Accelerated Barnes Maze Test in Mice for Assessment of Stress Effects on Memory

Repeated restraint stress in rodents impairs spatial memory in a Y-maze test and induces hippocampal neuronal changes that last up to 5 d after the stressor ends. Our goal was to implement a Barnes maze spatial memory test in mice that could be used to validate our findings of social stress induced Y-maze impairment. We measured performance of mice in 5- and 9-day test paradigms previously used in rats and mice, respectively. Selecting features from each paradigm, we implemented a 5-d test (pre-training, training (4 trials/d/3 d) and probe testing for assessment of spatial memory in mice. Stress consisted of placing each test mouse in a stainless steel perforated box (25.5 cm x 21.5 cm x 16.5 cm) within an aggressor's home cage for 6 h/d for 21 d; direct agonistic encounters occurred randomly throughout stress periods. Barnes maze pre-training (habituation) was on day 21 of the stress exposures. In a preliminary experiment, mice that habituated following their last stressor performed poorly relative to unstressed and to those not habituated prior to the last stressor, as demonstrated by a greater latency to escape and more errors. We conclude that acute stress in a chronic stress paradigm may impair spatial memory acquisition.

Pulsatile oxytocin for induction of labor: a randomized prospective controlled study

In a prospective randomized study, 20 patients with term pregnancies underwent induction of labor with either continuous or pulsed (every 8 minutes) intravenous oxytocin infusion. There were no significant differences with respect to induction-labor interval, induction-delivery interval, cesarean section rates, need for pain relief and Apgar scores. Sixty percent of patients receiving continuous oxytocin infusion developed uterine hyperstimulation but only 10% receiving pulsed oxytocin did so. However, the difference was not significant. The mean +/- SEM total amount of oxytocin given by continuous infusion was 4237 +/- 1066 mU which was 70% more than by pulsatile infusion (2454 +/- 808 mU). The highest rate of oxytocin infused was significantly lower by pulsatile administration (5.2 +/- 0.8 mU/min) than by continuous infusion (9.2 +/- 1.8 mU/min, p = less than 0.05). Our study demonstrates that pulsed administration of oxytocin every 8 minutes is as effective and safe as continuous intravenous infusion of oxytocin for induction of labor, requires less oxytocin with therefore, a wider margin of safety and is consistent with the pulsatile release of oxytocin during normal labor.

Vascular endothelial growth factor and interleukin-6 in peritoneal fluid of women with endometriosis

OBJECTIVE(S)

To determine [1] vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) levels in peritoneal fluid from women with endometriosis and compare them with those from oral contraceptive (OC) users and normal cycling women and [2] any correlation between VEGF and IL-6 concentrations.

DESIGN

Controlled clinical study.

SETTING

University medical center.

PATIENT(S)

Patients undergoing laparoscopy for infertility or other benign gynecologic conditions.

INTERVENTION(S)

Peritoneal fluid samples were collected.

MAIN OUTCOME MEASURE(S)

Levels of VEGF and IL-6 in peritoneal fluid were determined.

RESULT(S)

Compared with normal controls or women with less severe endometriosis (implant scores of 5 or less), women with more advanced endometriosis (implant scores of 6 or more) have elevated VEGF and IL-6 levels in peritoneal fluid. Compared with normal controls, markedly suppressed IL-6 but similar VEGF levels were found in peritoneal fluid from OC users. Neither VEGF nor IL-6 varied cyclically in normal women or those with endometriosis. There was no correlation between levels of VEGF and IL-6 in peritoneal fluid. There was no correlation between implant scores and VEGF or IL-6 levels.

CONCLUSION

The inflammation associated with endometriosis, through increased levels of peritoneal fluid VEGF, may promote angiogenesis for the progressive growth of endometriosis. Effective treatment of endometriosis by combination estrogen-progestin pills may involve the suppression of such inflammatory responses.

Localization and expression of oxytocin receptor and its messenger ribonucleic acid in peri-implantation phase human endometrium during control and clomiphene-treated cycles

OBJECTIVES

This study was undertaken to determine expression levels of oxytocin receptor and its gene in peri-implantation phase human endometrium during clomiphene-treated cycles compared with control cycles.

STUDY DESIGN

Oxytocin receptor and its messenger ribonucleic acid in peri-implantation phase endometrium during control and clomiphene-treated (50 mg days 5 to 9) cycles of 5 healthy fertile women were determined by immunohistochemical methods, Western blot analysis with monoclonal antibody against amino acids 20 through 40 of the extracellular N-terminal human oxytocin receptor, and reverse transcription-polymerase chain reaction with oligonucleotide primers to amplify the 391-base pair fragment of the oxytocin receptor gene.

RESULTS

Oxytocin receptor and its messenger ribonucleic acid were expressed in human peri-implantation phase endometrial samples from both control and clomiphene-treated cycles. The receptor was localized predominantly in the epithelial cells and glands, with little or none detected in the stroma. Oxytocin receptor protein was separated out as a single 70-kd band by Western blot analysis; its relative abundance was significantly reduced during clomiphene-treated cycles. The messenger ribonucleic acid was detected in all endometrium during control and clomiphene-treated cycles, with greater expression during control cycles.

CONCLUSIONS

The expressions of oxytocin receptor and its gene in luteal phase human endometrium suggest a functional relevance in modulation of biochemical changes for implantation.

Laparoscopic surgery of the fallopian tubes and ovaries

Operative laparoscopy can be used for many surgical procedures on the fallopian tube and ovary. These include: (1) tubal sterilization; (2) salpingectomy and salpingostomy for tubal pregnancy; (3) fimbrioplasty, salpingoneostomy, and linear salpingostomy for tubal obstruction and infertility; (4) microsurgical tubal reanastomosis for reversal of tubal sterilization; (5) oophorectomy, cystectomy, cyst drainage and fulguration, and excision of ovarian tumors; (6) wedge resection and ovarian drilling for polycystic ovaries; and (7) fulguration and laser vaporization for endometriosis. Many of these procedures are conservative and involve reconstruction of the tube and ovaries to preserve fertility. Microsurgical techniques are incorporated into such fertility sparing or enhancing procedures. Comparison of similar surgical procedures on the tube and ovaries indicates better or similar surgical outcome when done through the laparoscope rather than laparotomy; less blood loss, faster recovery, and cheaper cost are the hallmarks when the procedure is done by laparoscopy. With further improvement and expansion in laparoscopy equipment, it can be expected that more surgical procedures on the adnexa can be undertaken safely and effectively.

Gene transfer to cultured human endometrial stromal cells: a model to study cyclooxygenase-2 gene regulation

OBJECTIVE

To compare and optimize conditions for gene transfer to human endometrial stromal cells derived from primary culture and to determine the effect of interleukin-1beta (IL-1beta) and phorbol 12-myristate 13-acetate (PMA), a protein kinase C activator. on the promoter activity of the human cyclooxygenase-2 (COX-2) gene.

DESIGN

Prospective controlled study.

SETTING

Academic research laboratory.

PATIENT(S)

Women undergoing benign gynecologic surgery for indications other than endometrial diseases.

INTERVENTION(S)

Endometrial stromal cells were used for transient transfection study.

MAIN OUTCOME MEASURE(S)

Luciferase activity in transfected endometrial stromal cells.

RESULT(S)

Gene transfer mediated by cationic lipid was more efficient and more consistent. Lipofectamine, a polycationic lipid, yielded the highest efficiency. Phorbol 12-myristate 13-acetate (30 nM) and IL-1beta (100 ng/mL) increased COX-2 promoter activity by 2.6-fold and 2.2-fold, respectively.

CONCLUSION(S)

Induction of COX-2 by IL-1beta and PMA suggests that COX-2 and prostaglandin have important roles in the growth and differentiation of endometrial stromal cells. This model can be used to explore the roles of different promoter regulatory elements in COX-2 gene activation.

Oxytocin receptor and its messenger ribonucleic acid in human leiomyoma and myometrium

OBJECTIVE

The study determined the expression of oxytocin receptor and its gene in human uterine leiomyoma compared with the adjacent myometrium.

STUDY DESIGN

Paired samples of leiomyoma and the adjacent myometrium from 20 women through the menstrual cycle, menopause, and various hormone treatments were studied. Oxytocin receptor was immunohistochemically localized with use of the specific antibody (2F8) to human oxytocin receptor. Oxytocin receptor protein was determined by Western blotting, whereas reverse transcription-polymerase chain reaction was used for oxytocin receptor messenger ribonucleic acid expression.

