Mechanisms involved in the selective transfer of long chain polyunsaturated Fatty acids to the fetus

The concentration of long chain polyunsaturated fatty acid (LCPUFA) in the fetal brain increases dramatically from the third trimester until 18 months of life. Several studies have shown an association between the percentage of maternal plasma docosahexaenoic acid (DHA) during gestation and development of cognitive functions in the neonate. Since only very low levels of LCPUFA are synthesized in the fetus and placenta, their primary source for the fetus is the maternal circulation. Both in vitro and human in vivo studies using labeled fatty acids have shown preferential transfer of LCPUFA from the placenta to the fetus compared with other fatty acids, although the mechanisms involved are still uncertain. The placenta takes up circulating maternal non-esterified fatty acids (NEFA) and fatty acids released mainly by maternal lipoprotein lipase and endothelial lipase. These NEFA may enter the cell by passive diffusion or by means of membrane carrier proteins. Once in the cytosol, NEFA bind to cytosolic fatty acid-binding proteins for transfer to the fetal circulation or can be oxidized within the trophoblasts, and even re-esterified and stored in lipid droplets. Although trophoblast cells are not specialized for lipid storage, LCPUFA may up-regulate peroxisome proliferator activated receptor-γ (PPARγ) and hence the gene expression of fatty acid transport carriers, fatty acid acyl-CoA-synthetases and adipophilin or other enzymes involved in lipolysis, modifying the rate of placental transfer, and metabolism. The placental transfer of LCPUFA during pregnancy seems to be a key factor in the neurological development of the fetus. Increased knowledge of the factors that modify placental transfer of fatty acids would contribute to our understanding of this complex process.

Increased chromosome abnormalities in human preimplantation embryos after in-vitro fertilization in patients with recurrent miscarriage

Recurrent miscarriage is a pathological condition induced by maternal and embryonic causes. This paper describes a prospective study to determine the real incidence of aneuploidy for autosomes 13, 16, 18, 21, 22, and gonosomes in preimplantation human embryos obtained from patients with recurrent pregnancy loss after ovarian stimulation in an IVF-ET programme. Our results indicate that aneuploidy for the chromosomes analysed are abnormally higher in embryos obtained after IVF from recurrent abortion patients (58%) compared to non-recurrent abortion patients undergoing IVF. Furthermore, monosomies are six times more frequent than trisomies (47:8) in preimplantation embryos from recurrent abortion patients. Based on the present study, preimplantation genetic diagnosis (PGD) of embryos obtained from patients with recurrent miscarriage could prove advantageous in diagnosing abnormal embryos and selecting normal embryos for transfer.

Treatment of microscopic disease with hyperthermic intraoperative intraperitoneal chemotherapy after complete cytoreduction improves disease-free survival in patients with stage IIIC/IV ovarian cancer

BACKGROUND

We analyze the efficacy of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) for microscopic residual disease in patients with stage IIIC/IV ovarian cancer after a complete cytoreduction of their disease.

PATIENTS AND METHODS

We analyzed the data of 87 consecutive patients diagnosed with stage IIIC/IV ovarian cancer operated between December 1998 and July 2011. In every patient it was possible to achieve a complete cytoreduction of their disease. (Since January 2008, our center has incorporated the use of HIPEC in patients with peritoneal surface malignancies, including patients with peritoneal dissemination of primary ovarian cancer.)

RESULTS

Of 87 patients, 52 were treated with HIPEC (paclitaxel 60 mg/m(2), 60 min, 42 °C). After a univariate analysis, factors associated with lower disease-free interval were: performing a gastrointestinal anastomosis, operative time greater than 270 min, poorly differentiated histology, and not being treated with HIPEC. After multivariate analysis, independent prognostic factors included not being treated with HIPEC [hazard ratio (HR) 8.77, 95 % CI 2.76-14.42, p < 0.01] and the presence of poorly differentiated tumors (HR 1.98, 95 % CI 1.45-8.56, p < 0.05). Disease-free survival at 1 and 3 years was 66 and 18 %, respectively, in patients without HIPEC and 81 and 63 %, respectively, in patients treated with HIPEC (p < 0.01). HIPEC administration did not alter the results obtained for disease-free survival in patients with undifferentiated tumors.

