Preoperative versus postoperative dextran 70 for preventing adhesion formation

Since serosal drying and tissue abrasion play an important role in adhesion formation, we tested the hypothesis that the peritoneal instillation of 32% high-molecular-weight dextran 70 (H) before, rather than after, a surgical procedure results in less postoperative adhesion formation and reformation. Twenty rabbits were subjected to a standardized surgical injury on one ovary, the ipsilateral uterine horn and adjacent parietal peritoneum. Three weeks later the animals underwent a second laparotomy to blindly score the adhesions and subsequently lyse them using microsurgical techniques. The animals were randomly assigned to one of two treatment groups, with H administered either before or at the end of each surgical procedure. Three weeks after the second surgical procedure, the animals were killed to blindly score adhesions. There was no difference in the mean adhesion scores between the two groups after either the first (2.0 versus 2.9, NS) or second surgical procedure (5.5 versus 5.1, NS). Thus, we conclude that preoperative instillation of H does not offer any advantage over postoperative instillation in the prevention of either adhesion formation or reformation.

Ovarian function after incision of the ovary by scalpel, CO2 laser, and microelectrode

OBJECTIVE

The objective was to evaluate the relative effects of a standardized surgical incision performed with scalpel, CO2 laser, or microelectrode on ovarian tissue and function.

DESIGN

Thirty sexually mature female rabbits were randomly assigned to one of three surgical groups. The injury consisted of a linear incision along the long axis of both ovaries, from the cortex to the hilum, followed by immediate unilateral oophorectomy for evaluation of the acute tissue damage. The opposite ovary was left in situ to evaluate subsequent healing, steroidogenesis, folliculogenesis, and ovulation.

RESULTS

Minimal damage was observed after surgery with either laser or microelectrode. The ovarian stroma and follicles adjacent to the surgical site appeared normal both immediately and 15 days after all surgeries. Steroidogenesis, folliculogenesis, and luteinization were similar among the three groups. The number of ovulated oocytes after human chorionic gonadotropin was significantly reduced after scalpel and laser surgery compared with microelectrode (P less than 0.05). The former groups appeared to have a higher incidence of unruptured luteinized follicles with untrapped oocytes, which were often covered with a cellular fibrous membrane.

CONCLUSIONS

These findings suggest that surgical trauma is well tolerated by the ovaries and does not impair subsequent ovarian function. However, rupture of the preovulatory follicle and its release of the oocyte may be influenced by the presence of ovarian adhesions and/or surgical trauma.

A comparative analysis of the cycle fecundity rates associated with combined human menopausal gonadotropin (hMG) and intrauterine insemination (IUI) versus either hMG or IUI alone

Human menopausal gonadotropin (hMG) superovulation combined with washed intrauterine insemination (IUI) has been advocated for the treatment of various forms of infertility when more traditional therapy has failed. To assess the relative efficacy of combined treatment with hMG and IUI compared with either hMG or IUI alone, pregnancy outcomes of the three treatment groups were compared in couples having infertility because of male factor, cervical factor, endometriosis, or unexplained. A total of 751 cycles were analyzed from 322 couples. The mean cycle fecundity rate associated with hMG/IUI therapy was significantly higher than either hMG or IUI therapy alone for all patients (hMG/IUI = 19.6%, hMG = 6.3%, IUI = 3.4%). The improvement in cycle fecundity rates with hMG/IUI therapy was also observed when the couples were separated by infertility diagnostic groups: male factor (hMG/IUI = 15.3%, hMG = 4.4%, IUI = 3.0%), cervical factor (hMG/IUI = 26.3%, hMG = 7.9%, IUI = 5.1%), endometriosis (hMG/IUI = 12.85%, hMG = 6.6%), and unexplained infertility (hMG/IUI = 32.6%, hMG = 5.5%, IUI = 0%). Moreover, in patients who had failed to conceive with hMG or IUI alone, the cycle fecundity rate when they were switched to hMG/IUI therapy equaled that of patients who received combined therapy from the onset. We conclude that cycle fecundity rates and cumulative pregnancy rates are significantly greater using a combination of hMG and IUI compared with either modality alone in the treatment of male factor, cervical factor, endometriosis, or unexplained infertility. Indeed, in couples with nontubal related infertility, cycle fecundity rates with hMG/IUI approach the rates seen with in vitro fertilization and gamete intrafallopian tube transfer.

