Gonadotropin-releasing Agonist Research Articles

Differentiated approach to the treatment of external genital endometriosis as prevention of recurrence

The objective: to evaluate the effectiveness of a differentiated approach in the postoperative management of patients with external genital endometriosis (EGE) to determine the regression of clinical symptoms and reduce the number of recurrences. Materials and methods. 207 patients with different forms of EGE after surgical treatment of the endometriosis foci removal were examined. After the determination of the prevalence of the pathological process (intraoperatively), the subjects were divided into three groups. A1 group (n=67) included women with severe disease who had an optimized approach for postoperative management. A2 group (n=75) included patients with moderate severity of EGE and the traditional treatment approach. B group was a comparison group (n=65) and was formed from patients with severe disease who were traditionally treated.Clinical-anamnestic, laboratory, morphological, immunohistochemical methods, gynecological examination data, ultrasound examination of the pelvic organs were used during the examination of women with EGE; magnetic resonance imaging (MRI) – if necessary. The standard approach included surgical treatment (laparoscopic method), removal of visible endometrioid heterotopias and the medical treatment from the 1st day of the next menstrual cycle after surgery (progestins (dienogest 2 mg) for 6 months or gonadotropin-releasing agonists in the presence of comorbidity of hyperplastic processes for 3-6 months in combination with add-back therapy). In the absence of reproductive plans combined oral contraceptives or intrauterine levonorgestrel-releasing system were used. Patients were observed for 1 month, 1 year after surgery, and then once a year. The optimized approach included surgery (laparoscopy or laparotomy) with the removal of endometrioid heterotopias, use of nonsteroid anti-inflammatory drugs in the postoperative period for 5 days, then dienogest 2 mg for 3-6 months was used by the cases of algomenorrhea and other manifestations of pain. The pathogenetic therapy was started on the 2nd or 3rd day of the postoperative period. Patients were observed for 2 months after surgery, then every 3 months for 1 year. The severity of pain was assessed on the Biberoglu and Behrman (B’n’B) and Numerical Rating Scale (NRS) scales. Recurrence of the disease was diagnosed in the presence of endometrioid heterotopia according to ultrasound examination and/or MRI, as well as the appearance of clinical complaints (pain) in 6 months after their absence.Results. In one year after the first surgery, recurrence of the disease was found in 13.43 % of women in A1 group, 12 % – A2 group and 24.61 % – B group. The average value of pain on the NRS scale in 12 months after treatment was 3.26 points in A1 group, 2.47 – A2 group and 1.59 – B group, on the B’n’B scale - 1.94, 1.61, and 1.40 points, respectively. Conclusions. The applying an optimized approach in the management of patients with severe and moderate external genital endometriosis (more radical surgery, the prescription at once in the postoperative period the hormonal therapy and nonsteroid anti-inflammatory drugs, more frequent observation after surgery) compared with traditional treatment lead to decrease the pain severity on 3.26 points on the Biberoglu and Behrman scale and 1.94 points – the Numerical Rating Scale, and reduce the recurrence rate by 45.4%.

Comparison of Pregnancy Outcomes Between Fresh Embryo Transfer in a Natural IVF Cycle and IUI Cycle Among Infertile Young Women

Background: The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI).
 Methods: This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≤0.05 was considered significant.
 Results: The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p<0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups.
 Conclusion: Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.

Dual trigger with gonadotropin-releasing hormone agonist and recombinant human chorionic gonadotropin improves the outcome of intrauterine insemination.

