Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index

BACKGROUND

Anxiety and depression are more prevalent in women with polycystic ovary syndrome (PCOS) than in those without this disorder. Possible confounding effects of overweight and obesity are suggested. The aim was to compare symptoms of anxiety and depression in women with PCOS and controls matched for age, body weight and body mass index (BMI).

METHODS

Women with PCOS (n = 30) and controls (n = 30) were recruited from the community. Persons with ongoing psychotropic medication were excluded. All potential participants underwent gynecological examination to confirm case-control status. Participants completed the self-reported versions of the Brief Scale for Anxiety (BSA-S) and Montgomery Asberg Depression Rating Scale (MADRS-S).

RESULTS

Women with PCOS had a higher BSA-S score compared with controls (median, range: 10.5, 1-24 versus 5.0, 0-28, P < 0.001). They scored higher on the following four individual symptoms: reduced sleep (2.0, 0-5 versus 0, 0-2, P < 0.001), worry (1.5, 0-4 versus 0, 0-6, P = 0.004), phobias (1, 0-4 versus 0, 0-3, P < 0.001), and pain (1, 0-3 versus 0, 0-2, P < 0.001). No statistical difference was demonstrated regarding MADRS-S scores (10.0, 0-27 versus 5.5, 0-24, P = 0.053). Only one of the nine MADRS-S symptoms, reduced sleep, which is also included in the BSA-S, differed between cases and controls.

CONCLUSIONS

Several anxiety symptoms distinguished women with PCOS from a control group matched on BMI. A better understanding of the symptoms is needed to identify and alleviate anxiety symptoms in this vulnerable group.

Fertility and pregnancy outcome in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

BACKGROUND

Low pregnancy rate has been reported in women with congenital adrenal hyperplasia (CAH) and little information on pregnancy and children is known.

METHODS

In a Swedish study, 62 adult women with CAH, aged 18-63 years, and 62 age-matched controls were followed-up. Medical records, including those concerning pregnancies and deliveries, were examined and the 21-hydroxylase genotype of patients was noted. All women answered a questionnaire concerning sexual and reproductive health including health of the children.

RESULTS

Pregnancy and delivery rates were significantly lower in women with CAH (P < 0.001, P < 0.0056, respectively), and the severity of the 21-hydroxylase-mutation correlated with the reduced number of children born. More women with salt-wasting CAH were single and had not attempted pregnancy. Pregnancies were normal except for a significantly increased incidence of gestational diabetes in CAH patients (P < 0.0024). The children had normal birthweight and no malformations were observed. A later follow-up of the children showed a normal intellectual and social development. The sex ratio of the offspring differed significantly, with 25% boys in the CAH group compared with 56% among controls (P < 0.016). CAH women had more gynaecological morbidity during menopause.

CONCLUSIONS

Pregnancy and delivery rates are reduced in women with CAH mainly due to psychosocial reasons. The outcome of children did not differ from controls. The unexpected sex ratio in children born to mothers with CAH warrants further research.

A method for longitudinal microscopic in vivo examinations of morphology, vascularity, and motility in the ovary and the oviduct of the rat

OBJECTIVE

We developed an in vivo model to enable observation of dynamic changes in morphology, vascularity, and motility of the rat adnexa.

METHODS

Immature Sprague-Dawley rats (n = 16) were primed with equine chorionic gonadotrophin (eCG;15 IU) followed by human chorionic gonadotrophin (hCG; 15 IU) 48 hours later to induce ovulation. The experiments were performed during prolonged (up to 12 hours) thiobarbiturate anesthesia. During laparotomy the periovarian bursa was retracted, whereafter the oviductal-ovarian complex was submerged into an organ chamber. Water immersion lenses (4x-40x; final magnification up to 810x) enabled detailed observations that were recorded on Beta-SP videotape.

RESULTS

Capillary flow was monitored easily. At the level of the follicle, top blood flow velocity variations (8-10 per minute) were observed in the microvasculature. Ovulations were followed in detail, and oocyte-cumulus complexes were seen later in the oviductal ampulla. Regular contractions in the oviduct were synchronous with the oocyte-cumulus complexes moving back and forth in the oviductal lumen over a distance of about 900 microm. These contractions were more frequent (13-16 per minute) in the postovulatory phase compared with the time before ovulation (9-10 per minute). The oviductal contractions were initiated alternately from either end of the ampulla and were accompanied by a denudation of the oocytes, with a stream of cumulus cells seen moving in an abovarian direction in between contractions.

CONCLUSION

High-magnification video recording in vivo was useful for capturing microcirculatory events as well as structural and functional changes of the ovary and the oviduct.

Genetic analysis of mosaicism in 53 women with Turner syndrome

Mosaicism involving the sex chromosomes is a common finding in women with Turner syndrome (TS). It is especially important to detect Y-chromosomal material, since this is a risk factor for the development of gonadoblastoma. Recent studies have also indicated that the frequency of 45,X cells may be used to predict prognosis. As part of an ongoing multi-disciplinary study, we have examined the extent of Y-chromosomal material and sex chromosomal mosaicism and its tissue specificity in 53 women with TS. The results of lymphocyte karyotyping were compared with the use of interphase X/Y fluorescence in situ hybridisation (FISH) analysis of lymphocytes and buccal mucosal cells. As could be expected, an extended FISH analysis detected more Y-chromosomal material than karyotyping (in 15% vs. 11% of the women, respectively) and also detected more X-chromosomal mosaicism among the TS women (in 70% vs. 45 % of the women, respectively). In half of the women, tissue-specific differences between lymphocytes and buccal mucosal cells were found. Based on these results, we suggest the use of X/Y interphase FISH as a complement to karyotyping in order to obtain a more complete knowledge of the chromosome constitution of each individual with TS.

Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries

The aims of the present study were to investigate corticotropin-releasing factor (CRF) concentrations in the brain, the adrenal glands, and the ovaries in rats with estradiol valerate (EV) induced polycystic ovaries (PCO). The effect of 12 electro-acupuncture (EA) treatments on CRF concentrations was also investigated. The CRF concentrations in the median eminence (ME) were significantly increased in rats with PCO (both the PCO control group and the PCO group receiving EA) compared with the healthy control group (veichle control group), indicating increased activity in the hypothalamus-pituitary axis. The CRF concentrations in the ovaries were significantly reduced in the PCO group receiving EA compared with the PCO control group. Also, there was a decrease in comparison withthe healthy control group but the decrease was not as significant. This finding indicates that repeated EA treatments change the neuroendocrinological state in the ovaries, which may play an important role in reproductive failure.