Identification of follicles with fertilizable oocytes by sequential ultrasound measurements during follicular development

Patients undergoing ovulation induction for in vitro fertilization and embryo transfer (IVF-ET) were monitored daily with serum estradiol-17 beta (E2) and ultrasound. The location of each individual follicle was established by taking ultrasound images through serial sections of the ovary. The diameter of each follicle and the volume of its follicular wall (FW) were determined from ultrasound images using a computer-controlled image analyzer. A total of 44 follicles from nine patients was studied, with an overall fertilization rate of 46% In all patients, serum E2 levels increased prior to human chorionic gonadotropin (hCG). Whereas changes in either the average diameter or the volume of the entire follicle did not identify follicles with fertilizable oocytes, FW volume measurements were predictive. Prior to hCG, FW volume increased 24 +/- 8%/day in follicles with fertilizable oocytes but decreased 3 +/- 6%/day in follicles with nonfertilizable oocytes (P less than 0.05). Three major patterns of follicular development were observed for follicles with nonfertilizable oocytes: slow growing (less than 20% increase in FW volume), nongrowing (no change in the FW volume), and "degenerating" (a decrease in the FW volume), suggesting that these follicles are "postmature." These data demonstrate that FW volume measurements made from sequential ultrasound images provide an accurate method to identify those follicles that contain fertilizable oocytes.

Triplet tubal pregnancy treated by outpatient laparoscopic salpingostomy

To our knowledge, this represents the first case of a laparoscopically treated triplet EP and the first time that a double EP in the same tube was treated conservatively (with preservation of the tube). Multiple EPs may be more common than currently thought, and our report offers an alternative explanation for at least some cases of persistent EP after conservative surgical therapy. Finally, given the substantial cost savings and reduced postoperative recovery time associated with operative laparoscopy, when the patient is stable and the surgeon experienced, the laparoscopic approach should be tried, regardless of the number of EPs or their size.

Adhesion reformation after reproductive surgery by videolaseroscopy

After initial videolaseroscopy for the treatment of endometriosis-associated infertility, 157 patients underwent a second-look laparoscopy to evaluate and treat recurrence of disease and/or adhesions. The patients were divided into two groups. Group 1 consisted of 135 patients who underwent second-look laparoscopy for persistent infertility and/or recurrence of pain. Group 2 consisted of 22 patients who achieved pregnancy after initial surgery and underwent second-look laparoscopy for evaluation of ectopic pregnancy or in association with uterine evacuation for first trimester spontaneous abortion. Both groups of patients demonstrated a significant reduction in adhesion scores involving the ovaries, tubes, posterior cul-de-sac, anterior cul-de-sac, and omentum/bowel. Although the initial mean adhesion scores were similar for both groups, at second-look laparoscopy the mean adhesion scores were significantly lower for group 2, particularly for ovarian and tubal adhesions. None of the patients formed de novo adhesions. From these results we may conclude that videolaseroscopy: (1) is effective in reducing peritoneal adhesions; (2) is associated with a low frequency of postoperative adhesion recurrence; and (3) appears to completely avoid de novo adhesion formation.