ObjectiveThe objective of this study was to evaluate the effectiveness of dual trigger, which is a combination of gonadotropin-releasing agonist (GnRH-a) and recombinant human chorionic gonadotropin (hCG) in the final oocyte maturation, in the outcome of intrauterine insemination (IUI).MethodsThis retrospective observational study was conducted from January 2016 to October 2018 and involved 639 IUI cycles at the Halim Fertility Center, Indonesia. Controlled ovarian stimulation was performed during IUI cycles. The ovulation triggers were divided into two groups: group I received a combination of GnRH-a and recombinant hCG as a dual trigger, and group II received only recombinant hCG as a single trigger. The baseline characteristics, cycle parameters, and IUI outcomes of both groups were compared.ResultsOur study included a total of 639 IUI cycles, 334 were in the dual trigger group and 305 in the single trigger group. The clinical pregnancy rates were significantly higher in the dual trigger group than in the single trigger group (P<0.001). Based on the multivariate analysis, the dual trigger increased the clinical pregnancy rate by 2.524 times than that by the single trigger.ConclusionOur data showed that the dual trigger combination of GnRH-a and recombinant hCG significantly improves the outcome of intrauterine insemination.

Comparison of Pregnancy Outcomes Between Fresh Embryo Transfer in a Natural IVF Cycle and IUI Cycle Among Infertile Young Women

Background:The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI).Methods:This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≦0.05 was considered significant.Results:The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p<0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups.Conclusion:Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.

Association between GnRH Receptor Polymorphisms and Luteinizing Hormone Levels for Low Ovarian Reserve Infertile Women.

The choice of ovarian stimulation protocols in assisted reproduction technology (ART) cycles for low ovarian reserve patients is challenging. Our previous report indicated that the gonadotrophin-releasing (GnRH) agonist (GnRHa) protocol is better than the GnRH antagonist (GnRHant) protocol for young age poor responders. Here, we recruited 269 patients with anti-Müllerian hormone (AMH) < 1.2 ng/mL undergoing their first ART cycles for this nested case-control study. We investigated the genetic variants of the relevant genes, including follicular stimulating hormone receptor (FSHR; rs6166), AMH (rs10407022), GnRH (rs6185), and GnRH receptor (GnRHR; rs3756159) in patients <35 years (n = 86) and patients ≥35 years of age (n = 183). Only the genotype of GnRHR (rs3756159) is distributed differently in young (CC 39.5%, CT/TT 60.5%) versus advanced (CC 24.0%, CT/TT 76.0%) age groups (recessive model, p = 0.0091). Furthermore, the baseline luteinizing hormone (LH) levels (3.60 (2.45 to 5.40) vs. 4.40 (2.91 to 6.48)) are different between CC and CT/TT genotype of GnRHR (rs3756159). In conclusion, the genetic variants of GnRHR (rs3756159) could modulate the release of LH in the pituitary gland and might then affect the outcome of ovarian stimulation by GnRHant or GnRHa protocols for patients with low AMH levels.

نتایج بارداری بهروش لقاح خارج رحمی در تحریک با آگونیست آزاد کننده گنادوتروپین، گنادوتروپین جفتی انسان و یا گنادوتروپین جفتی انسان به همراه آگونیست آزادکننده گنادوتروپین در زنان نابارور؛ کارآزمایی بالینی تصادفی

Introduction: Human chorionic gonadotropin for the final maturation of eggs in the In-vitro fertilization cycle was associated with the possibility of a negative effect on endometrial acceptance, fetal quality and ovarian hyper stimulation syndrome. Replacing it with a gonadotropin-releasing hormone agonist to trigger final ovulation is expected to reduce these effects. Therefore, this study was performed with aim to evaluate the outcome of triggering in in vitro fertilization with antagonist protocol by gonadotropin-releasing hormone agonist, human chorionic gonadotropin simultaneously with human gonadotropin-releasing hormone agonist and human chorionic gonadotropin. Methods: In this randomized clinical trial study conducted in 2015 and 2016, women were divided into three random groups after preparing the follicles for triggering and ovum retrieval. One group received 0.2 mg of dipherline, the second group received 10,000 units of human chorionic gonadotropin and the other group received 0.2 mg of dipherline along with 1500 units of human chorionic gonadotropin. The number and quality of eggs and embryos were the outcomes of the study. Data were analyzed by SPSS software (version 17) and Leven tests and one-way analysis of variance. P < 0.05 was considered statistically significant. Results: The number of retrieved oocytes in the group receiving gonadotropin-releasing agonist was significantly higher than the other groups (p = 0.001). More embryos were produced in the gonadotropin-releasing hormone agonist group compared to the other two groups (p = 0.009). However, the number of high quality embryos produced in the groups was similar. Conclusion: The onset of final oocyte maturation with gonadotropin-releasing hormone agonist significantly increases the number of retrieved oocytes and obtained embryos. However, dual stimulation using low-dose human chorionic gonadotropin (IU1500) and gonadotropin-releasing hormone agonist did not alter quality of embryo compared to the standard dose of human chorionic gonadotropin (IU10000).

