Mean Follicular Diameter Research Articles

Natural Cycle and Timing of Intrauterine Insemination: HCG vs. Spontaneous LH Surge

To determine if there is a difference in fertility outcomes of natural cycles in which human chorionic gonadotropin (HCG) was administered versus allowing a spontaneous leutinizing hormone (LH) surge. This is a retrospective cohort study of 427 patients (HCG 261 patients, LH surge 166 patients) who underwent natural cycles at the Center for Reproductive Medicine and Infertility, (CRMI),between 1/1/03-12/31/04. Development of ovarian follicles was monitored by transvaginal ultrasound measurement of mean follicular diameter and serial assays of estradiol and serum or urine LH. When the mean follicular diameter was ≥ 18mm, 10,000 mIU of HCG was given to trigger ovulation. Intrauterine insemination, (IUI), was performed 24 hours after HCG administration. Alternatively, laboratory serum LH or patient monitoring of urinary LH levels was performed and when an LH surge was detected (from data previously found to be consistent with LH surge, ≥18 mIU/ml), IUI was performed the following day. All insemination cycles were performed with sperm from subfertile partners or frozen donor specimens. Pregnancy was diagnosed by quantitative Beta-Human Chorionic Gonadotropin, (B-HCG), two weeks after IUI. A comparison of groups with HCG administration versus spontateous LH surge was performed with the Student’s t-test and the Chi-square test where appropriate.Statistical analysis was performed using the SPSS software program. The two groups (HCG administration vs LH surge) were similar with respect to age (37.1yrs for HCG, 36.9yrs for LH), BMI (23.2 for HCG, 23.1 for LH) and peak estradiol level (215pg/ml for HCG, 232pg/ml for LH). Significant differences were noted for IUI day (14 for HCG, 15 for LH surge; p<0.001) and peak LH (14.8mIU/ml for HCG, 30.3mIU/ml for LH; p<0.0001). Patients receiving HCG were more likely to have a positive BHCG 8.04% than those patients with LH surge, 5.95%, though this difference was not statistically significant, p=0.4. The percentage of patients using donor sperm was not significantly different between the two groups, 30.3% for HCG and 35.7% for LH, p=0.24. The percentage of patients that had prior attempts of natural cycles or IVF was also not significantly different between the two groups, 48.7% for HCG and 53.0% for LH,p=0.4. View Large Image Figure ViewerDownload (PPT) HCG administration resulted in a greater number of patients with positive BHCG but did not show a statistically significant difference in outcome from those patients who had utilized spontaneous LH surge to time IUI. However, the patients who received HCG did have IUI performed an average of one day earlier than those patients awaiting an LH surge. It is important to note that this sample population has a large number of patients who have prior attempted cycles, almost 50% in both groups.

Modified natural cycle for IVF does not offer a realistic chance of parenthood in poor responders with high day 3 FSH levels, as a last resort prior to oocyte donation.

The purpose of this study was to evaluate the use of the modified natural cycle (MNC) for IVF in poor responders as a last resort prior to oocyte donation. Thirty-two patients with a regular menstrual cycle, FSH levels on day 3 of the cycle >12 IU/l and one or more failed IVF cycles with five or fewer cumulus-oocyte complexes (COCs) retrieved were included in this prospective study. Recombinant FSH 100 IU and GnRH antagonist 0.25 mg/day were started concomitantly when a follicle with a mean diameter of 14 mm was present at ultrasound. HCG 10 000 IU was administered as soon as the mean follicular diameter was > or =16 mm. Twenty-five out of 78 cycles performed (32.1%) did not result in oocyte retrieval. In nine out of 53 cycles (16.9%) in which oocyte retrieval was performed, no COCs were retrieved. Following fertilization, embryo transfer was performed in 19 out of 44 cycles in which COCs were retrieved (43.2%). No ongoing pregnancy was achieved in 78 MNCs (0.0%; 95% confidence interval 0.0-4.7). MNC does not offer a realistic chance of parenthood in patients with high levels of FSH on day 3 of the cycle and previous poor response to ovarian stimulation, when offered as a last resort prior to oocyte donation.

