Search

Prenatal diagnosis of a case of X/XXX mosaicism is presented. In spite of the fact that over 50% of the cells cultured from both ovaries were trisomic for the X chromosome, fetal öocytes were rarely found. This case illustrates that the presence of a triple-X cell line, even in a relatively high percentage of ovarian cells, does not necessarily protect the ovary from 'aöogenesis'. This observation might prove useful in the counselling of future cases involving the prenatal detection of sex chromosome mosaicism. [ABSTRACT FROM PUBLISHER]

Examines whether meiosis-activating sterols (MAS) play a physiological role in the resumption of meiosis in the rat when using ketoconazole as an inhibitor of sterol synthesis. Inhibition of ovulation; Ketoconazole-treated ovaries; Maturation and degeneration of oocytes; Luteinizing hormone-stimulated oocyte maturation; Follicular progesterone production.

Purpose: Description and evaluation of the sonographic changes at the site of the myomectomy and follow-up of the healing process., Methods: Twelve patients with intramural fibroids underwent myomectomy. Pre- and postoperative ultrasound examinations included measurements of uterine volume and the largest diameters of the largest fibroid and the myomectomy scar., Results: The mean uterine preoperative volume was 773 cm(3) (range 271-1,343) (SD 285). It decreased postoperatively to 318 cm(3) (range 98-756) (SD 192) and 185 cm(3) (range 78-420) (SD 96) in the immediate and late scans, respectively. The mean size of the largest diameter of the largest fibroid was 10 cm (range 7-15) (SD 2.3). The largest diameter of the immediate postoperative myomectomy site was 4.5 cm (range 2.2-8) (SD 1.8) decreasing later to 2.4 cm (range 0-6) (SD 1.6)., Conclusion: The postoperative sonographic findings following myomectomy demonstrates a solid finding that may mistakenly be interpreted as the remaining fibroid that shrinks gradually. The finding is probably the result of changes in hyperplastic myometrial tissue, focal small hematomata and suture material.

Clinical data indicate that tamoxifen (TAM) therapy may cause an increased risk of endometrial pathology in postmenopausal but not in premenopausal women. Molecular mechanisms of the uterotrophic activity of TAM have not been clearly established nor its relevance to apoptosis in endometrial cells. The present study was implemented to evaluate the apoptotic effect of TAM on primary endometrial cell cultures in the presence or absence of steroid hormones (SHs). A total of 14 primary endometrial cell cultures were established and maintained both with and without SHs. Cell cultures were treated for 24 h with either 20 microM TAM or 10 nM estradiol. Apoptotic cells presented in a pre-G1 peak and the expression of bcl-2 were studied using flow cytometry. All endometrial cell cultures maintained in a SH-containing environment, except one, responded to TAM by a significant increase (P = 0.03) in the pre-G1 cell fraction, indicating a proapoptotic effect. A significant (P = 0.03) reduction in the pre-G1 peak equivalent to an antiapoptotic response was observed in 6 of 13 cell cultures maintained in a SH-deficient environment. In 4 of 10 cell cultures evaluated in both media, the pre-G1 population was medium dependent. In 8 of 10 cultures evaluated for Bcl2 levels, no trend was found in either media, but a dependency on SH content was observed. Comparison between effects of TAM and estradiol demonstrated identical trends, regardless of the menstrual phase or SH content in cell environments. These results suggest that TAM acts as an estrogen agonist on endometrial tissue in both environments. We conclude that TAM modulates apoptotic pathways in primary endometrial cell cultures. The SH content in the cell environment influences the apoptotic effect of TAM and determines the propensity for a cell to undergo apoptosis or, on the contrary, to resist apoptotic death in response to TAM treatment. This is in concordance with the observed clinical risk of endometrial pathologies in postmenopausal versus premenopausal women.

Glanzmann's thrombasthenia is a rare inherited hematological disorder defined by deficiency or abnormality of the glycoprotein (GP) IIb-IIIa complex. Presenting symptoms are hemorrhagic events, mainly epistaxis, purpura, or menorrhagia. We describe the clinical course and management of a 14-year-old girl with Glanzmann's thrombasthenia and severe menorrhagia. Following treatment with 20 U of packed red blood cells, 37 U of platelets, 7 U of fresh frozen plasma, cryoprecipitate, intravenous estrogens, and methylergotrine maleate with no improvement, the uterine cavity was packed for 48 hr. This unusual procedure halted the bleeding and avoided the necessity for a hysterectomy. When treating acute menorrhagia in patients with Glanzmann's thrombasthenia, the physician should be familiar with the characteristics and all treatment modalities for this disorder.

Objective: To establish the predictive role of preovulatory ovarian ultrasonography in the occurrence of multiple pregnancy after hMG and hCG treatment for anovulatory infertility., Design: Prospective., Setting: Outpatient Infertility Clinic., Patients: Ninety-five anovulatory women who conceived after gonadotropin therapy., Intervention: Induction of ovulation by hMG and hCG monitored by plasma E2 measurements and ovarian ultrasonography., Main Outcome Measures: All follicles visualized on the day of hCG administration were recorded and divided into the following four groups: group I, 10 to 12 mm; group II, 13 to 15 mm; group III, 16 to 18 mm; and group IV, 19 mm and larger. The sonographic findings were statistically evaluated to 80 singletons and 45 multiple pregnancies., Results: No statistical correlation was found to exist between the number of follicles from the different groups and the number of fetuses., Conclusions: The number and sizes of follicles visualized on the day of hCG administration have no predictive value regarding the occurrence of a multiple pregnancy.