RESULTS

Immunohistochemistry showed positive staining in all tissues examined, relatively more intense in the myometrium than in the adjacent leiomyoma, and in tissues from the preovulatory than the postovulatory phase. Western blotting showed a single 70-kd band corresponding to the oxytocin receptor. The relative abundance of oxytocin receptor in both leiomyoma and myometrium was significantly higher during the preovulatory (n = 5) than the postovulatory (n = 5) phase (P = .034 and .05). In women receiving gonadotropin-releasing hormone agonist (n = 1) or oral contraceptives (n = 1), after the menopause (n = 2), and with irregular vaginal bleeding (n = 1), oxytocin receptor levels in leiomyoma and myometrium were unchanged but were reduced in anovulatory cycles (amenorrhea, n = 2). Reverse transcription-polymerase chain reaction showed messenger ribonucleic acid for oxytocin receptor as a 391-bp band in all leiomyomas and myometrium examined.

CONCLUSIONS

Leiomyoma and myometrium express the gene and protein for oxytocin receptor, which is probably partially regulated by ovarian sex steroids during the menstrual cycle.

Comparative aspects of oxytocin in baboon (Papio hamadryus anubis) and human corpora lutea

In spite of the importance of the corpus luteum in human reproduction, little is known about its formation after ovulation and during regression in the absence of conception. This is largely due to constraints on the availability of normal human tissue; therefore an appropriate model which could be studied and could provide information applicable to the human was sought. The baboon (Papio), a non-human primate, has been determined to be one such model. Thus, in the past several years our studies have examined the role of luteal peptides in corpus luteum function, and, when possible, we have attempted to examine corpora lutea from the human and baboon in parallel. Although a milk-ejection factor was recognized to be present in luteal tissue in 1910 (Ott and Scott, Proc. Soc. Exp. Biol. Med., Vol. 8, p. 49), the role of oxytocin in luteal physiology has not been easy to ascertain. This is in part due to the methodologies employed to assess its role. Our studies summarized below suggest that oxytocin does not directly affect luteal steroidogenesis but that it may play a role in cell to cell communication involving the expression of the gap junction proteins, the connexins. In view of the fact that oxytocin, its receptor, gap junctions and associated proteins are not unique to the human and non-human primates, the model of luteal development and demise proposed may be applicable to most species.

The expression of vascular endothelial growth factor isoforms in cultured human endometrial stromal cells and its regulation by 17beta-oestradiol

Angiogenesis or formation of new blood vessels is required for regeneration of the endometrium after its breakdown during each menstruation. Vascular endothelial growth factor (VEGF), a family of recently discovered angiogenic factors, may be involved in the repair and growth of the endometrium. In this study reverse transcription-polymerase chain reaction (PCR) was used to confirm the presence of VEGF mRNA and restriction enzyme digestion to confirm the identity of PCR products generated from different VEGF isoforms in cultured human endometrial stromal cells. The shortest isoform, VEGF 121, was the most abundant in quiescent stromal cells. It was about one-and-a-half times that of VEGF 165. The longest isoform, VEGF 206, was not detected; only a relatively weak signal for VEGF 189 was detectable. The mRNA for VEGF increased 2-fold after stimulation by 17beta-oestradiol (10 nM) for 30 min. A further increase to 3-fold above baseline occurred after 2 h incubation and remained steady at 6 h incubation, but decreased to 2-fold of baseline after 15 h. There was no differential stimulation of mRNA for VEGF isoforms: the ratio of VEGF 121 to 165 remained constant at 3:2 during the course of the incubation, with the exception at 15 h incubation when the ratio was 2:1. The VEGF protein, determined by specific enzyme immunoassay, increased from undetectable at baseline to 79.8 +/- 18.9 pg/ml (n = 4, mean +/- SD, 9.6 cm2/well/ml) after 2 h, with a further significant increase to 249.5 +/- 27.3 pg/ml after 15 h and 695.0 +/- 41.4 pg/well after 39 h. At 15 h incubation, the specific oestradiol antagonist ICI 182,780 (1 microM) significantly reduced VEGF secretion by 25% from 249.5 +/- 27.3 to 189.0 +/- 26.6 pg/ml. Thus, VEGF showed specific patterns of isoform expression in the human endometrial stromal cells; oestradiol (10 microM) stimulated, but not differentially, the mRNA for VEGF isoforms.

Hormonal regulation of connexin-43 in baboon corpora lutea

The synthesis and secretion of progesterone in the corpus luteum are regulated by both endocrine and paracrine/ autocrine factors which affect the steroidogenic cells. Evidence suggests that these cells communicate via cell-cell junctional proteins, the connexins. Previously we have shown that connexin-43 is expressed in both human and baboon (Papio hamadryus anubis) corpora lutea, with differential expression throughout luteal development, but is not detectable in corpora albicantia. We have examined the effect of human chorionic gonadotropin (hCG), oxytocin, clomiphene citrate and the anti-progesterone onapristone on expression of connexin-43 protein in the early luteal phase 1-5 days after the mid-cycle luteinizing hormone (LH) surge (LH+ 1-5 days), the mid-luteal phase 6-10 days after the LH surge (LH+ 6-10 days), and the late luteal phase 11-15 days after the LH surge (LH+ 11-15 days) in corpora lutea obtained from normal adult cycling females. Connexin-43 was localized by immunohistochemistry in cultured cells from all the three stages. Western blot analysis of the treated cells indicated the presence of two bands at 43 and 45 kDa. The band at 45 kDa was found to be phosphorylated connexin-43, indicating the presence of functional gap junctions. hCG (10 IU/ml) stimulated the expression of connexin-43 throughout luteal development; however, maximum expression occurred in the early luteal phase with a significantly greater expression of the non-phosphorylated protein. In contrast, in the mid-luteal phase, the expression of the phosphorylated protein was predominant. Oxytocin (200 mU/ml) also stimulated connexin-43 expression throughout luteal development with similar effects on the phosphorylated and non-phosphorylated protein in the early and mid-luteal phase; however, compared with hCG, oxytocin had a greater effect on mid-luteal phase connexin-43 expression. In the presence of both hCG and oxytocin, the expression of connexin-43 was significantly higher than the control only in the late luteal phase. Both clomiphene citrate and onapristone suppressed connexin-43 expression, and concomitant addition of hCG did not counteract their effect. In the context of our previous studies, it is concluded that, together with LH/hCG and the steroid hormones, oxytocin is involved in cell-cell contact-dependent communication in the corpus luteum.

E-cadherin and its messenger ribonucleic acid in periimplantation phase human endometrium in normal and clomiphene-treated cycles

OBJECTIVE

The purpose of this investigation was to determine whether treatment with clomiphene citrate, which is estrogenic and antiestrogenic, affects the expression of the cell adhesion molecule E-cadherin in human periimplantation phase endometrium.

STUDY DESIGN

Five healthy women were studied for two cycles each, a control and a treated (clomiphene 50 mg daily, days 5 through 9) cycle. A biopsy specimen of endometrial tissue was studied (8 to 10 days post luteinizing hormone surge) for immunohistochemical localization, Western analysis of E-cadherin with use of a highly specific monoclonal antibody to human E-cadherin, and determination of messenger ribonucleic acid for E-cadherin by reverse transcription-polymerase chain reaction by use of oligonucleotide primers specific to E-cadherin and amplifying a 432 bp fragment.

RESULTS

Luteal phase plasma progesterone levels were significantly higher in clomiphene cycles. E-cadherin was immunocytochemically present in endometrium of control and treated cycles with no apparent difference in staining intensity. Western blots revealed the presence of E-cadherin. It was relatively more abundant in clomiphene-treated than control cycles but not significantly different. The message for E-cadherin gene is expressed in endometrium of control (n = 5) and clomiphene cycles (n = 4).

CONCLUSIONS

E-cadherin and its gene transcripts are expressed in periimplantation phase endometrium and are not significantly affected by clomiphene treatment.

Interleukin-1 beta induces cyclooxygenase-2 gene expression in cultured endometrial stromal cells

Increasing evidence indicates that PGs may play an obligatory role in blastocyst implantation. Cyclooxygenase (also known as PGH synthase) isozymes 1 and 2 catalyze the rate limiting steps in the biosynthesis of PGs. The ubiquitous cyclooxygenase-1 (COX-1) subserves housekeeping functions, whereas the inducible cyclooxygenase-2 (COX-2) is expressed by limited cell types and tightly controlled. Here we report the induction of COX-2 gene expression by interleukin-1 beta (IL-1 beta) in cultured human endometrial stromal cells. COX-2 activity was induced by IL-1 beta (1 ng/mL); conversion of exogenous arachidonic acid to PGF2 alpha increased from 2.6 +/- 0.6 ng/well (mean +/- SEM; n = 6) to 22.2 +/- 5.6 ng, but was completely blocked (2.8 +/- 0.7 ng/well) by NS-398, a specific COX-2 inhibitor. Undetectable in quiescent stromal cells, messenger ribonucleic acid for COX-2 was induced 30 min after IL-1 beta treatment, reached a maximum at 4 h, and decreased after 15 h. Protein synthesis was not required for induction of the COX-2 gene, as it was blocked by actinomycin D but not by cycloheximide. The 70-kDa COX-2 protein was not detected in quiescent cells, became detectable 6 h after IL-1 beta treatment, and remained detectable even after 15 h. IL-1 beta (0.1-100 ng/mL) increased the luciferase activity in promoterless luciferase reporter containing the 900-bp 5'-flanking sequence (-891 to +9) of the COX-2 gene in a dose-dependent manner, with an ED50 of 0.1-1 ng/mL.