Follicular dynamics and steroid profiles in cows during and after treatment with progestin-based protocols for synchronization of estrus.

Two progestin-based protocols for the synchronization of estrus in beef cows were compared. Cyclic, nonlactating, crossbred, beef cows were assigned by age and body condition score to one of two treatments. Cows assigned to the MGA Select protocol were fed melengestrol acetate (MGA; 0.5 mg x cow(-1) x (-1)) for 14 d, GnRH was administered (100 microg i.m. of Cystorelin) 12 d after MGA withdrawal, and PGF2alpha (25 mg of i.m. Lutalyse) was administered 7 d after GnRH. Cows assigned to the 7-11 Synch protocol were fed MGA for 7 d and were injected with PG on d 7 of MGA, GnRH on d 11, and PG on d 18. Transrectal ultrasonography was performed daily to monitor follicular dynamics from the beginning of MGA feeding through ovulation after the synchronized estrus. All cows exhibited estrus in response to PG. Mean interval to estrus was shorter (P < 0.01) for 7-11 Synch-treated cows (56 +/- 1.5 h) than for cows assigned to the MGA Select protocol (73 +/- 4.7 h). Mean interval from estrus to ovulation did not differ between treatments (P > 0.10). Variances for interval to estrus differed (P < 0.01) between treatments. Mean follicular diameter at GnRH injection, PG injection, and estrus did not differ (P > 0.10) between treatments. Relative to MGA Select, serum estradiol-17beta concentrations were higher (P < 0.01) for 7-11 Synch 2 d and 1 d before, on the day of GnRH injection, in addition to 4 d after GnRH, and 24 h after PG. Mean progesterone concentrations were greater (P < 0.01) for MGA Select cows from 4 d before to 7 d after GnRH. Forty-four percent of the variation in interval to estrus between treatments was explained by differences in estradiol-17beta concentrations 24 h after PG. This study suggests that follicular competence is likely related to steroidogenic capacity of the follicle and the endocrine environment under which growth and subsequent ovulation of the dominant follicle occurs.

Follicular dynamics and steroid profiles in cows during and after treatment with progestin-based protocols for synchronization of estrus12

Two progestin-based protocols for the synchronization of estrus in beef cows were compared. Cyclic, nonlactating, crossbred, beef cows were assigned by age and body condition score to one of two treatments. Cows assigned to the MGA Select protocol were fed melengestrol acetate (MGA; 0.5mg•cow−1•−1) for 14 d, GnRH was administered (100 μg i.m. of Cystorelin) 12 d after MGA withdrawal, and PGF2α (25 mg of i.m. Lutalyse) was administered 7 d after GnRH. Cows assigned to the 7-11 Synch protocol were fed MGA for 7 d and were injected with PG on d 7 of MGA, GnRH on d 11, and PG on d 18. Transrectal ultrasonography was performed daily to monitor follicular dynamics from the beginning of MGA feeding through ovulation after the synchronized estrus. All cows exhibited estrus in response to PG. Mean interval to estrus was shorter (P < 0.01) for 7-11 Synch-treated cows (56 ± 1.5 h) than for cows assigned to the MGA Select protocol (73 ± 4.7 h). Mean interval from estrus to ovulation did not differ between treatments (P > 0.10). Variances for interval to estrus differed (P < 0.01) between treatments. Mean follicular diameter at GnRH injection, PG injection, and estrus did not differ (P > 0.10) between treatments. Relative to MGA Select, serum estradiol-17β concentrations were higher (P < 0.01) for 7-11 Synch 2 d and 1 d before, on the day of GnRH injection, in addition to 4 d after GnRH, and 24 h after PG. Mean progesterone concentrations were greater (P < 0.01) for MGA Select cows from 4 d before to 7 d after GnRH. Forty-four percent of the variation in interval to estrus between treatments was explained by differences in estradiol-17β concentrations 24 h after PG. This study suggests that follicular competence is likely related to steroidogenic capacity of the follicle and the endocrine environment under which growth and subsequent ovulation of the dominant follicle occurs.

