Henk J. Hoogland

Endometrial wavelike movements during the menstrual cycle

OBJECTIVE To qualify and quantify endometrial waves in regularly cycling women. DESIGN A prospective transvaginal ultrasound study was performed throughout 23 cycles of 16 healthy women. Wave type and wave frequency were evaluated. SETTING Normal human volunteers in an academic research environment. PATIENTS Sixteen healthy regularly cycling women. RESULTS Of 23 cycles, 19 proved to be ovulatory. Five types of endometrial waves could be distinguished. Waves from cervix to fundus and opposing waves were seen predominantly periovulatorily. Waves from fundus to cervix were absent in the postovulatory phase. Endometrial wavelike activity was most pronounced in the periovulatory phase. CONCLUSIONS Standardized qualification and quantification of endometrial waves, as described in this study, might shed new light on the underlying mechanisms in selected cases of hitherto unexplained subfertility.

Relation between endometrial wavelike activity and fecundability in spontaneous cycles

OBJECTIVE To determine whether endometrial activity is related to the occurrence of pregnancy in spontaneous menstrual cycles. DESIGN Prospective observational ultrasound evaluation of endometrial activity during fertility screening cycles. SETTING University hospital-based infertility clinic. PATIENT(S) Fifty-nine fertility screening cycles (ultrasound monitoring of follicle growth and ovulation, postcoital test, semen analysis, midluteal P, Chlamydia antibody determination, and tubal patency testing) were performed in 47 couples complaining of infertility. In 33 couples (37 cycles), no fertility impairing factors were found. Endometrial activity was analyzed in these cycles. INTERVENTION(S) Ultrasound examination was performed transvaginally throughout the cycle. MAIN OUTCOME MEASURE(S) Endometrial activity, wave pattern, pregnancy. RESULTS(S) Nine women conceived within the cycle studied. Conception cycles showed less-activity compared with nonconception cycles. Endometrial wavelike activity increased throughout the follicular phase and decreased after ovulation in conception and nonconception cycles. CONCLUSION(S) Endometrial activity is related to fecundability in a spontaneous cycle.

Follicle growth curves and hormonal patterns in patients with the luteinized unruptured follicle syndrome

A prospective longitudinal and standardized study is presented, dealing with ultrasonographic and hormonal characteristics of the luteinized unruptured follicle (LUF) syndrome. Among 600 cycles monitored in 270 infertility patients, 40 cycles in 27 patients showed no evidence of follicle rupture, in spite of signs of luteinization, as reflected by basal body temperature recordings and progesterone determinations. In this study, 20 LUF cycles in 20 infertile patients were compared with 45 ovulatory cycles in 45 control women. During the follicular phase, no substantial difference in follicle growth was found, but after the luteinizing hormone peak, LUF follicles, instead of rupturing, showed a typical accelerated growth pattern. Both mean luteinizing hormone peak levels and midluteal progesterone levels were significantly lower in LUF cycles than in the control cycles. However, the duration of the luteal phase was not affected. Both central and local factors can be held responsible for the lack of follicle rupture. Ultrasound offers new possibilities as a noninvasive method in diagnosing the LUF syndrome.

Endometrial wave direction switch and the outcome of in vitro fertilization

OBJECTIVE To describe endometrial wavelike activity, endometrial thickness and texture in IVF cycles, and to relate them to IVF outcome. To evaluate wave patterns on the day of hCG administration as a predictor of IVF outcome. DESIGN Ultrasound study. SETTING University hospital-based infertility clinic. PATIENT(S) Twenty-eight women undergoing IVF. INTERVENTION(S) Ultrasound examinations were performed at five fixed moments (start ovarian stimulation, hCG administration, ovum pickup (OPU), ET, and 7 days after hCG administration) and at three variable moments in the stimulation period in the cycle. The OPU was performed 2 days after hCG administration; ET was performed 2 or 3 days after that. MAIN OUTCOME MEASURE(S) Endometrial wave pattern, thickness, texture, IVF outcome. RESULT(S) Embryo transfer was performed in 22 cycles. In 73% of the cycles a wave direction switch (WDS) from fundus to cervix (FC) to cervix to fundus (CF) occurred before OPU. Eleven (50%) patients became pregnant. Significantly more FC waves persisted until hCG administration in the cycles in which the patients conceived. Endometrial thickness and texture were unrelated to IVF outcome. CONCLUSION(S) Endometrial wave pattern is associated with pregnancy in IVF. The persisting presence of FC waves until hCG administration (a late WDS) predicts a favorable IVF outcome.

Longitudinal ultrasonographic study of the ovarian suppressive activity of a low-dose triphasic oral contraceptive during correct and incorrect pill intake

A longitudinal study was conducted to evaluate the ability of a low-dose triphasic oral contraceptive to suppress ovulation as documented by frequent ultrasonographic scanning and progesterone determinations, even in the event of a missed pill. The extent of follicular growth and maturation, the incidence of escape ovulation, and the effect of correct and incorrect pill intake were assessed in 30 evaluable women during two consecutive spontaneous menstrual cycles. After the first cycle, 11 of 30 women (36.6%) had follicle-like structures of at least 10 mm in diameter. Ten of 11 structures gradually disappeared during the second cycle, with one persistent structure remaining through the second cycle. Seven of 30 women (23%) developed follicle-like structures during the second cycle. Of these, one woman had a probable ovulation, and another had an elevated progesterone level without follicle rupture, suggesting the luteinized unruptured follicle syndrome. Both of these women missed a pill on day 1 of the second cycle. In all cases cervical scores indicating hostility were noted. Thus, although suppression of ovarian activity may have been incomplete when oral contraceptives were incorrectly taken, secondary mechanisms of contraception remained operant. When they were correctly taken, low-dose triphasic oral contraception consistently prevented ovulation.