CONCLUSIONS

The treatment of the microscopic disease following complete cytoreduction with HIPEC in patients with advanced ovarian cancer is effective and can prolong disease-free survival. This survival benefit was not seen in undifferentiated tumors.

The role of hyperthermic intraperitoneal chemotherapy using paclitaxel in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction

BACKGROUND

We analyzed the role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) on the microscopic component of the disease in patients with a first recurrence of platinum-sensitive ovarian cancer after complete cytoreduction (CCR).

PATIENTS AND METHODS

We analyzed the data of 54 patients who were operated on between January 2001 and July 2012 with the diagnosis of platinum-sensitive recurrent ovarian cancer. In all patients, it was possible to achieve a CCR. Patients were divided into two groups: group I (cytoreduction alone) consisted of 22 surgical patients and group II (cytoreduction and HIPEC) consisted of 32 patients.

RESULTS

There were no significant differences in any of the preoperative variables studied. After a multivariate analysis of factors identified in the univariate analysis, only the presence of tumors with undifferentiated histology (hazard ratio 2.57; 95% CI 1.21-5.46; p < 0.05) was an independent factor associated with a reduced disease-free survival. The 1- and 3-year disease-free survival was 77 and 23% in patients from group I and 77 and 45% in patients from group II, respectively, with a tendency, but no significant differences (p = 0.078). There was no significant difference in postoperative morbidity between the two groups.

CONCLUSIONS

The administration of HIPEC in patients in whom it is possible to achieve a CCR of the disease has not increased postoperative morbidity and mortality rates in our center. HIPEC with paclitaxel is effective in the treatment of microscopic disease in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction, although with no statistically significant difference.

Dysfunctional plasminogen in full-term newborn

Full-term newborns (FTN) plasminogen was evaluated by different techniques (affinity chromatography, immunologic technique, casein method, and chromogenic substrate). The functional activity of the FTN plasminogen was about 50% of that of the adult. This suggests the possible existence of a functional anomaly of plasminogen in FTN. FTN plasminogen aminoacids were studied, and, besides small qualitative anomalies, a decrease in amino acid residues per mole of protein and a different N-terminal amino acid were detected.

Alterations in the Coagulation and Fibrinolysis System in Pregnancy Labour and Puerperium, with Special Reference to a Possible Transitory State of Intravascular Coagulation during Labour

Various tests of hemostasis were carried out during pregnancy, labour and the puerperium in a group of 259 women. Determinations were carried out in the 1st, 2nd and 3rd trimesters, in the period of dilatation, the expulsion period, the period of expulsion of the placenta and the immediate postpartum period of labour and on each of the first 5 days of the puerperium. It was confirmed that during pregnancy there is an elevation of the fibrinogen degradation producs (FDP) levels with a proportional increase in the numbers of positive protamine sulfate and ethanol tests. The proportion of positive protamine sulfate and ethanol tests reaches a maximum in the expulsion of the placenta coinciding with the presence of soluble complexes heavier than fibrinogen as detected by polyacrylamide gel electrophoresis and by column chromatography.

All this indicates that there is a transitory intravascular coagulation produced during labour reaching its maximum at the time of birth and tending to become normalized in the first few days of the puerperium.

Posttransplant lymphoproliferative disease: treatment and outcome in renal transplant recipients

Posttransplant lymphoproliferative disorders (PTLD) are a heterogeneous group of lymphoid diseases that occur after solid organ and bone marrow transplantation. We performed a retrospective study to assess the incidence, response to treatment, and patient and graft survival after PTLD.

PATIENTS

Between January 1980 and December 2002, 1.96% (n=10) of 509 renal transplant recipients developed PTLD. Seventy percent were men. Mean age was 40 years (range 21-65). They were classified into four groups based upon the type of PTLD: group I, early lesion (n=1); group II, polymorphic PTLD (n=1); group III, monomorphic PTLD (n=7) including five non-Hodgkin lymphoma [NHL] and two Burkitt (BL); and group IV, Hodgkin lymphoma (HL) (n=1). The mean time from transplantation to diagnosis was 77 months (range 4-138). Although only 20% of cases were early presentation, Epstein-Barr virus (EBV) was found in the tumor cells of seven cases. Treatment was individualized according to PTLD type: for group I, immunosuppression reduction (IR); group II, IR plus acyclovir; group III, withdrawal or IR plus chemotherapy and/or surgery in all but one patient who was also treated with anti-CD20 monoclonal antibody and radiotherapy. Interferon was also used in one patient. For group IV, treatment was IR plus radiotherapy.