Production of steroids by human ovarian surface epithelial cells in culture: possible role of progesterone as growth inhibitor

OBJECTIVE

The purpose was to investigate whether normal ovarian surface epithelial cells, harvested from premenopausal and postmenopausal women, are capable of steroid production, and to evaluate effects of estradiol and progesterone on growth regulation of such cells.

METHODS

Ovarian surface epithelial cells were obtained by brushing of the ovarian surface of 9 premenopausal and 10 postmenopausal women undergoing surgery for benign gynecological diseases. The conditioned media after culture, with and without addition of FSH and LH, were analyzed for estradiol and progesterone. The proliferative effects of the steroids were analyzed using two different culture models, nonconfluent cells and confluent cells, and two different detection methods, [(3)H]thymidine incorporation and a colorimetric method assaying cell number.

RESULTS

The normal ovarian surface epithelial cells were found to secrete both estradiol and progesterone, a production that was not regulated by FSH or LH. Addition of steroids to the cultured cells did not induce any overall significant growth effects. However, progesterone significantly inhibited the growth of ovarian surface epithelial cells from three of the patients. Enhanced thymidine incorporation was observed in the presence of the progesterone receptor antagonist Org 31710 in the nonconfluent cultures of cells from postmenopausal women, but no effect of an estrogen receptor antagonist was observed.

CONCLUSIONS

The normal ovarian surface epithelium is capable of steroid production, which is also often observed in tissue from ovarian epithelial tumors. Progesterone appeared to be a negative regulator of ovarian surface epithelial growth, while estradiol had no effect.

Preimplantation genetic diagnosis (PGD): the Gothenburg experience

BACKGROUND

A program for preimplantation genetic diagnosis of pre-embryos from patients with hereditary disorders was set up in our unit at Sahlgrenska University Hospital in 1994. The majority of the patients were carriers of X-chromosome linked disorders; a few patients were translocation carriers. In this paper we describe our experiences of our first 36 cycles, 30 gender determinations and six analyses of embryos with possible translocations.

METHODS

Conventional hormone replacement treatment with intracytoplasmic sperm injection to fertilize the eggs followed by blastomere biopsy and fluorescent in situ hybridization at the eight cell stage was used for sexing as well as detection of translocations.

RESULTS

Out of the 30 cycles in 13 patients for gender determination, blastomere biopsies could be carried out in 25 cycles. Transfer of normal female embryos (XX) was performed in 18 cycles, resulting in five pregnancies (pregnancy rate 27.8%) and an implantation rate of 20% per transfer. Three girls have been born. Hence the take home baby rate was 16.7% per transfer and 10% per started cycle. Six cycles (three patients) for detection of translocations in embryos were performed. Diagnosis was possible in four cycles. Transfer of normal embryos was carried out in one cycle. No pregnancy was achieved.

CONCLUSION

Successful PGD in its clinical application demands close collaboration between a large group of specialists. Even so, the success rate is considerably lower than after conventional IVF or ICSI procedures. Taking into account the stress caused to the parents facing late interruption of pregnancy following conventional prenatal diagnosis we are convinced that this technique is well worthwhile continuing and refining.

Diverse effects of FSH and LH on proliferation of human ovarian surface epithelial cells

The purpose of this study was to evaluate the effects of FSH and LH on growth regulation of normal ovarian surface epithelial (OSE) cells harvested from both premenopausal and postmenopausal women. Ovarian surface epithelial cells were obtained through brushing of the ovarian surface during surgery. FSH and LH were added to the OSE cultures and the proliferative effects were analysed using two different culture models, non-confluent and confluent cells, and two different detection methods, [(3)H]thymidine incorporation and a colorimetric cell number assay. FSH lowered the OSE proliferation under non-confluent conditions (10-27%), and the inhibitory effect was most pronounced among cells from postmenopausal women (P: < 0.01). In the confluent model only cells from postmenopausal women showed significantly (P: < 0.05) decreased proliferation. No effects of LH on OSE cells were detected. The unexpected results of an anti-proliferative effect of FSH on OSE, and the absence of effect by LH, do not support the theory that gonadotrophins are directly involved in ovarian carcinogenesis through an enhanced proliferation of OSE cells.

Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries

Despite extensive research on the pathogenesis of polycystic ovary syndrome (PCOS), there is still disagreement on the underlying mechanisms. The rat model for experimentally induced polycystic ovaries (PCO)-produced by a single injection of estradiol valerate-has similarities with human PCOS, and both are associated with hyperactivity in the sympathetic nervous system. Nerve growth factor (NGF) is known to serve as a neurotrophin for both the sympathetic and the sensory nervous systems and to enhance the activity of catecholaminergic and possibly other neuron types. Electro-acupuncture (EA) is known to reduce hyperactivity in the sympathetic nervous system. For these reasons, the model was used in the present study to investigate the effects of EA (12 treatments, approximately 25 min each, over 30 days) by analyzing NGF in the central nervous system and the endocrine organs, including the ovaries. The main findings in the present study were first, that significantly higher concentrations of NGF were found in the ovaries and the adrenal glands in the rats in the PCO model than in the control rats that were only injected with the vehicle (oil or NaCl). Second, that repeated EA treatments in PCO rats resulted in concentrations of NGF in the ovaries that were significantly lower than those in non-EA-treated PCO rats but were within a normal range that did not differ from those in the untreated oil and NaCl control groups. The results in the present study provide support for the theory that EA inhibits hyperactivity in the sympathetic nervous system.