Ortho Evra ™/Evra ™ versus oral contraceptives: follicular development and ovulation in normal cycles and after an intentional dosing error

Objective To compare the effects of the contraceptive patch to oral contraceptives (OCs) on follicular size and incidence of ovulation in normal cycles and after dosing errors. Design Randomized, open-label. Setting Twelve centers. Patient(s) One hundred twenty-four ovulatory women. Intervention(s) Subjects received either the patch (groups 1 and 2) or one of three OCs. Correct dosing occurred in cycles 1, 2, 3, and 5. The following dosing errors were planned during cycle 4, a shortened 10-day cycle: [1] patch group 1 subjects wore one patch for 10 consecutive days; [2] for patch group 2 and OC subjects, 7 dosing days were followed by 3 drug-free days. Main outcome measure(s) Follicular size, as determined at each cycle by the maximum mean follicular diameter. Result(s) After a 3-day dosing error, follicular size was significantly smaller in the patch group (mean, 7.0 mm) vs. each OC group (range of means, 11.8–17.1 mm). Similar results were seen after proper dosing. The incidence of ovulation was significantly lower for the patch users than for women using OCs. Conclusion(s) Follicular size and incidence of ovulation were significantly reduced among contraceptive patch users compared with women using OCs in normal cycles and after planned dosing errors.

Use of dexamethasone and clomiphene citrate in the treatment of clomiphene citrate-resistant patients with polycystic ovary syndrome and normal dehydroepiandrosterone sulfate levels: a prospective, double-blind, placebo-controlled trial

Objective: To evaluate the effects of short-course administration of dexamethasone (DEX) combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal DHEAS levels. Design: Prospective, double-blind, placebo-controlled, randomized study. Setting: Referral university hospitals. Patient(s): Two hundred thirty women with PCOS and normal DHEAS who failed to ovulate after a routine protocol of CC. Intervention(s): The treatment group received 200 mg of CC from day 5 to day 9 and 2 mg of DEX from day 5 to day 14 of the menstrual cycle. The control group received the same protocol of CC combined with placebo. Main Outcome Measure(s): Follicular development, hormonal status, ovulation rate, pregnancy rate. Result(s): Mean follicular diameters were 18.4124 ± 2.4314 mm and 13.8585 ± 2.0722 mm for the treatment and control groups, respectively. Eighty-eight percent of the treatment group and 20% of the control group had evidence of ovulation. The difference in the cumulative pregnancy rate in the treatment and control groups was statistically significant. Conclusion(s): Hormonal levels, follicular development, and cumulative pregnancy rates improved with the addition of DEX to CC in CC-resistant patients with PCOS and normal DHEAS. This regimen is recommended before any gonadotropin therapy or surgical intervention.

Effects of sympathetic denervation on follicular distribution, oestradiol and progesterone serum levels in prepubertal hemi-ovariectomized female guinea pig

Hemi-gonadectomy performed in prepubertal female guinea pigs is followed by a compensatory ovarian hypertrophy (COH) and compensatory ovulation (CO). Sympathetic denervation diminished the COH (left ovary: 28±1.6% versus 46±4% (control), P<0.05; and right ovary: 21.3±3.2% versus 34.2±3.7% (control), P<0.01) and does not modify the CO. The mean follicular diameter increased only in the right ovary of hemi-gonadectomized animals. This increase is greater in the hemi-gonadectomized-denervated groups. The mean follicular diameter measured in the right and left ovaries showed an opposite response in hemi-ovariectomized and hemi-ovariectomized-denervated animals: the diameter increased in the right ovary without modifications in the left. Present results add further support to the participation of ovarian innervation on the mechanisms, which regulate follicular development.