Temporal relationship and reliability of the clinical, hormonal, and ultrasonographic indices of ovulation in infertile women

To assess ovulatory function, 50 infertile but "normally" ovulating women were monitored closely during a single menstrual cycle with daily measurements of serum estradiol, progesterone, and LH (morning and evening urinary LH by standard radioimmunoassay and morning urinary LH by enzyme-linked immunosorbent assay); transvaginal ultrasound; basal body temperature (BBT) recording; and cervical mucus. All 50 cycles, 40 spontaneous and ten induced with clomiphene citrate, were ovulatory. Follicle rupture was confirmed by ultrasound in 47 cycles (94%), whereas three patients fulfilled the diagnostic criteria for luteinized unruptured follicle syndrome. Follicle rupture occurred on day +1 in three, on day +2 in 34, and on day +3 in ten of the ovulatory cycles. Urine LH testing correlated well with the serum LH peak, particularly in the evening urine, and predicted ovulation in all patients. The initial periovulatory rise in serum progesterone occurred on the same day as the LH surge (day 0) in 30%, on day +1 in 40%, on day +2 in 22%, and on day +3 or later in 8% of the cycles. The rise in BBT corresponded to an increase in serum progesterone to 5 ng/mL or greater. Neither the BBT nor cervical mucus was reliable in predicting ovulation.

Propanediol alters intracellular pH and developmental potential of mouse zygotes independently of volume change

Prior to treatment, mouse zygotes were incubated with acridine orange (AO) a fluorescent dye which fluoresces within a physiological pH range. The zygotes were then perifused with 1,2-propanediol (PROH) at rates of 0.18 mol/min, 0.36 mol/min and 1.0 mol/min and zygote volume and intracellular pH monitored. Zygotes perifused with phosphate-buffered saline maintained their initial volume and AO fluorescence. All of the zygotes exposed to PROH at a rate of 1 mol/min decreased in volume and lost their AO fluorescence by 10 min. The volume of the zygotes perifused at less than or equal to 0.36 mol/min was not altered. However, only 25% of the zygotes perifused at 0.36 mol/min maintained their fluorescence at 10 min and all lost their fluorescence by 15 min. At 0.18 mol/min 95% of the zygotes maintained their fluorescence at 10 min and 49% at 15 min. All of the PROH-exposed zygotes lost their fluorescence by 20 min. Although 2-cell development was not affected by 3.0 M PROH for 2.5 min, blastocyst development was reduced compared with controls (P less than 0.05). Longer exposures resulted in a significant decrease in both 2-cell and blastocyst development. These data demonstrate that a 2-7-min exposure to greater than or equal to 2.5 M PROH alters both the intracellular pH and developmental potential. Since these detrimental effects are independent of volume changes and therefore intracellular PROH concentrations, it is postulated that PROH mediates its toxic action by directly altering the cell membrane.

Propanediol-induced alterations in membrane integrity, metabolism and developmental potential of mouse zygotes

The effects of 1,2-propanediol (PROH) on embryonic development, membrane integrity and metabolism on B6D2F1 mouse zygotes in the pronuclear stage were evaluated. In both the control and the group treated with 1.5 M PROH, 78% of the zygotes developed into 2-cell embryos. With 3 M PROH, the proportion of 2-cell embryos was only 7% (P less than 0.05). In a second series of experiments, pronuclear mouse eggs were incubated in either fluorescein diacetate (FDA) or 5 microM Acridine Orange (AO) then transferred to PROH. FDA-induced fluorescence, which is maintained until the cell membrane is damaged, was retained in 100% of the control and 98% of the zygotes treated with 1.5 M PROH. Exposure to 3.0 and 6.0 M PROH reduced the percentage of zygotes with FDA-induced fluorescence to 81% (P less than 0.05) and 5% (P less than 0.05) respectively. AO fluoresces yellow-green within the physiological pH range (7.4). After AO exposure, 95% of the control zygotes and 95% of the zygotes exposed to 1.5 M PROH possessed yellow-green fluorescence, indicating a normal cellular pH. Treatment with 3.0 and 6.0 M PROH caused a shift in the fluorescence such that 93% (P less than 0.05) and 100% (P less than 0.05) of the zygotes respectively no longer fluoresced yellow-green, indicating a lower pH. These results demonstrate that a 20-min exposure to 1.5 M PROH does not affect embryonic development, while PROH at greater than or equal to 3.0 M inhibits embryonic development.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model

