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Alhelaisi A, Alrezaki A, Nahdi S, Aldahmash W, Alwasel S, Harrath AH. Early-Life Exposure to the Mycotoxin Fumonisin B1 and Developmental Programming of the Ovary of the Offspring: The Possible Role of Autophagy in Fertility Recovery. TOXICS 2023; 11:980. [PMID: 38133381 PMCID: PMC10747440 DOI: 10.3390/toxics11120980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Mycotoxins are produced by more than one hundred fungi and produce secondary metabolites that contaminate various agricultural commodities, especially rice and corn. Their presence in the food chain is considered a serious problem worldwide. In recent years, a link between exposure to mycotoxins and impaired fertility has been suggested. Consequently, it has become vital to investigate the interactive effects of these mycotoxins on ovarian function. In this study, we investigated the intergenerational effects of the mycotoxin fumonisin B1 (FB1) on ovarian structure and function. Virgin Wistar albino female rats were separated into control and FB1 treatment groups and examined from day 6 of pregnancy until delivery (20 and 50 mg/kg b.w./day). The obtained female rats of the first (F1) and second generations (F2) were euthanized at 4 weeks of age, and ovary samples were collected. We found that the ovary weight index increased with the high dose of the treatment (50 mg/kg b.w./day) among both F1 and F2, in a manner similar to that observed in polycystic ovary syndrome. As expected, FB1 at a high dose (50 mg/kg b.w.) reduced the number of primordial follicles in F1 and F2, leading to an accelerated age-related decline in reproductive capacity. Moreover, it reduced the fertility rate among the F1 female rats by affecting follicle growth and development, as the number of secondary and tertiary follicles decreased. Histopathological changes were evidenced by the altered structures of most of the growing follicle oocytes, as revealed by a thinning irregular zona pellucida and pyknosis in granulosa cells. These findings are concomitant with steroidogenesis- and folliculogenesis-related gene expression, as evidenced by the decrease in CYP19 activity and estrogen receptor beta (ESR2) gene expression. Additionally, GDF-9 mRNA levels were significantly decreased, and IGF-1 mRNA levels were significantly increased. However, the results from the ovaries of the F2 treatment groups were different and unexpected. While there was no significant variation in CYP19 activity compared to the control, the ESR2 significantly increased, leading to stereological and histopathological changes similar to those of the control, except for some altered follicles. The hallmark histological feature was the appearance of vacuolar structures within the oocyte and between granulosa cell layers. Interestingly, the autophagic marker LC3 was significantly increased in the F2 offspring, whereas this protein was significantly decreased in the F1 offspring. Therefore, we suggest that the promotion of autophagy in the ovaries of the F2 offspring may be considered a recovery mechanism from the effect of prenatal FB1 exposure. Thus, autophagy corrected the effect of FB1 during the early life of the F1 female rats, leading to F2 offspring with ovarian structure and function similar to those of the control. However, the offspring, treated female rats may experience early ovarian aging because their ovarian pool was affected.
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Affiliation(s)
| | | | | | | | | | - Abdel Halim Harrath
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (A.A.); (S.N.); (W.A.); (S.A.)
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Raperport C, Desai J, Qureshi D, Rustin E, Balaji A, Chronopoulou E, Homburg R, Khan KS, Bhide P. The definition of unexplained infertility: A systematic review. BJOG 2023. [PMID: 37957032 DOI: 10.1111/1471-0528.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/21/2023] [Accepted: 10/15/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There is no consensus on tests required to either diagnose unexplained infertility or use for research inclusion criteria. This leads to heterogeneity and bias affecting meta-analysis and best practice advice. OBJECTIVES This systematic review analyses the variability of inclusion criteria applied to couples with unexplained infertility. We propose standardised criteria for use both in future research studies and clinical diagnosis. SEARCH STRATEGY CINAHL and MEDLINE online databases were searched up to November 2022 for all published studies recruiting couples with unexplained infertility, available in full text in the English language. DATA COLLECTION AND ANALYSIS Data were collected in an Excel spreadsheet. Results were analysed per category and methodology or reference range. MAIN RESULTS Of 375 relevant studies, only 258 defined their inclusion criteria. The most commonly applied inclusion criteria were semen analysis, tubal patency and assessment of ovulation in 220 (85%), 232 (90%), 205 (79.5%) respectively. Only 87/220 (39.5%) studies reporting semen analysis used the World Health Organization (WHO) limits. Tubal patency was accepted if bilateral in 145/232 (62.5%) and if unilateral in 24/232 (10.3%). Ovulation was assessed using mid-luteal serum progesterone in 115/205 (56.1%) and by a history of regular cycles in 87/205 (42.4%). Other criteria, including uterine cavity assessment and hormone profile, were applied in less than 50% of included studies. CONCLUSIONS This review highlights the heterogeneity among studied populations with unexplained infertility. Development and application of internationally accepted criteria will improve the quality of research and future clinical care.
