The incidence of Sheehan's syndrome after obstetric hemorrhage

OBJECTIVE

To estimate the incidence of Sheehan's syndrome in a well-described cohort of patients with obstetric hemorrhage.

DESIGN

Retrospective cohort study.

SETTING

Tertiary care center.

PATIENT(S)

Two hundred patients.

INTERVENTION(S)

Questionnaires were sent to study and comparison patients asking about menstrual dysfunction, lactation difficulty, cold intolerance, fatigue, axillary and pubic hair loss, and secondary infertility.

MAIN OUTCOME MEASURE(S)

Women who experienced two or more symptoms were referred for hormone testing of insulin-like growth factor 1 (IGF-1), T4, PRL, and early morning cortisol (F) levels.

RESULT(S)

A total of 109 patients responded to the survey, a 55% response rate. Fourteen of 55 (25%) patients in the hemorrhage group identified themselves as suffering from two or more symptoms on the questionnaire. Eight of the 14 patients were tested, but none had hormonal evidence of hypopituitarism. Four of 54 (7%) comparison patients also identified themselves as suffering from two or more symptoms, but neither of the two tested had hormonal evidence of hypopituitarism.

CONCLUSION(S)

Among women with postpartum hemorrhage, subsequent development of clinical symptoms does not correlate well with laboratory evidence of hypopituitarism. Clinically significant Sheehan syndrome is an uncommon consequence of obstetric hemorrhage in today's environment.

The Evolution of in Vitro Fertilization: Integration of Pharmacology, Technology, and Clinical Care

For the couple having trouble achieving pregnancy, the options and opportunities for assistance have never been brighter. Options such as controlled ovarian hyperstimulation, in vitro fertilization, and intracytoplasmic sperm injection have been developed over the past five decades and provide hope for couples that previously would have been considered infertile. In vitro fertilization and intracytoplasmic sperm injection represent a coalescence of advances in physiology, endocrinology, pharmacology, technology, and clinical care. In vitro fertilization has assisted well over one million couples in their efforts to start or build a family, and the demand for such services continues to increase. The purpose of this manuscript is to review the pharmacological advances that made controlled ovarian hyperstimulation, and therefore in vitro fertilization and intracytoplasmic sperm injection, possible. We will discuss the early stages of gonadotropin use to stimulate ovarian production of multiple mature eggs, the advances in recombinant technology that allowed purified hormone for therapy, and the use of other hormones to regulate the menstrual cycle such that the likelihood of successful oocyte retrieval and embryo implantation is optimized. Finally, we will review current areas that require particular attention if we are to provide more opportunity for infertile couples.