Biphasic Basal Body Temperature Research Articles

The reproductive endocrine feature and conception outcome of women with unknown etiological menstrual cycle (36–45 days) with long follicular phase

Objective To explore the reproductive endocrine feature and conception outcome of women with unknown etiological long menstrual cycle (LMC) (36–45 days) with long follicular phase. Methods In the cohort study, we included 80 women with unknown etiological long menstrual cycle of biphasic basal body temperature (BBT) lasting for 36–45 days and 87 controls with normal cycle of biphasic BBT into LMC group and NMC group, respectively. Serum hormone levels, fasting glucose, and insulin of participants were tested, and ovulation was observed by ultrasound. The conception outcome was followed up within 12 menstrual cycles. Results In the LMC group, the rate of abnormality of HOMA-insulin resistance index (40.0% vs. 20.7%, p < .01), luteal phase defect (30.9% vs. 13.8%, p < .05) and abnormality of FSH/LH ratio (15.6% vs. 5.7%, p < .05) were all significantly higher, but the serum estradiol level on the day before ovulation (261.10 pg/mL vs. 320.26 pg/mL, p < .01) was lower. The rate of poor ovulation quality (31.3% vs.15.4%, p < .05) in the LMC group was significantly higher than the NMC group. In the LMC group, the natural conception rate within 12 menstrual cycles was lower (41.9% vs. 66.2%, p < .01), whereas the spontaneous abortion rate in early pregnancy (29.0% vs. 9.8%, p < .05) and the conversion rate (21.6% vs. 5.2%, p < .01) to anovulation within 12 cycles were significantly higher. Conclusions Women with unknown etiological menstrual cycle (36–45 days) with long follicular phase have greater endocrine abnormality and higher risk of spontaneous abortion, infertility, and conversion to anovulation. Moderate early intervention may be advisable for these women, especially those who wish to get pregnant.

Oriental herbal medicine and moxibustion for polycystic ovary syndrome: A meta-analysis.

Polycystic ovary syndrome (PCOS) is one of the most common disorders of reproductive endocrinology in women of reproductive age. Lifestyle intervention and oral contraceptives are the first-line treatments for PCOS. Recent studies have suggested that complementary and alternative medicine (CAM) therapies including acupuncture, herbal medicine, and mind-body therapy have the potential to alleviate the symptoms and/or pathology of PCOS and to improve the quality of life of women with PCOS. This meta-analysis aimed to quantitatively summarize the efficacy and safety of moxibustion combined with oriental herbal medicine (OHM), common CAM therapies, for treating PCOS. Four databases were searched from their inception to June 22, 2018. Randomized controlled trials (RCTs) and quasi-RCTs using both OHM and moxibustion as experimental intervention, and western medication (WM) as control intervention were included. Studies involving OHM plus moxibustion combined with WM as the experimental intervention were also included. The quality of included studies was assessed using risk of bias tool. Owing to the heterogeneity of reporting, meta-analysis was only performed for pregnancy rate, rate of normal biphasic basal body temperature (BBT), and total effective rate (TER). The results showed that compared to the WM group, the OHM combined with moxibustion group was associated with significantly higher pregnancy rate (risk ratio [RR] 1.95, 95% confidence interval [CI] 1.55-2.47; I = 0%), normal biphasic BBT rate (RR 1.66, 95% CI 1.34-2.05; I = 0%), and TER (RR 1.19, 95% CI 1.08-1.31; I = 0%). When OHM combined with moxibustion was used as an adjunctive therapy to WM, pregnancy rate (RR 1.65, 95% CI 1.29-2.11; I = 0%), and TER (RR 1.35, 95% CI 1.13-1.61; I = 43%) were significantly higher than those of the WM group. According to current evidence, OHM combined with moxibustion might be beneficial for treating PCOS. Moreover, the treatment might improve the therapeutic effects of conventional WMs including clomiphene citrate, oral contraceptives, and/or metformin. However, the findings should be interpreted with caution, owing to poor methodological quality of the included studies. Further larger, high-quality, rigorous RCTs should be conducted in this regard.