RESULTS

A complete response was achieved in nine cases (90%) with one recurrence. Three patients returned to dialysis. One patient with BL died.

CONCLUSIONS

The incidence of PTLD in our center was 1.96%. Patient survival after PTLD was 90%, with 60% maintaining allograft function. Individualized treatment according to extension, histology, and location is mandatory to obtain a high survival rate.

Use of contraceptive methods in Spain: results of a national survey☆

We conducted a personal interview of 2136 Spanish women aged 15 to 49 years with the aim of determining the contraceptive attitudes of this population. A stratified random sampling was performed to select the women who were to be interviewed, and this sampling design ensured adequate representation of the sample in Spain. At the time of the survey, only 1296 of the 2136 women used some type of contraceptive method (60.6%); the most commonly used method was the condom. The major reason given by the 840 women not using contraceptive methods was the absence of sexual intercourse. Nearly 25% of the Spanish women aged 15-49 years reported that they have no sexual relations.

The use of intrapartum fetal blood lactate measurements for the early diagnosis of fetal distress

Lactate concentrations were measured during labor and at delivery in blood samples from the fetal presenting part and from the umbilical cord with the use of a rapid electrochemical technique. The value of these measurements to discriminate between normal and distressed fetuses was compared to that of pH, base excess, PCO2 and PO2 measurements in the same blood samples. The fetuses were divided into three groups, normal, prepathologic, and pathologic, according to the presence and severity of fetal distress as evaluated by Apgar score, intrapartum cardiotocography, meconium staining of the amniotic fluid, and cord arterial pH at birth. Lactate and pH provided the best parameters to distinguish between groups, with lactate having the most discriminating power at least in early labor and midlabor. The prospective value of discriminant functions derived from lactate and pH data was good when the fetuses were allocated into the normal group but poor when an attempt was made to allocate the fetuses into prepathologic and pathologic groups, with a high false negative rate. However, the discriminating ability was improved when prepathologic and pathologic fetuses were included into one single abnormal group. These results confirm the potential use of rapid fetal blood lactate measurements for the early diagnosis of intrapartum fetal distress.

Contraceptive practices and trends in Spain: 1997-2003

OBJECTIVE

To know the contraceptive use and trends in the Spanish female population.

STUDY DESIGN

Since 1997, we have conducted a survey every 2 years on the use of contraceptive methods among a representative sample of Spanish women of childbearing potential (15-49 years).

RESULTS

In the period 1997-2003, the percentage of use of contraceptive methods in Spain rose from 55.6% to 71.2%. The most commonly used method was the condom (21% in 1997, 21.9% in 1999, 29.5% in 2001 and 35.7% in 2003), followed by the contraceptive pill (14.2%, 16.5%, 19.2% and 18.3%, respectively). Male or female sterilization remained stable with percentages of use of 5-7%. IUDs are used by about 5% of women.

CONCLUSIONS

The use of contraceptive methods among Spanish women of childbearing potential generally fits quite well the patterns found in other developed countries, and we observed a trend towards increased use of effective methods.

Use of contraceptive methods and risk of unwanted pregnancy in Spanish women aged 40–50 years: results of a survey conducted in Spain

A survey intended to ascertain the rate of use and type of contraceptive methods applied by Spanish women aged 40 to 50 years, and to determine the proportion of women in this group at risk of an unwanted pregnancy, was designed and validated. To achieve representative national results for the study population, it was estimated that a sample size of 2000 women was required. Women were selected using probabilistic, stratified random sampling. The survey questionnaire was prepared by the research group with the collaboration of experts in the conduct of population studies of this type. Participants were interviewed face to face by qualified and trained staff from a specialised company external to the research group. Overall, 1039 women (52%) resorted to some contraceptive method, of which (male or female) sterilisation was the most common. We estimate that in Spain there are 840,000 women (31.8%) aged 40 to 50 years at risk of unwanted pregnancy.