Objective: To investigate the relationship between the embryo number and morphology in conception cycles and the incidence of multiple pregnancies., Design: The study is based on information received from a computerized data base., Setting: In Vitro Fertilization Unit, Sapir Medical Center, Kfar Saba, Israel., Patients: A total of 117 consecutive pregnancies resulted from replacement of fresh embryos in our IVF-ET program., Main Outcome Measures: The impact of embryo quality, as assessed by morphological parameters, on the multiple pregnancy rate (PR)., Results: Implantation rates positively correlated with the number and the quality of transferred embryos. However, no multiple pregnancies occurred when only two embryos were replaced. There were no multiple pregnancies when only embryos of low quality (grades 1 and 2) were transferred. Furthermore, there was no correlation between the number of replaced embryos of poor quality and the rate of implantation. The multiple PR increased from 10% when a mixture of high and low quality embryos were transferred to 30.76% when only embryos of highest quality were transferred., Conclusion: The implantation rate of transferred embryos is directly correlated with the morphological scoring. The results of the study suggest that the number of embryos transferred should be balanced against their morphological quality to reduce the rate of multiple pregnancies.

Objective: To provide an up-to-date review of studies that have examined the relative role of endometrial development in in vitro fertilization (IVF) and embryo transfer (ET) treatment in relation to the treatment outcome., Data Identification: The most important published studies and personal communications related to this topic have been identified through a computerized bibliographical search (MEDLINE)., Study Selection: Studies that have evaluated the endometrial maturation in IVF and ET treatment with respect to different treatment protocols of ovarian stimulation. Clinical trials exploring the efficacy of various combinations of hormonal supplementation that aim to improve the endometrial environment and treatment outcome. Publications and personal communications reporting a variety of treatment protocols and drugs utilized for the creation of artificial endometrial cycles in IVF treatment employing donated eggs., Results: Ovarian stimulation frequently adversely affects the process of endometrial maturation. Various kinds of hormonal supplementation, used in clomiphene citrate- and/or human menopausal gonadotropin (hMG)-stimulated cycles have not improved treatment outcome. Human chorionic gonadotropin or natural progesterone (P) supplementation administered after controlled ovarian stimulation with gonadotropin-releasing hormone and hMG effectively corrected the luteal phase defect and resulted in an improved conception rate. The endometrium of agonadal women is highly conducive to hormonal manipulation. All estrogen preparations used effectively promoted endometrial growth and proliferation. Natural P is superior to synthetic progestins for induction of receptive secretory endometrium., Conclusion: The development of adequately receptive endometrium is a major factor determining the outcome of IVF and ET treatment.

Even with the most painstaking techniques, cornstarch granules used as surgical glove powder are deposited in the abdominal cavity during laparotomy. In tubal reconstructive surgery, aimed at the elimination of fibrous adhesions, this deposition may have undesirable consequences. After a successful operation, starch particles introduced in the abdominal cavity may result in the formation of new adhesions. It is therefore desirable to develop an alternative, completely nonreactive, glove powder.

A major problem in tubal reconstructive surgery is the recurrence of peritubal and periovarian adhesions which negate the surgical endeavors. In many cases the etiology of these adhesions is obscure. Histologic re-evaluation with polarized light of 49 resected adhesions revealed residual cornstarch glove powder and suture material in seven specimens. It is concluded that cornstarch powder may be an active agent, and may not be as innocuous as its widespread use indicates.

Microsurgical fimbriectomy with removal of the fimbria ovarica was performed on one side in 19 rabbits. The other tube was left intact as a control. In 10 animals the new ostium was left free, some distance from the ovary. In the remainder, the ostium was fixed to the ovarian capsule. Three animals with a fixed ostium developed mild hydrosalpinx even though the neostomy was patent. Of the remaining 16 rabbits, 15 conceived and became pregnant in both uterine horns. There was no significant difference between nidation index on the two sides. It is concluded that intact fimbriae with a fimbria ovarica are not essential for normal ovum capture. It is therefore suggested that methods for clinical salpingostomy may require re-evaluation.

Asymptomatic or undiagnosed tuboovarian autoamputation in teenagers may have its impact on fertility later in life. Two cases are presented with infertility following unilateral adnexal autoamputation. The importance of awareness for possible subtorsion or torsion of adnexa in childhood and adolescence and its impact on fertility are discussed.

The problem of retrograde seeding of endometrial tissue fragments to the peritoneum was investigated by injecting fluids through the cervical canal into the uterus before and after curettage. Fluid samples were collected from the peritoneal cavity through a laparoscope. Endometrial glands were detected in almost all of the fluids samples, and seeding was greater after curettage than before. It is concluded that any procedure in which fluids are pushed through the uterus may cause peritoneal seeding of endometrium.

Ovairan implantation into the uterus was performed in 27 women, none of whom conceived during the 4- to 6-year follow-up period. Bypassing the fallopian tube may, in itself, explain the disappointing results of this procedure in our series as well as in those reported in the literature. Experimental ovarian implantation into the uterus of rats supplied information regarding additional factors underlying the low success rate of this operation. It is concluded that this surgical intervention has been made superfluous in view of the poor results and the modern methods for extracorporal fertilization at present being developed.