Ultrasonographic characterization of ovarian events and fetal gestational parameters in two southern black rhinoceros ( [formula omitted][formula omitted][formula omitted]) and correlation to fecal progesterone

A tremendous potential exists for the application of transrectal ultrasonography as a tool to enhance the captive management of endangered species. Reproductive study of two southern black rhinoceros ( Diceros bicornis minor ) females was performed daily to every other day for a ∼60 day period to document ovarian changes, and three times weekly in early pregnancy to once monthly in late pregnancy in order to characterize changes in fetal parameters throughout gestation. All ovarian and fetal anatomical structures were measured in millimeters. The mean (+/− SD) length of the estrous cycle or interovulatory period was 26 +/− 1.4 days (n=2 cycles). Follicular growth rate of a dominant follicles was ∼3 mm/day once the follicle reached 35 mm in diameter. Ovulation was observed to occur at a mean (+/− SD) follicular diameter of 49.5 +/− 2.6 mm (n=4) and within 48 to 72 h after observed estrus (n=2). Large ovarian structures [mean (+/− SD) diameter of 71.7 +/− 2.9 mm; n=3], considered analogous to equine anovulatory hemorrhagic follicles, were observed to form in the winter months and suggest seasonal periods of reduced fertility. Fecal progesterone assays confirmed ultrasonographic events. Although preliminary, the results of fetal sexing are presented and compared to the horse. Our data indicate that fetal eye or fetal foot diameter measurements can be used to accurately predict gestational age from about 2 months to term, providing useful information to managers of both captive and wild rhino populations. The ability to identify and quickly release animals in late term pregnancy in the wild and thereby reduce abortions and neonatal mortalities in holding bomas is one potential practical conservation benefit of the fetal are predictive models.

Histological changes of thyroid tissues in patients with liver cirrhosis.

Alterations in thyroid hormone regulation and metabolism, such as low serum T3 and T4 with normal TSH, are frequently noted in liver cirrhosis, but few morphological studies have ever been done on thyroid tissue in liver cirrhosis. In this study we analyzed the histological changes of thyroid tissue in the patients with liver cirrhosis. Specimens of thyroid gland obtained from autopsies in 16 cirrhotic patients were examined, and compared with those of two control groups. Control group I consisted of 7 patients with diabetes mellitus and control group II, 12 patients who died from sudden onset of cardiovascular problems. We measured follicular diameter and epithelial width on light micrographs of the central portion of thyroid specimens. We graded the degree of colloid vacuole, lipofuscin deposition in follicular epithelia, regenerative reaction and perivascular fibrosis in 10 consecutive light microscopic fields of the specimen. In the cirrhotic group, mean follicular diameter and epithelial width were significantly shorter and thinner, respectively, than those in the two control groups. Perivascular fibrosis was more prominent in the cirrhosis group than in the controls. These findings suggest that thyroid glands in patients with liver cirrhosis have the characteristic features of hypoactivity.

Pharmacodynamics of the contraceptive patch

Objective: To select a contraceptive patch size that provides ovulation suppression and cycle control equal to or greater than a well accepted oral contraceptive (OC).Methods: Subjects were randomly assigned to 1 of 4 treatment groups (for 4 cycles): 10-cm2 patch (3.0 mg of 17-deacetylnorgestimate [17d-NGM]/0.38 mg of ethinyl estradiol [EE]) (n = 153), 15-cm2 patch (4.5 mg of 17d-NGM/0.56 mg of EE) (n = 157), 20-cm2 patch (6.0 mg of 17d-NGM/0.75 mg of EE) (n = 150), or oral NGM 250 μg/EE 35 μg (n = 150). Regimens: Three 7-day patches (21 days) plus 1 patch-free week; 1 pill daily (21 days) plus 1 pill-free week, with a 1-day late start in cycle 4 for all subjects. Suppression of ovarian activity was determined by serum progesterone levels on days 7, 14, 21 and 28 of cycles 1, 3, and 4, ovarian follicle size by ultrasonography in 109 subjects on days 2 (or 3), 7, 14, 21, and 28 of cycles 1, 3 and 4, and cycle control via diary cards.Results: The proportions of subjects with progesterone values greater than 3 ng/mL in cycles 1 and 3 were 41.9%, 10.2%, 5.5%, and 6.1% for the 10-, 15-, and 20-cm2 patch and OC groups, respectively. Maximum mean follicular diameter in cycles 1, 3, and 4 ranged from 10 to 11.1 mm in the 20-cm2 patch (EVRA) group and from 10.7 to 14 mm for the OC group. The percentages of subjects in the 20-cm2 patch (EVRA) and OC groups with breakthrough bleeding/spotting were similar for cycles 1 and 2 and, in cycle 3, were better for EVRA (10.5% vs 15%).Conclusion: The 20-cm2 contraceptive patch (EVRA) provides high levels of suppression of ovarian activity and effective cycle control compared with a widely accepted OC, while providing more complete suppression of follicular development.

