Experiments were performed in 12 normally cycling women (aged 39–49 years). Following abdominal hysterectomy plus bilateral ovariectomy performed on cycle day 3 (day 0), the women received either estradiol via skin patches (days 0–7, n = 6, group 1) or estradiol as above plus vaginal progesterone (days 1–7, n = 6, group 2). Serum estradiol values increased similarly in the two groups. After the operation, serum progesterone levels decreased significantly in group 1, while in group 2 they remained stable becoming higher than in group 1 (p < 0.05). An LH and an FSH surge occurred in group 2 with the values after the peak returning to the pre-surge baseline. In contrast, in group 1 LH and FSH levels following an initial decrease, increased gradually until the end of the experiment. These results demonstrate that, despite a variable response to estrogens, the positive feedback effect of progesterone remained intact immediately after ovariectomy in women. It is suggested that it is the combining action of estradiol and progesterone that can ensure the expression of a positive feedback mechanism in women.     

Effect of immune stress on body weight regulation is altered by ovariectomy in female rats

It has been suggested that obesity and loss of ovarian function alter the inflammatory response to immune stress. Ovariectomized (OVX) rats, which are used as a model of human menopause, exhibit both hyperphagia-induced obesity and gonadal steroid deficiency. To evaluate the effects of ovariectomy on inflammatory responses, we compared the anorectic response to LPS in OVX rats and gonad intact female rats. As leptin and hypothalamic interleukin-1β (IL1β) play pivotal roles in the anorectic response to immune stress, these factors were also measured. It was found that the OVX rats exhibited an increased anorectic response to LPS compared with the sham-operated rats. The OVX rats showed higher serum leptin concentrations and a greater increase in hypothalamic IL1β mRNA expression after LPS injection. In addition, in order to determine whether gonadal steroid deficiency contributes to the changes in the inflammatory responses of OVX rats, we compared responses between OVX rats treated with gonadal steroids and untreated OVX rats. There were no differences in appetite, the serum leptin level, and hypothalamic IL1β mRNA expression between the two groups after LPS injection. These findings suggest that the loss of ovarian function increases the induction of leptin and hypothalamic IL1β synthesis and consequently increases the anorectic response under immune stress conditions. It is possible that these alterations are caused by OVX-induced obesity rather than the direct effects of gonadal steroid deficiency.     

Effects of aging on basal levels of serum gonadotropins, ovarian compensatory hypertrophy, and hypersecretion of gonadotropins after ovariectomy in female rats.

Young adult (four months old) and old (14 months old) female rats were used in a series of experiments to determine the effects of aging on serum gonadotropin levels and on ovarian compensatory hypertrophy. Basal levels of gonadotropins were similar for rats of both ages. On the day after hemiovariectomy, serum FSH levels were elevated in both old and young rats. On that same day, serum LH levels were not elevated and the mean level for old rats was significantly lower than that for young rats. At two weeks and at two months after complete ovariectomy, the serum levels of both LH and FSH were lower in old than in young rats, suggesting imparied hypersecretion of gonadotropins in aged animals. After a suppressive dose of estradiol benzoate, ovariectomized old rats showed lower serum LH levels than did young ovariectomized rats. A comparison of the weights of ovaries removed two weeks after hemiovariectomy with those of the ovaries initially removed suggests that compensatory hypertrophy occurred in both groups of rats. However, ovarian weights, both before and after compensation, were lower in the old than in the young. After hemiovariectomy in old rats, the proportion of ovaries with corpora lutea increased, suggesting activation of some previously inactive ovaries.     

Developmental patterns of bioactive and immunoreactive FSH in the female rabbit: effects of ovariectomy.