In this study, we tested the null hypothesis that intraperitoneal adhesion formation and reduction after laser surgery are the same whether the surgery is performed by laparoscopy or laparotomy. Twenty rabbits were randomly assigned to either laparoscopy or laparotomy and subjected to standardized laser incisions over one uterine horn and over the peritoneal surface of either lower quadrant. Three weeks later, five animals from each group underwent laparoscopy and the other five received laparotomy to score the extent of postoperative adhesions formed and to carry out laser adhesiolysis. The same power density was delivered to tissues in both procedures. Three weeks after the second operative intervention, the animals were killed and the intraperitoneal adhesions blindly scored (scale of 0-3). After the initial procedure, adhesions were absent in the laparoscopy group, but in the laparotomy group, adhesions were frequently present not only at the operative sites of the peritoneal surfaces and uterine horn, but also on the bowel, bladder, and opposite uterine horn where no apparent injury had been inflicted (P less than .005). Three weeks after adhesiolysis, a significant reduction was observed in the mean adhesion scores in the laparoscopy group, but not in the laparotomy group (P = .001). These results lead to the rejection of the null hypothesis and confirm the clinical observation that besides reducing operative trauma, discomfort, and cost, laparoscopic laser surgery is very effective in reducing intraperitoneal adhesions and causes significantly less postoperative adhesion formation than does laparotomy.

Human chorionic gonadotropin localization and morphometric characterization of human granulosa-luteal cells obtained during in vitro fertilization cycles

The area and cytoplasmic-to-nuclear ratio (C/N) of cells aspirated from follicles with mature oocytes was determined using a computerized image analysis system. The presence of human chorionic gonadotropin (hCG) on the surface membrane and/or within the cytoplasm of each cell also was determined using a horseradish peroxidase immunocytochemical procedure. Based on morphometric characteristics, follicular cells were classified as granulosa or luteal. Granulosa cells were less than 75 micron 2 in area with a C/N of approximately 0.5. Luteal cells were classified as small (less than 75 micron 2, C/N approximately 1.5), midluteal (76 to 100 micron 2, C/N greater than 1.5) and large luteal (greater than 100 micron 2, C/N greater than 1.5). Compared with aspirates from follicles containing fertilizable oocytes, aspirates from follicles with nonfertilizable oocytes had fewer granulosa cells and more large luteal cells. HCG was localized on the membranes of granulosa and small luteal cells and within the cytoplasm of midluteal cells. Human chorionic gonadotropin was generally not observed on either the membranes or cytoplasm of luteal cells over 120 micron 2. These data support the concept that granulosa cells bind hCG to membrane receptors, internalize hCG, and begin to luteinize in response to hCG stimulation. Since the aspirates from follicles containing nonfertilizable oocytes possessed a higher percentage of large luteal cells, it is postulated that the cells from these aspirates began the luteinization process earlier than those from follicles containing fertilizable oocytes.

Hormonal therapy of endometriosis

Hormonal therapy has long been the mainstay of the medical management of endometriosis. However, there is considerable confusion regarding the appropriate application of hormones in the treatment of endometriosis. This article critically reviews the current status of the steroidal therapy of endometriosis.

Influence of human chorionic gonadotropin (hCG) and hCG internalization by granulosa cells on the rate of in vitro fertilization and embryonic development of human oocytes

Follicular fluids and granulosa cells were obtained from 28 aspirated follicles of nine women undergoing laparoscopy in an in vitro fertilization program. Follicular growth was stimulated by a human menopausal gonadotropin regimen and laparoscopy was performed 32 hours after human chorionic gonadotropin (hCG) administration. Follicular fluid 17 beta-estradiol (E2) levels were higher and hCG levels were lower in follicles with oocytes that fertilized and cleaved beyond two blastomeres (greater than two-cell group) than in those with nonfertilizable oocytes (NF group) (P less than 0.05). Compared to those from the NF group, granulosa cells from the greater than two-cell group secreted less progesterone (P) in vitro and had a fourfold increase in percentage of cells with internalized hCG. These results demonstrate that the steroidogenic capacity of granulosa cells from follicles whose oocytes fertilize and undergo accelerated embryonic development in vitro differs from the capacity of granulosa cells from NF follicles. This difference may be due to their enhanced ability to bind and subsequently internalize hCG.

