Ivo Brosens

Accuracy of Endometrial Biopsy Dating in Relation to the Midcycle Luteinizing Hormone Peak

The accuracy of endometrial biopsy dating was evaluated in a selected group of apparently normal women in whom the basal body temperature (BBT), the onset of subsequent menstruation, the midcycle luteinizing hormone (LH) peak, and the 17β-estradiol peak were determined. Forty-two women with regular cycles, normal ovaries at laparoscopy, and luteal phases of 12 to 15 days were studied. In group I (n = 20), the infertility could be explained satisfactorily by either tubal occlusion or infertility of the husband, while in group II (n = 22) no explanation was found for the infertility. In group I, the duration of the luteal phase, defined as the interval between the LH peak and the onset of subsequent menstruation, was 13.4 ± 0.7 days. The plasma 17β-estradiol concentration declined (P It is suggested that, in women with a progressive rise in BBT over several days, the localization of the LH peak can be helpful for correct interpretation of the endometrial biopsy.

CLOTTING AND FIBRINOLYTIC ACTIVITIES IN PERITONEAL FLUID

Peritoneal fluid does not clot spontaneously on collection, due to a lack of prothrombin activation, consequent upon a virtual absence of factors V and VIII. Factor VIII related antigen is present in peritoneal fluid in only very small amounts, suggesting that this factor is excluded from the peritoneal cavity, probably by virtue of its size. Slight thrombin activity is demonstrated by the presence of fibrin monomers in the fluid. That peritoneal fluid also contains fibrinolytic activity is shown by high levels of plasminogen and plasmin‐antiplasmin complexes, though no plasminogen activator could be detected. No differences were found in clotting and fibrinolytic activities between fluid taken from these patients with, and those without, laparoscopic evidence of pelvic endometriosis.

New combined oral contraceptive with incremental progestogen dosage regimen

n In a study of 506 women, 272 took a total of 2124 cycles of combined preparations of norgestrel and 234 women took a total of 2002 cycles of a combined contraceptive with incremental progestogen doses, in which the total D-norgestrel was 1800 g as opposed to 5250 g in the combined preparation. The step-up preparation group had a similar rate of side effects as the combined preparation group; however, women using the step-up preparation had significantly diminished intermenstrual bleeding after the 6th month of use. The step-up regimen has not induced any cases of endometrial hyperplasia but does have an inhibiting effect on endometrial proliferation in the 1st half of the cycle. The step-up preparation has similar effects on the hypothalamo-hypophysial-ovarian axis as the combined pill. The step-up preparation appears to inhibit ovulation from the 1st cycle as indicated by the absence of LH and FSH midcycle peaks and the low 17 beta-estradiol levels in the 2nd half of the cycle; therefore, the step-up preparation should be classified as a new combined, not sequential, oral contraceptive.n