A longitudinal study was performed to determine the relationship between immunoreactive and biologically active FSH in the serum of sham-operated and ovariectomized female rabbits. Twenty-two-day-old female rabbits, 8 per group, were sham-operated or bilaterally ovariectomized on day 23. Blood was taken every 3-4 days from each rabbit until they achieved a weight of 3 kg or age 100 days. Sera were analysed by radioimmunoassay for LH and FSH or for bioactive FSH. In sham-operated animals, immuno-FSH levels showed a 10-fold increase from 0.36 +/- 0.04 ng/ml to greater than 35 ng/ml between days 45 and 80. By contrast, bio-FSH levels increased more gradually from a baseline of 5.4 +/- 0.4 ng/ml to about 8 ng/ml. Bilateral ovariectomy resulted in a significant increase in both bio-FSH, 5.5 +/- 0.4 ng/ml to 12.6 +/- 1.5 ng/ml and immuno-FSH levels from 0.4 ng/ml to 5.2 +/- 1.4 ng/ml 24 h later. These levels of FSH remained elevated throughout the sampling period in both groups of animals and then decreased after day 100. Peripheral LH levels showed much more variation but were 2-fold higher in ovariectomized rabbits, 0.4-1.4 ng/ml in sham-operated vs. 0.8-2.4 ng/ml in ovariectomized rabbits. These results emphasize the marked variations in FSH levels according to the method of analysis. They also suggest that extra-ovarian factors may play a role in inhibiting gonadotropin release especially LH.     

Beneficial effects of estrogen on cardiac stunning in female rabbits

OBJECTIVE: To determine the effect of estrogen treatment on the contractile, relaxation, and chronotropic responses of hearts of female rabbits to cessation of perfusion. METHODS: Adult female rabbits were treated either with estradiol or with the vehicle (control). The hearts were then isolated and perfused at constant pressure by the Langendorff technique. A saline-filled balloon connected to a pressure transducer was inserted in the left ventricle in order to assess the mechanical function of the isolated heart. Cardiac stunning was induced by halting the perfusion of the coronary vasculature for four successive periods of 1, 3, 5, and 5 minutes, followed by reperfusion between nonperfusion periods. Changes in cardiac function induced by the cessation of perfusion were assessed by monitoring the changes in heart rate and in left ventricular pressure ([dP/dt]max as an index of ventricular contractility and [dP/dt]min as an index of ventricular relaxation). Changes in coronary flow were determined at baseline and following reperfusion. RESULTS: Halting coronary perfusion decreased (dP/dt)max, and (dP/dt)min and slowed left ventricular contractions both in control and in estrogen-treated hearts. The depressant effects of flow cessation on left ventricular (dP/dt)max and (dP/dt)min were smaller in estrogen-treated hearts than in control hearts. Treatment with estrogen had no effect on the changes on the heart rate in responses to cessation of flow and to reperfusion. Treatment with estrogen increased coronary flow by 40%. Coronary reperfusion increased coronary flow transiently, but the effects did not differ significantly between control and estrogen-treated hearts. CONCLUSION: Short-term treatment of adult female rabbits with doses of estrogen that are physiologic for the rabbit exerts a protective effect on cardiac contractility from repetitive periods without perfusion.     

依替膦酸二钠对卵巢切除妇女骨密度降低的预防作用

目的 探讨双膦酸盐对切除双侧卵巢的妇女骨密度减低的预防作用。方法 18例早期恶性肿瘤行双侧卵巢切除的患者使用骨吸收抑制剂依替膦酸二钠,400 mg/d×14d,每3个月间断用药一次,持续1年,并以20例因其它病因而实施去势手术的妇女作为对照,研究骨吸收抑制剂依替膦酸二钠对早期恶性肿瘤去势术后妇女骨量的保护作用。结果使用依替膦酸二钠1年时,患者的骨量虽然未能保持在术前水平,但可以显著减少骨量的丢失,与对照组相比差异有显著性(P<0.05),并且骨密度的变化与BALP呈负相关性(P<0.05)。投药1年时肿瘤患者无1例复发。结论依替膦酸二钠可以减少去势手术妇女的骨量丢失,对预防去势手术妇女的骨质疏松有积极的作用。