Gonadotropin- and cytokine-regulated expression of the chemokine interleukin 8 in the human preovulatory follicle of the menstrual cycle

Interleukin 8 (IL-8) is a chemotactic cytokine involved in the recruitment and activation of neutrophils as well as in cell proliferation and angiogenesis. Because these events are essential components of folliculogenesis, ovulation, and subsequent repair of the ruptured follicle, the presence and regulation of IL-8 in the human follicle of the menstrual cycle was investigated. The concentrations of IL-8 were higher in follicular fluids from dominant follicles of late follicular/ovulatory phase compared with those of midfollicular phase. IL-8 was detected in the media from cultured granulosa and theca cells, with 10-fold higher levels in the theca cell cultures. Exposure to FSH and LH increased the IL-8 secretion from granulosa cells, but no effect was seen in theca cell cultures. Estradiol and progesterone did not affect IL-8 secretion from any cell type. The cytokines IL-1alpha and IL-1beta, but not tumor necrosis factor alpha, enhanced IL-8 secretion from both cell types. IL-8 levels in cultures of granulosa-lutein cells from hyperstimulated in vitro fertilization cycles were not affected by either gonadotropins or steroids. These data provide evidence that ovarian IL-8 is gonadotropin and cytokine induced and may be involved in the hormonally regulated stages of follicular development and ovulation.

Upregulation of interleukin-8 and polarized epithelial expression of interleukin-8 receptor A in ovarian carcinomas

BACKGROUND

The chemokine interleukin-8 is present in a variety of tumor types with suggested effects on proliferation, migration, and angiogenesis. Elevated levels of interleukin-8 are present in cyst fluids from malignant ovarian tumors. The origin and potential targets for this chemokine in ovarian tumors were investigated in this study.

METHODS

Interleukin-8 and its receptors were analyzed in 26 ovarian samples, including both normal and neoplastic tissue, with immunohistochemistry, Western blotting, and in situ hybridization.

RESULTS

The mRNA for IL-8 was detected in higher amounts in the epithelial compartments compared to stromal areas, while the IL-8 protein was present in both epithelial and stromal areas, and in cystic formations of the tumors. The tissue levels of IL-8 protein increased with lower differentiation of the tumors. Both types of IL-8 receptors were detected in most specimens. A typical expression pattern for IL-8 receptor A was detected, with expression only on the luminal side of the epithelial tumor cells, while IL-8 receptor B was more evenly distributed in the tissue.

CONCLUSIONS

An increased synthesis of IL-8 during dedifferentiation of the tumor, and a typical expression pattern of the IL-8 receptor A were detected, indicating a function for IL-8 in biology of epithelial ovarian cancer.

Domestic violence during pregnancy. The prevalence of physical injuries, substance use, abortions and miscarriages

BACKGROUND

The aim of this study was to estimate the prevalence of physical injuries, alcohol and tobacco use, abortions and miscarriages due to domestic violence during pregnancy and to compare socio-economic background factors between abused and non abused women.

METHOD

Personal interview combined with a standardized questionnaire involving 207 pregnant Swedish born women married to or cohabiting with Swedish born men. The women were consecutively chosen from three different antenatal clinics in Göteborg, Sweden.

RESULTS

Overall 30 women were abused during the current pregnancy as defined from the category 'symbolic violence' in the Severity of Violence Against Women Scale (SVAW). The most frequent targets for physical abuse were: the upper arm, the forearm, and the face and neck region. Ninety-five percent of women abused during pregnancy had been abused prior to the pregnancy. Notable was the finding that 4.3% of the pregnant women had been exposed to serious violence. Abused women were significantly younger and single, had lower income and education compared to the non abused women. In the group of abused women a higher proportion of women had undergone one or more abortions than in the non-abused group. Smoking and alcohol use among partners were strongly correlated with physical and sexual abuse.

CONCLUSIONS

The results suggest that in antenatal and obstetric clinics, emphasis should be focused on previous history of abuse and a complete physical examination of the women. Since bruises often were located at hidden areas of the body, it is of importance to scrutinize those sites as part of a routine examination. It is also important to look for common defensive marks on the forearms. The partner's cigarette and alcohol use is also an important piece of information regarding risk factors connected to domestic violence.

Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome

BACKGROUND

The present study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS).

METHODS

Twenty-four women (between the ages of 24 and 40 years) with PCOS and oligo-/amenorrhea were included in this non-randomized, longitudinal, prospective study. The study period was defined as the period extending from 3 months before the first EA treatment, to 3 months after the last EA treatment (10-14 treatments), in total 8-9 months. The menstrual and ovulation patterns were confirmed by recording of vaginal bleedings and by daily registrations of the basal body temperature (BBT). Blood samples were collected within a week before the first EA, within a week after the last EA and 3 months after EA.

RESULTS

Nine women (38%) experienced a good effect. They displayed a mean of 0.66 ovulations/woman and month in the period during and after the EA period compared to a mean of 0.15 before the EA period (p=0.004). Before EA, women with a good effect had a significantly lower body-mass index (BMI) (p<0.001), waist-to-hip circumference ratio (WHR) (p=0.0058), serum testosterone concentration (p=0.0098), serum testosterone/sex hormone binding globulin (SHBG) ratio (p=0.011) and serum basal insulin concentration (p=0.0054), and a significantly higher concentration of serum SHBG (p=0.040) than did those women with no effect.

CONCLUSION

Repeated EA treatments induce regular ovulations in more than one third of the women with PCOS. The group of women with good effect had a less androgenic hormonal profile before treatment and a less pronounced metabolic disturbance compared with the group with no effect. For this selected group EA offers an alternative to pharmacological ovulation induction.

Evidence for the involvement of blood flow-related mechanisms in the ovulatory process of the rat

To elucidate whether any relationship exists between ovarian blood flow and ovulation rate, the effects on these parameters were examined in equine chorionic gonadotrophin/human chorionic gonadotrophin (eCG/HCG) (15I U/15I U) primed rats after bilateral ligation and severance of either the ovarian branch of the uterine artery and vein (UL), the ovarian artery and vein (OL) or both sites (UL+OL) in comparison to sham operations. Laser Doppler flowmetry demonstrated the presence of microcirculatory vasomotion and a reduction of blood flow after UL, OL and UL+OL performed during the intervals 0-3 h (78, 66 and 19% of pretreatment values respectively) and 6-9 h (68, 57 and 20%) after HCG. Experiments utilizing radioactive microspheres also indicated decreased ovarian blood flow by UL and OL. Ovulation rate was assessed 20 h after HCG in animals where ligations had been performed at 0, 3, 6 and 9 h after HCG. No ovulations were seen after UL+OL and significantly decreased ovulation rates ( approximately 50% of sham operated animals) were seen after UL at 0 and 3 h and after OL at 0, 6 and 9 h. Progesterone concentrations in blood 20 h after HCG were reduced by OL but not UL and ovarian weights were unaffected by ligation. It is concluded that acute blood flow reduction during the ovulatory interval reduces ovulation rate in the rat.