Tongue color changes within a menstrual cycle in eumenorrheic women

Tongue color (舌色 shé sè) has been used to diagnose abnormal body conditions for thousands of years in traditional Chinese Medicine (中醫 zhōng yī). However, it is not clear whether tongue color alters with physiological changes within a normal menstrual cycle (月經周期 yuè jīng zhōu qī). This study investigated difference in tongue color between the follicular phase and luteal phase in eumenorrheic women. Tongue surface photographs were taken in the follicular phase and the luteal phase of thirty-two volunteers with biphasic basal body temperature. Color values on five areas of the tongue surface were examined and comparisons of color values were made between the two phases according to the red–green–blue (RGB), hue–saturation–brightness (HSB), luminance-a-b (Lab), and cyan–magenta–yellow–black (CMYK) models. Based on the RGB model, the values of green and blue in the tip area were larger in the follicular phase than both in the luteal phase. The values of magenta and yellow based in the CMYK model were smaller in the tip area in the follicular phase than that in the luteal phase. The saturation in the tip area was smaller in the follicular phase than that in the luteal phase. Based on the Lab model, b value in the middle area was smaller in the follicular phase than that in the luteal phase. The data revealed that tongue color varied within a eumenorrheic menstrual cycle, suggesting that tongue color differences between the follicular and luteal phases need to be considered while practicing tongue diagnosis (舌診 shé zhěn) or performing clinical studies among childbearing women.

Chinese herbal medicine for female infertility: An updated meta-analysis

To assess the effect of Traditional Chinese herbal medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western medical (WM) treatment and update previous meta-analyses. We searched the Medline and Cochrane databases until December 2013 for randomized controlled trials and meta-analyses investigating Chinese herbal medicine therapy for female infertility and compared clinical pregnancy rates achieved with CHM versus WM drug treatment. Forty RCTs involving 4247 women with infertility were included in our systematic review. Meta-analysis suggested a 1.74 higher probability of achieving a pregnancy with CHM therapy than with WM therapy alone (risk ratio 1.74, 95%CI: 1.56-1.94; p<0.0001; odds ratio 3.14; 95%CI: 2.72-3.62; p<0.0001) in women with infertility. Trials included women with PCOS, endometriosis, anovulation, fallopian tube blockage, or unexplained infertility. Mean pregnancy rates in the CHM group were 60% compared with 33% in the WM group. Our review suggests that management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy.

The Role of Ultrasound in Ovulation Detection Compared To BBT and Other Methods

Background: The detection of timing of ovulation is an important step in the evaluation and management of subfertility. Ultrasonography plays a vital role in monitoring follicular growth. Aims: To assess the value of ultrasound scanning of the ovaries in the periovulatory period to detect ovulation and to correlate the results with basal body temperature (BBT) chart and other presumptive evidences of ovulation. Methods: In this prospective study, a total of 60 subfertile patients were selected from the outpatient department of obstetrics and gynaecology, BPKIHS, Dharan. BBT charting, midcycle abdominal pain record &amp; premenstrual endometrial biopsy were performed in all patients i.e. in spontaneous ovulating and anovulating (induced later). Ultrasonographic periovulatory follicular tracking was usually started around 10th day of the cycle. The results were then correlated with BBT mainly and also with mittelschmerz and endometrial biopsy. Results: In this series fifty five patients, who demonstrated sixty ovulations (with failed inductions in five patients) were monitored for hundred ten cycles. The mean preovulatory follicular diameter was 20.55 mm and 21.76 mm in spontaneous and induced cycles respectively. Majority (36%) demonstrated ovulation by disappearance of follicles accompanied by increase in the amount of fluid in the pouch of Douglas (POD). In this study five cases (14.2%) out of thirty five showing biphasic BBT were anovulatoty. Whereas five cases out of twenty one showing monophasic BBT were ovulating. Amongst the inconclusive group, one (25%) patient was ovulating and the rest four (75%) were anovulatoty. Only 35% patients experienced midcycle pain. Ipsilateral pain was commoner (16.6%) than contralateral (6.6%) and central pain (11.6%). Conclusion: Ultrasonographic follicular tracking is a reliable method of ovulation detection. Ovulation precedes the initial rise in temperature in most women confirming the limited value of the rise in BBT as a predictor of ovulation.DOI: http://dx.doi.org/10.3126/njr.v3i2.9608 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 57-64