Relationship of maternal glycosylated hemoglobin and fetal beta-cell activity with birth weight

A population of 40 mother-newborn pairs with a wide range of birth weight has been studied. Seventeen of the mothers were diabetic, while the other 23 were normal pregnant women. The chronic blood glucose levels were assessed in the mothers through the percentage of glycosylated hemoglobin (HbA1) at delivery. The functional activity of the pancreatic beta-cells in the newborns was estimated through the concentration of insulin and C-peptide in the cord blood. Maternal HbA1 was not quantitatively related to the birth weight ratio. In contrast, both insulin and C-peptide correlated significantly with it. Is is concluded that in populations with a good metabolic control, blood glucose levels, as measured by HbA1, are not the major determinant of fetal growth.

Psychological profile of teenagers toward organ donation: a multicentric study in Spain

Background

It is important for teenagers to have a favorable attitude toward organ donation and transplantation (ODT) in order to increase the number of future donors. To determine the attitude of teenagers in the South East of Spain toward ODT and to analyze the psychosocial variables related to this attitude.

Methods

The study population consisted of young teenagers in the South East of Spain. A stratified sample was selected by geographical location, sex and age (n = 4, 117). Attitude was assessed using a validated questionnaire about ODT (PCID-ODT Ríos). Statistical analysis: Student’s t-test, Chi-squared test and a multivariate analysis.

Results

The questionnaire completion rate was 87% (n = 3572). Attitude toward ODT was favorable in 46% of cases (n = 1633) and undecided in 43% (n = 1543). Several psychosocial variables had a favorable effect on donation: believing that one has good information about ODT (Odds Ratio [OR] 1.706); discussing the subject with the family (OR 1.543) and friends (OR 1.818); carrying out pro-social activities (OR 1.642); having a favorable attitude toward cremation (OR 1.466) and autopsy (OR 1.470); and, finally, not being afraid of scars (OR 4.184).

Conclusions

Teenagers in the South East of Spain are not currently inclined to support organ donation. This attitude is related to many psychosocial factors, mainly connected to not having good information about the subject, not discussing it in social circles and the fear of body mutilation. It would be appropriate to create educational interventional strategies in this group to prevent a negative impact on future donation rates.

The GnRH analogue triptorelin confers ovarian radio-protection to adult female rats

There is a controversy regarding the effects of the analogues of the gonadotrophin-releasing hormone (GnRH) in radiotherapy. This has led us to study the possible radio-protection of the ovarian function of a GnRH agonist analogue (GnRHa), triptorelin, in adult, female rats (Rattus norvegicus sp.). The effects of the X-irradiation on the oocytes of ovarian primordial follicles, with and without GnRHa treatment, were compared, directly in the female rats (F(0)) with reproductive parameters, and in the somatic cells of the resulting foetuses (F(1)) with cytogenetical parameters. In order to do this, the ovaries and uteri from 82 females were extracted for the reproductive analysis and 236 foetuses were obtained for cytogenetical analysis. The cytogenetical study was based on the data from 22,151 metaphases analysed. The cytogenetical parameters analysed to assess the existence of chromosomal instability were the number of aberrant metaphases (2234) and the number (2854) and type of structural chromosomal aberrations, including gaps and breaks. Concerning the reproductive analysis of the ovaries and the uteri, the parameters analysed were the number of corpora lutea, implantations, implantation losses and foetuses. Triptorelin confers radio-protection of the ovaries in front of chromosomal instability, which is different, with respect to the single and fractioned dose. The cytogenetical analysis shows a general decrease in most of the parameters of the triptorelin-treated groups, with respect to their controls, and some of these differences were considered to be statistically significant. The reproductive analysis indicates that there is also radio-protection by the agonist, although minor to the cytogenetical one. Only some of the analysed parameters show a statistically significant decrease in the triptorelin-treated groups.

Cytoplasmic and nuclear estrogen binding capacity in the rat uterus during treatment with danazol and testosterone

Danazol, testosterone and dihydrotestosterone (DHT) were tested as competitors for estrogen receptors on immature rat uterus cytosol. No competitive binding could be demonstrated for any of these steroids. After that, prepubertal Wistar rats were exposed to danazol, testosterone or propylene glycol (control) for 3 days or 17 days. After the appropriate exposure to medication, the animals were killed. Both danazol and testosterone appeared to be uterotropic after 3 days of treatment, although the increase in the uterine weight was significant only in the danazol-treated group (p less than 0.05). This effect was lost after 17 days of treatment. Estradiol receptor binding assays were done on the cytosolic and nuclear fractions of the homogenized uterine tissue of each group. The estrogen binding capacity of cytosols was increased in both the danazol (p less than 0.05) and the testosterone (p less than 0.01) groups after 3 days of treatment. A parallel increase was found in the nuclear fraction of both groups. After 17 days of treatment, the comparison between the 3 groups showed no differences in the cytosolic or nuclear estrogen binding capacity. The information provided by this study suggests that some effects of danazol may be due to an androgenic action and that may be associated to increases in the free fraction of testosterone.

