Perioperative androstenedione kinetics in women undergoing laparoscopic ovarian drilling: a prospective study

We evaluated perioperative androstenedione levels in laparoscopic ovarian drilling (LOD) for polycystic ovary syndrome (PCOS) and whether an intraoperative androstenedione change was predictive for spontaneous ovulation. In a prospective study, 21 anovulatory women with clomiphene citrate-resistant PCOS who underwent LOD and eight female controls who underwent diagnostic laparoscopy for infertility were included. Perioperatively, blood was drawn one day before surgery, directly before skin incision, ten minutes after surgery, and after two days. Within three months, spontaneous ovulation occurred in 15 women (71.4 %). For both the PCOS and the control group, an androstenedione increase was found from one day before surgery to skin incision (p < 0.05). In PCOS women, there was an intraoperative androstenedione decrease (median 3.5, IQR 2.2-4.8 vs. median 2.6, IQR 1.4-2.6 ng/ml, p = 0.002). In multivariate analysis, only higher preoperative androstenedione (odds ratio, OR 6.53) and luteinizing hormone levels (OR 7.31), as well as secondary infertility (OR 5.40), were associated with higher rates of postoperative spontaneous ovulation (p < 0.001). Androstendione declines significantly during LOD. However, intraoperative kinetics are not useful for the prediction of spontaneous ovulation after LOD, in contrast to preoperative androstenedione and LH levels, as well as a history of previous pregnancies.

Pharmacokinetics and safety profile of a novel progesterone aqueous formulation administered by the s.c. route

A novel aqueous progesterone formulation was developed. Study I: Three-way cross-over, open-label study in 24 post-menopausal women. Comparison of the pharmacokinetic profiles of a single 100 mg dose of test product administered by subcutaneous (s.c.) and intramuscular (i.m.) injection and an i.m. reference oily product. Study II: Three-way cross-over open-label study of 25, 50 and 100 mg s.c. single doses of the aqueous formulation in 12 post-menopausal women. Study III: Parallel-group, observer-blinded study in 25 fertile women administered multiple s.c. 25 and 50 mg doses of the aqueous formulation once daily for 11 days. Baseline-corrected pharmacokinetic parameters were evaluated. Aqueous formulation (100 mg) was promptly absorbed, achieving progesterone peak serum levels at an earlier time than the reference (1 h vs. 7 h; p < 0.0001). Test and reference were bioequivalent in the extent of exposure: confidence intervals for AUC(0-t) geometric means ratios were within the pre-specified 80-125% limits. Pharmacokinetics was linear over the range of doses studied. Steady state was reached within 4 days of multiple dose treatment. All treatments were well tolerated. Considering the advantages given by the possibility of self-medication, the s.c. aqueous formulation could offer a convenient alternative for patients on assisted reproductive technology treatments.

The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study

OBJECTIVE

To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol.

DESIGN

Prospective randomized controlled trial.

SETTING

University-based tertiary fertility center.

PATIENT(S)

Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF.

INTERVENTION(S)

Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E(2) patches and their doses were adjusted according to the serum levels.

MAIN OUTCOME MEASURE(S)

Incidence of OHSS and implantation rate.

RESULT(S)

None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively.

CONCLUSION(S)

The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate.

Serum cetrorelix concentrations do not affect clinical pregnancy outcome in assisted reproduction

OBJECTIVE

To analyze the potential association between serum cetrorelix levels and clinical pregnancy outcome in patients who had undergone assisted reproduction cycles with a GnRH antagonist cetrorelix acetate 3-mg injection.

DESIGN

Retrospective case-control study.

SETTING

University-affiliated private-assisted reproduction center.

PATIENT(S)

130 IVF and intracytoplasmic sperm injection first cycles, treated with the same cetrorelix acetate protocol, in two matched groups according to whether the cycle resulted in clinical pregnancy (n = 56) or not (n = 74).

INTERVENTION(S)

Cetrorelix acetate administration at 3 mg in a sandwich protocol.