Evaluation of oral medroxyprogesterone acetate in the treatment of endometriosis

Medroxyprogesterone acetate was administered orally at the daily dose of 50 mg for four months to 21 symptomatic women with moderate to severe endometriosis, staged according to the American Fertility Society classification. The efficacy of the therapy was evaluated prospectively by the patients' symptomatology, monthly pelvic examinations, and by restaging the disease at second-look laparoscopy during the last week of treatment. The effects of therapy on the serum gonadotropin and ovarian steroid levels and on the endometrium and the implants of endometriosis were also evaluated. Improvement of symptoms, pelvic nodularity, and tenderness occurred in 80% of the patients. The mean stage score of disease by the American Fertility Society classification decreased from 18.2 +/- 2 before therapy to 5.9 +/- 1 after therapy (P less than .005). Amenorrhea, breakthrough bleeding, and persistent cyclic bleeding occurred in 75, 20, and 10% of the patients, respectively. Ovulation was inhibited in all patients, but serum hormone changes were statistically significant only for LH, which decreased from 9.5 +/- 4 to 5.2 +/- 2 IU/L (P less than .001), and estradiol (E2), which decreased from 80 +/- 30 to 46 +/- 26 pg/mL (P less than .02). Atrophic changes and pseudodecidualized reaction occurred in both the endometrium and the implants of endometriosis. In summary, oral medroxyprogesterone acetate is effective in relieving symptoms and objectively improving endometriosis. Besides inducing a pseudodecidualized reaction and atrophic changes in the endometrium and ectopic implants, medroxyprogesterone acetate also suppresses ovulation and the serum levels of both LH and E2.

Clinical and metabolic responses of menopausal women to sequential versus continuous estrogen and progestin replacement therapy

To minimize the cyclic menstrual bleeding associated with the sequential administration of estrogen and progestin in menopausal women, medroxyprogesterone acetate at the daily dose of 10 mg orally was administered, either sequentially for ten days of each 25-day treatment cycle or continuously with conjugated equine estrogen for three months. Cyclic menstrual bleeding occurred in all ten patients on sequential therapy; their endometrial histology was secretory in six, proliferative in two, and adenomatous hyperplasia in one. Of the ten patients on continuous therapy, four were amenorrheic and six experienced acyclic bleeding, but the endometrial histology was atrophic or inactive in all ten. The continuous treatment group experienced a statistically significant decrease in the mean serum levels of total cholesterol, whereas the serum levels of both low- and high-density cholesterol fractions decreased slightly. However, the sequential group experienced no change in serum levels of total cholesterol, a slight rise in high-density lipoprotein, and a significant decrease in low-density lipoprotein cholesterol fractions. Our data suggest that the combined and continuous use of conjugated equine estrogen and medroxyprogesterone acetate effectively relieves menopausal symptoms, decreases the frequency of uterine bleeding, induces endometrial atrophy, and significantly decreases serum levels of total cholesterol.

A comparison of thermal injury, healing patterns, and postoperative adhesion formation following CO2 laser and electromicrosurgery

To further define the role of CO2 laser in infertility surgery, the authors compared the immediate tissue damage and the subsequent healing patterns that followed the randomized use of CO2 laser and electrocautery on opposite sides of the reproductive tracts of 20 mature, female rabbits. Blind histopathologic evaluations were performed on the ovarian and uterine tissues immediately to compare the extent of the acute thermal damage, and 4 weeks postoperatively to compare the healing patterns. There were no differences in the depth of thermal damage, extent of collagen deposition, or in postoperative adhesion formation between CO2 laser and electrocautery. However, the mean depth of the acute thermal damage was significantly less on the ovary than on the uterus, and the area of fibrosis was significantly less when the incised uterine surfaces were approximated.

