Francis W. Byrn

The normal variabilities of the menstrual cycle

OBJECTIVE To address conflicts in the normal variabilities of the menstrual cycle using the newest generation test methods and to establish normal ranges for use in clinical practice. DESIGN Daily urine samples were collected from 167 women eager to achieve pregnancy. Samples were tested prospectively for LH and total hCG. A total of 458 nongestational and 111 gestational menstrual cycles were evaluated. SETTING Division of Womens Health Research, University of New Mexico. PATIENT(S) One hundred sixty-seven women desiring pregnancy. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Levels of hCG and LH. RESULT(S) Menstrual cycles were 27.7 +/- 2.4 days in length. The LH peak indicated the onset of the presumed ovulatory window, which occurs at 14.7 +/- 2.4 days. Implantation (first day of sensitive detection of hCG) occurred in gestational menstrual cycles at 24.6 +/- 3.1 days, or 4.3 +/- 2.2 days before missing the expected onset of menses. CONCLUSION(S) Our data confirm epidemiological studies on menstrual cycle length and variability and hormonal studies on timing of the ovulatory window and its variability. They dispute, however, the published data on the timing and variance of implantation. As shown, implantation is limited to a 10-day interval culminating in the day of the expected onset of menses. Reference range data provide guidelines for differentiating normal and problem menstrual cycles.

Donor insemination: a comparison of lesbian couples, heterosexual couples and single women

OBJECTIVE To compare single women, lesbian couples, and heterosexual couples receiving therapeutic donor insemination (TDI). DESIGN Chart review followed by anonymous mail questionnaires to donor insemination recipients and their partners. SETTING Infertility clinic in a university hospital. PATIENTS One hundred fifteen women receiving donor insemination were identified by chart review. RESULTS Too few single women responded for reliable comparison. Lesbian women were similar to married women in age, education, duration, and outcome of donor insemination. When considering alternatives to TDI, married women were more likely to consider adoption and lesbians were most likely to consider using a known semen donor or having intercourse with a man aware of their desire to have a child. Married couples were less likely to tell others, including the child, about conception by donor insemination. They were also less likely to support disclosing identifying data about the donor to the child. Lesbians were more likely to report stress in their relationships as a result of TDI. Married men were most likely to support mandatory counseling before TDI initiation.

Human chorionic gonadotropin testing for early pregnancy viability and complications

Human chorionic gonadotropin (hCG) is a heterogeneous molecule that is the marker of choice for detecting pregnancy and indicating ectopic pregnancies and spontaneous abortions. This article describes the use of hCG in detecting pregnancy, and how pregnancy detection is complicated by the extreme variation in individual hCG results and by the varying structure of hCG. The problems of false-positive pregnancy tests due to early pregnancy losses or heterophilic antibodies, and of false-negative pregnancy tests due to delayed implantation, are discussed. Different kinds of pregnancy tests, professional laboratory assays, point-of-care, and home devices are compared. The use of hCG measurement and hCG doubling rates, progesterone measurements, and transvaginal ultrasound in identifying ectopic pregnancies and failing pregnancies also is reviewed.

Use of intrauterine device in the setting of uterus didelphys.

BACKGROUND: Uterine anomalies are frequently diagnosed in reproductive-aged women and are generally considered a contraindication to the use of intrauterine contraception. We elected to offer this method to a woman with uterus didelphys and a poorly controlled seizure disorder who wished to avoid hormonal and barrier contraceptives. CASE: A 17-year-old woman (gravida 1, para 1) with a seizure disorder desired an intrauterine device (IUD). She was found to have uterus didelphys and a complete vaginal septum. After obtaining informed consent, an IUD was placed in each uterine horn. The patient retained both IUDs and was satisfied with the method 9 months after IUD insertion. CONCLUSION: Intrauterine contraception should be considered an option for women with uterine anomalies on a case-by-case basis.

3D Volume Assessment of a Cornual Heterotopic Double Anembryonic Gestation and Response to Methotrexate Treatment

A pregnancy developing in the cornu is rare and accounts for less than 1% to 4% of ectopic pregnancies. This case describes a cornual heterotopic gestation occurring as a first pregnancy where both gestational sacs were anembryonic. Presented are subsequent 2D and 3D sonographic findings with laboratory changes following treatment in an ectopic systemic methotrexate protocol.

15 – Use of hCG in Reproductive Dysfunction

Human chorionic gonadotropin (hCG) is a heterodimeric glycoprotein. The primary structures of the α- and β-subunits were determined in 1972. The hormone is approximately 30% carbohydrate. Its similarity to luteinizing hormone (LH) and its capacity to bind to its receptors has fostered interest in hCGs clinical utility in human reproductive medicine. Studies were performed that clarified the disappearance rates of hCG following pregnancy delivery, after intravenous (IV) and intramuscular (IM) injections to healthy males and females, after subcutaneous or IM injections in healthy males, as well as calculating metabolic and renal clearance rates with continuous-infusion and single-injection techniques. These studies similarly confirmed that hCG disappears in a rapid phase and a slower phase, taking approximately 6 h and 36 h, respectively. Studies examining the pharmacokinetics of hCG when administered to humans have been published. In males, the peak hCG concentrations are reached 6–8 h after IM injection. When administered intramuscularly to three subjects, the half-life of the tail was longer compared to clearance rates after IV injection, which averaged approximately 26 h. There were no appreciable differences in the disappearance curves between males and females. Using then current second international reference preparation-human menopausal gonadotropins (IRP-hMG) standards, the authors noted that LH in human ovulation reaches 40–200 mIU during a 24-h period. The slower disappearance rate of hCG relative to LH was characterized as a disadvantage, in that slower metabolism could be an aggravating factor in multiple ovulation and an independent factor for ovarian hyperstimulation syndrome (OHSS).

CA 125 Levels in Chromosomally Abnormal Pregnancies

CA 125 levels have been measured in the amniotic fluid of 86 gravidas between 14 and 20 weeks gestation as well as in 18 women at term, all carrying chromosomally normal fetuses; in 36 gestations, the samples were paired with maternal serum specimens. These controls were then compared with the amniotic fluid values in pregnancies of karyotype trisomy 21 (n = 24), trisomy 18 (n = 7), sex chromosome trisomy (n = 5), and sex chromosome monosomy (n = 2), and in the maternal serum of 4 trisomy 21 pregnancies, in an effort to determine if CA 125 could act as a marker for these chromosomal anomalies. Results indicated no significant difference in the amniotic fluid measurements at the time of genetic amniocentesis in normal gestations (5,064 U/ml) and trisomy 21 gestations (4,864 U/ml). The sex chromosome anomalies, too, were not different. Alternatively, the values in trisomy 18 pregnancies were significantly lower (3,154 U/ml; P < 0.05) than controls. There appeared to be no significant correlation between the...