Hypofertility With Thick Cervical Mucus: Another Mild Form of Cystic Fibrosis?

To the Editor. —Male infertility due to congenital bilateral absence of the vas deferens (CBAVD) is frequently recognized as a mild form of cystic fibrosis (CF). 1,2 However, CF with primarily genital involvement may not be limited to males. Report of a Case. —We recently observed a 40-year-old woman with a medical history of infertility. She used oral contraceptives from 1974 to 1978. In 1975, she had electrocoagulation for ectropion. From 1981 to 1986, she had unprotected sexual intercourse but could not become pregnant. In 1986, she and her husband underwent investigations for infertility. Her husband's semen analysis was normal. Ovulation was confirmed by biphasic basal body temperature charts. Hysterosalpingogram was normal. The only consistent abnormality was found in postcoital tests. On 3 separate cycles, repetitive testing revealed tenacious mucus, which did not vary according to the time of cycle and contained no motile sperm. Testing for antisperm antibodies was

Changes of serum follicular stimulating hormone, luteinizing hormone and follicular sizes during electroacupuncture for induction of ovulation

Changes in follicular stimulating hormone (FSH), luteinizing hormone (LH) and follicular sizes were observed in 10 patients with chronic anovulation during electroacupuncture treatment. Seven cases were diagnosed as suffering from polycystic ovary syndrome, 2 from dysfunctional uterine bleeding, and 1 from hypogonadotropic amenorrhea. Among them 8 cases complained of infertility for an average of 2. 7years. Ovulation was confirmed by pregnancy or the combination of biphasic basal body temperature and ultrasonographic signs. During one course of 3 consecutive days of electroacupuncture treatment on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16) and Sanyingjiao (Sp 6), ovulation resulted in 5 patients (ovulating group) and 3 of the 4 infertile women became pregnant. Five cases failed to ovulate (non-ovulating group), 3 of them reached a biphasic basal body temperature without ovulatory signs on ultrasonograph. Serum FSH, LH values and FSH pulse frequency increased significantly during-electroacupuncture treatment in the ovulating group (from 2. 10±0.42 pulses/4h to 3. 70±1.64 pulses/4 h), but not in the non-ovulating group. No apparent change was found in LH pulse frequency, or in pulse amplitudes for FSH and LH. In the ovulating group, diameters of ovarian follicules markedly increased, but their growth was limited in the non-ovulation group. The results suggest ovulation may be induced by electroacupuncture via a regulation on the hypothalamic-pituitary function, leading to normal secretion of FSH and LH.

Evaluation of hormonal testing in the screening forin vitro fertilization (IVF) of women with tubal factor infertility