Colloid in the pituitary pars distalis of viscacha (Lagostomus maximus maximus): ultrastructure and occurrence in relation to season, sex, and growth.

Randomly distributed extracellular colloidal accumulations were observed in the pars distalis of viscacha (Lagostomus maximus maximus). They were preferentially located in the peripheral zone of the gland and showed variability in shape and size. Two different types of colloidal accumulations were found by electron microscopy: 1) those surrounded by nongranulated follicular cells that correspond to characteristic follicles, and 2) those surrounded by granulated cells. In the follicles lined by nongranulated follicular cells, long, prominent microvilli and cytoplasmic processes protruded into the lumen. The frequency of these accumulations varies during the year in adult male animals, showing an increase in number during summer and a decrease during winter. The lowest value was registered in August (winter). The mean follicular diameter did not vary seasonally. The number of colloidal accumulations did not vary seasonally in adult female viscachas, but a significant difference in the mean follicular diameter between pregnant and non-pregnant females was observed. Pituitaries of immature animals contain fewer colloidal accumulations than those of adults. In fetuses, these accumulations were absent. The administration of melatonin provoked a decrease in the number of these structures. The numeric changes of the colloidal accumulations observed in this study are associated with: 1) the seasonal reproductive activity in adult males, and 2) the reproductive condition, body weight and sexual maturity in males and females. The fact that melatonin administration decreases the population of colloidal accumulations in males suggests participation of the pineal gland in these changes.

Inhibition of gonadotropin surge by a brief mid-cycle regimen of ethinyl estradiol and norethindrone: possible role in in vitro fertilization

Various methods to prevent premature luteinizing hormone (LH) surge and improve cycle control during hyperstimulation for in vitro fertilization (IVF) are standard of care. The purpose of the present study was to determine the influence of a 5-day regimen of ethinyl estradiol (EE) and norethindrone (NET) on folliculogenesis, gonadotropin surge, and ovulation.In a prospective randomized and comparative study, ten patients were assigned to two groups. A combination of 50 μg of EE and 1 mg of NET was used in groups I and II from days 6 through 10, and days 8 through 12, respectively. Blood samples and transvaginal ultrasound imaging were carried out throughout a 28-day cycle.Follicular diameter, plasma levels of LH, follicle-stimulating hormone (FSH), estradiol and progesterone, and endometrial thickness were determined.No LH surge or ovulation was detected in any patient studied. Peak estradiol concentrations were not significantly different between the groups (152.04 ± 107.1 pg/ml vs 162.1 ± 56.1 pg/ml [mean ± SD] for groups I and II, respectively). No differences were noted between the groups for serum concentrations of FSH (range: 2–9 mIU/ml) or LH (range: 2–10 mIU/ml) for any given cycle day. Mean follicular diameters were not different between groups I and II (20.5 ± 8.1 mm2 vs 20.6 ± 14.2 mm2). Ultrasound assessment of mid-cycle follicular growth revealed diameters ranging from 18.5 mm2 to 34.0 mm2. Endometrial thickness ranged from 8 to 10 mm. There was no evidence of ovulation on ultrasound examination and either persistence or gradual resolution of follicles through the luteal phase. Peak serum concentrations at mid-luteal phase were ≤ 2 ng/ml.In this pilot study, the combination of EE and NET restricted to a 5-day course beginning on day 6 or 8 permitted folliculogenesis but effectively inhibited mid-cycle LH surge and ovulation. Such regimens may have a role in IVF cycles for prevention of premature LH surges, especially as stimulation regimens evolve toward decreased gonadotropin use for stimulation and strict FSH preparations with the potential need for less complete pituitary suppression.