Hyperprolactinemia and contraception: a prospective study

The authors measured serum concentrations by single and multiple sampling techniques in 347 women before, during, and after treatment with either hormonal or barrier methods of contraception. The prolactin responses to an intramuscular injection of estrogen also were evaluated in control and selected study patients. The incidence of hyperprolactinemia in oral contraceptive users was higher than control subjects (12 versus 5%). Hyperprolactinemia was best assessed by multiple blood sampling, it is often transient and resolves spontaneously in about 50% of women. The estrogen provocation study suggests that some women who develop hyperprolactinemia while taking oral contraceptives are more sensitive to the effects of exogenous estrogen and may be at greater risk of developing pill-related menstrual aberrations and hyperprolactinemia.

Hyperprolactinemia in polycystic ovary syndrome

With the use of multiple blood sampling, the prevalence of hyperprolactinemia in 150 consecutive patients with polycystic ovary syndrome (PCO) was found to be 17%. To further compare these two groups of PCO patients, the pituitary responses to gonadotropin-releasing hormone and thyrotropin-releasing hormone and the adrenal responses to dexamethasone suppression and adrenocorticotropic hormone stimulation were evaluated in 40 normoprolactinemic and 10 hyperprolactinemic PCO patients. Adrenal and pituitary perturbation tests were normal in both groups of PCO patients. Besides the higher levels of prolactin, the hyperprolactinemic patients also had higher blood levels of thyrotropin and testosterone, a higher luteinizing hormone/follicle-stimulating hormone ratio, lower levels of follicle-stimulating hormone, and lower follicle-stimulating hormone responses to gonadotropin-releasing hormone. Our data are consistent with the hypothesis that in some cases, the pathogenesis of PCO may be due to a central deficiency in dopaminergic activity at the basal hypothalamus. The hyperprolactinemia observed in a significant number of PCO patients may reflect a greater deficiency of hypothalamic dopamine, as manifested by the basal elevations of both prolactin and thyrotropin levels.

Decidual, amniotic fluid, maternal and fetal prolactin in normal and abnormal pregnancies

In the present studies, the content and the in vitro production of prolactin by decidua as well as the concentrations of prolactin in amniotic fluid, maternal and fetal serum in normal term pregnancies, induced abortions at various gestational ages, and in pregnancies complicated by diabetes mellitus, preeclampsia, chronic hypertension, and polyhydramnios were measured. Maternal and fetal prolactin levels varied considerably throughout gestation, but at term did not differ significantly between normal and abnormal pregnancies. Prolactin levels in amniotic fluid as well as decidual prolactin content and production were significantly lower only in pregnancies complicated by either hypertension or polyhydramnios. In both normal and abnormal pregnancies, decidual prolactin production correlated strongly with amniotic fluid concentrations. The present data suggest that 1) maternal and fetal prolactin levels do not differ significantly between normal and abnormal pregnancies, 2) the decidua is the principal source of amniotic fluid prolactin, and 3) the significantly lower levels of prolactin in amniotic fluid of pregnancies complicated by hypertension or polyhydramnios are probably due to adverse effects of these conditions on the synthesis and release of prolactin by decidua.