Interleukin-1 beta inhibits in vitro pulsatile progesterone secretion and stimulates prostaglandin F2 alpha secretion by micro-retrodialyzed baboon corpus luteum

Interleukin-1 beta (IL-1 beta) modulates steroidogenesis and prostaglandin (PG) secretion by dispersed luteal cells of some non-primate species. To determine if IL-1 beta affects progesterone (P) and PGF2 alpha secretion by the baboon corpus luteum (CL), we microretrodialyzed the intact CL for 48 h; 12 h media (baseline), 12 h with IL-1 beta (3 IU/h), 12 h media only (post- IL-1 beta) and 12 h with cAMP (5 nmol/h). Four CL from the midluteal phase (LH + 8 days) were studied. P was measured by a sensitive and specific radioimmunoassay and PGF2 alpha by an enzyme immunoassay in the 10-min fractions of retrodialysates collected. P secretions were analyzed for peaks by PC Pulsar (3.0) and total P retrieved/12 h for each experimental segment was calculated. P secretion was pulsatile. Pulses of P declined from 8.2 +/- 1.2/12 h (mean +/- SEM) before to 5.0 +/- 1.2 h after IL-1 beta treatment (P = 0.022), but increased to 10.2 +/- 4.3/12 h with cAMP. Interpulse interval increased significantly from 92 +/- 23 min (baseline) to 137 +/- 31 min (p = 0.025) after IL-1 beta treatment. Total P secreted decreased significantly from 2471 +/- 515 nmol/12 h (baseline) to 1480 +/- 167 nmoles/12 h during IL-1 beta and 788 +/- 85 nmoles/12 h after IL-1 beta (P = 0.015). P was immediately suppressed after starting IL-1 beta in 2 CL but declined only towards the end of treatment in the other 2 CL. PGF2 alpha secretion increased during IL-1 beta with a further increase after IL-1 beta, while P secretion was progressively inhibited. Therefore, IL-1 beta is luteolytic to the primate midluteal phase CL by inhibiting P while simultaneously stimulating PGF2 alpha secretion, demonstrating paracrine-autocrine interaction within the luteal tissue.

Oxytocin and its receptor in pregnancy and parturition: current concepts and clinical implications

OBJECTIVE

To present our current understanding of oxytocin and its receptors during pregnancy and parturition and their potential clinical applications.

DATA SOURCES

A MEDLINE search was conducted for pertinent articles from 1966 to October 1996 related to oxytocin and its receptor and their clinical implications during pregnancy and parturition. Review articles, book chapters, and published trials were also searched.

METHODS OF STUDY SELECTION

Only references in English that were deemed relevant were used. When possible, human data and sometimes animal data pertinent to understanding the interaction of oxytocin and its receptors were selected.

TABULATION, INTEGRATION, AND RESULTS

Oxytocin is synthesized in the hypothalamus and in many reproductive tissues during pregnancy, whereas the receptors are synthesized in reproductive tissues. The genes for oxytocin and its receptors are on chromosomes 20 and 3, respectively. Oxytocin and its receptors are regulated by sex steroids and by oxytocin itself. The paracrine and autocrine mechanisms regulating oxytocin and its receptor within the fetoplacental-uterine unit are central to the control of uterine contractions and parturition. Such current understanding provides the basis for appropriate oxytocin regimens to induce or augment labor, to inhibit preterm labor by blockade of oxytocin receptors, and to achieve cervical ripening.

CONCLUSION

Advances in our knowledge of oxytocin and its receptor have provided rational and sound principles for current concepts about their role in parturition, the appropriate use of oxytocin to stimulate the pregnant uterus or ripen the cervix, and the use of oxytocin antagonist to inhibit uterine contractions and preterm labor.

Clinical, endocrine, and metabolic effects of two doses of gestrinone in treatment of pelvic endometriosis

OBJECTIVE

Our purpose was to determine and compare the efficacy and hormonal and metabolic effects of 1.25 mg with 2.5 mg of gestrinone given twice a week in the treatment of mild and moderate pelvic endometriosis.

STUDY DESIGN

A phase II, prospective, randomized, double-blind study involving 11 patients given gestrinone 1.25 mg (five patients) or 2.5 mg (six patients) orally twice a week for 24 weeks was performed. Revised American Fertility Society scores were determined by laparoscopy before and at the end of treatment. Serum hormone (free thyroxine, free testosterone, estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone), sex hormone binding globulin, and lipid concentrations were measured before, throughout, and for 6 months after treatment. Quantitated computerized tomography of thoracic 12 through lumbar 4 vertebral bodies were determined before, at the end of, and 6 months after treatment.

RESULTS

Gestrinone 2.5 mg significantly reduced the endometriosis implant score from 10.3 +/- 2.8 to 3.8 +/- 0.8 (p = 0.05). Both doses significantly reduced serum progesterone and sex hormone binding globulin levels. Estradiol, free testosterone, free thyroxine, follicle-stimulating hormone, and luteinizing hormone levels were not significantly affected. Spinal bone increased significantly by 7.1% with 2.5 mg but lost significantly by 7.1% with 1.25 mg gestrinone; these changes had not reversed completely 6 months after stopping treatment.

CONCLUSIONS

In mild to moderate pelvic endometriosis 2.5 mg of gestrinone twice a week was more effective and had a more positive effect on bone mass than did 1.25 mg of gestrinone.

Epidermal growth factor receptors in uteroplacental tissues in term pregnancy before and after the onset of labor

Using saturation binding assays and Scatchard analyses, we determined the concentrations and binding affinities of epidermal growth factor (EGF) receptors in human myometrium (n = 13) and decidua (n = 10) before and during labor and in placenta (n = 15), chorion (n = 17), and amnion (n = 17) before labor, during labor, and after vaginal delivery. Each tissue was individually assayed. In myometrium and chorion, EGF receptors increased significantly from 5.6 +/- 0.8 and 13.5 +/- 1.7 fmol/mg protein (mean +/- SEM) before labor to 11.1 +/- 2.8 and 26.7 +/- 3.0 fmol/mg protein, respectively, after the onset of labor (P < 0.05). In amnion, EGF receptors increased from 12.8 +/- 2.7 fmol/mg protein before labor to 33.0 +/- 2.3 fmol/mg protein during labor, but decreased significantly (5.9 +/- 1.2 fmol/mg protein) with vaginal delivery (P < 0.05). Decidual and placental concentrations of EGF receptors did not change significantly with labor. The binding affinity of EGF receptors in all tissues studied did not change significantly with labor, as reflected by their respective association and dissociation constants. Up-regulation of EGF receptors in myometrium, chorion, and amnion with spontaneous labor may enhance stimulation of prostanoid production and stimulate uterine activity.

Immunohistological localization and expression of alpha-actin in the baboon (Papio anubis) corpus luteum

We have recently shown the presence of E-cadherin and of alpha- and gamma-catenins in human and baboon corpora lutea. These are components of adherens junctions between cells. The cytoplasmic catenins link the cell membrane-associated cadherins to the actin-based cytoskeleton. This interaction is necessary for the functional activity of the E-cadherins. Our aim therefore was to determine the presence of alpha-actin in the baboon corpus luteum, to further establish whether the necessary components for E-cadherin activity are present in this tissue. An antibody specific for the smooth muscle isoform of actin, alpha-actin, was used for these studies. The results using immunohistochemistry show that (a) alpha-actin is present in steroidogenic cells of the active corpus luteum, theca externa of the corpus luteum, cells of the vasculature, and the tunica albuginea surrounding the ovary. The intensity of immunoreactivity for alpha-actin varied, with the cells of the vasculature reacting more intensely than the luteal cells. A difference in intensity of immunoreactivity was also observed among the luteal cells, with the inner granulosa cells showing stronger immunoreactivity than the peripheral theca lutein cells. There was no detectable immunoreactivity in the steroidogenic cells of the atretic corpus luteum. However, in both the active and atretic corpora lutea, alpha-actin-positive vascular cells were dispersed within the tissue. (b) Total alpha-actin (luteal and non-luteal), as determined by Western blot analyses, does not change during the luteal phase and subsequent corpus luteum demise (atretic corpora lutea). (c) hCG stimulated the expression of alpha-actin and progesterone secretion by the early luteal phase (LH surge + 1-5 days) and mid-luteal phase (LH surge + 6-10 days) cells in culture, but only progesterone in the late luteal phase (LH surge + 11-15 days). The data show that alpha-actin is present in luteal cells and that its expression is regulated by hCG, thus suggesting that E-cadherin may form functional adherens junctions in the corpus luteum.