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Affiliation(s)
- Claudia Raperport
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Desai
- Queen Mary University of London Medical School, London, UK
| | | | | | - Aparna Balaji
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | | | - Roy Homburg
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool, UK
| | - Khalid Saeed Khan
- Department of Preventative Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- CIBER Epidemiology and Public Health, Madrid, Spain
| | - Priya Bhide
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Aldawood N, Jalouli M, Alrezaki A, Nahdi S, Alamri A, Alanazi M, Manoharadas S, Alwasel S, Harrath AH. Fetal programming: in utero exposure to acrylamide leads to intergenerational disrupted ovarian function and accelerated ovarian aging. Aging (Albany NY) 2022; 14:6887-6904. [PMID: 36069806 PMCID: PMC9512500 DOI: 10.18632/aging.204269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022]
Abstract
In this study we investigated the effects of multigenerational exposures to acrylamide (ACR) on ovarian function. Fifty-day-old Wistar albino female rats were divided into the control and ACR-treated groups (2.5, 10, and 20 mg/kg/day) from day 6 of pregnancy until delivery. The obtained females of the first (AF1) and second generation (AF2) were euthanized at 4 weeks of age, and plasma and ovary samples were collected. We found that in utero multigenerational exposure to ACR reduced fertility and ovarian function in AF1 through inducing histopathological changes as evidenced by the appearance of cysts and degenerating follicles, oocyte vacuolization, and pyknosis in granulosa cells. TMR red positive cells confirmed by TUNEL assay were mostly detected in the stroma of the treated groups. Estradiol and IGF-1 concentrations significantly decreased as a result of decreased CYP19 gene and its protein expression. However, ACR exposure in AF2 led to early ovarian aging as evidenced by high estradiol and progesterone levels among all treated groups compared to control group, corresponding to the upregulation of the CYP19 gene and protein expression. The apoptotic cells of the stroma were greatly detected compared to that in the control group, whereas no significant difference was reported in ESR1 and ESR2 gene expression. This study confirms the developmental adverse effects of ACR on ovarian function and fertility in at least two consecutive generations. It emphasizes the need for more effective strategies during pregnancy, such as eating healthy foods and avoiding consumption of ACR-rich products, including fried foods and coffee.
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Affiliation(s)
- Nouf Aldawood
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Maroua Jalouli
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarem Alrezaki
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saber Nahdi
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alamri
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Alanazi
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Salim Manoharadas
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alwasel
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdel Halim Harrath
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
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Jackson R, Li XF, Newton JR. A study comparing the ovarian effects of levonorgestrel and desogestrel given orally and by vaginal ring. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619409027851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mikolajczyk RT, Stanford JB, Ecochard R. Multilevel model to assess sources of variation in follicular growth close to the time of ovulation in women with normal fertility: a multicenter observational study. Reprod Biol Endocrinol 2008; 6:61. [PMID: 19077200 PMCID: PMC2633009 DOI: 10.1186/1477-7827-6-61] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 12/10/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the amount of variability in ovarian follicular growth rate and maximum follicular diameter related to different centers, women and cycles of the same women in a multicenter observational study of follicular growth. METHODS Secondary analysis of a prospective cohort study from eight centers in Europe. There were 533 ultrasound examinations in 282 cycles of 107 women with normal fertility. A random effects model with center, woman and cycle as hierarchical units of variation was used to analyze mean follicular diameter on days preceding ovulation. RESULTS Follicular growth did not differ by center. There was homogenous growth across women and cycles, and the maximum follicular diameter before ovulation varied substantially across cycles but not across women. Many (about 40%) women had small maximum follicular diameter on the day before ovulation (<19 mm). Pre-ovulatory cycle length was not related to maximum follicular diameter. CONCLUSION In normal fecundity, there is a substantial variation in maximum follicular diameter from cycle to cycle based on variation in the duration of follicular development, but the variation could not be explained by different characteristics of different women. Explanation of variation in follicular growth has to be found on the cycle level.
