1/13. biliary atresia with hyperandrogenic amenorrhea.The etiology of hyperandrogenic amenorrhea in a patient with biliary atresia successfully treated by a Kasai operation was unclear. Delayed puberty and menarche were evident at 16 years of age. Investigations showed no luteinizing hormone (LH)-follicle-stimulating hormone surge. A LH-releasing hormone provocative test showed a normal response. Peripheral aromatization of androgens appeared to function normally. Free testosterone (T) was normal, however, plasma levels of sex-hormone-binding globulin and total T were high. After menarche at 18 years of age, anovulatory menstrual cycles continued. A combination of estrogen and progesterone therapy was effective. A possible explanation may be that metabolic clearance of T is reduced in the presence of liver cirrhosis and a portosystemic shunt.- - - - - - - - - - ranking = 1keywords = menstrual cycle, cycle (Clic here for more details about this article) |
2/13. A case of ovulatory cycle-dependent symptoms in woman with previous interferon beta therapy.A woman with a menstrual cycle-dependent fever (more than 38 degrees C) and severe fatigue that disrupted her ability to work was referred to our hospital. Six years ago, the patient received interferon beta injections (6,000,000 IU day-1x48 days) for the treatment of hepatitis c virus. Although the treatment was successful against the virus, the symptomatic fever occurred monthly since the third year after receiving the treatment. The symptoms occurred a few days after ovulation in every menstrual cycle. When the ovarian function was suppressed by GnRH agonist (GnRHa), the symptoms disappeared. While in anovulation, the patient received estrogen followed by estrogen with progestogen, which resembles the sex hormone milieu of a normal menstrual cycle without the LH surge; this treatment did not induce the symptoms. When human CG (hCG) was injected on the beginning day of estrogen with progestogen following treatment with estrogen alone, the previous symptoms reappeared. However, the hCG injection without estrogen priming did not induce the symptoms. These studies indicated that the LH surge after estrogen priming induced the symptoms. Changes in serum inflammatory cytokine levels (interleukin-1, interleukin-6, and tumor necrosis factor-alpha) were examined during the ovulatory cycle and the interleukin-1 levels during the treatment. There were no significant changes on these levels in the febrile period. The patient experienced normal menstrual cycles after finishing the five-month GnRHa treatment. Although her symptoms still occur, they are mild and do not require further medical treatment.- - - - - - - - - - ranking = 4.2531799704516keywords = menstrual cycle, cycle (Clic here for more details about this article) |
3/13. pregnancy in cirrhotic and noncirrhotic portal hypertension.The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. Both women experienced massive upper gastrointestinal bleeding from esophageal varices. Bleeding was difficult to control and required variceal ligation in 1. Both patients manifested features suggesting cerebral edema indicating the need for caution with fluid and electrolyte therapy. Recovery of the woman with CAH after termination of pregnancy was slow. review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.- - - - - - - - - - ranking = 0.050635994090318keywords = cycle (Clic here for more details about this article) |
4/13. Endometrial carcinoma following chronic anovulation in a premenopausal woman with systemic lupus erythematosus.Endometrial carcinoma was diagnosed in a premenopausal woman suffering with systemic lupus erythematosus. She had received both prednisolone and an immunosuppressive agent for more than 10 years. Anovulatory cycles persisted during drug administration, along with dysfunctional uterine bleeding. The serum estrogen: progesterone ratio was high. Repeated endometrial biopsies revealed a progression of change from benign proliferation to cystic hyperplasia, adenomatous hyperplasia, atypical hyperplasia and invasive adenocarcinoma. These clinical data suggest that a result of long-term unopposed endogenous estrogen can have been the cause of the endometrial carcinoma.- - - - - - - - - - ranking = 0.050635994090318keywords = cycle (Clic here for more details about this article) |
5/13. Pathophysiology of the ovarian hyperstimulation syndrome.ovarian hyperstimulation syndrome occurred after induction of ovulation with menotropins (follicle-stimulating hormone and luteinizing hormone) and implantation of an intrauterine pregnancy. Serial determinations of aldosterone, deoxycorticosterone, 17 beta-estradiol, progesterone, human chorionic gonadotropin, urinary and plasma electrolytes, and fluid balance were obtained. plasma renin activity, aldosterone, deoxycorticosterone, and antidiuretic hormone rose markedly. Hydration for four days improved urinary output but also accelerated sodium and fluid retention. Subsequent restriction of salt and water stabilized the patient. Spontaneous abortion was followed by prompt diuresis without a change in therapy. regression analysis of the authors' data, the clinical observations, and other data in the literature suggest that the ovarian hyperstimulation syndrome is produced by excessive secretion of an unknown hormone that regulates peritoneal fluid during the normal menstrual cycle, and that elevations of plasma renin, aldosterone, and antidiuretic hormone are secondary.- - - - - - - - - - ranking = 1keywords = menstrual cycle, cycle (Clic here for more details about this article) |
6/13. clomiphene-induced pregnancy in a patient with diabetes insipidus and hypothyroidism.A patient with diabetes insipidus and hypothyroidism developed anovular menstrual cycles. Ovulation, which was followed by pregnancy, was induced by the administration of clomiphene. In the later stages of pregnancy, an increase in the dosage of vasopressin was necessary to achieve a satisfactory control of the symptoms of diabetes insipidus. Labour was induced before the estimated date of confinement by the intravenous administration of oxytocin and an intra-partum haemorrhage necessitated delivery by the lower-segment caesarean section. The post-partum period was uneventful. lactation was suppressed on request from the patient.- - - - - - - - - - ranking = 1keywords = menstrual cycle, cycle (Clic here for more details about this article) |
