Jean Schwers

Luteal function in ectopic pregnancy

Human chorionic gonadotropin, estradiol, progesterone, and 17-hydroxyprogesterone have been measured in the serum of 46 patients with ectopic pregnancy. All these hormones were significantly lower than in normal pregnancy. Unruptured ectopic pregnancy differed from the ruptured state by a lower serum human chorionic gonadotropin concentration, a slower human chorionic gonadotropin increment, a higher incidence of metrorrhagia, and an earlier diagnosis. The concentration of estradiol, progesterone, and 17-hydroxyprogesterone in the serum of patients with ectopic pregnancy was lower than could be expected from the decrease of human chorionic gonadotropin, often lower than in a normal luteal phase. It is suggested that, as long as ultrasonography fails to show an intrauterine pregnancy, the simultaneous determination of serum human chorionic gonadotropin and progesterone could aid in the early diagnosis of ectopic pregnancy and in the improvement of subsequent fertility; to that regard any progesterone level below 15 ng/ml in the presence of detectable amounts of human chorionic gonadotropin is highly suggestive of either a threatened abortion or an ectopic pregnancy, whatever the gestational age.

Serum progesterone in nonpregnant women: I. Comparative study of serum progesterone concentration and urinary pregnanediol excretion

The normal range of serum progesterone (measured by radioimmunoassay) and urinary pregnanediol during the menstrual cycle was determined in 86 patients (33 control and 53 with menstrual disorders or sterility) and the values were found to show a logarithmic distribution. The overall correlation between serum progesterone and urinary pregnanediol concentration was .82. Clinical diagnostic applications of these measurements include: 1) anovulatory demonstration, 2) determination of secondary amenorrhea, 3) investigation of prolonged cycles, 4) investigation of probable luteal insufficiency, and 5) response to clomiphene citrate.

Effects of Chronic Renal Failure and Hemodialysis on Hormonal Evaluation of Pregnancy

Different hormonal parameters are studied in a pregnant woman with chronic renal failure undergoing hemodialysis. Serum concentrations of human chorionic gonadotropin, progesterone, 17-hydroxyprogesterone, alpha-fetoprotein, human placental lactogen were all higher than the normal range. This is probably related to a decreased metabolic clearance rate of these hormones. Dehydroepiandrosterone sulfate (DHEAS), which is low before pregnancy and during the first week of gestation, tends to increase later. Serum estradiol is lower than the normal range. This decrease probably results from the low concentration of DHEAS available to placental aromatization. Finally, pregnancy-specific beta 1-glycoprotein concentration follows the normal range and may be considered as the most reliable parameters to evaluate the fetoplacental well-being in these high-risk pregnancies.

Serum progesterone in nonpregnant women. II. Correlation between serum progesterone and some other luteinization parameters.

Abstract Correlation between serum progesterone concentration, urinary pregnanediol excretion, endometrial biopsies, vaginal cytology, and basal body temperature was performed to determine the most dependable method for assessing the presence of a functioning corpus luteum. Vaginal cytology was not completely reliable as it had relatively poor correlations. A biphasic basal body temperature was always associated with a rise of progesterone to luteinization range, but a monophasic chart did not necessarily indicate anovulation. This fallacy, together with difficulties in recording and interpretation, made basal body temperature not totally accurate for assessing luteal activity. Premenstrual endometrial biopsies gave the best correlation with hormonal assays. It is thus concluded that serum progesterone determination and properly interpreted endometrial histology are the most accurate diagnostic luteinization parameters.

In vitro oestrogen biosynthesis by human polycystic ovaries

Abstract In vitro steroid biogenesis by human polycystic ovaries has been investigated in four patients. Aliquots from each ovarian homogenate were incubated in virto with tritiated pregnenolone, dehydroepiandro-sterone and androstenedione. Labeled metabolites were isolated and identified by crystallizations to constant S.A. The general pattern of steroid metabolism in those four cases is very similar to that reported from incubations of normal ovarian tissue. It should be noticed particularly that significant amounts of oestrone and oestradiol were recovered from each incubation, whatever the substrate. This finding does not match with a lack of aromatization, therefore it is suggested that such enzyme deficiencies in the polycystic ovaries are not so common as it is generally assumed in the literature. A ratio of oestrone to oestradiol lower than one was observed in most of the polycystic ovary incubations, whereas in normal ovaries that ratio is usualy higher than one. That trend is the only descrepancy that is suggested by the comparison between normal and polycystic ovaries. However, such difference could be the result rather than the origin of the menstrual cycle disturbance.

Steroid metabolism in vitro by gonadal tissue from a true hermaphrodite

The case of a true hermaphrodite, with a normal ovary and an ovotestis is presented. The ovotestis was removed and incubated in vitro with tritiated steroids (testosterone, dehydroepiandrosterone, pregnenolone and 17 alpha-hydroxyprogesterone). Labeled metabolites were isolated and identified. Based upon these findings, a pathway of steroid biogenesis in this abnormal gonadal tissue is suggested. The ovotestis studied did not contain all the enzymes involved in ovarian steroidogenesis: 3 beta-hydroxysteroid dehydrogenase, isomerase, 17--20 desmolase and 17 beta-hydroxysteroid dehydrogenase were present, but other important enzymes, such as 16 and 17-hydroxylases, and aromatizing enzyme systems, were deficient or absent.