Andrea Baglioni

Marked deciliation and insufficient secretory modification of endometrial surface during treatment with a new progestogen-estrogen combination

Endometrial modifications induced by SHB 209 AE, a new progestogen-estrogen combination, was investigated using scanning and transmission electron microscopy, in order to demonstrate specific variations of the endometrial surface and if these contribute to the contraceptive effects of the preparation. Endometrial biopsies were performed in 27 volunteers who had taken SHB 209 AE during the preceding 3 months. Endometrial biopsies of 15 normomenstruating volunteers were used as controls. Each fragment was subdivided for scanning and transmission electron microscopy examination. The ciliated cells were always significantly fewer in the various phases of the treatment cycle than in the control endometria although, as in the controls, their number and ratio with nonciliated cells was greater mid-way through the cycle. Ciliogenesis was always notably delayed compared to the normal endometria during the different treatment cycle phases. Secretory modifications appeared prematurely but remained incomplete through the treatment cycle. These modifications caused total and characteristic alterations of the mucosal architecture and cellular maturation that comprised the implantation phase.

What is the source of elevated serum levels of CA 125 in patients with endometriosis

The presence of CA 125 was investigated in endometriotic tissue and endometrial mucosa using two different immunohistochemical methods, indirect immunofluorescence and the avidin-biotin immunoperoxidase technique. Neither of the methods revealed the antigen in the 12 endometriotic fragments studied. The endometrial mucosa both of patients with endometriosis and of the control subjects was positive with indirect immunoperoxidase staining in all cases, whereas with indirect immunofluorescence it was positive in 75 and 67%, respectively. Thus the mechanism(s) responsible for distribution of the antigen in different tissues and its reported high serum levels in advanced endometriosis is still unclear.

Vaginal patterns during danazol and buserelin acetate therapy for endometriosis: structural and ultrastructural study

OBJECTIVE To evaluate histologic and ultrastructural changes of the vaginal mucosa in patients given buserelin acetate or danazol treatment for endometriosis. DESIGN Controlled clinical study. SETTING Infertility clinic of an academic unit. PATIENTS Infertile women with endometriosis randomized to receive buserelin acetate or danazol and undergoing vaginal biopsies during treatment were selected. INTERVENTIONS Buserelin acetate was administered IN 400 micrograms three times per day and danazol orally 600 mg/d. Vaginal biopsies were performed baseline and at 3 and 6 months of treatment, and specimens were examined by light microscopy and scanning electron microscopy. 17 beta-Estradiol and P levels were determined in each patient at the time of each biopsy. MAIN OUTCOME MEASURE Structural and ultrastructural patterns of vaginal mucosa after 3 and 6 months of treatment. RESULTS Buserelin acetate treatment induced early, marked hypotrophy of the vaginal mucosa with aspects typical of the menopause. The modifications caused by danazol occurred mainly in the intermediate layer, which was weakly hypotrophic only at the end of the treatment. CONCLUSION Vaginal mucosa undergoes constant and well-defined modifications during both buserelin acetate and danazol treatment for endometriosis. The modifications are compatible with the biological effects of the drugs.

Structural and Ultrastructural Patterns of the Human Preovulatory Endometrium Following Clomiphene Citrate Treatment

To investigate ultrastructural modifications in the endometrium of women receiving clomiphene citrate (CC) treatment, we performed endometrial biopsies in the preovulatory phase in 17 patients with anovulatory infertility and 16 normo‐ovulating women with tubal or male sterility. Histology, scanning and transmission electron microscopy (SEM and TEM) revealed midproliferative phase aspects in 11.7% of the treated group and 6% of the controls, late prolif erative aspects in 76.4% and 82%, and postovulation days 1–3 characteristics in 11.7% and 12% respectively. No significant differences were observed between the patients and controls; our data indicate that CC taken in a dose not exceeding 100 mg/day from day 3 of the cycle can induce endometrial maturation that is almost identical with that of a spontaneous preovulatory phase. This type of endometrium should therefore allow implantation of a fertilized egg and maintain unmodified the complex biohumoral relations with the embryo.

Evaluation of Histological and Ultrastructural Aspects of Endometrium During Treatment with Gestrinone in Women with Amenora or Spotting

Nineteen patients with a laparoscopic diagnosis of endometriosis were treated with gestrinone at a dosage of 2.5 mg twice a week for 6 months. In 7 who reported spotting in the first 3 months, the dose was increased to 2.5 mg three times a week during the second trimester. An endometrial sample was obtained from each patient at the time of laparoscopy (basal) and at 3 and 6 months of treatment. Endometrial structure and ultrastructure were studied. Areas of hemorrhage and of loss of surface epithelium and a lesser degree of involution of the surface epithelium were observed in the 3‐month samples of 7 patients with spotting, compared with 12 with amenorrhea. It is hypothesized that incomplete endometrial involution could be due to differences in gestrinone pharrnacokinetics in individual patients, in the quality and/or quantity of endometrial cytosolic receptors for sex steroids, or in endocrine compensation to administration of the drug.

Dental Elements in Mature Teratomas of the Ovary: Scanning Electron Microscope Ultrastructure

Seventy-two teeth from 10 ovarian mature teratomas and 12 unerupted and erupted teeth from subjects aged 8 to 21 years were examined at the scanning electron microscope to evaluate the morphologic and histogenetic differences. The ultrastructure of the teratomatous teeth was similar to that of the corresponding orthotopic tissues. Despite this similarity the morphology of the teratomatous teeth was much less well defined, attesting to the inductive effect of the contiguous tissues that are normally present in the oral cavity.

Ultrastructure of endosalpingeal biopsies in infertile patients: correlation with reproductive success

We calculated the percentage of ciliated cells (PCC) in salpingeal microbiopsies of 41 patients with tubal infertility and ampullary microbiopsies of 36 fertile women, using the planimetric method at 500–1000x at the scanning electron microscope. No relation was found between PCC and fertility after surgery. Thus normal ciliation does not seem to be essential for reproductive success and other factors such as the state of preservation of the tubal wall may be important.

Enhanced pre-ovulatory progesterone levels in fertile cycles during clomiphene citrate treatment

We compared ovulatory changes in fertile and preceding infertile cycles in 21 patients with unexplained infertility conceiving after clomiphene citrate treatment. No significant differences were observed in follicular growth, cervical score and follicle stimulating hormone (FSH) levels. Progesterone was higher (P < 0.05) in the 2 days preceding ovulation in fertile cycles, luteinizing hormone (LH) higher (P < 0.05) the day before, and 17‐β‐estradiol lower (P < 0.05) 4 days before. Stimulating progesterone secretion by systematic LH administration before ovulation could improve secretory endometrial transformation and thus reproductive prognosis.