To evaluate the frequency of abnormal prolactin and thyroid stimulating hormone (TSH) test results in ovulatory women with tubal factor infertility who were screened for in vitro fertilization (IVF). Charts were identified from 112 ovulatory women with follicle stimulating hormone (FSH) < 20 mIU/ml who were diagnosed with tubal factor infertility and were screened for IVF with thyroid stimulating hormone (TSH) and prolactin levels. Women previously diagnosed with thyroid disease were subsequently excluded and 98 subjects remained. All subjects were determined to be ovulatory by biphasic basal body temperature (BBT) charts, luteal phase progesterone > 4 ng/ml, or endometrial biopsy revealing secretory endometrium. Results of cycle day 3 serum TSH and prolactin concentrations were recorded. The normal range for each test reflects the geometric mean +/- 2 standard deviations (i.e., 95% interval), as obtained from the reference laboratory. Under this construct, hypothesis tests were performed to determine whether or not our study population was consistent with the reference range of normal hormone levels. Under the null hypothesis (normal levels), we expected 5% of the TSH tests to be abnormal (i.e., high or low levels), and 2.5% of the prolactin tests to be abnormal (i.e., high levels). Exact bionomial confidence intervals and P-values were calculated. We also tested for age trend in the proportion of abnormal results. Study subjects had an age range of 25-43. In the study group, 4 (0.041) out of the 98 women screened had abnormal TSH levels. Of these four abnormal TSH results, three were elevated (i.e., TSH > 4.6 microIU/ml) and one was low (i.e., TSH < 0.6 microIU/ml). The frequency of an abnormal TSH value was not significantly different from that expected from the reference laboratory normal values (95% CI 0.011, 0.101). Of the 98 subjects, 7 (0.071) had abnormal prolactin levels, which was significantly different from that expected from the reference laboratory normal values (95% CI 0.029, 0.142; P = 0.023). When stratified by age, there was no observed trend of abnormalities for TSH or prolactin levels with increasing age. In ovulatory women presenting for IVF with tubal factor infertility, our results show that routine screening with a TSH test does not yield a significantly higher proportion of abnormal results than that expected from the reference laboratory normal values. However, prolactin level screening was found to yield a higher incidence of abnormal tests than expected from the reference laboratory normal values.

Low luteal phase serum progesterone levels in regularly cycling women are predictive of subtle ovulation disorders.

Serial hormonal and ultrasound measurements were performed in a group of 50 infertile women with regular menstrual cycles of normal length, and evidence of luteinization by measurement of biphasic basal body temperature (BBT). The progesterone levels however, remained below a critical threshold of 32 nmol/l (1 nmol/l = 0.315 ng/ml) in two cycles. In 50 cycles, 25 showed definite abnormalities. In 16 other cycles, ovulation was observed, but relatively low luteal progesterone followed. Although pregnancy in these 16 cycles could be less likely, the real significance of this finding is questionable. The etiology of these 'subtle cycle anomalies' is not clear and may be multifactorial. For this reason, no therapy other than use of ovulation-inducing agents by trial and error is as yet available. Preliminary results indicate that cycle disturbances may persist under ovulation induction, even though progesterone levels are normalized.

Serum gonadotrophin and sex steroid hormone levels during mid-follicular and mid-luteal phases in hyperprolactinaemic women with regular menstrual cycles.

Hyperprolactinaemia was found in 15 of 135 infertile patients with regular menstrual cycles, biphasic basal body temperature record and no galactorrhoea. In those 15 women, mean serum prolactin levels during the mid-follicular and mid-luteal phases of the menstrual cycle were 29.8 (SEM 1.8) ng/ml and 29.5 (SEM 1.3) ng/ml, respectively. Although serum FSH and LH levels were similar in normal and hyperprolactinaemic women, serum oestradiol level during the mid-follicular phase was subnormal in hyperprolactinaemic women (P less than 0.05). In contrast, serum oestradiol and progesterone levels during the mid-luteal phase and luteal phase length were similar in normoprolactinaemic and hyperprolactinaemic groups. The results suggest that hyperprolactinaemia is associated with defects of follicle development as measured by oestradiol production during the mid-follicular phase, but not with corpus luteum function as measured by progesterone production during the mid-luteal phase, and luteal phase length.