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Affiliation(s)
- Rafael T Mikolajczyk
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah, Utah, USA
| | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
- CNRS, UMR 5558 Equipe Biostatistique-Santé, Villeurbanne, France
- Université Lyon 1, UMR 5558 Laboratoire Biostatistique-Santé, Villeurbanne, France
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van Zonneveld P, Koppeschaar HP, Habbema JD, Fauser BC, te Velde ER. Diagnosis of subtle ovulation disorders in subfertile women with regular menstrual cycles: cost-effective clinical practice? Gynecol Endocrinol 1999; 13:42-7. [PMID: 10368797 DOI: 10.1080/09513599909167530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Serial monitoring by plasma progesterone measurement is advised in the literature for fertility work-up, to detect ovulation disturbances in women presenting with regular menstrual cycles. Three strategies to diagnose such 'subtle ovulation disorders' (SOD, defined as anovulation, inadequately timed ovulation or ovulation of a follicle of reduced size in regularly cycling women) were evaluated, in order to investigate costs of such a diagnosis. On the basis of a 'maximal', an 'ultrasound-only', and a 'preselection' strategy, total medical costs and costs including non-medical costs were calculated for each SOD diagnosis. A 'maximal' diagnostic strategy resulted in a total medical cost of ECU 9057 per diagnosis (including non-medical costs ECU 12,787); an 'ultrasound-only' strategy in ECU 4520 (ECU 6791) per diagnosis. By use of a 'preselection' strategy, 4.25% of the women were found to have an SOD, at a cost of ECU 3036 (ECU 6868) for each diagnosis. As the real significance of SOD diagnosis for the prognosis of the patient to become pregnant without treatment remains unclear, and as no randomized trials on treatment effectiveness have as yet been undertaken, it is questionable whether this approach is worthwhile.
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Affiliation(s)
- P van Zonneveld
- Department of Reproductive Endocrinology and Fertility, University Hospital Utrecht, The Netherlands
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Lachapelle MH, Hemmings R, Roy DC, Falcone T, Miron P. Flow cytometric evaluation of leukocyte subpopulations in the follicular fluids of infertile patients. Fertil Steril 1996; 65:1135-40. [PMID: 8641486 DOI: 10.1016/s0015-0282(16)58327-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the leukocyte subpopulations present in follicular fluid (FF) of infertile patients undergoing IVF-ET for tubal factor, idiopathic infertility, and endometriosis. PATIENTS Sixty patients undergoing IVF-ET with a tubal factor diagnosis (n = 35), idiopathic infertility (n = 13), and endometriosis (n = 12) had their subpopulations of FF leukocytes analyzed by flow cytometry. MAIN OUTCOME MEASURE Nonblood-contaminated samples of FF were collected under sterile conditions and centrifuged. Cells were labeled with a panel of monoclonal antibodies: anti-CD3, -CD4, -CD8, -CD14, -CD20, -CD45, and -CD56, and analyzed by cytofluorometry. RESULTS Follicular fluid leukocytes from patients with idiopathic infertility had a significantly higher proportion of T lymphocytes than tubal factor and endometriosis patients. Endometriosis patients had significantly higher proportions of natural killer (NK) cells, B lymphocytes, and monocytes compared with groups of idiopathic infertility and tubal factor. CONCLUSIONS The differences observed in the leukocyte subpopulations from FF of patients with idiopathic infertility and endometriosis may affect folliculogenesis and oocyte maturation. Moreover, these modifications could be one of the factors altering their fertility.
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Affiliation(s)
- M H Lachapelle
- Institut de Médecine de la Reproduction de Montréal, Québec, Canada
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8
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van Zonneveld P, te Velde ER, Koppeschaar HP. Low luteal phase serum progesterone levels in regularly cycling women are predictive of subtle ovulation disorders. Gynecol Endocrinol 1994; 8:169-74. [PMID: 7847101 DOI: 10.3109/09513599409072451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Serial hormonal and ultrasound measurements were performed in a group of 50 infertile women with regular menstrual cycles of normal length, and evidence of luteinization by measurement of biphasic basal body temperature (BBT). The progesterone levels however, remained below a critical threshold of 32 nmol/l (1 nmol/l = 0.315 ng/ml) in two cycles. In 50 cycles, 25 showed definite abnormalities. In 16 other cycles, ovulation was observed, but relatively low luteal progesterone followed. Although pregnancy in these 16 cycles could be less likely, the real significance of this finding is questionable. The etiology of these 'subtle cycle anomalies' is not clear and may be multifactorial. For this reason, no therapy other than use of ovulation-inducing agents by trial and error is as yet available. Preliminary results indicate that cycle disturbances may persist under ovulation induction, even though progesterone levels are normalized.