Evaluation of commonly used adjuvants in the prevention of postoperative adhesions

The uterine horns of 30 rats were subjected to both division and microsurgical anastomosis of the proximal segment and division only of the distal segment. They were equally assigned to three groups, of which group 2 received dexamethasone and group 3 received ibuprofen preoperatively and postoperatively for a total of eight doses. During operation, five rats of each group were irrigated with normal saline and the other five, with 32% dextran 70 (Hyskon). The left uterine horn was anastomosed with 7-0 coated Vicryl, and the right horn, with 7-0 Dexon-S sutures. At repeat laparotomy 2 weeks later, the intraperitoneal adhesions were graded blindly according to their severity. Tissue blocks were obtained from the areas of anastomosis and division only for histologic assessment. Total adhesion scores were 104 for group 1, 53 for group 2 (p less than 0.05), and 90 for group 3 (p = 0.7). The histologic evaluation showed no difference between the three groups. The inflammatory tissue reaction was least around the areas of division only and greatest at the anastomotic sites, where it was most pronounced around the surgical knots. No difference in gross adhesions or histologic assessment was observed between the left horn and the right horn. Adhesions were significantly less in the Hyskon-treated animals (p less than 0.05) but the histologic evaluation showed similar inflammatory reactions. These results suggest that in this species there is no difference between Dexon-S and coated Vicryl sutures, that dexamethasone and Hyskon are effective in preventing postoperative adhesions, and that the inflammatory tissue reaction is not altered by these adjuvants but is significantly augmented by the presence and quantity of suture material.

Effects of danazol on plasma lipid and lipoprotein levels in healthy women and in women with endometriosis

Previous studies of the effects of danazol on lipid and lipoprotein levels have been conflicting and limited to women with endometriosis. In the present study, plasma levels of lipids and lipoprotein-cholesterol and triglycerides were determined in 25 infertile women with endometriosis and in eight normal women before, during, and after treatment with danazol at daily doses of 200 to 800 mg for 2 to 6 months. Pretreatment values of cholesterol, triglycerides, and lipoprotein were within the normal range in all subjects except three (one with type III and two with type IV hyperlipoproteinemia). During treatment, the mean levels of total cholesterol and triglycerides decreased slightly, while no significant changes in low-density and very low-density lipoproteins were seen. However, a marked (40%) reduction in the mean levels of high-density lipoprotein cholesterol and triglycerides occurred (P less than 0.001) within 4 weeks of therapy in all subjects, which persisted for the duration of the treatment. Patients with pretreatment hyperlipoproteinemia experienced a substantial fall in plasma lipids and lipoprotein and had normal lipoprotein profiles during treatment. Within 4 weeks after danazol was discontinued, all changes in plasma lipid and lipoprotein levels returned to pretreatment levels. These findings have important implications for the atherogenic potential of danazol, a new treatment for hyperlipidemia, and the relationship between gonadal hormones and lipoprotein levels.

Peritoneal fluid evaluation in infertility

Cul-de-sac fluid collected at laparoscopy from 58 women during various stages of the menstrual cycle was evaluated by volume and by estradiol and progesterone content. Volumes were consistently higher in the third cycle week, especially with evidence of a fresh corpus hemorrhagicum. Peritoneal hormonal values were equal to serum values before ovulation, but were significantly elevated after ovulation. In the present study, maximal fluid volume was 78 ml, maximal peritoneal estradiol exceeded 3000 pg/ml, and maximal peritoneal progesterone exceeded 265 ng/ml. Luteal phase peritoneal fluid volumes and hormonal values were not significantly different in women with or without endometriosis. Aspiration of peritoneal fluid at laparoscopy in the infertile woman may provide significant information regarding ovulation.

Effect of danazol on plasma lipid and lipoprotein levels in normal women

Prior studies of lipid and lipoprotein levels alterations associated with the administration of danazol, a testosterone derivative, in patients treated for endometriosis have been conflicting. We administered danazol to 7 normal menstruating women and measured plasma lipid and lipoprotein cholesterol levels prior to and 2 months after treatment. Small, non-significant decreases in total plasma cholesterol and triglyceride levels were seen, largely due to a dramatic decline in one woman with type IV hyperlipoproteinemia. No significant change in low density or very low density lipoprotein cholesterol levels was seen. However, a marked (40%) reduction of high density lipoprotein cholesterol level in the mean was found. These findings have implications for the atherogenic potential of danazol, the treatment of hyperlipidemia, and the relationship between gonadal hormones and lipoprotein levels.