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HALVARD GJøNNÆSS NILS NORMAN 《BJOG : an international journal of obstetrics and gynaecology》1987,94(8):779-783
Summary. The mechanism by which ovarian electrocautery induces regular ovulatory cycles was studied in 16 women with polycystic ovarian disease (PCO) and compared with 25 normal fertile women who were undergoing sterilization by tubal electrocautery. Gonadotrophins (LH and FSH), prolactin, androgens, oestrogens, 17-hydroxy-progesterone and progesterone were determined immediately before operation and 24 h later. Following the sampling of blood for these tests, 100 μg of gonadotrophin releasing hormone (GnRH) was given intravenously and the LH and FSH responses were measured at 30 min. In the PCO-group, these tests were repeated after the first induced ovulatory cycle. After operation, LH increased only in the patients with PCO and this increase was associated with an enhanced response to GnRH, FSH showed a similar response to GnRH, also confined to the PCO-group. These pituitary responses are best explained by a change in ovarian feedback induced by the direct electrocautery of the glands in the PCO-group. There was little change in serum oestrogen. Prolactin showed an increment in all cases and serum androgens were reduced in all groups, most pronounced in the PCO patients, possibly as a result of the stress of operation. An ovarian factor—released or reduced by the electrocautery—seems to be responsible for the changes. 相似文献
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Idiopathic hypogonadotrophic hypogonadism (IHH) is a potentially
correctable cause of male infertility. However hormonal treatment is
usually a slow process and artificial reproductive techniques such as
intracytoplasmic sperm injection (ICSI) might be resorted to before full
testicular response has been achieved. We report here an unusual variant of
IHH of post-pubertal onset in which early intervention with ICSI was
attempted. Our patient was 37 years old and presented with male infertility
due to azoospermia and undetectable serum gonadotrophin concentrations. He
had an apparently normal pubertal development, a testicular volume of 8 ml,
normal pituitary-thyroid and pituitary-adrenal function, as well as normal
computerized tomographic appearance of the sella region. A combination of
human chorionic gonadotrophin (HCG) and menopausal gonadotrophins (HMG) was
administered. Spermatozoa were first detected in the semen after 3 months
and reached a concentration of approximately 2x10(6)/ml after 9 months.
ICSI was attempted at this point; the spermatozoa had good fertilizing
ability and three embryos were obtained and replaced. Unfortunately no
pregnancy resulted. Treatment with 5000 IU HCG and 150 IU HMG three times
per week was continued and sperm counts rose rapidly thereafter to reach
28.3x10(6)/ml after 16 months of injections. His wife conceived naturally
during this period and the pregnancy is now in the second trimester. This
case illustrates the good prognosis of the rare patient with IHH of
post-pubertal onset when treated with gonadotrophins, and suggests that
ICSI procedures should be delayed until final testicular maturation is
attained.
相似文献
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