[Don't miss prolactinoma! On the importance of measuring prolactin and how it is done]

Prolactinoma is the most common functional pituitary tumor. Since appropriate treatment is often pharmacological rather than surgical, all patients with a tumor within or close to the sella turcica should be evaluated for prolactinoma before being sent for neurosurgery. Preanalytical factors affecting serum prolactin concentration should be taken into account when planning blood sampling. Diagnostic laboratories should aim for the use of common international calibrators and a common unitage for expressing concentrations. Assays should be carried out in such a way that the risk of falsely high or low values is minimized. Any patient with high values due to an immunometric method should be evaluated for the possible presence of endogenous antibodies against prolactin ("macroprolactinemia").

Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF

Many retrospective studies have shown that hydrosalpinx is associated with poor in-vitro fertilization (IVF) outcome. The mechanism of the actual cause is not yet fully understood. A clinical practice of performing salpingectomy before IVF has developed, without any evidence from prospective trials. The aim of the present prospective randomized trial was to test if a salpingectomy prior to IVF was effective in terms of increased pregnancy rates. Patients with hydrosalpinx were randomized to either a laparoscopic salpingectomy or no intervention before IVF. A total of 204 patients was available for an intention-to-treat analysis and 192 actually started IVF. Clinical pregnancy rates per included patient were 36.6% in the salpingectomy group and 23.9% in the non-intervention group (not significant, P = 0.067) and the ensuing delivery rates were 28.6% and 16.3% (P = 0.045). The corresponding delivery rates per transfer cycle were 29.5% versus 17. 5% (not significant, P = 0.083). A subgroup analysis revealed significant differences in favour of salpingectomy, in implantation rates in patients with bilateral hydrosalpinges (25.6% versus 12.3%, P = 0.038) and in clinical pregnancy rates (45.7% versus 22.5%, P = 0.029) and delivery rates (40.0% versus 17.5%, P = 0.038) in patients with ultrasound visible hydrosalpinges. The delivery rate was increased 3.5-fold in patients with bilateral hydrosalpinges visible on ultrasound (P = 0.019).

A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization

The aim of the present study was to evaluate the anaesthetic effect during oocyte aspiration of a paracervical block (PCB) in combination with either electro-acupuncture (EA) or intravenous alfentanil. In all, 150 women undergoing in-vitro fertilization (IVF) and embryo transfer were randomized to receive either EA plus PCB or alfentanil plus PCB. Visual analogue scales (VAS) were used to evaluate subjective experiences during oocyte aspiration, and IVF outcome parameters were recorded. No differences in pain directly related to oocyte aspiration, adequacy of anaesthesia during oocyte aspiration, abdominal pain, or degree of nausea were found between the two groups in the VAS ratings. Before oocyte aspiration, the level of stress was significantly higher in the EA group than in the alfentanil group (P < 0.05), and the EA group experienced discomfort for a significantly longer period during oocyte aspiration (P < 0. 01). Compared with the alfentanil group, the EA group had a significantly higher implantation rate (P < 0.05), pregnancy rate (P < 0.05), and take home baby rate (P < 0.05) per embryo transfer. In conclusion, EA has been shown to be as good an anaesthetic method as alfentanil during oocyte aspiration, and we suggest that EA may be a good alternative to conventional anaesthesia during oocyte aspiration.

The invisible wounds: the occurrence of psychological abuse and anxiety compared with previous experience of physical abuse during the childbearing year

The aim of this study was to measure the prevalence, effects and character of psychological abuse in women visiting antenatal clinics. A standardized questionnaire based on four different established scales (PMWI, SVAW, TSC-33, and STAI) was used to estimate the frequency of psychological, physical and sexual abuse, anxiety and depression. In the study 207 pregnant Swedish born women married to or cohabiting with Swedish born men were consecutively chosen from three different antenatal clinics from the city of Göteborg, Sweden. Personal interviews were conducted in connection to their regular visit to the antenatal clinic, ranging from the first to the third trimester. Fifty-one (24.5%) women out of 207 reported threats and/or acts of violence during the last year according to the Severity of Violence Against Women Scale (SVAW). There was 89.4% who had experienced dominance/isolation according to the Psychological Maltreatment of Women Inventory (PMWI) and 44.4% of the women reported emotional/verbal abuse. Occupational status, but not age income or education, was found to be significantly correlated to physical violence, dominance/isolation and to emotional/verbal factor according to Psychological Maltreatment of Women Inventory (PMWI). Threats of moderate violence' and 'serious violence' were strongly correlated to physical violence (correlation coefficient 0.9433 and 0.9405, respectively). Sexual abuse demonstrated a high correlation to physical violence and emotional/verbal factor. The results indicate that sexual violence is highly represented in the abusive relationship and also that depression and anxiety in the childbearing year may be caused by domestic violence. This study emphasises the importance of incorporating screening for threats and actual acts of psychological, physical and sexual abuse into routine care for women, enabling health care providers to identify high-risk patients and improve quality of care.

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples

BACKGROUND

To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy.

METHODS

Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of Göteborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy.

RESULTS

Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence.

CONCLUSIONS

This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.