Ovulatory disturbances: Causative factors among japanese student nurses in a dormitory

The incidence of ovulatory disturbances in student nurses living in a restricted circumstance was evaluated by observing a basal body temperature (BBT) chart recorded for three to nine months by all of the student nurses in our medical college. The students were 18-21 years of age and were all living in a school dormitory. One hundred of the 154 students (64.9%) were anovulators during the school term. However, 40 of the anovulators showed ovulatory cycles with biphasic BBT patterns during their spring and/or summer holidays. The subjects' living conditions were investigated by questionnaire. Age of menarche, sport activity, self-perceived physical and mental work load, and native region did not appear to be related to their ovulatory disturbances. Weight-height-derived indices indicated that the anovulators had a tendency to corpulence as compared to the regular ovulators. Serum luteinizing hormone, follicle stimulating hormone, and prolactin levels of the anovulators were not significantly different from the regular ovulators.

Abnormal ovarian cycles as diagnosed by ultrasound and serum estradiol levels

A significant portion of human infertility is presumably due to defective ovulation, including patients who fail to conceive despite medical induction of ovulation, those who fail despite repeated timely donor inseminations, and those with "infertility of unknown etiology". All point out the inadequacy of standard criteria for normal ovulation. This investigation correlates preovulatory serum estradiol and gonadotropin concentrations with dominant follicle growth measured ultrasonographically and serum progesterone levels. The data indicate a 35% incidence of cycles with significantly abnormal serum estradiol levels, decreased dominant follicle size, and abnormal progesterone levels despite biphasic basal body temperature curves and normal cycle length. If these cycles represent inadequate or abnormal ovulation, they can be distinguished from adequate cycles prior to follicle rupture and may benefit the treatment of human infertility.

Correlation of Ovutron readings and the basal body temperature (BBT) with serum sex-hormone and luteinizing hormone levels

Prior studies have produced conflicting results about whether a change in electric potential occurs at the time of ovulation. This study was undertaken to determine whether the Ovutron R, a digital voltmeter which displays the sign and magnitude of voltage measured when the index fingers are applied to the electrodes, would produce a mix in polarity, some positive and some negative voltages, with 5 consecutive measurements preceding ovulation. This device was used daily in 10 normally ovulating women to determine whether such a mix in polarity occurred during the menstrual cycle and its relationship to the corresponding daily measurements of luteinizing hormone, total immunoreactive estrogen (IRE) and progesterone heralding and confirming ovulation. In addition, the Ovutron readings were compared to the basal body temperature (BBT) measurements. In 8 of 10 women studied with the Ovutron device, a mix in polarity was observed in 2 of 3 consecutive days preceding ovulation and was associated in all but 2 subjects with a 50 pg/ml/day incremental increase in IRE. By comparison, only 4 of the 10 subjects had a “classic” biphasic BBT curve. This novel device should be evaluated in a larger group of women employing these and other additional parameters (e.g., ultrasonography) in order to determine its efficacy and whether it has a role in the treatment of infertility as well as contraception.

DIAGNOSIS OF THE LUTEINIZED UNRUPTURED FOLLICLE SYNDROME BY STEROID HORMONE ASSAYS ON PERITONEAL FLUID

The luteinized unruptured follicle syndrome is a frequent phenomenon, occurring in half of our women with regular cycles and infertility. Progesterone concentrations and 17 beta-oestradiol concentrations were assayed in peritoneal fluid of women during the luteal phase. Up to day 20 of the cycle, the concentrations were significantly higher in women with an ovulation stigma than in women without an ovulation stigma on their corpus luteum. The range of concentrations was sufficiently different in the early luteal phase to be used diagnostically, the only limitation being the presence of a cystic corpus luteum. We suggest that the assay of progesterone and 17 beta-oestradiol in peritoneal fluid should be done in all women with infertility and biphasic basal body temperature charts in order to diagnose the luteinized unruptured follicle syndrome.