In vitro microdialysis of baboon corpus luteum: effects of oxytocin on total and pulsatile progesterone secretion

Baboon corpora lutea (two each from the early, mid- and late luteal phases) were individually microretrodialyzed in vitro for 48 h, 12 h initial baseline, 12 h retrodialysis with OT (9 mU/h), 12 h without OT and 12 h with cAMP (5 mmol/h). Progesterone (P) was measured by a sensitive and specific radioimmunoassay in 10-min fractions of retrodialysates and analyzed for P peaks by PC-pulsar 3.0. Neither OT nor cAMP had any effect on the characteristics of P pulses. In early and late luteal phase CL, OT inhibited P secretion within 1 h of administration followed by increased P secretion late during OT perfusion. In midluteal phase, OT did not affect P secretion. In all CL, P secretion was sustained or further increased during the 12 h after stopping OT. cAMP also sustained baseline or stimulated P secretion. In contrast, OT either increased total P output/12 h (28 to 49% above baseline) with a further increase of 21% to 296% above baseline after stopping OT, or inhibited total P output by 4% to 13% percent with a further decline of 51% to 61% after stopping OT. Thus, while overall OT is luteotropic, its dual effect (initial inhibition followed by stimulation) suggests direct and indirect effects through paracrine-autocrine mechanisms.

Immunocytochemical localization and expression of E-cadherin and beta-catenin in the human corpus luteum

We have previously shown that the protein connexin-43 which forms the connexons in gap junctions is present in the human corpus luteum. Abundant expression of connexin-43 is seen in the mid-luteal phase corpora lutea. Since the formation of gap junctions in a tissue requires the presence of adherens junctions formed by the cadherins, our aim in these studies was firstly to localize immunocytochemically E-cadherin and beta-catenin (a cytoplasmic protein associated with E-cadherin) in the human corpus luteum, and secondly to determine the concentrations of these proteins in the early, mid- and late luteal phase human corpora lutea. E-cadherin was localized to the periphery of luteal cells and was not detected in non-luteal tissue. beta-catenin was observed in the cytoplasm of the luteal cells. Abundant expression of E-cadherin was observed by Western analysis in the early luteal phase and the level of expression was significantly different from that observed in the mid- and late luteal phase corpora lutea. In contrast the concentrations of beta-catenin were higher in the mid-luteal phase compared to the early luteal phase. The differential expression of the cell adhesion molecule E-cadherin suggests that it may play a significant role in cell-to-cell communication in the corpus luteum, and in the cyclic development and demise of this tissue.

Immunocytochemical localization and expression of E-cadherin, beta-catenin, and plakoglobin in the baboon (Papio anubis) corpus luteum

We have previously shown that gap junctions and gap junction-associated protein connexin 43 are present in the human and baboon corpus luteum. Abundant expression of connexin 43 is seen in the midluteal phase corpora lutea. Since the formation of gap junctions requires the presence of adherens junctions formed by the cadherins, our aim in these studies was 1) to immunocytochemically localize E-cadherin and the associated proteins, beta-catenin and gamma-catenin (plakoglobin), in the baboon corpus luteum; 2) to determine by Western analysis the levels of these proteins in early, mid-, and late luteal phase and atretic baboon corpora lutea; and 3) to examine whether or not cell-cell contact in cells in culture is disrupted by the addition of the antibody for E-cadherin. E-cadherin was localized to the peripheral cell membranes of luteal cells at all stages examined, except atretic corpora lutea, with the strongest immunoreactivity in the early luteal phase. Both beta-catenin and plakoglobin were localized in the cytoplasm of the luteal cells. Immunoreactivity for all three peptides was not observed in nonluteal tissue. By Western analysis, abundant expression of E-cadherin was observed in the early luteal phase, and the level of expression was significantly different from that observed in the mid- and late luteal phase corpora lutea. In contrast, the levels of beta-catenin and plakoglobin were higher in the midluteal phase compared to the early luteal phase. Addition of the E-cadherin antibody to early luteal phase cells in culture disrupted the cell-cell contacts between cells. Thus, cell adhesion involving E-cadherin may play a significant role in the cyclic development and demise of this tissue.

Localization and expression of zonula occludens-1 tight junction-associated protein in baboon (Papio anubis) corpora lutea

The identification of the cell junction-forming proteins connexin-43, a gap junction protein and E-cadherin, which is a component of adherent junctions, in the corpus luteum of both humans and baboons suggests that cell-cell interactions and metabolic cooperation must occur in this tissue. Occluding junctions are a third type of junction which form a physical barrier between cells. Thus, our aims in this study were firstly to examine the presence of the tight junction-associated protein zonula occludens-1 (ZO-1) by immunohistochemistry, and secondly to determine the concentrations of this protein in the early-, mid- and late luteal phase baboon corpora lutea of the menstrual cycle by a Western analysis. ZO-1 was localized mainly at the periphery of the luteal cells, and the intensity of immunoreactivity varied through the luteal phase, with comparatively stronger immunoreactivity in the mid-luteal phase than the early and late luteal phases. Atretic corpora lutea were devoid of activity. By Western analysis, bands of immunoreactivity were observed at 225 kDa, further confirming the presence of the protein. Maximum activity, as determined by densitometry, was observed in the mid-luteal phase. These data infer the presence of tight junctions in the corpus luteum and suggest that expression of the ZO-1 protein forming these junctions may be hormonally regulated within this tissue.

Epidermal growth factor and basic fibroblast growth factor in peritoneal fluid of women with endometriosis

OBJECTIVE

To determine and compare the concentrations of epidermal growth factor (EGF) and basic fibroblast growth factor (FGF) in the peritoneal fluid of women with and without endometriosis.

DESIGN

Prospective study.

SETTING

Tertiary care center affiliated with university medical school.

PATIENTS

Forty-two women with endometriosis and 34 women without endometriosis confirmed by laparoscopy.

MAIN OUTCOME MEASURES

Epidermal growth factor and basic FGF concentrations were determined by highly sensitive enzyme immunoassays using monoclonal antibodies.

RESULT

Approximately 50% of the PF samples had EGF concentrations of > 0.4 pg/mL (conversion factor to SI unit, 0.17) and 90% had basic FGF concentrations of > 1 pg/mL (conversion factor to SI unit, 0.058). Concentrations of EGF or basic FGF in PF did not differ significantly between the two groups. In normal women, there was a significant correlation between EGF and basic FGF during the luteal phase. In women with endometriosis, EGF levels were higher during the luteal phase, but there was no correlation of either EGF or basic FGF levels with the severity of endometriosis.

CONCLUSIONS

The concentrations of EGF and basic FGF were highly variable in the PF of women with or without endometriosis and did not differ significantly. The concentrations were so low that neither EGF nor basic FGF in PF could bind to its receptor.

In vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination: efficacy and potential health hazards on babies delivered

OBJECTIVE

The purpose of this article was to review the efficacy and potential hazards of assisted conception.

STUDY DESIGN

A review of pertinent scientific articles published in English was done.

RESULTS

There are no adequate prospective, randomized, controlled, or comparative studies of sufficient power on the efficacy of in vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination in well-defined infertile couples. In vitro fertilization can overcome tubal sterility. The pregnancy per cycle is 19.8% and delivery per cycle is 16.0% for in vitro fertilization (all indications) and 29.5% and 19.8%, respectively, for gamete intrafallopian transfer. In limited prospective studies, in vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination have similar fecundity. Multiple births from in vitro fertilization and gamete intrafallopian transfer are increased, whereas preterm labor and low-birth-weight babies are significantly more common, even in singletons.

CONCLUSION

The efficacy or relative superiority of IVF, gamete intrafallopian transfer, and superovulation with intrauterine insemination in nontubal subfertility remains to be shown by properly designed, prospective, randomized, controlled, or comparative studies. Therefore less invasive and less expensive methods such as expectant management or superovulation with intrauterine insemination should be used before embarking on in vitro fertilization and gamete intrafallopian transfer. Further studies on the outcome of babies delivered after assisted conception are required.