Hormonal therapies for acne

Acne is a common, worldwide problem that is usually multifactorial in etiology, but androgens may play a pivotal role in the development and severity of acne. Endocrinopathies, such as polycystic ovarian syndrome, ovarian tumors, or adrenal hyperplasia or tumors, may be detected in some patients with acne, especially if acne is sudden in onset, associated with hirsutism or menstrual irregularities, or associated with cushingoid facies, acanthosis nigricans, patterned hair loss, or deepened voice. In these instances, serum-free and total testosterone, dehydroepiandrosterone, luteinizing hormone, and follicle stimulating hormone should be tested. Appropriate referral and long-term follow-up is warranted in patients diagnosed with an endocrinopathy. Hormonal therapies for acne include systemic medications with various mechanisms: androgen receptor blockers, adrenal androgen production blockers, or ovarian androgen production blockers. Androgen receptor blockers include spironolactone, cyproterone acetate, chlormadinone, and flutamide; adrenal androgen production blockers include glucocorticoids; and ovarian production blockers include gonadotropin-releasing agonists and oral contraceptives. Practical guidelines are shared for the practicing physician treating hormonally related acne.

Acute Transverse Myelitis Associated with Buserelin Use during IVF

A healthy woman undergoing in vitro fertilization (IVF) developed acute transverse myelitis (ATM) following the use of Buserelin. ATM has a multifactorial etiology and may develop as a result of the activation of immune responses. Infectious agents have been postulated as possible triggers of an immune response (Sá, 2009). Gonadotropin-releasing agonists may have a similar role and trigger the acceleration of preexisting disease by the activation of immune responses (Ho et al., 1995, and Umesaki et al., 1999).

Gonadotropin Releasing Agonist for Triggering Final Oocyte Maturation Has Fewer Side Effects Than Recombinant hCG in Oocyte Donors

To determine whether the use of a GnRH-a has fewer side effects than r-hCG in inducing final oocyte maturation. Retrospective cohort study. Academic medical center-based IVF practice. 258 cycles of oocyte donors (age 21 to 31) undergoing IVF between Jan 2007 and Dec 2009 were reviewed. Donors were pre-treated with OCP's and underwent standard GnRh antagonist protocol starting stimulation with FSH and Human Menopausal Gonadotropins (HMG) on day 2 off OCP's. GnRh antagonist was imitated as clinically indicated around cycle day 6. In order to induce final oocyte maturation, patients either received a GnRH-a trigger (Lupron 2 mg) (N=32) if deemed to be at high risk for OHSS, or r-hCG (ovidrel 250 mg) (N=226). A quantitative subjective pain and bloating questionnaire was completed by all donors. Mean ovarian size and degree of discomfort 5-8 days post retrieval were compared between both groups. Baseline characteristics and stimulation outcomes (oocytes retrieved and mature oocytes) for both groups were also collected. Data were analyzed using SPSS software [Table 1]. No significant differences were seen in IVF outcomes between the GnRh-a and r-hCG groups, other than significantly higher levels of peak estradiol and number of retrieved oocytes, consistent with the GnRH-a group being a high responder group. Despite this, patients in the GnRH-a trigger group had a lower mean ovarian size and were less likely to report bloating or pain 5 – 8 days post retrieval compared to those in the r-hCG group. As compared with r-HCG, the use of a GnRh-a was associated with fewer side effects when used to trigger final oocyte maturation. A significantly smaller mean ovarian size was also noted in the GnRH-a group.Table 1GnRH-a versus r-hCG GroupGnRH-a Trigger Group (N=32)r-hCG Trigger Group (N=226)BMI (kg/m2) (M SD)26.4±3.327.1±3.9Total gonadotropin dose(IU) (M SD)2122±8872412±967Peak E2 (pg/ml) (M SD)3536±11712402±891αDays of stimulation (M SD)10.1±1.610.0±1.7Oocytes retrieved (M SD)28.6±4.623.8±7.5 αPercent oocytes mature (%)83.2±3.285.1±7.3Mean right ovarian size 1 week post (mm) (M SD)39.6±10.651.3±11.4 βMean left ovarian size 1 week post (mm) (M SD)40.9±12.249.8±12.4 βBloating (Total N, %)29 (7%)104 (26%) γMild-moderate pain (%)21%45% αSevere OHSS0%0%α p<0.05, β p<0.001, γ p=0.05. Open table in a new tab

