Restoration of the gonadotrophin response to LH-RH and oestrogen administration in patients after molar abortion

Return of ovulation after evacuation of hydatidiform moles

Plasma levels of progesterone, 17 beta-estradiol and prolactin and serum levels of the beta-subunit of human chorionic gonadotropin were measured by radioimmunoassay before evacuation and then weekly after evacuation in 52 patients with complete moles and 15 patients with partial moles. The first menstrual cycle was ovulatory in 20 patients (29.9%) and anovulatory in 36 patients (53.7%). In 11 patients (16.4%) it was uncertain whether they ovulated in the first cycle. There was no difference in the ovulation rate between patients with complete moles and those with partial moles. The ovulation rate in patients with theca-lutein cysts was lower than that in patients without theca-lutein cysts. The preevacuation serum level of the beta-subunit of human chorionic gonadotropin in patients who ovulated in the first cycle was significantly lower than that in patients who did not ovulate, but there was no significant difference in the other hormones. By the sixth week, 12 patients already had the first ovulatory menstrual period and 40% of patients ovulated when the serum level of the beta-subunit of human chorionic gonadotropin was still above 10 mlU/ml. It is recommended that an effective method of contraception be instituted immediately after evacuation of hydatidiform moles.

Ovarian dysfunction in patients with gestational trophoblastic neoplasia treated with short intensive courses of etoposide (VP-16-213)

The effect of oral Etoposide (VP-16-213) on the ovarian function in 22 patients with residual gestational trophoblastic disease was studied by serial weekly measurement of serum follicle stimulating hormone (FSH), 17 beta-estradiol (E2), progesterone (P) and prolactin (PRL), and monitoring of the menstrual patterns during and after drug treatment. Multiple courses of VP-16-213 at a dosage of 200 mg/m2 X 5 days were given 1 week apart. Following an average dose of 5.0 gm, five young patients developed transient ovarian failure for a mean period of 2.4 months and two elderly patients developed permanent ovarian failure (total incidence, 7/22, 31.8%) as evidenced by hypergonadotropic, hypoestrogenic amenorrhea. In addition, two patients each developed anovulatory cycles and hypomenorrhea. VP-16-213 should therefore be regarded a potent gonadotoxic drug and these hitherto unreported side effects should be recognized when the drug is used in menstruating females.