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Affiliation(s)
- P van Zonneveld
- Department of Reproductive Endocrinology and Fertility, University Hospital Utrecht, The Netherlands
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9
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Rodin DA, Fisher AM, Clayton RN. Cycle abnormalities in infertile women with regular menstrual cycles: effects of clomiphene citrate treatment. Fertil Steril 1994; 62:42-7. [PMID: 8005302 DOI: 10.1016/s0015-0282(16)56813-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the incidence and nature of cycle abnormalities and the effect of clomiphene citrate (CC) treatment in women with apparently ovulatory cycles and unexplained infertility. DESIGN Nonrandomized, open study of patients before and during treatment. SETTING The Reproductive Medicine Clinic of a District General Hospital. PATIENTS Thirty-five women with regular, apparently ovulatory menstrual cycles and unexplained infertility. INTERVENTIONS Detailed ultrasound and hormonal cycle tracking was performed before and during treatment with CC. MAIN OUTCOME MEASURES Serial ultrasound scans and measurements of serum LH, FSH, E2, and P. RESULTS Before treatment, 54% of cycles were uniovulatory, 40% were characterized by cyst formation, and 6% were characterized by poor follicular growth. Fifty-one percent of pretreatment cycles had normal hormone profiles, 31% had defective luteal phases, 14% had increased early follicular phase serum FSH levels, and 9% had increased early follicular phase serum LH levels. Treatment with CC reduced the incidence of cyst formation to 9% and the incidence of luteal phase defects to 3%. However, 28% of CC-treated cycles showed ultrasound features of overstimulation and 51% had high follicular phase E2 peaks so that only 34% of CC-treated cycles had normal hormone profiles. CONCLUSIONS Cycle abnormalities are common in unexplained infertility. The incidence of cyst formation and luteal phase defects, the most common abnormalities in this group, is reduced by CC treatment.
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Affiliation(s)
- D A Rodin
- Clinical Research Centre, Harrow, United Kingdom
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10
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Davies GC, Feng LX, Newton JR, Van Beek A, Coelingh-Bennink HJ. Release characteristics, ovarian activity and menstrual bleeding pattern with a single contraceptive implant releasing 3-ketodesogestrel. Contraception 1993; 47:251-61. [PMID: 8462316 DOI: 10.1016/0010-7824(93)90042-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The properties of a single contraceptive subdermal implant releasing 3-ketodesogestrel were assessed in fifteen women over twelve months. Serum levels of 3-ketodesogestrel were monitored regularly following insertion and after removal. The mean serum level of 3-ketodesogestrel was 245 pg/ml after 72 h (steady state) and 176 pg/ml after twelve months. All volunteers demonstrated ovulation inhibition throughout the study. Transient oestradiol peaks occurred during the study. No luteal activity was noted. The cervical mucus was rapidly rendered hostile to sperm migration. Two women withdrew from the study during the first six months for medical reasons. Both volunteers cited bleeding irregularity as the main cause, one complaining of oligomenorrhoea, the other of prolonged bleeding/spotting episodes. A small but significant increase in weight was noted during the study period.