Male pseudohermaphroditism with 17 alpha-hydroxylase deficiency. A case report

A case of male pseudohermaphroditism with 17 alpha-hydroxylase deficiency is reported in a 23-year-old woman presenting with primary amenorrhoea and a history of bilateral inguinal hernia repair. She was tall, had hypoplastic external genitalia with a blood pressure of 220/140 mm Hg. Her karyotype was XY. Acute adrenal failure occurred following exploratory laparotomy. After treatment with glucocorticoids and oestrogens, the hormone and electrolyte profiles returned to normal and the blood pressure fell. The biochemical implications of this enzyme deficiency are discussed.

Analysis of compliance with oral contraception in Spain

OBJECTIVE

The study was designed to analyze factors related to compliance in oral hormonal contraception in Spain.

METHOD

A review study and a multicenter analysis of experience of compliance by 300 doctors, by means of a questionnaire and discussion about the determinants of contraceptive use.

RESULTS

Compliance is a major problem in Spain, being influenced mainly by side-effects, the general perception of the method and personal factors. The different factors involved in non-compliance in Spain were analyzed, with regard to the perspective of the professionals.

CONCLUSIONS

Strategies to improve compliance in Spain aim mainly at improving the general perception of the method and the accessibility of family planning centers. Factors associated with compliance are still not well known in our country. Better knowledge of the determinants of non-compliance in Spain is needed. For this purpose, another research group was formed to conduct a national study among women.

Effect of angiotensin-converting enzyme inhibitor on renal function in ovarian hyperstimulation syndrome in the rabbit

OBJECTIVE

To investigate renal function and whether captopril prevents alterations in the handling of sodium and water in the ovarian hyperstimulation syndrome (OHSS) in the rabbit.

DESIGN

Experimental study

SETTING

Physiology laboratory.

ANIMAL(S)

Six female New Zealand white rabbits were used as controls, and 13 were hyperstimulated with gonadotropins.

INTERVENTION(S)

Saline or captopril.

MAIN OUTCOME MEASURE(S)

Renal excretory and hemodynamic variables.

RESULT(S)

The 3% extracellular volume expansion in OHSS animals induced a significant elevation in mean arterial pressure by 27%, although increments in natriuresis and diuresis were similar to those observed in controls. The OHSS group had impaired pressure-natriuresis sensitivity compared with controls (0.36 +/- 0.07 microEq/min/g of Na excreted per mm Hg vs. 1.74 +/- 0.45 microEq/min/g of Na excreted per mm Hg; P<.05. Captopril significantly reduced mean arterial pressure (P<.05) and shifted the pressure-natriuresis response to the left by 0.85 +/- 0.17 microEq/min/g of Na excreted per mm Hg (P<.05).

CONCLUSION(S)

In OHSS in the rabbit model, pressure-natriuresis sensitivity is impaired. Angiotensin II may play a significant role in this phenomenon, since angiotensin-converting enzyme inhibition normalized the pressure-natriuresis relationship.

Symmetrical fetal growth retardation after gestational cocaine exposure in the rat

Cocaine use during pregnancy results in an increase in different maternal and perinatal complications. The fetal effects of cocaine could be mainly related to the disturbances in the brain development, microcephaly being the most common brain abnormality. The aim of this study was to analyze maternal outcome and fetal somatic effects of cocaine and to evaluate the hypothesis that maternal cocaine exposure would specifically impair fetal global brain development. Fifty-four timed-pregnant female Sprague-Dawley rats were daily injected with 15 or 40 mg/kg per day from gestational day (GD) 1 or 8 and sacrificed at gestational day 20. By analyzing different maternal and fetal outcomes, it could be suggested that the cocaine exposure in pregnant rats decreased maternal weight gain without significant maternal mortality, did not affect the mean number of fetuses by litter, although notably increased stillbirths, reduced fetal birth weight, and reduced the fetal central nervous system weight. Present results are globally in agreement with the literature and underline a possible selective effect of cocaine on the fetal CNS resulting in symmetrical intrauterine fetal growth retardation in contrast to the asymmetrical retardation of undernutrition.