7/13. Successful induction of ovulation and conception with pulsatile intravenous administration of human menopausal gonadotropins in anovulatory infertile women resistant to clomiphene and pulsatile gonadotropin-releasing hormone therapy.gonadotropins are released in a pulsatile fashion at a frequency of between 1 and 2 hours in the follicular phase of the menstrual cycle. Human menopausal gonadotropins are usually administered intramuscularly. We evaluated the gonadal response to intravenous human menopausal gonadotropins administered in a pulsatile fashion over nine treatment cycles in three anovulatory infertile women. Human menopausal gonadotropin pulses in doses up to 12 IU follicle-stimulating hormone at frequencies between 2 to 3 hours over 3 to 17 days resulted in ovulation in five cycles with one pregnancy being conceived. In the ovulatory cycles (5,000 to 10,000 IU of human chorionic gonadotropin was used to induce ovulation), the 17 beta-plasma estradiol level was 961 /- 128 versus 326 /- 95 pg/ml (mean /- SEM) in the anovulatory cycles (p = 0.015). The dose of human menopausal gonadotropins (in ampules of Pergonal, 75 IU of follicle-stimulating hormone and 75 IU of luteinizing hormone) in the intravenous cycles needed to induce ovulation was 12.3 /- 1.4 versus 20.4 /- 0.9 for intramuscular cycles (n = 80 in 23 women, p = 0.008). Treatment was well tolerated and without complications. We are continuing to explore the use of this apparently more efficient mode of administering human menopausal gonadotropins to anovulatory patients resistant to other techniques of ovulation induction therapy.- - - - - - - - - - ranking = 1.3038159645419keywords = menstrual cycle, cycle (Clic here for more details about this article) |
8/13. Reversal of persistent anovulation in polycystic ovarian disease by administration of chronic low-dose follicle-stimulating hormone.Low doses of follicle-stimulating hormone (FSH) were administered once daily to two consecutive patients with polycystic ovarian disease (PCOD) for therapy of infertility. Serial blood samples were obtained for gonadotropins and ovarian steroid determinations during the period of FSH administration. Exogenous FSH resulted in an initial and concomitant decrease in serum androstenedione (A), estrone (E1), and luteinizing hormone (LH), with an increase in estradiol (E2) and FSH. Subsequent changes in the above-mentioned hormonal levels were typical of a normal ovulatory cycle, with the exception of FSH, which continued to rise in the second half of the follicular phase. This was attributed to the exogenous administration of FSH. Both patients became pregnant in their first induced ovulatory cycle by administration of chronic low-dose FSH. These preliminary data demonstrate (1) a correction of the biochemical imbalance characteristic of PCOD, (2) successful ovulation induction, and (3) restoration of fertility in PCOD treated with chronic low-dose FSH.- - - - - - - - - - ranking = 0.10127198818064keywords = cycle (Clic here for more details about this article) |
9/13. Two cases of ovarian tumours in women who had undergone multiple ovarian stimulation attempts.Concerns have been raised recently about the possible association between superovulation and ovarian cancer. In order to contribute to the limited literature on this important issue, two cases of ovarian tumours in women who had undergone multiple ovulation inductions are presented. In the first case, the patient had secondary anovulatory infertility. She was treated with human menopausal gonadotrophin (HMG) alone and in combination with clomiphene citrate or buserelin for six cycles. She then underwent ovarian stimulation with buserelin/HMG in the long protocol for in-vitro fertilization (IVF) and embryo transfer. In preparation for a new IVF/embryo transfer attempt, 8 months later, the screening ultrasound revealed a cystic formation of the left ovary and an enlargement of the right. During laparotomy, both ovaries were found to bear large tumours (approximately 6 x 5 x 4 cm) which were removed. Histological examination showed that they were epithelial tumours (serous-papillary cystadenomas) of borderline malignancy. The patient conceived spontaneously 1.5 years after the operation. In the second case, the patient presented with secondary anovulatory infertility. She underwent ovulation induction with clomiphene/HMG and with buserelin/HMG in the long protocol, and intra-uterine insemination with husband's spermatozoa and conceived (singleton pregnancy). She was delivered by Caesarean section, during which a cystic tumour of the left ovary was removed. Histological examination revealed a benign mucous cystadenoma of the ovary.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.050635994090318keywords = cycle (Clic here for more details about this article) |
10/13. plasma hormones in human gonadotropin induced ovulation.plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol-17beta(E2), progesterone (P), androstenedione (A), and testosterone (T) were analyzed in daily plasma samples of seven cycles of human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) induced ovulation. plasma FSH rose gradually and remained at a higher level (20 to 30 mlU/ml) during hMG injection while LH stayed at a low tonic level. The FSH/LH ratio of plasma gonadotropins was consistently higher than 1 in spite of injecting an hMG preparation with FSH/LH ratio of 1. A pharmacologically induced high RSH/LH ratio in the late follicular phase is contradictory to the low ratio seen in the normal ovulatory cycle. This may be one of the causes of multiple follicular maturation and ovulation frequently encountered in the hMG-hCG induced ovulation. Higher than normal levels of plasma progesterone commonly seen in the hMG-hCG induced cycle is attributed to the multiple ovulation. plasma androgen levels, both A and T, in these therapy cycles stayed consistently within normal range. This is a strong contrast to the clomiphene induced cycle in which A and T were frequently elevated in parallel with elevated LH. No significant differences in plasma hormones were observed between the pregnant and nonpregnant patient following hMG-hCG induced ovulation. A consistent and similar ovarian response to hMG-hCG was noted in 1 individual who had 3 consecutive therapy cycles studied. The plasma hormone levels in the multiple ovulation did not show a significant difference from those in the single ovulation with the exception of a higher plasma P level in the former.- - - - - - - - - - ranking = 0.30381596454191keywords = cycle (Clic here for more details about this article) |
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