Expression of gap junction protein connexin-43 in the human and baboon (Papio anubis) corpus luteum

In the nonhuman primate and human corpora lutea, gap junctions have been identified by means of electron microscopy. Gap junctions are formed by connexons, which consist of a multigene family of tissue-specific connexins. In the ovarian follicle, the gap junction protein connexin-43 is present and hormonally regulated. However, there is little evidence indicating the type of connexin present in the corpus luteum. Therefore, the aim of this study was to demonstrate the presence of gap junctions by electron microscopy and the presence of connexin-43 and messenger ribonucleic acid (mRNA) for this protein. Using immunocytochemical procedures, we have shown the presence of connexin-43 in baboon and human midluteal phase corpora lutea and in the atretic corpora lutea of the baboon. The intensity of immunoreactivity was lower in atretic corpora lutea than in the midluteal phase corpora lutea. Western analysis indicates the presence of two bands at 43-45 kDa, and that the levels of connexin-43 protein are abundant in the midluteal phase. The two bands suggest the presence of the protein in a phosphorylated or a nonphosphorylated form. Ribonuclease protection assay suggests that the mRNA levels of connexin-43 remain constant throughout the luteal phase. mRNA for connexin-43 was not detectable in atretic corpora lutea. Thus, connexin-43 is one of the connexin family of proteins forming the connexon of gap junctions in the baboon and human corpus luteum. The expression of the protein may be hormonally regulated by locally produced factors, such as estradiol and progesterone. We suggest that gap junctional communication between the cells of the primate and human corpus luteum may be important in hormone synthesis and secretion and may be involved in the process of luteolysis through luteal cell apoptosis.

Bioactive oxytocin in human and baboon corpora lutea

Oxytocin has been identified in both non-human primate and human corpora lutea of the menstrual cycle by RIA, immunocytochemistry and HPLC. Evidence for the transcription of the oxytocin gene in this tissue using PCR is available. Oxytocin receptors have been characterized by biochemical procedures. However, there is some debate as to whether the oxytocin identified in these tissues is biologically active and has a role in luteal function. In this study we have demonstrated that oxytocin isolated by gel chromatography of tissue extracts from the baboon and the human corpus luteum is biologically active as determined in a rat uterine bioassay. Since both oxytocin and its receptors are present in these tissues, it is suggested that oxytocin in the human and non-human primate corpora lutea has a functional role.

Depot leuprolide acetate versus danazol for treatment of pelvic endometriosis: changes in vertebral bone mass and serum estradiol and calcitonin

OBJECTIVE

To determine changes in trabecular vertebral bone mass, serum E2, and serum calcitonin during and after therapy of pelvic endometriosis with depot leuprolide acetate (LA) or danazol.

DESIGN

Prospective, randomized, double-blind study.

SETTING

Academic university hospital and department of obstetrics and gynecology.

PATIENTS

Twelve women with symptomatic pelvic endometriosis diagnosed and staged by laparoscopy.

INTERVENTIONS

All patients received blinded treatment with either 3.75 mg JM depot LA given every month and daily placebo tablets (n = 6) or 800 mg oral danazol daily with a monthly placebo injection (n = 6) for 24 weeks.

MAIN OUTCOME MEASURES

Quantitated computerized tomography of bone density of thoracic 12 to lumbar 4 vertebral bodies were determined before, at the end of 24 weeks of treatment, and 6 and 12 months after completing treatment. Gain or loss of bone mass was based against pretreatment levels. Serial serum levels of E2 and calcitonin before, throughout, and after therapy were compared with changes in bone mass.

RESULTS

Bone loss with LA was 14.0% +/- 0.5% (mean +/- SEM), recovering to a deficit of 4.2% +/- 3.8% and 3.3%, 6 and 12 months after stopping therapy. Danazol increased bone by 5.4% +/- 2.2%, with a further gain to 8.2% +/- 3.5% and 7.5%, 6 and 12 months after stopping treatment. Serum E2 levels usually were < 25 pg/mL (conversion factor to SI unit, 3.671) with LA but > 47.3 pg/mL with danazol. Calcitonin levels did not change significantly with either treatment.

CONCLUSION

Depot LA produced marked sustained hypoestrogenemia and significant bone loss with incomplete recovery 1 year after stopping treatment. Danazol maintained normoestrogenemia and increased bone mass with the gain maintained even 1 year after stopping therapy.

Baboon corpus luteum: epidermal growth factor receptor messenger ribonucleic acid expression during early, midluteal, and late luteal phases

OBJECTIVE

To determine the presence and compare the relative abundance of messenger RNA for epidermal growth factor receptor (EGFR) in baboon corpora lutea of different luteal ages.

DESIGN

Prospective controlled nonhuman primate study.

SETTING

Animal facility in an academic research institution.

PARTICIPANTS

Six adult female baboons with well-defined regular menstrual cycles. Stage of the menstrual cycle was determined by observation and scoring of perineal turgescence. The day of maximal turgescence was referred to as the day of LH surge.

INTERVENTION

Ten corpora lutea were obtained by luteectomy during early (LH + 1 to 5 days, n = 3), midluteal (LH + 6 to 10 days, n = 3), and late (LH + 11 to 15 days, n = 4) luteal phases.

MAIN OUTCOME MEASURE

Relative levels of messenger RNA for EGFR as determined by ribonuclease protection assay using RNA probe generated from complementary DNA for human EGFR.

RESULTS

Messenger RNA for EGFR is present in baboon corpora lutea with relative levels of 0.51 +/- 0.18 (mean +/- SEM) in the early, 0.43 +/- 0.17 in the midluteal, and 0.50 +/- 0.17 arbitrary units in the late luteal phase.

CONCLUSION

Baboon corpus luteum is a site of EGFR production; the levels of its messenger RNA did not change appreciably throughout the luteal phase.

Quality of life during sequential hormone replacement therapy -- a placebo-controlled study

OBJECTIVE -- The purpose of the study was to determine the efficacy of sequential 17 beta-estradiol and norethindrone acetate (Trisequens) in the relief of vasomotor symptoms by comparing the quality of life data from questionnaires, number and severity of symptoms, and the dropout rate versus placebo treatment. STUDY DESIGN -- Women 40 to 60 years old, who spontaneously complained of menopausal symptoms, were randomly allocated to four consecutive cycles with Trisequens (n = 40) or placebo (n = 42). Analysis of variance and two-tailed tests (P < .05) for all comparisons were used. RESULTS -- The mean number of pretreatment vasomotor symptoms per day was 7 (1.3 severe) for Trisequens and 6 (1.8 severe) for placebo, whereas posttreatment a reduction to 1.3 (0.1 severe) versus 4.2 (1.8 severe), respectively, was observed. Quality of life scores, utilizing the Kupperman Scale, 3-Factor Green Index, and Beck Depression Inventory all produced statistically significant differences (P = 0.0015, 0.0037, 0.0026, 0.0003, 0.0242, respectively). The dropout rate difference between groups was significant (P = 0.028): 12 from the Trisequens group and 23 from the placebo group. CONCLUSION -- Trisequens significantly improves vasomotor symptoms. Quality of life rating scales provide additional data to support the utility of sequential estrogen/progestin treatment for menopause therapy.

Epidermal growth factor receptors in human corpora lutea during the menstrual cycle and pregnancy

We have demonstrated the presence of epidermal growth factor (EGF) and its receptors in human non-gestational corpora lutea. To determine further the characteristics of EGF receptor binding, we examined 30 human corpora lutea throughout the luteal phase and during pregnancy. Scatchard plots of EGF binding in 29 of the 30 corpora lutea were curvilinear, suggesting negative co-operativity. The mean +/- SE of the association constant Ka was (0.9 +/- 0.2) x 10(9) l/mol, the dissociation constant Kd was (2.2 +/- 0.3) x 10(-9) mol/l and the number of binding sites (Rt) was (15.8 +/- 2.1) x 10(-19) mol/micrograms protein for non-gestational corpora lutea. The Kd increased significantly in late pregnancies compared to early pregnancies (P = < 0.005), while Rt was significantly higher in term pregnancies than in either early pregnancy (P < 0.01) or the menstrual cycle (P < 0.001). Corpora lutea atretica (n = 2) and ovarian stroma (n = 6) did not show any EGF binding activity. Our findings demonstrate the presence of specific EGF receptors in human corpora lutea of both the menstrual cycle and pregnancy. The changes in EGF binding parameters in early pregnancy suggest that there may be a relationship between the role of EGF and ovarian steroidogenesis.

