Stimulation of ovulation by follicular puncture

We report on a patient with long-standing sterility, who became pregnant only after laparoscopic puncture of the follicle in spite of all possible diagnostic and therapeutic procedures being applied. The methods so far used for stimulation of ovulation are discussed and the puncture of the ovary is proposed as new possibility in the treatment of sterility.     

Induction of ovulation by antiestrogens]

The mode of action of antioestrogens is in blocking oestrogen receptors in the target cell cytoplasm. For this reason they can be used only in cases where basal oestrogen activity is present. We treated two groups of patients with antioestrogens. In the first group (30 patients) with oligomenarrhoe and an ovulatory sterility we had 15 pregnancies. In the second group of 26 patients with amenorrhoe and sterility we had 4 of pregnancies and 12 menstruations. In this very small group a child with enterocoele was born to a 38-years old patient. All other patients' children were normal. Out of 19 pregnancies 4 were completed by early abortion.     

Antenatal screening by history taking--a missed opportunity.

In order to determine how effectively obstetricians and midwives identify and manage women at increased risk of fetal abnormality a case note review was undertaken. Two district general hospitals in each of two health regions and their tertiary referral centres making seven hospitals in all were studied. Women booked for antenatal care over a one-year period were included (19 895) which was estimated to be 75% of the total. Significant numbers of women at high risk because of age, past obstetric, medical or family history were not offered appropriate tests such as detailed scanning, carrier status testing, amniocentesis or chorion villus sampling. Asian women were less likely to be offered screening compared with Caucasians. Women at low risk were subjected to inappropriate tests such as amniocentesis. Ultrasound departments were rarely informed that a woman had had a previous baby with a structural abnormality. In conclusion the quality of booking histories was poor allowing important information about past medical, family or obstetric history to be overlooked. Maternity units should use carefully structured forms taking when booking histories and all staff must have regular training on risk factors.     

The changing morphological picture of endometriosis. 1. Unusual regression in a pseudopregnant retrocervical endometriosis caused by ovulation inhibitors

Marked transformation and involution phenomena were observed in relation to lynestrenol-induced pseudogravidal changes of mucus membrane in a small (nut-size) retrocervical endometriosis. At 1st plump-papillary hyperproliferation occurred in the glandula epithel, followed by cytoplasma eosinophilia, -granulation, pseudo-apocrinal structures, intense epithel desquamation with cavity formation, loss of cell and nucleus polarity, epithel atrophy, gland collapse, and gland contraction. The large cellular, polymorph nuclear decidual stroma was swollen, free from endometrial granule cells and spiral arteries, and tissue destruction was very slow. Sparse glands of the basalis type characterized the predominating functionalis-endometriosis. Determination of the type of endometriosis is significant for successful therapy.     

Monitoring the induction of ovulation by HMG-hCG

Despite correct management of HMG and hCG, the margin between effective dose and overdose is narrow. Surveillance must be clinical, biochemical and echographic. Biochemistry and echography give information on follicle maturation. Echography is a particularly valuable means of monitoring the effect of administration of hypophyseal hormones on the development of follicles.     

Platelet function, coagulation and fibrinolysis during termination of missed abortion and missed labor by PGF2 alpha and oxytocin

In cases of missed abortion and missed labor, labor was induced by PGF2 alpha i.a., i.v. and by oxytocin infusion. Platelet function (methods of Born and Breddin), the coagulation system and fibrinolysis have been studied within the three groups. Using PGF 2 alpha i.v., the initially increased platelet aggregation showed a tendency to become normal. There was no manifestation of activation of the coagulation system. Fibrinolytic activity showed a slight increase during PGF2 alpha i.v. No essential changes in platelet function, coagulation and fibrinolytic system were found after i.a. injection of PGF2 alpha. When inducing labor by oxytocin i.v., both the coagulation and the fibrinolytic system were slightly activated and platelet aggregation increased. The results and their clinical importance for hemostasis as well as therapeutic consequences are discussed.     

Inhibition of ovulation in marmoset monkeys by indomethacin.