The expression of CCAAT/enhancer binding protein (C/EBP) in the human ovary in vivo: specific increase in C/EBPbeta during epithelial tumour progression

The CCAAT/enhancer binding protein (C/EBP) family of transcription factors is involved in metabolism and differentiation of cells, especially in rodent liver cells and adipocytes. Their roles in vivo and in particular during pathophysiological conditions in humans are largely unknown. We have investigated the presence of C/EBPalpha, -beta, -delta and -zeta in normal ovaries and in epithelial ovarian tumours of different stages. Immunohistochemical experiments demonstrated that C/EBPalpha and C/EBPbeta were preferentially expressed in epithelial/tumour cells irrespective of stage or grade of the tumour. C/EBPbeta was located in the nuclei of the cells, in contrast to C/EBPalpha, which was present only in the cytoplasm of these cells. The nuclear localization of C/EBPbeta indicates an active role of this transcription factor in tumour cells, whereas the cytoplasmic distribution suggests a more passive function of C/EBPalpha. C/EBPdelta and -zeta demonstrated a more diverse distribution with predominant localization to epithelial cells, but stromal distribution was also noted. The intracellular distribution was confined to both the nucleus and the cytoplasm for C/EBPdelta and -zeta. Western blotting demonstrated that C/EBPalpha, -beta, -delta and -zeta were present in a majority of the samples. The amount of C/EBPbeta increased markedly with malignancy, i.e. with degree of dedifferentiation, while the other members of the C/EBP family displayed a more constant expression level. These results demonstrate an association between the expression of members of the C/EBP family and the formation of epithelial ovarian tumours, with C/EBPbeta as a potential marker for these tumours. As C/EBPbeta is known to be expressed during proliferation of cells in vitro, it may participate in the proliferative process of ovarian epithelial tumour cells in vivo and play a central role in tumour progression.

The chemotactic cytokine interleukin-8--a cyst fluid marker for malignant epithelial ovarian cancer?

Due to the difficulties in separating malignant and benign ovarian cysts by transvaginal ultrasound and other techniques, there is a need for biochemical markers in serum or cyst fluids. In the present study we have evaluated the levels of the chemokine interleukin-8 (IL-8) in ovarian cysts. IL-8 is known to be expressed in the normal ovary and to influence proliferation and angiogenesis of several nonovarian types of tumors. Cyst fluids from benign (n = 15) and malignant (n = 13) ovarian tumors were analyzed. The levels of IL-8 were found to be significantly (13-fold) higher in cyst fluids from malignant tumors (18.1 +/- 7.5 ng/ml; mean +/- SE) compared to benign cysts (1.3 +/- 0.7 ng/ml). The plasma levels of IL-8 were considerably lower (2.9 and 0.3% of levels in benign and malignant cyst fluids, respectively) than in cyst fluids. No difference in the plasma levels of patients with benign or malignant tumor could be detected. In contrast, the levels of CA 125 were significantly higher in plasma of patients with malignant disease with the inverse relation in cyst fluids. In conclusion, the levels of IL-8 are markedly elevated in cyst fluid from malignant tumors compared to benign. This specific increase indicates a role for this cytokine in ovarian tumor biology.

Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome

Thirty-two women with polycystic ovary syndrome (PCOS) were allocated to two antiandrogen treatment regimens; 28 women completed the trial. Twenty women were treated with ethinyloestradiol and cyproterone acetate (EO-CA) cyclically for 6 months and eight women were treated with the gonadotrophin releasing hormone (GnRH) analogue, goserelin for 6 months. Effects on hirsutism, insulin sensitivity (estimated by glucose clamp technique), blood lipids and hormones were measured. Women treated with EO-CA showed a reduction in hirsutism (P <0.05), and decreased serum androgen concentrations (P <0.001) as well as reduced insulin sensitivity (P <0.05). In women treated with goserelin, serum androgen concentrations also decreased (P <0.001), but there was no significant reduction of hirsutism. This group, however, showed an improved insulin sensitivity (P <0.05) despite an unchanged body mass index. Bone mineral density was unaltered in both treatment groups. The reduction in androgen concentrations caused by EO-CA was not paralleled by increased insulin sensitivity, most probably due to the effect of ethinyloestradiol per se. In contrast, the reduction in androgen concentrations by goserelin was accompanied by an improved insulin sensitivity.

Follitropin (FSH) deficiency in an infertile male due to FSHbeta gene mutation. A syndrome of normal puberty and virilization but underdeveloped testicles with azoospermia, low FSH but high lutropin and normal serum testosterone concentrations

We studied a man who sought medical attention at age 28 years because of infertility in both his first and second marriages. His sexual development appeared to have been normal, with normal puberty and virilization, and normal libido and sexual potency. At examination, his testicles were small and soft; otherwise he had a normal physical appearance. Evaluations revealed azoospermia, undetectable in serum before and after 100 microg of intravenously administered gonadotrophin releasing hormone, but moderately elevated lutropin concentration with a brisk rise after gonadotrophin releasing hormone. The alpha subunit concentration was normal before and after gonadotrophin releasing hormone; that of inhibin B was very low. Analysis of the follitropin beta gene, exon 3, revealed a Cys82 --> Arg mutation (TGT --> CGT). Judging from studies of the biosynthesis of the chorionic gonadotrophin beta subunit one may conclude that inability to form the first intramolecular disulphide bond in the follitropin beta subunit results in an abnormal tertiary structure during follitropin beta biosynthesis with extensive intracellular degradation of the products, inability to associate with the alpha subunit and defective glycosylation, as well as inability to form a biologically active hormone. This first male case of follitropin deficiency thus defines a new syndrome of male infertility.

Acute effects of a transdermal nitric oxide donor on perifollicular and intrauterine blood flow

BACKGROUND

Nitric oxide is a potent vasodilator and is involved in several physiological events during the female reproductive cycle.

OBJECTIVE

The aim of this study was to determine the acute effects of a nitric oxide donor on ultrasound-derived indices of blood flow in the intact human uterus and ovaries during the follicular phase of the normal menstrual cycle.

STUDY DESIGN

The plan was to perform an observational study of six healthy volunteers, recruited during days 9-12 from day 1 of the last menstruation. Subjects were scanned transvaginally, with B-mode and color Doppler imaging around 12.00, and 2 h after the application of a transdermal glyceryl trinitrate (GTN) patch 10 mg/24 h. The patch was then removed and the subjects were rescanned 2 h later. END-POINTS: The main outcome measures were the peak systolic velocity (PSV), time-averaged maximum velocity (TAMV) and the pulsatility index (PI) derived from flow velocity waveforms, in the left and right main uterine arteries, a radial artery and subendometrial vessels, and from vessels at the rim of the dominant ovarian follicle.