The positive feedback of estradiol on gonadotropin secretion in women with perimenopausal dysfunctional uterine bleeding

The functionality of the hypothalamic-pituitary-ovarian axis was explored in 27 women with perimenopausal dysfunctional uterine bleeding. The positive feedback effect of estradiol on LH and FSH was studied by the estrogen challenge test, which was performed by a single i.m. injection of estradiol benzoate. An early decline of both LH and FSH was followed by an increase of LH, mainly due to the cases in which the estrogen test was positive. FSH remained low through the whole period tested. The results were compared with those found in 5 normal menstruating women. The frequency of positive estrogen tests, defined by an acute estradiol-induced discharge of LH, was lower in the perimenopausal patients (P less than 0.025). The results of the tests used in our study showed an impairment of the positive feedback system in the perimenopausal-dysfunctional-bleeding group.

Role of nitric oxide on the central hemodynamic response to acute volume expansion in the pregnant rat

OBJECTIVES

Our hypothesis was that during pregnancy nitric oxide acts as mediator in the hemodynamic response to volume expansion.

STUDY DESIGN

The study was performed on 12 rats on days 19 to 20 of pregnancy. Six rats were injected intravenously with hexamethonium bromide plus the inhibitor of nitric oxide synthase L-nitro-arginine methyl ester. For a control group, six rats were injected with hexamethonium bromide plus the L-nitro-arginine methyl ester vehicle. A volume expansion (1.2% body weight) was performed in both groups by intravenous infusion of bovine albumin (6%) solution.

RESULTS

In the control group volume expansion induced a hyperdynamic circulation characterized by increased cardiac output, decreased total vascular resistance, and no change in arterial pressure; however, in the study group volume expansion induced a pressor response without hyperdynamic circulation.

CONCLUSION

During pregnancy volume expansion induces a hyperdynamic circulatory state possibly mediated by nitric oxide release. A defect in the release of nitric oxide may be responsible for an inadequate hemodynamic response to volume expansion.

Immunoradiometric studies with a monoclonal antibody against an estrogen-receptor-related protein in human breast cancer

The concentration of P29, a phosphoprotein related to estradiol receptor (RE), was measured by an immunoradiometric assay in human breast cancer cytosol and the results compared with the levels of RE and progesterone receptors (RP), as measured by the classical ligand-binding assay. Good linear correlation was found between P29 and RE, but not RP. Tumors which were positive for both RE and RP had a higher P29 mean value than RE-negative, RP-negative tumors. Menopausal status of the patients influenced the result, since premenopausal women had lower mean concentrations or were P29-positive less frequently than postmenopausal women. RE-negative, RP-positive tumors tended to have positive P29 levels. The correlation between RE and P29 corroborates results obtained with other techniques and supports a role for P29 in predicting response to hormonal treatment.

Response to clomiphene citrate in the polycystic ovarian syndrome according to different LH/FSH ratios

Twenty-nine clomiphene tests were carried out, 19 on subjects with polycystic ovarian syndrome (PCO) who did not wish to conceive and 10 on women with correct ovarian function (control women). The intention was to determine if the response of the hypothalamic-pituitary-ovary axis varies according to different LH/FSH ratios. The results indicate that with repeated LH/FSH ratios of less than 3, the positive and negative feedback systems are preserved in most subjects, but when the ratio is higher than 3, both systems are significantly altered (P less than 0.01). In the control group, both systems were preserved in all subjects. In another group composed of 26 infertile patients with PCO, the rate of ovulation and pregnancy after administration of clomiphene citrate (CC) was correlated according to different LH/FSH ratios. A significant (P less than 0.0001) reduction in the rate of ovulation and a lesser reduction in pregnancy was found with increasing LH/FSH ratios. In conclusion we suggest that the LH/FSH ratio is a good marker of this syndrome, and can be used to give a prognosis on the severity of the syndrome, as well as the ovulatory capacity of the subject after administration of CC.