MAIN OUTCOME MEASURE(S)

Serum cetrorelix concentrations on the day of hCG administration with regard to clinical pregnancy outcome, pre- versus post-hCG percent change in serum E(2) levels and implantation rates.

RESULT(S)

The cetrorelix serum concentrations were in the range of 0.29 to 5.12 ng/mL. The comparisons between groups with and without clinical pregnancy revealed comparable serum cetrorelix levels. There was no significant correlation between the serum cetrorelix concentrations and percent change in pre- versus post-hCG serum E(2) levels. Serum cetrorelix levels were comparable among patients with various implantation rates.

CONCLUSION(S)

Although a wide range of serum cetrorelix levels could be detected during a GnRH antagonist cycle, these levels were comparable in patients with and without clinical pregnancies.

[Changes in carbohydrate metabolism of PCOS patients in cycle stimulated by rFSH]

24 patients with clomiphene citrate-resistant PCOS were enrolled in the study. We used low-dose step up protocol of recombinant FSH administration. Ovulation induction by rFSH injection was commenced on 3 day of cycle, at a dose of 50 IU for 7 days initially. The dose was continued at 50 IU, and ultrasonographic scans were performed daily until a dominant follicle had developed to a size of at least 18-20 mm, at which point 5,000 IU of hCG was administrated. If no response was noted after 7 days, the dose was increased by 50 IU for a further 7 days. Insulin and glucose serum levels were determined 7 times: in days 3, 5, 8 of a cycle and later when diameter of ovarian follicle was 10, 12, 16 mm and in the day of hCG injection. Estradiol serum level was determined in 8 day of cycle and when diameter of ovarian follicle was 10, 12, 16 mm and in the day of hCG injection. BMI and WHR was determined in the day of admission to hospital.

RESULTS

The correlation between mean insulin level in the examined cycle and BMI and as well as the correlation between mean insulin level and WHR were determined. Mean level of serum glucose increased as the level of estradiol raised. No influence of growth level on insulin level was detected.

Evaluation of synchronization of oestrus based on gonadotrophin-releasing hormone and its potential use for fixed-time breeding in Tuli beef cows

The objective of the experiment was to compare the reproductive post-partum performance of beef cows synchronized for oestrus using prostaglandin F2alpha (PGF2alpha) alone or with a gonadotrophin-releasing hormone (GnRH)-based drug. Fifty-five post-partum lactating Tuli cows were randomly allocated to three groups. Two groups were synchronized using either two injections of PGF2alpha (500 microg Prosolvin per injection) given 11 days apart (group 1), or GnRH (12.5 microg Receptal per injection) followed 6 days later by an injection of 500 microg PGF2alpha (group 2). The cows were bred by artificial insemination 12 h after they were observed in oestrus. Group 3 was synchronized as for group 2, but a second injection of GnRH was given 54 h after the PGF2alpha injection, at which time the cows were bred by artificial insemination (AI) without detection of oestrus. Blood samples were taken from the cows in group 3 and analysed for progesterone concentration to establish which cows were cycling and in oestrus before and at the time of breeding. Detection of oestrus and breeding by AI was done over 60 days. There were no significant differences (p>0.05) among the three groups in the first service and total conception rates. The percentage of cows in oestrus within 10 days of the synchronization treatment was not significantly different (p>0.05) between groups 1 and 2. The progesterone concentrations in the cows in group 3 showed that only those that were cycling at the start of the experiment responded to the synchronization treatment and conceived after fixed-time breeding. These results suggest that combinations of PGF2alpha and GnRH may be of value in synchronizing oestrus and controlling breeding in Tuli cows. However, the benefit might be greater if only cows that are known to be cycling are bred in this way.

