Hector D. Croxatto

A Seven-Cell Human Egg Recovered from the Oviduct *

A seven-cell human egg recovered from the proximal middle quarter of the oviduct is described. Whether or not it is a normal representative of this stage of human development cannot be established at the present time. The specimen was recovered 83 hours after intercourse and 77 hours after the first significant elevation of the luteinizing hormone level in the urine. According to these data and the results of the endometrial and corpus luteum biopsies, the age of the egg was estimated to be approximately 72 hours. An analysis of size and the reaction of the blastomeres to toluidine blue suggests that they already show some differentiation at this early stage of development. The addition of these findings to previous reports of eggs recovered from human oviducts and uteri gives support to the concept that human eggs are delivered to the endometrial cavity when they contain between 7 and 12 blastomeres.

Adnexal complications in women under treatment with progestogen implants.

Abstract Symptoms and complications related to pelvic organs in women treated with subdermal progestogen implants are described. Of a total of 709 women, 110 presented low abdominal discomfort of significance. One-hundred-eighteen episodes of low abdominal discomfort were reported during 11,519 months of treatment. Surgical exploration of the pelvic cavity was made for diagnosis and/or treatment of this symptom in 27 cases. Ovarian cysts were found in 11 cases, hematosalpinx was found in 3 patients, and one of the latter was associated with an ovarian cyst. In two instances, the exploration was negative. Implants filled with megestrol acetate gave the highest incidence of tubal pregnancies and the absolute number of ectopic pregnancies was clearly greater than expected for the general population. The present findings are discussed in comparison with other clinical trials of continuous progestogen reported in the literature.

Effects of a sequential regimen of mifepristone-medroxyprogesterone acetate on ovarian function, endometrial development and hormonal parameters.

The efficacy of a low dose of mifepristone, 5 mg/day for the first 15 days of the menstrual cycle, followed by medroxy-progesterone acetate (MPA), 10 mg/day for the next 13 days, for inhibiting ovulation was assessed in ten volunteers who were treated for three successive cycles. Hormonal determinations in blood and urine samples, ovarian ultrasonography and an endometrial biopsy taken on day 21-24 of the third treatment cycle were used to monitor the cycles. Ovulation was confirmed in 11 of the 30 treated cycles and, in these 11, the LH peak and follicular rupture occurred during MPA treatment periods. Out of 19 anovulatory cycles, 16 had no increase in progesterone levels and another 3 developed a luteinized unruptured follicle. Progestin administration induced secretory changes in the endometrium, but irregular or delayed development was found. Regular withdrawal bleeding occurred in all subjects. These data indicate that the sequential regimen can suppress ovulation while maintaining regular bleeding but increased efficacy is needed for phase II clinical trials.