Gonadotropin releasing agonist for triggering final oocyte maturation has fewer side effects than recombinant hCG in oocyte donors

Gonadotropin releasing agonist for triggering final oocyte maturation has fewer side effects than recombinant hCG in oocyte donors

Different expressions of mitogen-activated protein kinase (MAPK) family between cumulus and mural granulosa cells

Objective: The morphology and function of cumulus granulosa cells are very different from those of mural granulosa ones. In previous studies, apoptosis was higher in mural granulosa cells than in cumulus cells. This may result from the difference of intracellular signal transductions. MAPK family is one of important intracellular signals. To further understand the differences between mural and cumulus granulosa cells, we evaluated and compared their expression of MAPKs. Design: A prospective study. Materials and Methods: Patients (n=3) with male factor caused infertility were stimulated with gonadotropin releasing agonist and human menopausal gonadotropin for follicle development in an in vitro fertilization and embryo transfer treatment program. Thirty-five hours after the human chorionic gonadotropin injection, follicle aspiration was performed. Oocytes and granulosa cells were obtained and cumulus granulosa cells were mechanically separated from the oocyte, immediately after the retrieval. Mural and cumulus granulosa cells were washed with cooled phosphate buffered solution (PBS) containing Na3VO4 and lysed with cold lysis buffer. Whole cell lysates were centrifuged, and lysate supernatant was analyzed by Western blot analysis using antibodies of the MAPK family; extracellular signal-regulated kinase (ERK)1/2, Jun amino-terminal kinase (JNK), and p38 proteins (p38). Results: The expression of total ERK1/2 in the mural cells detected by Western blotting was stronger than that in the cumulus cells. Phospholized or activated ERK1/2 in the mural cells was intensively expressed in comparison with the cumulus cells. The expression of total JNK in the mural cells was stronger than that in the cumulus cells. Phospholized or activated JNK in both mural and cumulus cells showed almost no expression. The expression of total p38 in the mural cells was stronger than that in the cumulus cells. Phospholized or activated p38 in the mural cells was intensively expressed when compared with the cumulus cells. Conclusion: MAPK family in cumulus and mural granulosa cells showed different expressions. MAPK family has an important role in intracellular signaling and is involved in key functions such as cell proliferation, differentiation, cell survival and death. This different expression indicates that granulosa cells of each location in a follicle are using their unique intracellular signal transduction and therefore express their own unique functions including steroidogenesis and production of essential substances for ovulation.