Baboon corpus luteum: autonomous pulsatile progesterone secretion and evidence for an intraluteal oscillator demonstrated by in vitro microretrodialysis

Pulsatility of serum progesterone (P) is usually ascribed to stimulation of the corpus luteum (CL) by pulsatile release of pituitary LH. We investigated P secretion by the primate CL by performing microretrodialysis on 6 fresh CL obtained at laparotomy from baboons (Papio anubis) with well defined menstrual cycles. Individually microdialyzed for 24-26 h with Dulbecco's Modified Eagle's Medium and Ham's F-12 enriched with HEPES buffer in a perifusion chamber, the retrodialyzed fluid was collected every 10 min and measured for P, estradiol, and 17 alpha-hydroxyprogesterone by specific and sensitive RIAs. The chronodynamics of hormone secretion were analyzed for pulse detection by PC-Pulsar 3.0. All 6 CL (2 each from early, LH +1 to +5; mid, LH +6 to +10; and late luteal phases, LH +11 to +15) demonstrated pulsatile secretion of P in vitro, with distinct and detectable peaks over the 24-26 h studied. The CL secreted 23-27 pulses of P in 24 h in early luteal, 8-20 pulses in midluteal, and 6-19 pulses in late luteal phases. Peak lengths were 23.8 +/- 18.5 to 35.7 +/- 17.1 min. Four CL gave interpeak intervals of 46-55 min, whereas two gave intervals of 136-137 min. Analysis of distribution of pulses against different interpulse intervals in individual CL and all CL together revealed a bell-shaped distribution, with the largest number of pulses seen at an interpulse interval of 21-40 min. Because of the low concentrations of estradiol and 17 alpha-hydroxyprogesterone retrodialyzed, a similar analysis of these data was not possible. Histological examination of the tissue at the termination of the experiment using hematoxylin and eosin and localization of 3 beta-hydroxysteroid dehydrogenase activity indicates that the steroidogenic potential of the tissue is minimally affected, although some morphological changes do occur. Our findings suggest autonomous pulsatile P secretion by the primate CL, indicating local control by and the presence of an intraluteal oscillator or pulse generator for P secretion.

In vitro microdialysis of the ovine corpus luteum of pregnancy: effects of insulin-like growth factor on progesterone secretion

The effects of insulin-like growth factor-1 (IGF-1) and cAMP on progesterone (P) secretion by CL of streptozotocin-induced-diabetic pregnant ewes were compared with the effects on normal pregnant animals. Two types of CL were identified in the ovaries removed on Days 126.6 +/- 2 of pregnancy. They were either large, reddish in color, and vascular (type A) or small and pale yellow (type B). Both types were found in diabetic and normal sheep. Each CL was divided in two and perfused in parallel for 14 h in an in vitro microdialysis-perifusion system. One half was used to evaluate basal P secretion and the effect of cAMP. The effect of IGF-1 and cAMP infusion was studied in the other half. During microdialysis, fractions were collected every 15 min, and P was determined by RIA. IGF-1 stimulated secretion of P in the large type A, normal and diabetic sheep CL in discrete pulses. The smaller CL (type B) from normal sheep produced comparatively higher levels of P in discrete pulses in the presence of IGF-1. However, the small CL from diabetic sheep showed no response to IGF-1 or cAMP, and P secretion was lower. Thus, it is probable that the large CL may be the "active" CL producing P and that IGF-1 stimulates pulsatile P secretion in such CL from both normal and diabetic pregnant sheep.

Human corpus luteum: human chorionic gonadotropin receptors during ectopic pregnancy

OBJECTIVE

To examine hCG receptor levels and binding kinetics in corpora lutea (CL) from tubal pregnancies.

DESIGN

Corpus luteum from tubal pregnancies, term normal pregnancies, and midluteal phase were obtained and compared for hCG binding.

SETTING

Department of Obstetrics and Gynecology, University Hospital.

INTERVENTIONS

Corpus luteum were obtained at elective cesarean section at term, tubal ligation, or surgery for ectopic pregnancy (EP).

MAIN OUTCOME MEASURES

Human chorionic gonadotropin receptor levels, dissociation and association constants using saturation binding assay, and Scatchard analysis.

RESULTS

Corpus luteum from late tubal pregnancies (> 7 weeks) and term intrauterine pregnancies had undetectable hCG binding. Corpus luteum from early tubal pregnancies (< 6 weeks) had significantly reduced hCG receptors with higher dissociation constants than from midluteal phase CL.

CONCLUSIONS

Significant reduction of hCG receptors with accelerated binding dissociation may be the basis of CL dysfunction in some EPs.

Corpus luteal insufficiency

The corpus luteum is controlled by luteinizing hormone (LH) and intraovarian morphofunctional specialization and autocrine/paracrine mechanisms. Corpus luteal insufficiency produces luteal phase defects (LPD). The poor precision and validation of endometrial histologic dating and single or random multiple serum progesterone measurements produce widely variable diagnoses. The true prevalence rate of LPD may be only 3-5% similar to that due to chance. The role of LPD in causing infertility can be challenged because the diagnosis is not predictive of recurrence in subsequent cycles, and other causes of infertility are not controlled for. Intraobserver and interobserver variability, uterine site of biopsy, luteal phase length, time of ovulation, and luteal phase timing of biopsy have been examined and have confirmed the imprecision of dating as a sensitive and reliable assessment of luteal insufficiency. There is support for either early or late luteal phase biopsy. Endometrial dating using LH timing as a reference point is relatively more reliable. Integrated luteal progesterone is the only currently accurate assessment of luteal sufficiency. Clomiphene does not increase LPD but increases serum progesterone, integrated progesterone, corpus luteum LH/human chorionic gonadotropin (hCG), and insulin-like growth factor-1 (IGF-1) receptors, all of which promote increased progesterone production and do not affect endometrial estrogen and progesterone receptors. hCG is more likely to stimulate progesterone production if given at the mid rather than early luteal phase corresponding to the phase with highest total and available (unoccupied) corpus luteal LH receptors. Careful analysis of published studies on treatment of LPD revealed only one randomized controlled study, and, statistically, all studies revealed no better outcome with progesterone treatment.

Plasma insulin-like growth factor-I, CA-125, estrogen, and progesterone in women with leiomyomas

OBJECTIVE

To determine plasma levels of insulin-like growth factor-I (IGF-I), CA-125, estrone (E1), E2, and P in women with uterine leiomyomas compared with normal women.

DESIGN

Women with leiomyomas were compared with normal women (control).

SETTING

University Department of Obstetrics and Gynecology.

PATIENTS

Fifty-one premenopausal women with uterine myomas > 14 weeks gestation and 30 normal fertile women (controls) were studied. Peripheral blood samples were obtained before myomectomy or hysterectomy and during the nonmenstruating phase in the controls.

MAIN OUTCOME MEASURES

Plasma levels of E1, E2, P, CA-125, and IGF-I were determined by specific and sensitive RIAs and immunoradiometric assays.

RESULTS

Plasma IGF-I levels were 2,006 +/- 185 mU/mL (mean +/- SEM, n = 35) and 2,335 +/- 287 mU/mL (n = 16) in women with leiomyomas during the follicular and luteal phases, respectively, whereas the corresponding values for normal women were 1,702 +/- 120 (n = 30) and 1,774 +/- 239 mU/mL (n = 30). Similarly, plasma CA-125 levels were unchanged in women with leiomyomas (myomas: 18.8 +/- 2.4, 21.5 +/- 3.7 U/mL; normal: 15.9 +/- 1.5, 15.8 +/- 1.3 U/mL during follicular and luteal phases, respectively). Women with leiomyomas had plasma E1, E2, and P levels during the follicular phase (91.9 +/- 11.5 pg/mL; conversion factor to SI unit, 3.699; 94.6 +/- 19.0 pg/mL; conversion factor to SI unit, 3.671; and 1.5 +/- 0.4 ng/mL; conversion factor to SI unit, 3.180, respectively) and the luteal phase (105.8 +/- 11.2 pg/mL; conversion factor to SI unit, 3.699; 128.7 +/- 24.8 pg/mL; conversion factor to SI unit, 3.671; and 9.6 +/- 1.6 ng/mL; conversion factor to SI unit, 3.180) similar to normal women.

CONCLUSION

Plasma levels of IGF-I, CA-125, E1, E2, and P are normal in women with leiomyomas.

Bioequivalence of a 17 beta-estradiol hydroxypropyl-beta-cyclodextrin complex in postmenopausal women

Five postmenopausal women received single doses of a 0.675 mg estradiol hydroxypropyl-beta-cyclodextrin (estradiol-HP beta CD) sublingual tablet by the sublingual and oral route. A single dose of a 1 mg micronized estradiol tablet was given orally for comparison. Blood samples were obtained over 48 hours for measurement of estradiol, estrone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) concentrations. Sublingual administration produced faster and significantly higher peak estradiol concentrations than after oral administration of either estradiol-HP beta CD or micronized estradiol. The concentration-time area under the curve of estradiol after sublingual estradiol-HP beta CD was also significantly larger than after oral administration of either estradiol-HP beta CD or micronized estradiol, reflecting a larger estradiol bioavailability. The estradiol/estrone concentration ratio after sublingual estradiol-HP beta CD revealed a predominance of estradiol for the first 2 hours after the dose, followed by an estrone predominance. Both oral doses produced a predominant delivery of estrone to the systemic circulation. There was not difference in time-averaged LH suppression between the three phases. However, estradiol-HP beta CD sublingually produced greater FSH suppression than oral micronized estradiol.