Chronic-Persistent Hepatitis and Pregnancy

The course and possible risks of pregnancy in 7 women between the ages of 20 and 30 yr with chronic-persistent hepatitis (CPH) were evaluated. Ten pregnancies occurred in these women during the follow-up period which ranged from 3 to 8 yr. Four of the fetuses were aborted electively for nonmedical reasons. The other six pregnancies resulted in normal spontaneous vaginal deliveries at term. Each of the women experienced uneventful pre- and postnatal courses, and the neonates were all healthy and developmentally normal at birth. There was no biochemical or clinical evidence to suggest worsening liver disease during pregnancy. Normal menstrual patterns when not pregnant and normal biphasic basal body temperature patterns in 4 women suggested that ovulation and fertility were not impaired significantly. Pregnancy in women with CPH appears safe to both mother and fetus alike. This finding contrasts with the morbidity and mortality some authors have found to be associated with cirrhosis and with portal hypertension. We speculate that our findings may be relevant to women with other portal lesions resembling CPH such as resolving acute hepatitis and chronic active hepatitis in sustained remission.

Chronic-persistent hepatitis and pregnancy

The course and possible risks of pregnancy in 7 women between the ages of 20 and 30 yr with chronic-persistent hepatitis (CPH) were evaluated. Ten pregnancies occurred in these women during the follow-up period which ranged from 3 to 8 yr. Four of the fetuses were aborted electively for nonmedical reasons. The other six pregnancies resulted in normal spontaneous vaginal deliveries at term. Each of the women experienced uneventful pre- and post-natal courses, and the neonates were all healthy and developmentally normal at birth. There was no biochemical or clinical evidence to suggest worsening liver disease during pregnancy. Normal menstrual patterns when not pregnant and normal biphasic basal body temperature patterns in 4 women suggested that ovulation and fertility were not impaired significantly. Pregnancy in women with CPH appears safe to both mother and fetus alike. This finding contrasts with the morbidity and mortality some authors have found to be associated with cirrhosis and with portal hypertension. We speculate that our findings may be relevant to women with other portal lesions resembling CPH such as resolving acute hepatitis and chronic active hepatitis in sustained remission.

Endocrine consequences of continuous antiestrogen therapy with tamoxifen in premenopausal women.

Daily administration of estrogen antagonists to premenopausal women has been incorporated into the adjuvant treatment of breast cancer. We have studied the changes in reproductive hormones, pituitary responses to hypothalamic-releasing hormones, and endometrial histology during treatment with the antiestrogen tamoxifen in five healthy, premenopausal women. These studies were carried out during one menstrual cycle before and during two cycles of antiestrogen treatment. All subjects continued to have regular menses with biphasic basal body temperature records. During treatment, estradiol (E2) levels were increased but followed the usual pattern reflecting follicular maturation and corpus luteum formation. The mean E2 concentration at the midcycle peak and during the luteal phase was twice that observed during the non-treatment cycle. By contrast, the concentrations and secretory patterns of luteinizing hormone and follicle-stimulating hormone were not greatly changed, and the gonadotropin responses to gonadotropin-releasing hormone were not suppressed. Endometrial biopsies obtained during the follicular phase of control and tamoxifen treatment cycles showed no differences whereas biopsies obtained during the luteal phase of tamoxifen cycles uniformly showed a lack of changes attributed to progesterone action with no progression of histologic changes beyond those expected on day 7-8 of the luteal phase. These observations are consistent with maturation of multiple ovarian follicles, a surprising finding considering the normal gonadotropin concentrations. The retarded development of the endometrium in the presence of supranormal serum E2 and progesterone concentrations is a morphologic demonstration of the antiprogestational effect of antiestrogens. The lack of gonadotropin suppression in the presence of hyperestrogenemia suggests a major antiestrogen action on the hypothalmus and pituitary gland.