Adrenal and gonadal steroidogenesis in patients with ovarian polycystosis during buserelin test

Relationships between the secretion of gonadotropic hormones of the pituitary gland, the androgenic and glucocorticoidal functions of the adrenals and the steroidogenic function of the ovaries were studied in 21 patients with the ovarian polycystic syndrome (OPS) and in 7 healthy women in test with buserelin, a gonadotropin-releasing agonist. When stimulated with corti- sole, the secretion remained unchanged. Depending on the baseline level of dehydroepiandrosterone sulfate (DHAS), a change was found in the secretion of dehydroepiandrosterone (DHA) and its precursor 17-OH-pregnenolone. With the nor­mal baseline level of DHAS, the content of hormones increases while with its high level, their content does not change. The stimulation of gonadotropic secretion results in a higher disso­ciation in the secretion of luteinizing hormone (LH) and folli­cle-stimulating hormone (FSH) in patients with OPS, by in­creasing the LH/FSH ratio that is most significant in patients with the normal level of DHAS. Under stimulation, aromatase activity becomes higher in patients with high DHAS levels and remains unchanged in the other group of patients. The findings may lead to the conclusion that buserelin-induced stimulation of gonadotropic secretion may be accompanied by the activated synthesis of adrenal androgens in some patients with OPS. De­pending on the baseline androgenic activity of the adrenals, buserelin-induced stimulation of gonadotropic secretion is at­tended by a higher aromatase activity.

Induction of ovulation and ovarian cancer: A meta-analysis

Objective: To evaluate the current available data regarding induction of ovulation and the incidence of ovarian cancer. Design: Meta analysis Materials/Methods: A systematic review and meta analysis has been conducted. A comprehensive, literature search employing the following databases was done: Premedline, Medline, Cancerlit, Cinahl, Current contents and Biological abstracts. The search was not limited by language or year of publication. All citations were reviewed for relevance. The final group of citations was then reviewed for inclusion/exclusion criteria, quality assessment and data abstraction. This process has been completed by two independent reviewers. Discrepancies between reviewers have been resolved by consensus. Citations were supplemented by references pulled from review articles and studies as well as hand searches (10 years) of 5 key journals. We also searched for grey/unpublished literature by consultation with content experts, reviews of conference proceedings, and we attempted contact with authors. Inclusion/Exclusion criteria included: outcome: primary incident ovarian cancer of any histological type; population: women who had an explicit and reproducible diagnosis of infertility and these cases were to be compared with fertile and infertile controls; intervention/exposure: induction of ovulation by the following medications: clomiphene citrate, human menopausal gonadotropin, and gonadotropin releasing agonists. Data analyses was done using Revman 4.1 and Metaview 4.0. Cohort and case control data were analysed separately and infertile controls were used as the reference group where possible. Both fixed and random effects models were used for reasons identified in the manuscript Results: Original search revealed 2114 articles, which were reduced to 947 when limited to human, adult female. Relevance filter and manual removal of duplicates reduced the number further to 94. Inclusion/ exclusion criteria further reduced these numbers to 38. These also included : Search for unpublished literature revealed 2 studies whose results were at least partly published subsequently. Hand searching revealed 3 extra studies. When multiple publication occurred only the most recent or complete papers were included. Precision of the search strategy was 1.6% and recall was 83%. In the final quantitative analysis 3 cohort studies and 7 case control studies were included. Case control data comparing infertile treated women with general population controls:OR 1.52 (1.16, 2.01); Case control data comparing infertile treated with infertile untreated: OR 1.00 (0.68, 1.46); Cohort data comparing infertile treated to infertile untreated : RR 0.66 (0.31, 1.41). Conclusions: These data do not support an increased risk of ovarian cancer as a result of induction of ovulation. In fact, fact the results are reassuring if not encouraging. There is a trend towards protection of infertile women from ovarian cancer via induction of ovulation. Supported by: None.