The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles.

The aim of this prospective study of the use of transvaginal power Doppler ultrasound was to assess the subjectivity of the grading system and to elucidate, on a much larger series (200) of treatment cycles, the findings of previous authors. Vascular perfusion was studied using a grading system based on the percentage of follicular circumference (grade 1 < 25%, grade 2 < 50%, grade 3 < 75% and grade 4 > 75%) that depicted an echo signal. Interobserver variation was low (k = 0.81 + 0.08). A total of 1285 follicles were studied, of which 64% were of high (grades 3 or 4) and 36% were of low (grades 1 or 2) grade vascularity. Mean follicular diameter, oocyte retrieval rate, number of mature oocytes recovered and fertilization rates were all significantly higher (P < 0.05) and triploidy rate significantly lower (P < 0.05) from the cohort of follicles with high grade vascularity. There was no correlation between embryo morphology and vascularity grade. The pregnancy rate for cycles where the embryos transferred were derived from follicles with uniformly high grade (3 or 4 only) vascularity was significantly higher than for those cycles where the embryos transferred were derived from mixed (1 to 4) or low (1 or 2 only) grade follicles [24/72 (34.7%) versus 22/122 (18%); P < 0.05]. There were no significant differences in uterine artery or intraovarian pulsatility index values between the pregnant and non-pregnant treatment cycles. This study suggests that follicles with high grade vascularity are associated with better outcome variables. Thus, follicular assessment may be used prospectively to improve the outcome in in-vitro fertilization treatment cycles.

The effects of equine somatotropin (eST) on follicular development and circulating plasma hormone profiles in cyclic mares treated during different stages of the estrous cycle

The effects of exogenous equine somatotropin (eST) administration on ovarian activity and plasma hormone levels were evaluated on horse and pony mares. The objectives of this study were to determine the effects of eST on follicular development and circulating concentrations of leutinizing hormone (LH), estradiol, progesterone, and insulin-like growth factor I (IGF-I) in cyclic horse and pony mares. Sixteen mares received daily injections (im) of eST at a concentration of 25 μg/kg body weight on either Days 6 through 12 (Treatment A) or 13 through 19 (Treatment B) postovulation. In addition, contemporary mares were similarly given the carrier vehicle and served as controls (Treatments C and D). Blood samples were collected at 24-hr intervals and ultrasonographic evaluations were performed on the ovaries of each mare at 48-hr intervals beginning on the first day of treatment and ending either on the day of ovulation or 5 d postovulation. Circulating levels of insulin-like growth factor-I (IGF-I) were increased in treated mares by Day 3 post-treatment (P < 0.05). Also, mares in Treatment B exhibited a decrease in plasma estradiol concentrations (P < 0.05) when compared with control mares on Days 1 through 5 postovulation of the post-treated estrous cycle. In addition, circulating leutinizing hormone levels were different for mares in Treatment A compared with controls on Days −8 through −1 pre-ovulation (P < 0.05). All follicles present on the ovaries of each mare were measured and placed into one of five categories based on their diameter. Neither the mean number of follicles per size category ⩾8 mm in diameter nor the mean follicular diameter within each size category differed among treatment and control mares. However, eST treatment significantly increased the number of follicles ⩽7 mm on the ovaries of mares treated early in the estrous cycle when compared with control mares on Days 3 and 7 post-treatment and at the onset of standing estrus.

Inhibition of iodine organification and regulation of follicular size in rat thyroid tissue in vitro.