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Affiliation(s)
- G C Davies
- Academic Department of Obstetrics and Gynaecology, University of Birmingham, Great Britain
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11
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Fedele L, Parazzini F, Radici E, Bocciolone L, Bianchi S, Bianchi C, Candiani GB. Buserelin acetate versus expectant management in the treatment of infertility associated with minimal or mild endometriosis: a randomized clinical trial. Am J Obstet Gynecol 1992; 166:1345-50. [PMID: 1595789 DOI: 10.1016/0002-9378(92)91602-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We performed a randomized clinical trial to evaluate the efficacy of intranasal 400 micrograms buserelin three times daily for 6 months versus expectant management in the treatment of infertile women with pelvic endometriosis stage I or II of the revised American Fertility Society classification. STUDY DESIGN Seventy-one consecutive patients (mean age 32 years) were studied at the First Department of Obstetrics and Gynecology, University of Milan, and the Department of Obstetrics and Gynecology, Ospedali Riuniti, Bergamo, between February 1988 and June 1989. Thirty-five women were randomly allocated to buserelin treatment and 36 to expectant management. The baseline distribution of subjects for age, disease stage, and reproductive history was similar in the two groups. All patients were followed regularly; median follow-up was 17 months in the buserelin group and 18 months in the women given expectant management. If pregnancy did not occur within 12 months of randomization, cycles were monitored by ultrasonography and hormone measurements, and when abnormalities were detected clomiphene citrate and human chorionic gonadotropin were administered. RESULTS A total of 17 pregnancies were observed both in the buserelin-treated patients and in the expectant management group. The 1- and 2-year actuarial overall pregnancy rates were similar in the two groups, 30% and 61% in the former and 37% and 61% in the latter group, respectively. Spontaneous abortion occurred in five of the 17 pregnancies in the women treated with buserelin and in one of the 17 in those managed expectantly; this difference was, however, not statistically significant (chi 1(2) adjusted for disease stage and use of clomiphene citrate and human chorionic gonadotropin treatment = 3.01, p = 0.08). No fetal death or stillbirth was observed. CONCLUSIONS Our findings suggest that treatment with gonadotropin-releasing hormone agonists is unlikely to have a marked influence on the reproductive outcome of infertile women with minimal or mild endometriosis.
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Affiliation(s)
- L Fedele
- Centro per lo Studio e la Terapia dell'Endometriosi, Università di Milano, Italy
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12
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Li XF, Davies GC, Newton J. A review of the effects of long-acting progestogen-only contraceptives on ovarian activity. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1992; 8:1-19. [PMID: 1590097 DOI: 10.1007/bf01849342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Progestogen-only contraception acts mainly by blocking cervical mucus and preventing sperm penetration through it does have a variable pattern of contraceptive effects on the endometrium and ovary. In contrast with the complete suppression of ovarian function with combined pill or injectable use, a variable degree of endocrine activity is demonstrated in women choosing a long-acting progestogen-only contraceptive. This degree of suppression of ovarian activity explains the decrease in systemic side-effects, the rapid resumption of ovulation and recovery of fertility following the discontinuation of the method. New delivery systems of progestogens, the vaginal ring and implant, offer better and more consistent contraceptive effects.
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Affiliation(s)
- X F Li
- Department of Obstetrics and Gynaecology, Birmingham Maternity Hospital, Edgbaston, UK
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13
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Flynn AM, Docker M, Brown JB, Kennedy KI. Ultrasonographic patterns of ovarian activity during breastfeeding. Am J Obstet Gynecol 1991; 165:2027-31. [PMID: 1755463 DOI: 10.1016/s0002-9378(11)90573-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this study, ultrasonography was used to detect follicular activity in lactating women, and these findings were related to the underlying hormonal profiles and to the mucus symptom. A number of different patterns of follicular development were seen before the women returned to normal fertile cycles during the period that was previously considered to be characterized by ovarian quiescence. Some of the transitory patterns of follicular activity were reflected in rising hormone levels and patterns of fertile mucus that were sometimes confusing for these lactating women who were using natural family planning.
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Affiliation(s)
- A M Flynn
- Department of Obstetrics and Gynecology, Birmingham Maternity Hospital, Queen Elizabeth Medical Centre, Edgbaston, United Kingdom
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14
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Mahmood TA. The impact of previous danazol treatment on circulating hormone levels, follicular development and oocyte maturity in minimal-mild endometriosis. Eur J Obstet Gynecol Reprod Biol 1991; 41:207-14. [PMID: 1936505 DOI: 10.1016/0028-2243(91)90026-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to assess the impact of previous danazol treatment on peripheral endocrinology, folliculogenesis, oocyte maturity and follicular fluid endocrinology in women with minimal-mild endometriosis in a spontaneous menstrual cycle. A group of 10 women previously treated with danazol (Group A) and another group of 10 women whose endometriosis was left untreated (Group B) were studied. A group of 10 women with tubal infertility acted as a Control. Circulating hormone levels and characteristics of an endogenous luteinizing hormone (LH) surge were studied. A diagnostic laparoscopy was performed 32 h after the onset of an endogenous LH surge in all women to undertake follicular aspiration. There were no significant differences in oocyte maturity, fertilisation and cleavage rate among women studied in three study groups. The presence of peritoneal endometriosis did not affect the steroidogenic potential of the granulosa cells, and the endocrine milieu of the pre-ovulatory oocyte was comparable in all study groups.