Antagonist versus agonist in IVF cycles with ovarian resistance

Objective: How to best stimulate women with ovarian resistance (low responders) in IVF cycles has remained controversial. This study attempts to define the value of gonadotropin releasing agonists (agonists) with gonadotropin releasing antagonists (antagonists). Design: Retrospective cohort study Materials/Methods: During 2001, 155 consecutive in vitro fertilization (IVF) cycles, involving a microdose-agonist and 22 IVF cycles involving an antagonist protocol, in combination with pure FSH stimulation (Follistim, Organon Inc., New Jersey), were conducted in women with documented low ovarian response. Patient characteristics between the groups did not vary significantly. Results: The table summerizes the outcomes in both groups.TableResultsAgeAntagonistAgonistn-Cyclesn-ETsClin. Prep. (%)n-CyclesnETsClin. Prep (%)≤34765 (83.3)∗p < 0.05484016 (40.0)∗p < 0.0535–37431 (33.3)32265 (19.2)38–40641 (25.0)402913 (44.8)≥41540 (0.0)35258 (320.)Total22177 (41.2)15512042 (35.0)∗ p < 0.05 Open table in a new tab Conclusions: Antagonists in combination with pure FSH stimulation appear to result in higher pregnancy rates in younger women (≤ 37 years. Between age 38–40 years, antagonists and agonist appear to have similar outcomes but at ≥ 41 years of age agonists demonstrate higher pregnancy rates in women with poor ovarian reserve. These data support the previously published notion that down regulation with agonists, followed by pure FSH stimulation, is least successful in young women Supported by: Foundation of Reproductive Medicine, Chicago, Illinois.

Hysteroscopic fallopian tube recanalization using a flexible guide cannula and hydrophilic guide wire

Objective To evaluate an innovative and simple procedure of hysteroscopic recanalization of cornual occlusion using a diagnostic hysteroscopic sheath, a Labotect flexible guide cannula and a Terumo hydrophilic guide wire, which were all used under laparoscopic guidance. Design In this prospective study, 17 patients with primary or secondary infertility with proven bilateral cornual blockage were scheduled for a recanalization procedure, between June 1995 and October 1998. Setting University-based teaching hospital and the principal author's private clinic. Subjects and methods We combined hysteroscopic cannulation of the proximal fallopian tube using a Labotectcannula with laparoscopic guidance in 17 patients with proximal tubal obstruction which had been diagnosed by hysterosalpingography and confirmed at laparoscopy. This procedure, in addition to being minimally invasive, also accomplishes the objective of causing minimal trauma to the fallopian tube by virtue of the dual hysteroscopic and laparoscopic guidance. Main outcome measures Successful on-table atraumatic recanalization of blocked fallopian tubes, documented by laparoscopic chromopertubation. Results Hysteroscopic cannulation could be attempted in 30 tubal ostia and was successfully accomplished in 15 cases. The instances in which we could not cannulate the tubal ostia (two patients) were not failures of cannulation but failures to visualize the internal tubal ostia because of thick endometrium. Four of our patients have conceived following this procedure and have delivered at term. Conclusion Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients. We recommend the use of a depot gonadotrophin-releasing agonist, such as triptorelin, 10–15 days before attempting this procedure, for easy visualization and access to the internal tubal ostia. The relative simplicity of the procedure means a shorter learning curve for clinicians in training and other beginners, and the results can be consistently reproduced as shown by the 15 successful cases in this study.

Effect of disruption versus continuation of gonadotrophin-releasing agonist after human chorionic gonadotrophin administration on corpus luteum function in patients undergoing ovulation induction for in-vitro fertilization

Previous studies have described the luteolytic effect of gonadotrophin-releasing hormone agonist (GnRHa) administered in the early luteal phase. The present work was undertaken to compare in a prospective and randomized design the effect of disruption versus continuation of daily GnRHa after human chorionic gonadotrophin (HCG) administration on corpus luteum function in patients undergoing ovulation induction for in-vitro fertilization (IVF). Two different studies were designed and a total of 38 ovum donors, aged 23-30 years, were included. In the first study, the effect of GnRHa on the early luteal phase of IVF-stimulated cycles was investigated (n = 27); the patients were divided into two groups, according to whether they stopped (n = 13) or continued with daily GnRHa injections (n = 14) for an additional period of 15 days after HCG administration. Blood was drawn from luteal phase days 2 to 6 (day 0 = day of HCG administration) and oestradiol and progesterone concentrations were analysed. The second study focused on the effects of continuation versus disruption of GnRHa administration in the mid-late luteal phase. A similar design was employed including six patients who stopped GnRH on day 0 and five other women who continued GnRHa for 15 days after HCG administration. In this second study, blood was drawn from days 5 to 11 and oestradiol, progesterone and luteinizing hormone (LH) concentrations were analysed. IVF parameters were similar in both groups. The results indicate that continuous GnRHa administration, after HCG injection, does not produce changes in oestradiol, progesterone and LH concentrations in the early, mid- and late luteal phases compared to those patients in whom GnRHa is discontinued at the day of HCG administration. The present work demonstrates that, when ovulation induction is performed, the corpus luteum is driven primarily by the HCG, regardless of the administration or disruption of GnRHa in the luteal phase. This suggests that the lack of differences between continuation versus disruption of GnRHa may be due to the accumulation of the product over the previous 2-3 weeks of treatment.