Hypogonadism following prostate-bed radiation therapy for prostate carcinoma

BACKGROUND

The degree of testicular damage resulting from primary treatment of prostate carcinoma by external beam radiation therapy (EBRT) to the prostate bed has not been determined. If significant testicular damage has occurred, the resulting endocrine changes may result in modified tumor behavior, contribute to postradiation impotence, and may aggravate other signs and symptoms of hypogonadism, potentially influencing a patient's choice of primary treatment for his tumor.

METHOD

Three to eight years after primary treatment for localized prostate carcinoma, serologic evaluation for hypogonadism was undertaken in 33 men who had received EBRT and in 55 similar men who had received radical prostatectomy (RP). No subjects had developed recognized tumor recurrence, and none had undergone hormonal treatment since primary therapy.

RESULTS

Among men of similar age, prior treatment with EBRT was associated with significantly more frequent hypogonadism than prior treatment with RP. In men with EBRT, total testosterone levels averaged 27.3% less, free testosterone levels 31.6% less, dihydrotestosterone levels 33.4% less, luteinizing hormone (LH) levels 52.7% greater, and follicle-stimulating hormone (FSH) levels 100% greater than those values in men who had prior treatment with RP. Differences between postradiation and postsurgical men in LH and FSH levels were most prominent in men older than 70 years.

CONCLUSIONS

Three to eight years after primary treatment for prostate carcinoma, striking hormone differences were present between men who had received EBRT to the prostate bed and those with prior RP. These differences strongly suggested that prominent and permanent testicular damage was sustained during EBRT, frequently severe enough to cause hypogonadism.

Effect of continuous infusion of a GnRH agonist (Buserelin) on ovarian hormone secretion and estrous cycle length in cows

The importance of the ovarian steroid hormones estradiol and progesterone in the control of luteolysis in domestic ruminants is well established. However, there is a lack of studies specifically investigating the effect of stimulating "physiological" changes in endogenous estradiol or progesterone secretion on subsequent luteolysis. In this study we have stimulated endogenous ovarian hormone secretion by infusion of the GnRH analogue, Buserelin, and have assessed the effect of these changes on the timing of luteolysis. Concentrations of estradiol and progesterone were monitored in plasma samples collected from 6 mature, cyclic, lactating, Friesian cows during a control cycle and during a cycle in which Buserelin was infused via osmotic minipump (8.6 microg/h) for 28 days starting on Day 2 of the cycle. Buserelin infusion had little effect on progesterone secretion but did result in a marked stimulation of estradiol secretion from Days 6 to 10 of the cycle (treated cycle 4.3+/-0.2 pg/mL; control cycle 1.8+/-0.3 pg/mL; P<0.001). In addition, there was a significant advancement in the timing of luteolysis during the Buserelin -infused cycle (Day 19.3+/-0.3 compared with Day 21.3+/-0.4; P<0.01). In this study, we have found that infusion of buserelin caused both a significant stimulation of estradiol secretion from the first follicle and a significant advancement in the timing of luteolysis. We hypothesise that the increased secretion of estradiol may have been involved in causing this advancement of luteolysis.

A comparison of the effects of progesterone sponges and ear implants, PGF2alpha, and their combination on efficacy of estrus synchronization and fertility of Mashona goat does

Efficacy of estrus synchronization and fertility after synchronization of 60 multiparous Mashona goat does using intravaginal progesterone (P4) sponges (Group 1), norgestomet ear implants (Group 2), cloprostenol (Group 3), or a combination of P4 sponges and cloprostenol (Group 4) was compared with untreated does (Group 5). At the end of treatments, all does were mated to intact fertile bucks for 21 d. The number of does bred within 11 to 96 h was significantly higher (P < 0.05) in the treated groups than the untreated control, with rates of 80, 80, 64, 67 and 30% for Groups 1 to 5, respectively. There were no differences (P > 0.05) among treated does. Kidding rates ranged from 64 to 83% but were not different (P > 0.05) between groups. Prolificacy and overall fecundity were similar (P > 0.05) among the groups. The results indicate that all 4 treatment methods were effective in synchronizing estrus and that none of the methods affected overall fertility of the does.