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Affiliation(s)
- T A Mahmood
- Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, U.K
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15
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Kumar TC, Shah RS, Chitlange SM, Hazari KT, Gopalkrishnan K, Vadigoppula AD, Vernekar VJ, Borkar DM, Puri CP. Effects of intranasal administration of norethisterone on folliculogenesis, cervical mucus, vaginal cytology, endometrial morphology and reproductive-endocrine profile in women. Contraception 1991; 44:245-67. [PMID: 1764942 DOI: 10.1016/0010-7824(91)90016-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of intranasal administration of norethisterone (NET) on menstrual cycle length, folliculogenesis, serum levels of estradiol, FSH, LH and progesterone, vaginal cytology, cervical mucus and endometrial morphology were studied in 8 volunteers (age 28 to 39 years, weighing between 46 and 54 kg). The study period comprised 4 consecutive menstrual cycles. In the first cycle (pretreatment cycle), only the vehicle (alcohol, propylene glycol, water; 3:3:4) was sprayed intranasally (100 microliters in each nostril), using a metered nebulizer, once daily from day 3 to the last day of menstrual cycle. In the next two cycles (treatment cycles), NET (300 micrograms/day) was administered once daily, starting from day one of menstrual cycle, between 9 and 10 a.m. The fourth cycle was a post-treatment cycle in which the volunteers were monitored for recovery. Blood samples (about 5 ml each) were collected once daily from day 8 to 24 and thereafter on alternate days until the last day of cycle during all the 4 cycles. Levels of estradiol, FSH, LH and progesterone were measured in the serum samples by radioimmunoassay methods. Cervical mucus samples and vaginal smears were collected once daily starting from day 7 or 8 of each cycle until the mucus was very scanty. Serial pelvic ultrasonography was performed starting from day 7 or 8 until the growing follicle disappeared or throughout the cycle in case a growing follicular cyst was observed. Endometrial aspirates were collected once around day 22 in each cycle and processed for routine histological examination.
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Affiliation(s)
- T C Kumar
- Institute for Research in Reproduction (ICMR), Parel, Bombay, India
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16
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Mahmood TA, Messinis IE, Templeton A. Follicular development in spontaneous and stimulated cycles in women with minimal-mild endometriosis. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:783-8. [PMID: 1911586 DOI: 10.1111/j.1471-0528.1991.tb13483.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study follicle development in women with minimal-mild endometriosis. DESIGN In women with endometriosis a spontaneous ovulatory cycle was compared with two subsequent cycles in which either clomiphene or clomiphene and FSH were given to stimulate folliculogenesis. Spontaneous cycles in women with tubal infertility provided a comparison group. SETTING Infertility clinic, Aberdeen Maternity Hospital. SUBJECTS 17 women with minimal-mild endometriosis and 10 women with tubal infertility. INTERVENTIONS The women with endometriosis were treated with 150 mg clomiphene citrate from days 2 to 6 in one cycle and in a subsequent cycle with 150 mg clomiphene citrate on days 2 to 6 plus 75 iu FSH daily thereafter. MAIN OUTCOME MEASURES Follicular size measured daily using ultrasound. Serum FSH estimated on days 5 and 7 and then daily. RESULTS Spontaneous follicular growth in the women with endometriosis was similar to that in the women with tubal infertility. Follicular development began earlier in cycles with clomiphene/FSH and the leading follicle reached 16 mm 2 days sooner but the rate of growth was similar whether or not either regimen of stimulation was used. CONCLUSION Follicular growth is not impaired by minimal-mild endometriosis. Infertility with this condition cannot be explained by altered follicular growth or responsiveness.