RESULTS

One woman was scanned on day 9, two on day 10 and three on day 12 of the cycle. The median pretreatment values for endometrial thickness and follicular volumes were 7.2 mm (range 6.0-10.0 mm) and 3.1 ml (range 0.3-6.8 ml), respectively. GTN induced a significant (p < 0.05) increase in the PSV and TAMV in the subendometrial vessels in all subjects. There was a corresponding decrease in the PI in four cases. Changes in blood flow were reversible (50% of the changes in PSV, TAMV and PI were essentially reversed 2 h after the patch had been removed). In the uterine arteries, PSV and TAMV were significantly (p < 0.01) and progressively decreased with a concomitant significant (p < 0.01) increase in PI. There was also a tendency for the mean PI to decrease progressively in the vessels at the rim of the dominant follicle with decreased post-treatment values in four out of six subjects.

CONCLUSIONS

GTN induces a reversible increase in subendometrial blood flow velocity during days 9-12 of the menstrual cycle. The expected circadian decrease in uterine artery blood flow seemed to be partly interrupted by GTN treatment.

IMPLICATIONS

These data justify the implementation of randomized controlled studies to determine the potential beneficial effects of transdermal GTN on ovarian and uterine blood flow and function.

Attitudes of different groups of women in Sweden to oocyte donation and oocyte research

OBJECTIVES

To evaluate attitudes of Swedish women towards oocyte donation and oocyte research.

METHODS

Five different groups of women, with approximately 50 patients in each, were asked anonymously about their attitudes to legislation, tentative roles as donors or recipients, anonymity, suitable donors or recipients, research on fetuses and cadavers as a source of oocytes, age limits and economic aspects. The groups were: 1. Women undergoing IVF treatment (IVF). 2. Infertile women during work-up (INF). 3. Recently delivered women attending a maternity unit (MAT). 4. Women attending a family planning center applying for therapeutic abortion (FPC). 5. Women with Turner's syndrome (TUR).

RESULTS

More than 90% of women in all groups investigated advocated amendment of the law in order to permit oocyte donation. The women of infertile groups were more in favor of donating oocytes compared to women of fertile groups (p<0.05). A great majority would prefer anonymity both if they were donors and if they were recipients. If no anonymity was guaranteed, the acceptance of both the donor and recipient groups decreased but more than half of the women in all groups would still donate/accept oocytes. There was a significant difference in attitude towards non-anonymous oocyte donation, with the highest acceptance among Turner patients and the lowest among IVF patients (p<0.01). A majority in all groups were more motivated to donate/accept oocytes from a close relative, with the exception of Turner patients (p<0.01). All groups had a negative attitude to the use of donated fetuses and cadavers as sources of oocytes. IVF patients, close relatives and volunteers were all regarded as suitable donors by a majority of women in all groups. Women of fertile age, with ovarian failure or a genetic disorder, were accepted as recipients by all groups. Postmenopausal women were not accepted as recipients by a great majority in all groups. All groups preferred an age limit for recipients. More than 70% set the limit to the interval 40 to 45 years of age. A majority in all groups believed that donors should be paid to cover medication and loss of income. The recipients were expected, by a majority of women, to pay for some of the costs of the oocyte donation program.

CONCLUSIONS

A great majority wanted a change in the Swedish legislation to permit oocyte donation. All groups had a generous attitude to donation of oocytes although anonymity would be preferred. Ovarian dysfunction and genetic disorders among women of fertile age were regarded as major indications for oocyte donation. IVF patients, close relatives and volunteers were all regarded as acceptable donors.

Transarterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature

BACKGROUND

Therapeutic embolization of the uterine arteries has been successfully used to manage profuse gynecological hemorrhage. In the present study we aimed to investigate whether embolization of uterine arteries may serve as a safe and effective alternative treatment in cases of menorrhagia in fertile and perimenopausal women. As a first step, we have evaluated the methodology, patient reactions and effects on the uterine vasculature.

METHODS

The distal part of the uterine artery was embolized with polyvinyl alcohol particles via catheterization of the right femoral artery. Total abdominal hysterectomy was performed the next day.

RESULTS

Bilateral embolization in two patients resulted in considerable pain that required morphine analgesic medication and epidural analgesia. One patient was embolized unilaterally and experienced only slight discomfort with no need for analgesic medication at all, indicating that unilateral embolization is a well-tolerated method. After embolization, angiography showed stagnant flow in embolized vessels without contrast filling of distal branches. Angiography of the specimen showed normal vascular architecture in non-treated vessels. In treated vessels the main arterial trunks were patent but all smaller branches were occluded. Histology showed that most of the particles lodged in small arteries and that arterioles never showed injected material.

CONCLUSION

The study indicates that the procedure involves an efficient occlusion of uterine vessels and that unilateral embolization of uterine arteries is well tolerated.

Results of gonadotrophin stimulation with the option to convert cycles to in vitro fertilization in cases of multifollicular development

BACKGROUND

To avoid a high cancellation rate and/or a high multiple pregnancy rate due to multifollicular development in gonadotrophin stimulated cycles, such cycles were converted in the same cycle to in vitro fertilization/embryo transfer (IVF/ET). The results from a four year period using this strategy are summarized.

PATIENTS AND METHODS

Seventy-three anovulatory women (seven WHO group I, 66 WHO group II) were studied during this period. In a majority of the cycles a GnRH-analogue was used for down-regulation according to a long protocol, followed by stimulation with FSH and/or hMG.

RESULTS

Out of 154 WHO group II gonadotrophin stimulation cycles intended for ovulation induction, 25 cycles were converted to IVF. The pregnancy and delivery rates in the IVF-converted cycles were 50% and 41%, respectively, and 31% and 22% when gonadotrophin stimulation was followed by intercourse. The cancellation rate, including both ovulation induction and IVF cycles, was 15% and the multiple pregnancy rate was 30%, mainly twins. Lean women achieved better outcome than obese women. In WHO group I only 12 cycles were performed. One cycle was converted to IVF resulting in delivery and one cycle was cancelled. The pregnancy- and delivery rates were both 50% when gonadotrophin stimulation was followed by intercourse.

CONCLUSION

It is concluded that the option to convert a gonadotrophin stimulation cycle to IVF in the same cycle, in cases of multifollicular development, seemed to be a good alternative. The conversion results in a low cancellation rate and a low incidence of high order multiple pregnancies. Patients should be informed of this opportunity before entering ovulation stimulation.