The factors mediating the accumulation of thyroglobulin are of great importance to the understanding of the pathogenesis of human and experimentally induced colloid goiters. To elucidate further the underlying cellular mechanism, thyroid fragments from newborn rats were incorporated into semisolid alginate beads and were cultured as three-dimensional organoids for up to 21 d. In five parallel cultures, the medium contained either no supplements (group A), Nal (group B), thyroid-stimulating hormone (TSH) (group C), Nal plus TSH in the same concentrations as B and C (group D), or Nal and TSH (as in group D) plus methimazole (MMI, group E). The thyroid organoids maintained morphological integrity, functional activity, and ability to proliferate in vitro. Addition of iodine to the cultures significantly increased mean (+/-SEM) follicular diameters from 19.5 +/- 0.7 microm in controls to 33.9 +/- 2.2 microm (p < 0.0001) when NaI was added alone (group B), and 30.4 +/- 1.7 microm (p < 0.0001) when combined with TSH (group D). The effect of NaI on follicular size was abolished by MMI (group E, follicular diameter 23.5 +/- 1.3 microm). The results presented support the recent finding, using a rat colloid goiter model, that not only TSH but also iodine organification or its inhibition are important factors in modulating follicular morphology.

Correlation between endometrial dating of luteal phase days 6 and 10 of the same menstrual cycle.

Endometrial maturation, important in the diagnosis of infertile couples, has been evaluated since 1950 using the Noyes criteria. Nevertheless, there is no consensus regarding the most suitable period of the luteal phase for performing the biopsy. This study evaluated the correlation between the histological dating of two endometrial biopsies performed in the same menstrual cycle, on luteal phase days six and ten. Prospective study. Human Reproduction Division of the Federal University of São Paulo, referral center. Twenty-five women complaining of infertility had their menstrual cycles monitored by ultrasound and LH plasma levels, to obtain evidence of ovulation. Endometrial biopsies were performed on luteal phase days LH + 6 and LH + 10 (luteal phase day 1 = LH + 1 = the day that follows LH peak). Dating was done according to morphometric criteria, in which an endometrium sample is considered out of phase if the minimum maturation delay is one day. On day LH + 6, blood was drawn for plasma progesterone level determination. All patients had an ovulatory cycle (mean LH peak: 47.4 U/L; mean follicular diameter on LH peak day: 18.9 mm; mean endometrial thickness on LH peak day: 10.3 mm; mean plasma progesterone level on day LH + 6: 14.4 ng/ml). 14 patients had both biopsies in phase; 5 patients had out of phase biopsies only on day LH + 6; 3 had out of phase biopsies only on day LH + 10 and 3 patients had out of phase biopsies on both days. McNemar's test showed no statistical difference between these data (p > 33.36%). The correlation found between the endometrial datings suggests that biopsies performed on either of these two days are suitable for evaluation of endometrial maturation.

The effects of equine somatotropin (met-eGH) on follicular development in cycling mares

The effects of exogenous equine somatotropin (eST) administration on ovarian activity and plasma hormone levels were evaluated on horse and pony mares. The objectives of this study were to determine the effects of eST on follicular development and circulating concentrations of leutinizing hormone (LH), estradiol, progesterone, and insulin-like growth factor I (IGF-I) in cyclic horse and pony mares. Sixteen mares received daily injections (im) of eST at a concentration of 25 μg/kg body weight on either Days 6 through 12 (Treatment A) or 13 through 19 (Treatment B) postovulation. In addition, contemporary mares were similarly given the carrier vehicle and served as controls (Treatments C and D). Blood samples were collected at 24-hr intervals and ultrasonographic evaluations were performed on the ovaries of each mare at 48-hr intervals beginning on the first day of treatment and ending either on the day of ovulation or 5 d postovulation. Circulating levels of insulin-like growth factor-I (IGF-I) were increased in treated mares by Day 3 post-treatment (P < 0.05). Also, mares in Treatment B exhibited a decrease in plasma estradiol concentrations (P < 0.05) when compared with control mares on Days 1 through 5 postovulation of the post-treated estrous cycle. In addition, circulating leutinizing hormone levels were different for mares in Treatment A compared with controls on Days −8 through −1 pre-ovulation (P < 0.05). All follicles present on the ovaries of each mare were measured and placed into one of five categories based on their diameter. Neither the mean number of follicles per size category ⩾8 mm in diameter nor the mean follicular diameter within each size category differed among treatment and control mares. However, eST treatment significantly increased the number of follicles ⩽7 mm on the ovaries of mares treated early in the estrous cycle when compared with control mares on Days 3 and 7 post-treatment and at the onset of standing estrus.