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Affiliation(s)
- T A Mahmood
- Department of Obstetrics and Gynaecology, University of Aberdeen, Foresterhill
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17
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Barbosa I, Bakos O, Olsson SE, Odlind V, Johansson ED. Ovarian function during use of a levonorgestrel-releasing IUD. Contraception 1990; 42:51-66. [PMID: 2117516 DOI: 10.1016/0010-7824(90)90092-a] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ovarian function was studied for two complete menstrual cycles in 9 regularly menstruating women and for 8 weeks in three amenorrhoeic women who had used levonorgestrel-releasing IUDs (LNG-IUD) for more than four years. Nine patients using copper IUDs (Nova-T) were studied for two complete menstrual cycles as controls. According to progesterone levels, 15/17 cycles in women using LNG-IUDs were ovulatory, whereas only 8/17 cycles showed normal follicular growth and rupture as judged by ultrasound. In ovulatory cycles, the peak progesterone levels were lower than in the controls. The preovulatory estradiol and LH peak levels were also lower than in control subjects. SHBG levels were lower in LNG-IUD users than in copper IUD users. It is concluded that, although the dose of levonorgestrel released from the IUD is very low, it probably exerts an effect on the gonadotrophin secretion, which disturbs follicular development in many of the women studied, which in addition to the local effect on the endometrium, contributes to its high contraceptive efficacy.
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Affiliation(s)
- I Barbosa
- Department of Obstetrics and Gynecology, University of Uppsala, Sweden
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18
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Hamilton MP, Fleming R, Coutts JR, Macnaughton MC, Whitfield CR. Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation**Supported by grant G8200415 SB from the Medical Research Council, London, United Kingdom. Fertil Steril 1990. [DOI: 10.1016/s0015-0282(16)53632-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Larsen T, Larsen JF, Schiøler V, Bostofte E, Felding C. Comparison of urinary human follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in polycystic ovarian syndrome. Fertil Steril 1990; 53:426-31. [PMID: 2106449 DOI: 10.1016/s0015-0282(16)53335-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A randomized, double-blind, crossover study was carried out to compare purified urinary follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) for ovarian stimulation in polycystic ovarian syndrome (PCOS). Twelve patients were stimulated with FSH and hMG in three alternate cycles. FSH, luteinizing hormone (LH), estradiol, dihydroepiandrosterone sulphate, free and total testosterone, delta 5-androstenedione, sex hormone binding globulin, and ovarian volume were monitored during the stimulation. There was no difference between the dose of FSH and hMG necessary to induce preovulatory follicles in the individual patients. The mean increase of ovarian volume during stimulation with FSH and hMG was 120% and 129% respectively (no significant difference). Two patients became pregnant in the first cycle. Two other patients had delayed bleeding and positive serum-human chorionic gonadotropin. No significant difference was found in the endocrine changes during the two different stimulation methods. The LH/FSH ratio was normalized after a few days of treatment regardless of the type of stimulation. The size of the material does not permit a comparison of the efficacy of the two treatment schedules. Our clinical and ultrasonic observations do not support the theory that treatment of infertility in PCOS with FSH is more safe than with hMG.
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Affiliation(s)
- T Larsen
- Department of Obstetrics and Gynecology, Herlev University Hospital, Copenhagen, Denmark
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20
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Tang L, Obhrai M, Docker MF, Sawers RS, Newton JR. Dysfunctional ovulation in infertile women with cervical mucus disorders. J OBSTET GYNAECOL 1990. [DOI: 10.3109/01443619009151238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Finn MM, Gosling JP, Tallon DF, Joyce LA, Meehan FP, Fottrell PF. Follicular growth and corpus luteum function in women with unexplained infertility, monitored by ultrasonography and measurement of daily salivary progesterone. Gynecol Endocrinol 1989; 3:297-308. [PMID: 2626978 DOI: 10.3109/09513598909152469] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ovarian function was evaluated over a minimum of 3 consecutive menstrual cycles from each of 41 women with unexplained infertility. Follicular development and ovulation were monitored using real time ultrasonography and luteal function was evaluated by daily salivary progesterone measurement. In 129 spontaneous cycles, normal single ovulations were detected in 121 (93.8%). Luteal phase insufficiency was identified in 21 (17.4%) of these 121 cycles and this was a recurrent phenomenon in the cycles of 5 of the 41 women (12.2%). A successful pregnancy was seen only in association with consistently normal salivary progesterone profiles or where the empirical use of clomiphene citrate therapy had corrected previously diagnosed luteal phase insufficiency. Basal body temperature records or mid-luteal serum progesterone measurements were less satisfactory indices of luteal function than a salivary progesterone profile.