Nonsteroidal antiinflammatory drugs and reproduction

The role of nonsteroidal antiinflammatory drugs in human reproduction and reproductive disorders is reviewed. Nonsteroidal antiinflammatory drugs inhibit the biosynthesis of prostanoids and can cross the placental barrier into the fetal circulation. Nonsteroidal antiinflammatory drugs are the treatment of choice in primary dysmenorrhea and intrauterine contraceptive device-induced dysmenorrhea and menorrhagia. Nonsteroidal antiinflammatory drugs can be used for effective control of menorrhagia, preterm labor, and polyhydramnios and for prevention of preeclampsia, but larger definitive clinical trials are needed. Prostaglandin inhibition with some nonsteroidal antiinflammatory drugs appear promising in the relief of some premenstrual symptoms and in the prevention of postoperative pelvic adhesion formation, but more studies are needed in women. Whereas implantation and tubal mobility are mediated by local prostaglandins, the potential use of nonsteroidal antiinflammatory drugs to suppress prostaglandin in these reproductive processes for enhancing or reducing fertility warrants further studies. In the last 2 decades nonsteroidal antiinflammatory drugs have been used increasingly in the treatment of some reproductive disorders and are promising for many others.

Baboon corpus luteum: presence of oxytocin receptors

To determine whether the effect of oxytocin (OT) on progesterone production in primate luteal tissue may be receptor-mediated, we used biochemical procedures to examine the CL of the baboon (Papio anubis) for the presence of OT receptors (OT-R). CL (n = 5) were obtained by luteectomy from the early (LH + 1-5 days), mid- (LH + 6-10 days), and late (LH + 10-15 days) luteal phases. Biopsies from the uterine fundus were also obtained at the same time. Total receptors were measured by incubating the membrane fractions (120,000 x g fraction) with increasing concentrations of [3H]oxytocin (0.08-1.6 nM) for 30 min at 22 degrees C with a protein concentration of 200 micrograms per tube. Nonspecific binding was evaluated by the addition of excess nonradioactive OT. The receptor-bound tritiated ligand was separated from the nonreceptor-bound ligand through use of polyethylene glycol. For the midluteal phase CL, the affinity Kd was 1.70 +/- 0.03 nmol/L and the mean receptor number (RT) was 122.6 +/- 8.3 fmol/mg protein. In comparison, myometrial tissue examined at the same phase of the cycle had a Kd of 1.3 +/- 0.1 nmol/L and an RT of 205.0 +/- 49.7 fmol/mg protein. Receptors were not detectable in the late luteal phase CL and were significantly lower in the early luteal phase CL (50.7 +/- 6.9 fmol/mg protein), with no difference in the Kd value. Competitive studies with structurally related and nonrelated peptides indicated the presence of specific receptors for OT in baboon CL.(ABSTRACT TRUNCATED AT 250 WORDS)

Baboon corpus luteum: the effect of melatonin on in vitro progesterone production

OBJECTIVE

To determine the effect of melatonin on baboon corpus luteum (CL) cell progesterone (P) production.

DESIGN

Five baboon CL obtained during the midluteal phase by luteectomy were dissociated using collagenase, and incubations were performed (50,000 cells per plate) in quadruplicate for 3 hours at 37 degrees C with melatonin (0.001 to 1.0 ng/mL) (basal) or with melatonin and 10 IU of human chorionic gonadotropin (hCG) (hCG-stimulated). Total P was measured by a specific radioimmunoassay.

MAIN OUTCOME MEASURES

Progesterone concentrations measured in the presence and absence of melatonin and hCG.

RESULTS

Melatonin (0.01 to 1.0 ng/mL) inhibited basal P production in all the CL (41.8 +/- 9.9 ng P without melatonin compared with 32.2 +/- 2.0 ng P, 28.4 +/- 2.1 ng with 0.01 and 1.0 ng/mL melatonin, respectively). Human chorionic gonadotropin-stimulated P production was significantly inhibited with as little as 0.01 ng of melatonin (150.8 +/- 11.4 ng with 10 IU hCG versus 120.3 +/- 6.4 ng with 10 IU hCG and 1.0 ng melatonin). The degree of inhibition in the hCG-stimulated cells was greater than in the nonstimulated cells. Melatonin at a concentration of 0.001 ng/mL did not affect P production in both stimulated and nonstimulated cells. Serotonin in similar concentrations had no effect on luteal cell P production.

CONCLUSION

These findings indicate that melatonin exerts a suppressive effect on baboon dispersed luteal cell P production and thus may play a role in luteal function.

Impact of medical treatment of endometriosis on bone mass

A review of studies examining the effect of medical therapy of endometriosis on bone mass and potential approaches to preventing bone loss was undertaken. Studies specifically examining bone density in women with endometriosis treated medically were used. Reports on effects of oral contraceptives and progestins on bone mass were derived from women using them for contraception. Oral contraceptives and medroxyprogesterone acetate apparently did not adversely affect bone mass. While initial studies with dual-photon absorptiometry were unable to detect appreciable bone loss with gonadotropin-releasing hormone agonist, subsequent studies have invariably found significant bone loss beginning as early as 3 months of treatment. Quantitated computerized tomography always shows significant trabecular bone loss of the vertebrae and hip with gonadotropin-releasing hormone agonist. Depot preparations appear to produce more marked loss than daily injections of intranasal spray. Recent studies indicate recovery of bone loss may take longer than 6 months or even 1 year after discontinuation of therapy with considerable individual variation. Danazol produced bone gain. Bone loss with gonadotropin-releasing hormone agonists could be prevented or attenuated with progestins, and this is worthy of further studies. Impact of medical therapy on bone mass should be a practical consideration in the selection of patients, in repeat medical therapy for recurrence of endometriosis, and in formulation of medical therapy so as to attenuate or overcome such silent adverse effects.

Insulin-like growth factor I receptors in human corpora lutea

OBJECTIVE

To determine the presence and binding characteristics of insulin-like growth factor (IGF) receptors in corpora lutea (CL) of spontaneous and clomiphene citrate (CC)-induced cycles and to identify any relationship between IGF receptors and cytosol progesterone (P) and 17 alpha-hydroxyprogesterone (17 alpha-OHP) levels.

DESIGN

Women undergoing bilateral tubal ligation were divided into two groups. One group received no medication (controls) and the other took 50 mg of CC. Midluteal phase CL were recovered at tubal ligation for hormone and receptor analysis.

SETTING

Patients were recruited from a university hospital setting.

PATIENTS

Eleven fertile women 26 to 37 years of age requesting bilateral tubal ligation were studied.

INTERVENTIONS

Four women were given 50 mg/d of CC from days 5 through 9 of study cycle. Seven women did not take any medication. Minilaparotomy bilateral tubal ligation and luteectomy were performed 7 to 9 days after midcycle urinary (LH) surge.

MAIN OUTCOME MEASURES

Insulin-like growth factor receptor concentrations and binding characteristics and cytosol P and 17 alpha-OHP levels in individual CL.

RESULTS

Optimal binding for 125I-IGF-I with membrane fractions of homogenized CL was obtained with incubation at 4 degrees C for 16 hours. Specific binding (mean +/- SEM) was significantly higher in CC-treated (53.6% +/- 4.8%) than in control cycles (25.9% +/- 5.5%, P less than 0.001). Receptor concentrations were also significantly higher in CL from CC-induced (145.6 +/- 21.8 pmol/mg protein) than from control cycles (74.8 +/- 15.2 pmol/mg protein, P less than 0.02). Insulin-like growth factor receptor levels correlated with neither serum nor cytosol P and 17 alpha-OHP in CL from either cycles.

CONCLUSION

Specific IGF-I receptors are present in human CL of the menstrual cycle with higher concentrations present in CC-induced cycles. Thus IGF may express its action on luteal function through its receptors in CL.

Histology of midluteal corpus luteum and endometrium from clomiphene citrate-induced cycles

OBJECTIVE

To determine the histologic development of midluteal corpus luteum (CL) and endometrium in normal fertile women after induction of ovulation with clomiphene citrate (CC). DESIGN, PATIENTS, INTERVENTIONS: Twelve normally cycling women planning to undergo an elective tubal ligation were treated with 50 to 150 mg of CC daily on days 5 through 9 of the cycle. Luteectomy and endometrial biopsy were performed simultaneously 7 days after the urinary luteinizing hormone surge.

RESULTS

Because polyovulation occurred in 10 of the 12 women, 22 CL and 12 endometrial biopsies were studied. Ten women had luteal and endometrial histology that were within 2 days of the ovulation to biopsy interval. The 2 remaining women had endometrial histology that lagged 3 days behind the chronological postovulatory date. In these women, out-of-phase endometrium occurred despite polyovulatory cycles in which two and three histologically normal CL lutea were present and associated with elevated progesterone concentrations.

CONCLUSIONS

In CC-induced ovulatory cycles: (1) midluteal CL histology is normal and (2) apparently out-of-phase preimplantation endometrium occurs in midluteal phase.