Inhibition of follicular growth by two different oral contraceptives (monophasic and triphasic) containing ethinylestradiol and gestodene

Objective To evaluate the inhibition level of ovarian follicular growth produced by a triphasic oral contraceptive (OC) containing ethinylestradiol and gestodene vs. the level produced by a monophasic OC containing the same components.Methods A randomized, blind, cross-over trial was performed in a sample of 56 women. The follicular diameters were measured in 56 cycles under triphasic contraceptive treatment, and the other 56 under monophasic contraceptive treatment, using vaginal ultrasound. The statistical analysis was performed using the Student's t test.Results The mean follicular diameter under monophasic OC treatment was found to be 8.16 mm (standard deviation 4.5), and while under triphasic OC treatment was found to be 7.44 mm (standard deviation 2.8) (p > 0.05). In 17 out of 112 cycles (15%), a certain degree of follicular activity was found (follicular diameter more than 10 mm), 10 cycles under monophasic OC and 7 cycles under triphasic OC.Conclusions The triphasic OC provides good inhibition of follicular growth and excellent contraceptive efficacy.

Combined serial ultrasonography and fecal progestin analysis for reproductive evaluation of the female white rhinoceros (Ceratotherium simum simum): Preliminary results

Ultrasonographic examinations of one multiparous 33-year-old female southern white rhinoceros (Ceratotherium simum simum) resulted in documentation of the animal's estrous cycle, elucidation of the timing of ovulation in relation to estrus, and ultrasonographic evidence of endometritis and associated early embryonic death. The preovulatory follicle was observed to change in shape from spherical to pear-shape (n = 3) and to reach a mean follicular diameter of ˜30 mm (n = 4) in the 48 hr preceding estrus. An ovulation site in the location of the preovulatory follicle was observed to occur within 24 hr postbreeding on one occasion. Both pregnancies monitored in this female in 1995 were lost by day 28 postovulation, with collapse of the embryonic vesicle documented via ultrasound. Ultrasonographic evidence of endometritis was observed in this female and was characterized by small quantities of anechoic intrauterine fluid collections (5–20 mm diameter) in late diestrus (n = 4, mean day observed was 20.5 days postovulation, with a range of 18–24 days). Fecal samples collected at the time of ultrasound were evaluated via radioimmunoassay for progesterone metabolites. A substantial rise in fecal progestins was not identified until 7–9 days postovulation. This study illustrates the value of combining the complementary techniques of ultrasonographic “mapping” of events with fecal hormone assay to enhance the accuracy of reproductive monitoring. Zoo Biol 16:445–456, 1997. © 1997 Wiley-Liss, Inc.

Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle

OBJECTIVE: Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. STUDY DESIGN: Seven women who had bilateral tubal patency, a normal pelvis on laparoscopy, and regular ovulatory cycles underwent serial transvaginal ultrasonography on menstrual cycle day 2, daily from estimated day of ovulation –6, hourly from estimated day of ovulation –2, or when the mean follicular diameter was >16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transvaginal color Doppler ultrasonography and serum concentrations of follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone assessed by fluoroimmunoassay. RESULTS: In one case there was evidence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hormone surge. On the side with the dominant follicle, follicular and ovarian stromal peak systolic blood flow velocity rose significantly during the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with changes in serum follicle-stimulating hormone, luteinizing hormone and progesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. Uterine artery time-averaged maximum velocity on the side of the developing ovarian follicle increased during the menstrual cycle with no significant change in the contralateral vessel. Uterine artery pulsatility index on the side of the developing follicle declined during the midluteal phase and was significantly lower than on the contralateral side. The changes in time-averaged maximum velocity correlated with the changes in serum estradiol and progesterone concentrations. CONCLUSION: The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activity of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implantation of the blastocyst. (Am J Obstet Gynecol 1996;175:625-31.)