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The coexistence of a cystadenoma with an ectopic pregnancy in the same fallopian tube is extremely rare. A 30-year-old gravid woman exhibited increasing human chorionic gonadotropin concentrations. Intramuscular methotrexate therapy was administered and ectopic precautions were taken. The patient eventually underwent diagnostic laparoscopy. After pathologic review, an ectopic pregnancy and serous cystadenoma were identified in the left fallopian tube., (Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.)

This study was designed to test the efficacy of a long-acting GnRH agonist (alpha) for inhibition of ovulation and menses in monkeys as well as suppression of mild to moderate endometriosis through an individualized, intermittent regimen. Endometriosis was surgically induced in 21 cynomolgus monkeys; ectopic tissue viability was verified histologically. GnRH alpha (leuprolide, D-Leu6-Pro9-Net-LHRH, Abbott Laboratories) was injected weekly in treatment cycle 1 (10 microgram/kg, sc; n = 15). Ovulation and menses ceased in 6 of 15 females. For the remaining 9 monkeys, the GnRH alpha dose was increased to 15 microgram/kg weekly in treatment cycle 2. Still, 4 monkeys resisted suppression; in treatment cycle 3, their regimen increased to 15 microgram/kg every fourth day. Thus, anovulation and amenorrhea was achieved in 14 of 15 monkeys within 90 days, seemingly as a result of ovarian desensitization, since GnRH alpha injections usually enhanced serum LH and FSH levels (P less than 0.05). Frequent laparotomies and daily hormonal profiles of estradiol, progesterone, FSH, and LH in serum confirmed these findings. After treatment, 12 of 15 monkeys manifested resolution of ectopic endometrial tissue; concurrently, there was no change in the severity of endometriosis in the 6 saline-injected controls. Six of 15 monkeys became pregnant within 90 days after cessation of GnRH alpha injections; 1 of 6 control females conceived. These findings may encourage consideration of clinical investigations employing individualized and/or intermittent GnRH alpha administration for the treatment of endometriosis or to achieve contraception.

The relationship between ovarian steroids and LH during the midcycle gonadotropin surge is controversial. Recent demonstration of temporal and quantitative differences in immunoassayable LH (I-LH) and bioassayable LH (B-LH) at midcycle have further clouded this issue. To evaluate the relationship of I-LH, FSH, and ovarian steroids to the onset of the midcycle B-LH surge, blood samples were obtained from five chronically catheterized rhesus monkeys at 2-h intervals for 5-6 days. The plasma was assayed for FSH, LH, 17 beta-estradiol (E2), progesterone (P4), and 17 alpha-hydroxyprogesterone (17-OHP) by RIA and for LH by a rat interstitial cell testosterone in vitro bioassay. The initiation of the B-LH surge served as time zero (to) for the temporal analysis of changes in plasma hormone levels. The I-LH and FSH surges were initiated 6.4 +/- 2.2 h (mean +/- SEM) and 5.2 +/- 1.9 h, respectively, after the onset of the B-LH surge. Although the duration of the ascending limb of the surge was similar for B-LH, I-LH, and FSH, the mean +/- SEM total duration of the B-LH surge (34.5 +/- 3.5 h) was significantly longer (P less than 0.025) than those of I-LH (24.4 +/- 5.0 h) and FSH (27.6 +/- 2.3 h). Before the onset of the B-LH surge (to - 4 h), the ratio of B-H to I-LH was unity; however, during the acme of gonadotropin secretion (to + 12-16 h), the B-LH to I-LH ratio approached 6:1. Doubling times for B-LH, I-LH, and FSH were similar during the ascending phase of the surge. Plasma E2 concentrations increased continuously from to - 40 h to to, with a mean +/- SEM doubling time of 32.6 +/- 4.7 h. Peak E2 concentrations occurred within 6 h after the onset of the B-LH surge. Plasma P4 concentrations began to increase at to - 6 h in four monkeys and at to in one monkey. Plasma P4 concentration plateaued from to to to + 24 h, then increased rapidly, with a mean +/- SEM doubling time of 20.5 +/- 2.9 h. Although there were significant individual variations in plasma 17-OHP concentrations, a definite increase in 17-OHP occurred by to - 10 h, and peak concentrations occurred at to + 1 h.(ABSTRACT TRUNCATED AT 400 WORDS)

Histologic and hormonal documentation of a luteinized unruptured follicle that occurred during a spontaneous menstrual cycle in a rhesus monkey is presented. Frequent (every 2 hours) blood sampling to assess midcycle hormonal dynamics in the monkey with the luteinized unruptured follicle and in five monkeys with an ovulatory stigma revealed significant aberrations in the gonadotropin and steroid hormone profiles associated with a luteinized unruptured follicle. Although the midcycle 17 beta-estradiol surge was normal, the monkey with the luteinized unruptured follicle demonstrated (1) blunted midcycle bioassayable luteinizing hormone, immunoassayable luteinizing hormone, and follicle-stimulating hormone surges; (2) absence of disparity in the bioassayable luteinizing hormone: immunoassayable luteinizing hormone ratio during the gonadotropin surge; (3) absence of progesterone and 17 alpha-hydroxyprogesterone secretion during the gonadotropin surge; and (4) delayed and blunted rise in progesterone and 17 alpha-hydroxyprogesterone after the gonadotropin surge. These findings suggest that an impaired luteinizing hormone surge, perhaps mediated by insufficient midcycle progestin secretion, is one possible cause of the luteinized unruptured follicle syndrome.

It is often assumed that ovulation commonly occurs from alternating sides each month, but it is unknown whether it can occur repeatedly from the same side. In an effort to answer this question, we selected 39 women from our infertility clinic who had six consecutive courses of ultrasound (US) to monitor ovulation and in whom the side of ovulation was recorded. Nine patients (23.1%) ovulated from the same side for six consecutive cycles, whereas no patient alternated side of ovulation in the same period of time. Stimulation with clomiphene citrate and/or human menopausal gonadotropin that results in single ovulation did not affect this pattern. The data were analyzed statistically with the use of a Markov Chain Model and the chi-square goodness-of-fit; the occurrence of persistent same-side ovulation was significant to P less than or equal to 0.001.