Rare occurrence of ovarian hyperstimulation syndrome in oocyte donors

Objectives: To define the incidence and severity of ovarian hyperstimulation syndrome (OHSS) occurring in oocyte donors. Methods: Women ( n = 149) aged 31.3 ± 4.8 years (mean ± S.D., range 21–41 years) participated as designated oocyte donors and underwent 400 consecutive cycles of controlled ovarian stimulation using human menopausal gonadotropin following pituitary downregulation with gonadotropin-releasing agonist. Patients were monitored by serial transvaginal ultrasound examinations and serum estradiol (E 2) determinations. Oocytes (15.6 ± 7.5 per aspiration; range 2–57) were harvested by ultrasound-directed transvaginal follicle aspiration 36 h following the intramuscular injection of human chorionic gonadotropin (hCG). Follow-up examination occurred 1 and 2 weeks post-aspiration. Results: On the day of hCG injection E 2 levels ranged from 512 to 13 502 pg/ml (mean 2902.7 ± 1486.9 pg/ml). Over the next few weeks the degree of hyperstimulation in donors was staged: mild 65% (grade I, n = 98; grade II, n = 162); moderate 33.5% (grade III, n = 120; grade IV, n = 14); severe 1.5% (grade V, n = 6; grade VI, n = 0). Associated preaspiration E 2 levels were: grade I, 1120 ± 424 pg/ml; grade II, 2084 ± 613 pg/ml; grade III, 3785 ± 1713 pg/ml; grade IV, 5370 ± 1264 pg/ml; grade V, 4286 ± 1100 pg/ml. Worsening OHSS was associated with increasing levels of E 2. There were no serious complications and hospitalization was not required. All symptoms resolved within 30 days of aspiration, disappearing by the time of the first menstrual flow in women of grade-III or lower stage. Conclusion: Although oocyte donors commonly experienced exaggerated levels of serum E 2 they rarely (<2%) developed severe OHSS. This may be attributable to their lack of embryo transfer which avoids exacerbating the illness.

The efficacy of an adjuvant norethisterone (jenapharm) therapy in endometrial cancer

Acne is a common, worldwide problem that is usually multifactorial in etiology, but androgens may play a pivotal role in the development and severity of acne. Endocrinopathies, such as polycystic ovarian syndrome, ovarian tumors, or adrenal hyperplasia or tumors, may be detected in some patients with acne, especially if acne is sudden in onset, associated with hirsutism or menstrual irregularities, or associated with cushingoid facies, acanthosis nigricans, patterned hair loss, or deepened voice. In these instances, serum-free and total testosterone, dehydroepiandrosterone, luteinizing hormone, and follicle stimulating hormone should be tested. Appropriate referral and long-term follow-up is warranted in patients diagnosed with an endocrinopathy. Hormonal therapies for acne include systemic medications with various mechanisms: androgen receptor blockers, adrenal androgen production blockers, or ovarian androgen production blockers. Androgen receptor blockers include spironolactone, cyproterone acetate, chlormadinone, and flutamide; adrenal androgen production blockers include glucocorticoids; and ovarian production blockers include gonadotropin-releasing agonists and oral contraceptives. Practical guidelines are shared for the practicing physician treating hormonally related acne.