The effect of indomethacin on human menopausal gonadotropin/human chorionic gonadotropin-induced ovulation was studied in marmoset monkeys. Indomethacin was effective in preventing follicular rupture and ovum extrusion when administered simultaneously with gonadotropin. The production of progesterone and luteinization of the granulosa cells were not affected by indomethacin treatment. Histologic examination of corpora lutea from indomethacin-treated animals revealed the presence of entrapped oocytes surrounded by luteal cells. These results suggest that prostaglandin synthesis is required for ovulation in this species, but not for luteinization and progesterone production.     

阴道镜直视下宫颈活检诊断CINII中漏诊CINII以上病变的研究及意义

目的:评价阴道镜直视下活检诊断CINII的准确性,分析影响漏诊CINII以上病变(简称CINII~+)的相关因素,并探讨P16~(INK4a)蛋白表达在预测漏诊CINII~+中的价值。方法:回顾分析2013年12月至2015年7月在南京医科大学第一附属医院宫颈病中心阴道镜直视下宫颈活检诊断为CINII,且在短期内行LEEP的148例患者。研究患者手术前后病理诊断,同时对患者年龄、初次TCT结果、高危型HPV负荷量、阴道镜下病变累及宫颈象限数、转化区类型、阴道镜图像表现以及CINII组织中P16~(INK4a)蛋白表达等与漏诊CINII~+的关系进行单因素及多因素分析。结果:(1)阴道镜直视下活检诊断的148例CINII中,71例(49.97%)漏诊CINII~+,其中1例宫颈鳞癌IA1期,1例宫颈鳞癌IB1期。单因素分析显示,患者年龄、初次TCT结果、高危型HPV负荷量、阴道镜下病变累及象限数、转化区类型、阴道镜图像特征与CINII~+病变漏诊无明显相关性(P0.05),CINII组织中P16~(INK4a)蛋白表达与CINII~+病变漏诊明显相关(P0.05)。多因素分析显示,P16~(INK4a)蛋白阳性表达是影响阴道镜直视下活检诊断CINII漏诊CINII~+的危险因素(OR=9.846,95%CI为2.165~44.787;P=0.003)。(2)21例(14.19%)P16~(INK4a)蛋白呈阴性表达,127例(85.81%)呈阳性表达。P16~(INK4a)蛋白表达阴性组中漏诊CINII~+3例(14.29%),P16~(INK4a)蛋白表达阳性组中漏诊CINII~+68例(53.54%),两组比较差异有统计学意义(P0.05)。P16~(INK4a)阳性表达预测漏诊CINII~+的敏感性95.77%,特异性为23.38%,阴性预测值为85.71%,阳性预测值为53.54%。结论:阴道镜直视下活检诊断的CINII中存在CINII~+的漏诊,而CINII并P16~(INK4a)蛋白阳性表达是影响CINII~+漏诊的危险因素,对P16~(INK4a)蛋白表达阳性的CINII患者的临床干预存在其合理性。针对CINII的个体化管理,需综合考虑患者的年龄、P16~(INK4a)蛋白表达、对生育功能保护的需求及随访的依从性。     

Events from ovulation to implantation studied by three-dimensional ultrasound

During the last decade transvaginal color Doppler has played an important role in increasing understanding of early human development. Although our knowledge of early pregnancy development has recently improved, little is known about the most critical period of human development: between conception and implantation. Recent advances in 3D ultrasound have made studies of follicular development, ovulation and uterine receptivity more accurate. The same method can be used for evaluation of the Fallopian tube patency and assessment of the ovarian and uterine causes of infertility which hamper processes of early human development. Storage capacities, reconstruction of the volume images and simultaneous viewing of all three orthogonal planes are the main advantages of this method. Introducing 3D ultrasound into assessment of early pregnancy has enabled visualization and volume estimation of the gestational sac, yolk sac and embryo. Switching on power Doppler superimposed to 3D gray scale can detect early vasculogenesis within the intervillous space and embryo/fetus. Here we review the potential application of this novel technique in monitoring the morphological and functional processes from ovulation towards implantation and early pregnancy.     

Predetermination of ovulation timing by luteinizing hormone assay.

A modified rapid,solid-phase radioimmunoassay for serum luteinizing hormone requiring only 1 1/2 hours of incubation is presented. The method has been used to predetermine the time of ovulation in six infertile patients. Its advantages are presented in these cases. The simplicity and accuracy of the method make it practical, and it can serve well in the management of infertility.