Effect of clomiphene citrate on the synthesis and release of the human beta-lactoglobulin homologue, pregnancy associated endometrial alpha 2-globulin, by the uterine endometrium

As an extension to a previous study to examine the effects of clomiphene citrate (CC) on human chorionic gonadotrophin/luteinizing hormone (LH) receptors in human corpora lutea, we sought to determine the effect of CC on the synthesis of the beta-lactoglobulin homologue, pregnancy associated endometrial alpha 2-globulin (alpha 2-PEG) by the luteal phase human endometrium. Seventeen normally-cycling women aged 25.9 +/- 2.1 years (mean +/- SE), undergoing elective tubal ligation, were divided into four groups consisting of controls (n = 2) and three treatment groups. Each of the treatment groups (n = 5/group) was treated with either 50 mg (group 1), 100 mg (group 2) or 150 mg (group 3) of CC daily on days 5 to 9 of the cycle. Portions of endometrial tissue were obtained by curettage 7 to 9 days following the urinary LH surge and were either fixed for histological analyses or cultured in vitro in the presence of [35S]methionine. Tissue media (TCM) that were analysed by two-dimensional gel electrophoresis followed by fluorography indicated that the synthesis of alpha 2-PEG was most markedly reduced in groups 2 and 3. Densitometric scans of TCM Western blots and radioimmunoassay (RIA) of TCM showed that the overall synthesis of alpha 2-PEG decreased from 5.8 +/- 1.9 arbitrary units (AU) and 371.2 +/- 239.3 ng/ml in group 1 to 3.1 +/- 0.8 AU and 69.4 +/- 24.9 ng/ml, and 2.7 +/- 1.1 AU and 52.4 +/- 19.8 ng/ml in groups 2 and 3 respectively. On cycle days 20-22, control values were 5.8 AU and 498.1 ng/ml respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Luteal insufficiency: correlation between endometrial dating and integrated progesterone output in clomiphene citrate-induced cycles

Midluteal phase endometrium was histologically dated with midcycle luteinizing hormone surge time in 29 cycles from 10 parous women during untreated cycles (control) and treatment with clomiphene citrate 50 mg and 150 mg daily on days 5 through 9. Integrated progesterone output for 7 days after luteinizing hormone surge calculated from the daily plasma progesterone levels was 66.6 +/- 9.8 ng/ml in the control group compared with 117.5 +/- 18.6 ng/ml for clomiphene citrate 50 mg treatment and 152.1 +/- 11 ng/ml for clomiphene citrate 150 mg treatment (p less than or equal to 0.05). Only one cycle (clomiphene citrate 150 mg) had an out-of-phase endometrium and a significantly reduced integrated progesterone output of 28 ng/ml. All other cycles showed synchronous endometrial maturation. We conclude that luteal insufficiency as a result of clomiphene citrate treatment in ovulatory women is infrequent and is more likely to be a result of functional outcome of a relative lack of luteal phase progesterone output.

Induction of labor with pulsatile oxytocin

In a prospective, randomized study, 106 patients underwent induction of labor with either pulsed (every 8 minutes) (n = 50) or continuous (n = 56) intravenous infusion of oxytocin. Maternal characteristics, gestational age at induction, induction-delivery interval, analgesia for labor, cesarean section rates, and newborn characteristics were similar in both groups. The mean +/- SEM total oxytocin administered was significantly less in the pulsed group (3564 +/- 487 mU) than in the continuous group (7684 +/- 844 mU; p less than 0.0001); the average dose of oxytocin administered per minute was significantly lower in the pulsed group (3.9 +/- 0.3 mU/min) than in the continuous group (7.8 +/- 0.4 mU/min; p less than 0.0001); the peak or highest administered dose of oxytocin expressed per minute was also signficantly lower in the pulsed group (9.6 +/- 0.8 mU/min) than in the continuous group (14.1 +/- 0.7 mU/min; p less than 0.0001). These significant differences persisted even when controlled for parity, Bishop's score of the cervix, and number of days induction of labor was carried out. Uterine hyperstimulation occurred infrequently in both groups (3.6% to 4.0%). The pulsed group required a significantly smaller infusion volume (25 +/- 14 ml) than the continuous group (780 +/- 84 ml; p less than 0.0001). Thus pulsatile administration uses significantly less oxytocin and infusion fluid but is as effective and safe as continuous infusion.

Luteinizing hormone and human chorionic gonadotropin receptors in human corpora lutea from clomiphene citrate-induced cycles

Midluteal phase corpora lutea (CL) obtained from women induced with 50 mg (n = 5), 100 mg (n = 5), and 150 mg (n = 5) of clomiphene citrate (CC) were measured for luteinizing hormone/human chorionic gonadotropin (LH/hCG) concentrations and cytosol progesterone (P) and 17 alpha-hydroxyprogesterone (17-OHP) and compared with midluteal phase CL from eight normal women (controls). More CL (26) that were significantly heavier (2.0 +/- 0.3 g, [mean +/- SEM]) were obtained with CC than in controls (10). Clomiphene citrate treatment increased LH/hCG receptor concentrations and the dissociation constant significantly from 69 +/- 12 fmol/mg protein and 1.1 +/- 0.2 x 10(-10) M, respectively, in controls to 112 +/- 6 fmol/mg protein and 2.1 +/- 0.1 X 10(-10) M. Cytosol P and 17-OHP levels were not significantly increased. Cumulatively these cellular effects may be responsible for increasing serum P and responsiveness to hCG and for correcting luteal dysfunction.

Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo TENS and ibuprofen

In a randomized four-way crossover study, 32 women with primary dysmenorrhea were treated with transcutaneous electrical nerve stimulation (TENS) for two cycles, placebo (sham) TENS for one cycle, or ibuprofen 400 mg four times a day for one cycle. The TENS setting used was 100 pulses per second with 100-microsecond pulse widths. The subjects were allowed to adjust the amplitude to a comfortable level. The pain rescue medication was ibuprofen 400 mg as needed, up to 1600 mg/day. Significantly more subjects who had TENS treatment did not require rescue medication or required less backup ibuprofen at 0-4, 4-8, and 8-12 hours after the onset of dysmenorrhea and starting treatment, as well as during the first 24 hours and for the duration of the menstrual flow, when compared with placebo TENS or ibuprofen-treated cycles (Tukey multiple comparison, P less than .01). Transcutaneous electrical nerve stimulation significantly delayed the need for ibuprofen by an average of 5.9 hours, compared with 0.7 hours when using ibuprofen alone (P less than .05, paired t test). Transcutaneous electrical nerve stimulation alone provided good to excellent subjective pain relief in 42.4% of subjects, compared with 3.2% with placebo TENS, and significantly reduced diarrhea, menstrual flow, clot formation, and fatigue compared with placebo TENS. Transcutaneous electrical nerve stimulation plus less ibuprofen provided pain relief equivalent to that obtained with ibuprofen alone (71 and 75% of the subjects, respectively). We conclude that TENS is a safe, effective, non-medication method for managing primary dysmenorrhea and that TENS plus ibuprofen was the best overall treatment, as indicated by pain relief.

Cytosol progesterone and 17 alpha-hydroxyprogesterone levels and luteinizing hormone and chorionic gonadotropin receptors in human corpora lutea

Cytosol progesterone (P) and 17 alpha-hydroxyprogesterone (17-OHP) levels and luteinizing hormone/human chorionic gonadotropin (LH/hCG) receptors were measured in 27 corpora lutea and four corpora albicantia. Cytosol P concentrations were highest in corpora lutea (mean +/- SEM, 3.1 +/- 0.8 micrograms/g) during the midluteal phase (days 15 to 19) rather than the early (2.2 +/- 0.8 micrograms/g, days 20 to 25) and late luteal phases (1.8 +/- 0.8 micrograms/g, days 26 to 30). Cytosol 17-OHP concentrations also were 3.3 +/- 0.5, 4.3 +/- 0.6, and 3.3 +/- 1.0 micrograms/g in early, midluteal, and late luteal phases, respectively, and was significantly inversely correlated with occupied LH/hCG receptors in midluteal phase. Corpora albicantia had the lowest P (0.3 +/- 0.05 microgram/g) and 17-OHP (0.9 +/- 0.6 micrograms/g) concentrations. Cytosol P and 17-OHP may therefore reflect the balance between the luteal cell production and secretion, whereas the amount of occupied and unoccupied LH/hCG receptors may partially explain the relationship between LH and P secretion.

Retention of intrauterine fetal bone increases menstrual prostaglandins

Intrauterine retention of fetal bone is a rare complication of abortion that can cause secondary infertility by an unknown mechanism. We report such a case in which menstrual fluid prostanoids were measured to elucidate the possible pathophysiology. The pattern of prostanoid increases was similar to that seen in intrauterine device users.