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Affiliation(s)
- M M Finn
- Department of Obstetrics and Gynecology, University College, Galway, Ireland
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22
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Abstract
The pharmacodynamic effects of a new type of 3-keto-Desogestrel [3kDOG] releasing vaginal ring was studied in a group of 20 normally ovulating women during a period of 21 days continuous use. Peripheral blood samples were taken for the estimation of progesterone and oestradiol levels, ultrasound tracking for follicular growth and cervical mucus sampling for scoring [modified Insler] and sperm penetration testing during a control, treatment and recovery period. Additional blood samples were taken for the estimation of 3kDOG levels during the treatment period. After a control cycle, twenty normally ovulating women were selected and randomly divided into two groups. Group A were given a vaginal ring on day 5 of the menstrual cycle releasing 30 ug/24 hours of 3kDOG and group B a similar ring releasing 15 ug/24 hours of kDOG. Of the treatment cycles, none showed an ovulatory pattern in group A and there was only one in group B, the respective mean plasma levels of 3kDOG were 0.38 and 0.25 pmol/ml. The formation of "cysts" or persistent follicles was common to both groups, 6 out of 10 subjects in group A and 8 out of 10 subjects in group B had "cysts" greater than 25mm in diameter in the treatment cycle, this had become 5 out of 10 and 8 out of 10, respectively, in the recovery cycle. A comparison of the cervical mucus scores and sperm penetration of cervical mucus showed a significant reduction between the control and treatment groups but no significant difference between the two groups. The bleeding profiles showed an increase in percentage of bleeding days in both treatment groups to 25% in group A and 21.7% in group B [cf, 17.1%, 15.9%, respectively, in control month]; there being no statistical difference between groups. In conclusion, it is believed that given the efficacy demonstrated and the low level of menstrual disturbances found, this system warrants further investigation as a means of contraception as it appears to offer a better compromise than previous vaginal ring systems.
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Affiliation(s)
- R Jackson
- Department of Obstetrics and Gynaecology, University of Birmingham, U.K
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23
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MacLachlan V, Besanko M, O'Shea F, Wade H, Wood C, Trounson A, Healy DL. A controlled study of luteinizing hormone-releasing hormone agonist (buserelin) for the induction of folliculogenesis before in vitro fertilization. N Engl J Med 1989; 320:1233-7. [PMID: 2496310 DOI: 10.1056/nejm198905113201902] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Treatment with clomiphene citrate and human menopausal gonadotropin (HMG) is often used to induce folliculogenesis before in vitro fertilization, but not all women have an adequate response. It has been hypothesized that abnormally high levels of luteinizing hormone (LH) may contribute to the reduced folliculogenesis. We therefore performed a controlled, open trial in which treatment with buserelin, an agonist of luteinizing hormone-releasing hormone citrate and HMG in 44 consecutive women in whom no oocytes or only one had been produced by standard treatment with clomiphene and HMG. Twenty-nine women received buserelin with HMG, and 15 received clomiphene citrate with HMG. The median number of oocytes per patient recovered from those who received buserelin with HMG was 4 (range, 0 to 19), as compared with 0 (range, 0 to 5) in those who received clomiphene citrate with HMG. The fertilization rates of oocytes recovered from both groups of patients were similar (75.8 percent and 76.5 percent, respectively). Fifty-four percent of patients given buserelin with HMG underwent triple-embryo transfer, as compared with 13 percent of those given clomiphene citrate with HMG. Pregnancy (n = 3) occurred only among the patients receiving buserelin with HMG. In the buserelin-HMG group, significantly fewer oocytes were recovered from patients with occult ovarian failure (infertility and elevated follicular-phase levels of follicle-stimulating hormone, with regular menses) (median, 1; range, 0 to 4) than from those with other causes of infertility (median, 8; range, 0 to 19). Our data suggest that, except in women with occult ovarian failure, buserelin and HMG improve embryologic and clinical outcomes in patients with previously unsatisfactory stimulation of the ovaries for in vitro fertilization.
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Affiliation(s)
- V MacLachlan
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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24
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Tummon IS, Maclin VM, Radwanska E, Binor Z, Dmowski WP. Occult ovulatory dysfunction in women with minimal endometriosis or unexplained infertility**Presented at the Forty-Third Annual Meeting of The American Fertility Society, Reno, Nevada, September 28 to 30, 1987. Fertil Steril 1988. [DOI: 10.1016/s0015-0282(16)60304-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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