Velocity of endometrial wavelike activity in spontaneous cycles.

OBJECTIVE To analyze the velocity and wave intervals of endometrial wavelike activity in spontaneous menstrual cycles. DESIGN Prospective observational ultrasound (US) evaluation of endometrial wavelike activity. SETTING University hospital. MAIN OUTCOME MEASURE(S) Endometrial wavelike activity, wave velocity, wave intervals. PATIENT(S) Twenty-three menstrual cycles were evaluated by frequent US investigations in 16 healthy, regularly cycling female volunteers. INTERVENTION(S) Transvaginal US examination of endometrial wavelike activity. RESULT(S) Nineteen cycles proved to be ovulatory. Wave velocity and wave intervals were calculated in waves from fundus to cervix and in waves from cervix to fundus. The velocity of waves from fundus to cervix increased from the midfollicular phase to the late follicular phase. Waves from cervix to fundus showed their highest velocity in the periovulatory period. CONCLUSION(S) Velocity of endometrial wavelike activity reached a peak in the periovulatory phase, whereas the wave intervals were shortest in that phase.

Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles

OBJECTIVE To describe endometrial wavelike activity, endometrial thickness, and texture in controlled ovarian hyperstimulation (COH) cycles. DESIGN Prospective observational ultrasound study. SETTING University hospital-based infertility clinic. PATIENT(S) Thirty-five COH cycles in 19 women with unexplained infertility. INTERVENTION(S) Transvaginal ultrasound examination was performed throughout COH cycles. Intrauterine insemination was performed after hCG administration. MAIN OUTCOME MEASURE(S) Endometrial wavelike activity, wave frequency, wave velocity, endometrial thickness, and endometrial texture. RESULT(S) Endometrial wavelike activity increased from menstruation to ovulation and decreased in the luteal phase. On day hCG+2, endometrial wave-like activity was observed in all cycles. Waves from cervix to fundus prevailed in the periovulatory phase. Endometrial wavelike activity was related significantly to endometrial thickness at the start of ovarian stimulation and in the luteal phase. Endometrial thickness increased throughout the cycle. Endometrial texture showed periovulatory a triple-line aspect. CONCLUSION(S) In COH cycles, endometrial wavelike activity is more pronounced than in spontaneous cycles. The number of follicles and endometrial wavelike activity were not correlated significantly. This is the first prospective study to provide longitudinal observational evidence that endometrial thickness increases throughout the COH cycle and that a triple line pattern develops.

Subendometrial contractions in the nonpregnant uterus: an ultrasound study

Endometrial wavelike activity was studied by ultrasound, throughout 19 ovulatory cycles in 16 healthy female volunteers. Analysis was focused on the presence of endometrial activity and the wave types. Five activity patterns were distinguished, which varied throughout the cycle. Endometrial activity was most striking during the periovulatory phase.

Ultrasonographic placental localization with respect to fetal position in utero

Ultrasonographic localization of the placental site was performed serially throughout pregnancy in 56 primigravidas with anteriorly located placentas. The placenta was found to be located on the right side of the uterus significantly more frequently than at any other site on the anterior uterine wall. Placental position was found to be related to the position of the fetus in utero. The role of placental location in determining the high incidence of the left occiput position at delivery is discussed.

Death from chemotherapy in gestational trophoblastic disease

Multiple cytotoxic drug administration is the generally accepted treatment of patients with a high-risk stage of choriocarcinoma. Based on this principle a 27-year old woman, classified as being in the high-risk group (Goldstein and Berkowitz score: 11), was treated with multiple cytotoxic drugs. The multiple drug schema consisted of: Etoposide 16.213, Methotrexate, Cyclophosphamide, Actomycin-D, and Cisplatin. On the first day of the schedule, moderate high doses of Methotrexate, Etoposide and Cyclophosphamide were administered. Within 8 hours after initiation of therapy the patient died with a clinical picture resembling massive pulmonary obstruction due to choriocarcinomic tissue plugs, probably originating from the uterus. Formation of these plugs was probably due to extensive tumor necrosis at the level of the walls of the major uterine veins, which resulted in an open exchange of tumor plugs to the vascular spaces; decrease in tumor tissue coherence secondary to chemotherapy may have further contributed to the formation of tumor emboli. In view of the close time association between the start of chemotherapy and the acute onset of massive embolism other explanations, such as spontaneous necrosis, must be considered less likely. Patients with large pelvic tumor loads are, according to existing classifications, at high risk to die and to develop drug resistance. Notwithstanding these facts our findings suggest that these patients might benefit from relatively mild initial treatment, especially true for patients not previously exposed to this drug. Close observation of the response status both clinically and with beta-hCG values may indicate whether and when more agressive combination chemotherapy should be started.(ABSTRACT TRUNCATED AT 250 WORDS)