Global importance of infertility and its treatment: role of fertility technologies

Understanding the reasons for infertility and the development of new techniques for its treatment is one of the fields within medicine which has undergone a dramatic development during the last two decades. In the past, gynecologists seemed more successful in the treatment of female problems than urologists and andrologists on the male side, while in the last couple of years this scenario has changed due to the development of both operative procedures to harvest spermatozoa from the epididymis and the testis and the ability to micro-inject single spermatozoa (ICSI) or even spermatides directly into metaphase II oocytes. It should, however, be emphasized that the successful development of in vitro fertilization (IVF) and other assisted reproduction technologies (ART), could not have taken place without the development of diagnostic innovations, such as immunoassays of hormones, high resolution ultrasound and various endoscopic techniques. Today, treatment of the infertile couple is less of a medico-technical problem and more a socio-economic dilemma. This communication is an attempt to summarize the more prominent steps in reproductive medicine during the last decades and one more general conclusion of global relevance which can be drawn, is that less money must be spent on diagnosis and more resources transferred to treatment options.

E-cadherin expression in human epithelial ovarian cancer and normal ovary

The ovarian surface epithelium (OSE) is the origin of the majority of human ovarian cancers. These adenocarcinomas are characterized by initial local growth followed by spreading into the peritoneal cavity at later stages of tumor progression. The cell-adhesion molecule E-cadherin (E-cad) plays an important role in maintaining tissue integrity. Disappearance or impaired function of E-cad have often been associated with tumor formation and invasion in vivo and in vitro. The cell-specific expression of E-cad was investigated in normal human ovaries (n = 12), in benign (n = 5) and borderline (n = 4) ovarian epithelial tumors and in adenocarcinomas of different stages and histological grades (n = 18), by immunohistochemistry and immunoblotting. An ovarian cancer cell line (NIH-OVCAR3) was used as a reference. The epithelial origin of the cells was confirmed with cytokeratin (AE1/AE3) staining. In normal ovaries, the expression of E-cad was limited to inclusion cysts or deep clefts lined with OSE, whereas no staining of the OSE could be demonstrated at the surface of the ovary. In contrast, benign and borderline tumors uniformly expressed E-cad. This was observed in malignant tumors of all stages despite their degree of differentiation. E-cad was also present in metastasis from such tumors. The cell-specific expression of E-cad in inclusion cysts of normal ovaries and in epithelial layers of borderline tumors indicates a role for E-cad in the early events of the progression to a malignant phenotype. E-cad was not downregulated in later stages of ovarian cancer progression.

Steroid release from two human epithelial ovarian tumors: evidence for an intrinsic production in vitro

Tissue specimens from the primary tumor and metastasis (histological examination: cystadenocarcinoma) of two postmenopausal women were cut into pieces and were incubated or superfused for 3- to 4-hr periods. The incubation and superfusion procedures were performed in the absence and presence of human chorionic gonadotropin (hCG, 10 IU/ml). After incubation, the medium concentrations of progesterone (P), testosterone (T), androstendione, and 17beta-estradiol (E2) were determined by radioimmunoassay, while after superfusion the medium concentrations of cyclic AMP (cAMP), P, T, and E2 were analyzed. HCG stimulated the production of cAMP in the superfused tissue of the first case and in the second case the addition of hCG to the incubation medium caused a significant drop in testosterone release by the primary tumor and in androstendione release by the metastasis. These results suggest that tissues from primary tumor and metastasis were capable of releasing steroids into the media, supporting the contention that tissue from epithelial ovarian cancers can produce and/or release steroids in its own right.

The human preovulatory follicle is a source of the chemotactic cytokine interleukin-8

Mammalian ovulation has several similarities to local inflammatory reactions, involving participation of leukocytes and inflammatory mediators. In response to a preovulatory luteinizing hormone surge, there is an influx of leukocytes into the preovulatory follicle and uncharacterized chemotactic activity towards these cells has previously been reported in follicular fluid of several species, including the human. In the present study, we have investigated the presence and local production of interleukin-8 (IL-8), a potent leukocyte-chemotactic and neutrophil-activating cytokine, in the human preovulatory follicle. Immunoreactive IL-8 was present in the follicular fluid in all of 12 in-vitro fertilization (IVF) patients investigated. IL-8 concentrations in follicular fluid (1269 +/- 245 pg/ml) were approximately 30-fold higher than in plasma (41 +/- 14 pg/ml). Isolated granulosa cells in culture secreted large amounts of IL-8 protein. Basal secretion of IL-8 was dose-dependently enhanced by the presence of fetal calf serum and was further stimulated by the addition of the ovulation-associated cytokine IL-1 beta. Messenger RNA for IL-8 was detected by reverse transcription/polymerase chain reaction (RT-PCR) in all tested samples of granulosa cells of IVF patients (n = 8) and in all biopsies from preovulatory follicle walls obtained in natural cycles (n = 6). This is the first demonstration of IL-8 in the mammalian ovary. Local production, combined with high follicular fluid concentrations, suggests that this cytokine plays a role in cyclic ovarian events, such as ovulation.

Background factors and scoring systems in relation to pregnancy outcome after fertility surgery

BACKGROUND

A study was initiated to identify background factors, clinical features and pre-operative scoring systems of importance for future selection of patients suitable for fertility surgery.

METHODS

Surgical procedures, background factors and scoring systems for tubal lesions and adnexal adhesions and risk factors for ectopic pregnancy were analyzed with respect to possible correlation to subsequent fertility in a retrospective study of 246 patients undergoing fertility surgery (adhesiolysis, salpingostomy, tubal anastomoses, implantation and myomectomy) between 1986 and 1990. Follow-up periods varied between one to six years.

RESULTS

In 94% of cases a second look laparoscopy was performed. Adhesiolysis was done in 62%. The conception rate was 41.1%, the ectopic pregnancy rate was 14.6% and the delivery rate was 22.0%. Myomectomy procedures were most successful, with a delivery rate of 44.0% and no ectopic pregnancy. Previous ectopic pregnancy indicated a higher risk for recurrence, as did a high risk score for ectopic pregnancy. The extent of tubal damage was most relevant to subsequent fertility. Salpingostomies in women with mild or moderate tubal damage resulted in a delivery rate of 25.4% compared with those with severe damage (5.6%). No deliveries were seen after lysis of extensive adnexal adhesions.