Transsphenoidal selective removal of the functioning pituitary microadenomas--operative results (author's transl)

From December 1974 to October 1977, 11 transsphenoidal microsurgical operations were performed on 11 patients with functioning pituitary microadenomas. Of these patients, 6 had symptoms of hypersecretion of human growth hormone (acromegaly with or without diabetes mellitus), and the remaining 5 showed symptoms due to hypersecretion of prolactin (galactorrhea with or without amenorrhea). Preoperatively, elevated serum HGH concentration was observed in the acromegalic patients (12-86 ng/ml), and they were responsive to intravenous TRH. Elevated serum prolactin (PRL) concentration was also observed in 3. The secretional function of other anterior pituitary hormones was normal or slightly decreased. Elevated serum PRL concentration was noticed in all of the patients with galactorrhea (200-1050 ng/ml), and they were variably responsive to intravenous TRH. The other anterior pituitary hormones were normal or slightly decreased. Neuroradiological examination revealed that each adenoma was an enclosed tumor without suprasellar extension. The sella turcica was of almost normal size, but discrete bulging of the sellar wall was seen. Anteroposterior tomograms showed unilaterally depressed sellar floor, and lateral projection revealed double contour of the sellar wall. Selective gross total removal was attempted through the transsphenoidal procedure. The adenomas were found within the pituitary gland just adjacent to the discrete bulging of the sellar floor. The size of the tumor varied from 5 to 10 mm in diameter. A small cyst was found within the adenoma tissue in 2 patients with galactorrhea, who, as others, had not undergone prior therapy. Diabetes inspidus was a postoperative hazard in 4 cases. Neither operative deaths nor complications were recorded. Postoperatively, a marked decrease of serum HGH concentration below 5 ng/ml and relief of clinical symptoms was obtained in 4 acromegalic patients. In one of the other 2 patients, because of insufficient reduction of serum HGH concentration, postoperative irradiation was given, but no responsiveness was noted. In the patients with galactorrhea, the elevated serum PRL concentration was significantly reduced immediately after the operation, and there was no further lactation. During follow-up period ranging from 1 to 34 months, regular menstration was observed in 6 out of 9 female patients, biphasic basal body temperature in 2, and pregnancy in 1 patient. In the patients who underwent removal of the microprolactinoma, there was a tendency of gradual increase of serum PRL concentration, and galactorrhea recurred in 1 patient. Ethanol fixation of the tumor bed should have been undertaken during surgery.

SUPPRESSION OF MENSTRUAL PROSTAGLANDINS AND RELIEF OF DYSMENORRHEA WITH IBUPROFEN

This communication reports the results of a double-blind, cross-over study to determine the efficacy of the prostaglandin (PG) synthetase inhibitor ibuprofen (MotrinB , Upjohn) in relieving primary dysmenorrhea, and in suppressing the release of PG in menstrual fluid. A total of 7 patients and 23 menstrual cycles were studied, following a double-blind cross-over protocol. All subjects recruited for the study were 23-25 years of age, nulliparous, weighed 50-70 kg, had a history of primary dysmenorrhea starting within a year of their menarche, had no clinical evidence of pelvic pathology on repeated bimanual pelvic examination, and were not on any form of hormonal contraception or intrauterine device. One or more control cycles, during which no medication was taken, were studied in each patient. In the study cycles, 400 mg ibuprofen or a placebo of identical appearance were taken four times a day, beginning 3 days before through 3 days after the expected onset of menses, with a total duration not exceeding 7 consecutive days in any cycle. The patients abstained from sexual intercourse in the last week of their cycle and did not take any other medications. All cycles studied were ovulatory as documented by biphasic basal body temperature and plasma progesterone.

LUTEINIZED UNRUPTURED FOLLICLE SYNDROME

A clinical description of luteinized unruptured follicles is presented. This abnormality in ovulation is characterized by normal endocrinologic presumptive signs of ovulation: biphasic basal body temperature curves, secretory endometrium, and laboratory evidence of progesterone production by elevated urinary pregnanediol or plasma progesterone levels In a group of 102 such infertile women, laparoscopy performed 3 to 5 days after apparent ovulation revealed the absence of a corpus hemorrhagicum in 30 women, and the absence of a stigma on a corpus hemorrhagicum in an additional 32 women. These findings were evidence that a follicle had not ruptured and an ovum had not escaped. Of 28 patients undergoing follicular stimulation with clomiphene citrate or human menopausal gonadotropin after this diagnosis, 15 conceived.