CONCLUSION

Adhesion formation is not negligible and a second look laparoscopy is recommended. Women with fibroids should always be considered for fertility surgery, not only because of high success rates, but also as an adjuvant to subsequent in vitro fertilization. Patients with previous ectopic pregnancy, extensive adhesions and unfavorable tubal scores should not be considered for surgery but referred for in vitro fertilization.

In vitro production of cyclic AMP and steroids from an ovarian Sertoli-Leydig cell tumor. Notes on clinical management

A 27 year old nulliparous woman with a history of chronic anovulation and signs of virilization with a markedly elevated serum level of testosterone, underwent a laparotomy with peroperative bilateral ovarian vein catheterization and bilateral bisection of both ovaries. A solid, 1.5 cm, well delimited tumor located centrally in the right ovary, was excised. Testosterone levels in ovarian venous blood from the tumor bearing side, were 88.4 nmol/l and from the contralateral ovary 3.9 nmol/l. Histopathological examination showed a Sertoli-Leydig cell tumor which was radically extirpated. Postoperatively, the serum levels of androgen normalized, the woman had regular cycles, became pregnant and delivered a normal female baby. Pieces of tumor tissue were incubated for 2 h, with and without addition of gonadotropins and adrenocorticotropic hormone (ACTH). Human chorionic gonadotropin (CG), follicle stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH) caused significant increases in cyclic monophosphate (cAMP) production in tumor tissue in vitro, as compared to controls. Furthermore, ACTH also significantly stimulated 17 beta-estradiol production. In tumor cells cultured for 48 h, FSH slightly, but not significantly, increased the production of progesterone. In the cell culture, [3H]-thymidine incorporation into deoxyribonucleic acid (DNA) was stimulated by IGF1 alpha but not by hCG and FSH. It is concluded that Sertoli-Leydig cell tumors may be sensitive to gonadotropins and ACTH and that their small size, solid shape and intra-ovarian localization can cause diagnostic difficulties.

Parity, age at first childbirth, and risk of ovarian cancer

Increasing parity is associated with a reduction in the risk of ovarian cancer, but it is not clear whether this association applies to different histopathological types and to borderline tumours. Moreover, the temporal relations are poorly understood, and the possible role of age at first birth remains unequivocal. We have investigated these issues in a case-control study nested in a nationwide cohort of women born between 1925 and 1960 in Sweden. During follow-up until 1984, 3486 invasive ovarian cancers (2992 epithelial, 330 stromal, 149 germ-cell, 15 not classifiable) and 510 tumours of borderline malignant potential were diagnosed. 5 individually age-matched controls (total 19,980) were selected for each case woman. After simultaneous adjustment for parity and age at first birth, increasing parity was associated with a pronounced consistent decrease in relative risk of all invasive cancers (odds ratio for each additional birth 0.81 [95% Cl 0.77-0.85]), epithelial cancer (0.81 [0.77-0.86]), stromal cancer (0.84 [0.72-0.98]), and germ-cell cancer (0.71 [0.48-1.05]), but a less consistent decrease for borderline tumours (0.92 [0.81-1.04]). The risk of ovarian cancer decreased by about 10% for each 5-year increment in age at first childbirth (odds ratios 0.89 [0.84-0.94] epithelial cancer, 0.92 [0.77-1.10] stromal cancer, 0.92 [0.65-1.32] germ-cell cancer, 0.93 [0.80-1.09] borderline tumours). Because our findings cannot be readily explained by theories involving incessant ovulation or high serum concentrations of gonadotropins, new aetiological hypotheses are needed. Pregnancy-dependent clearance from the ovaries of cells that have undergone malignant transformation could explain the reproductive risk factors for ovarian cancer.

Hemostatic and metabolic variables in women with polycystic ovary syndrome

OBJECTIVE

To study whether a previously demonstrated increased morbidity in cardiovascular disease (CVD) and diabetes mellitus in women with polycystic ovary syndrome (PCOS) is associated with certain hemostatic variables that are known to be markers for CVD.

DESIGN

The study was a trans-sectional follow-up study from a cohort of women with PCOS.

SETTING

The women with PCOS were recruited from hospital clinics and referents were randomized from a population study of women from the same area.

PARTICIPANTS

The investigation involved 28 women aged 43 to 62 years diagnosed to have PCOS on ovarian histopathology at wedge resection 25 to 34 years previously and 56 referents who were matched by age and body mass index.

MAIN OUTCOME MEASURES

In connection with a clinical investigation, the hemostatic variables fibrinogen, von Willebrand factor antigen, factor VII procoagulant activity, factor VII antigen, and plasminogen activator inhibitor as well as the metabolic variables serum insulin and serum triglycerides were assayed.

RESULTS

There was a strong positive correlation between serum concentrations of triglyceride, basal insulin, and abdominal obesity on the one hand, and plasminogen activator inhibitor, fibrinogen, and von Willebrand factor on the other, among women with PCOS as well as among referents. There were significantly higher mean concentrations of fibrinogen and factor VII:Ag among referents, but the mean values of most hemostatic variables studied showed no differences between the groups.

CONCLUSION

Women with an altered metabolic profile were also found to have affected hemostatic factors, but PCOS in itself did not seem to influence them.

Toxicity testing using the isolated in vitro perfused ovary

This article discusses the use of in vitro perfusion techniques as a tool for toxicity testing in the ovary and how the rat ovary has been adapted for this purpose. A brief review of the development of in vitro ovarian perfusion is provided, focusing on steroidogenesis and physiology of ovulation. Adaptation of this model for use as a toxicologic model is discussed in the context of other isolated organ models, (that is, liver, heart, lung). Surgical procedures, perfusate and criteria for viability are outlined. Advantages of this technique are highlighted including ability to administer high doses of drugs directly to intact organ devoid of other influences. Applications of this model are discussed and data from studies of glutathione depleted ovaries perfused with hexachlorobenzene (HCB) are presented. Increased oxygen consumption after addition of HCB is suggestive of a disordered respiratory metabolism and is an example of future markers of ovarian injury using this innovative technique.