Kaisa Juntunen

Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy

Background Reproductive endocrine disorders are more common among women with epilepsy than among normal women. These disorders have been attributed to epilepsy itself, but could be related to antiepileptic-drug therapy. Methods We studied 238 women with epilepsy who were seen regularly at the Outpatient Department of the University Hospital, Oulu, Finland. Their mean age was 33 years (range, 18 to 45), and the mean duration of therapy was 9 years (range, 0 to 31). Twenty-nine (12 percent) were treated with valproate, 120 (50 percent) with carbamazepine, 12 (5 percent) with valproate and carbamazepine, and 62 (26 percent) with other medications; 15 (6 percent) were untreated. Vaginal ultrasonography was performed to determine ovarian size, and serum sex-hormone concentrations were measured in 41 women with epilepsy and menstrual disturbances, 57 women with epilepsy and regular menstrual cycles, and 51 normal women. Results Menstrual disturbances were present in 13 of the women receiving valproate alone (45...

Menstrual disorders in women with epilepsy receiving carbamazepine

Summary: We measured concentrations of serum sex hormones and sex hormone binding globulin (SHBG) in relation to regularity of the menstrual cycles in 8 women before carbamazepine (CBZ) treatment was initiated and after 1 and 5 years of CBZ therapy. In addition, we evaluated menstrual cycle regularity and related endocrine changes in 56 women receiving CBZ treatment for >5 years. Serum SHBG levels increased, and serum concentrations of 17β‐estradiol (estradiol) and estradiol/SHBG ratio decreased during CBZ treatment. Two of the 8 patients (25%) in the prospective study group developed menstrual irregularities during the first 5 years of therapy. In the cross‐sectional study group of patients treated with CBZ for >5 years, the frequency of menstrual disturbances was also 25.0% (14 of 56 patients). Concentrations of serum sex hormones and SHBG were measured in 13 women with menstrual disorders and in 11 randomly selected women with regular cycles. In most cases, menstrual disorders were associated with increased serum SHBG and decreased serum estradiol levels and low estradiol/SHBG ratio. Long‐term CBZ treatment results in increased serum SHBG levels and decreased estradiol effect, which correlate with the frequency of menstrual disorders in CBZ‐treated women with epilepsy.

Outcome after a high number (4–10) of repeated caesarean sections

Objective  To evaluate outcomes in caesarean sections repeated several times.

Comparison of fallopian tube sperm perfusion with intrauterine insemination in the treatment of infertility

OBJECTIVE To compare the efficacy of fallopian tube sperm perfusion utilizing a Foley catheter technique with standard IUI. DESIGN Randomized controlled study. SETTING The infertility units of the University Central Hospital and the Family Federation of Finland, Oulu, Finland. PATIENT(S) One hundred infertile women with unexplained factor, minimal to mild endometriosis, mild male factor, or ovarian dysfunction, undergoing 50 IUI and 50 fallopian tube sperm perfusion cycles stimulated by clomiphene citrate and hMG. INTERVENTION(S) Thirty-six hours after hCG administration, patients were randomized to either the IUI group (group 1, 50 patients and cycles) or the fallopian tube sperm perfusion group (group 2, 50 patients and cycles). Intrauterine insemination was performed using a standard method and fallopian tube sperm perfusion with a pediatric Foley catheter, which prevents the reflux of sperm suspension. MAIN OUTCOME MEASURE(S) Number of clinical pregnancies. RESULTS(S) The fallopian tube sperm perfusion method using a Foley catheter technique was easy to perform and convenient for the patients. The overall pregnancy rate per cycle was 8% for fallopian tube sperm perfusion and 20% for IUI, a difference that was not significant. CONCLUSION(S) The fallopian tube sperm perfusion method using a Foley catheter offers no advantage in comparison with the conventional IUI technique.

NATURAL INTERPREGNANCY INTERVALS OF FERTILE COUPLES : A LONGITUDINAL SURVEY OF GRAND GRAND MULTIPAROUS WOMEN

OBJECTIVE To characterize the natural fecundity of grand grand multiparous women (> or = 10 deliveries) in relation to age, number of pregnancies, body mass index, and chronic diseases. DESIGN A retrospective longitudinal analysis of interpregnancy intervals of married couples who had never used any kind of contraception. PATIENTS, PARTICIPANTS The interpregnancy intervals (months from delivery or spontaneous abortion to the next conception) of 96 grand grand multiparous women with a total of 1,327 pregnancies were evaluated from the first to the latest pregnancy (14 +/- 1.7; mean +/- SD). Because of the lack of reliable data on conception times, 109 pregnancies had to be excluded. The number of interpregnancy intervals remaining for evaluation was thus 1,218. RESULTS The mean interpregnancy intervals in the material of 1,218 pregnancies was 8.5 +/- 4.9 months, being significantly shorter after an abortion (5.3 +/- 4.8 months) or stillbirth (6.0 +/- 4.7 months) than after a delivery (8.9 +/- 5.6 months). The interpregnancy interval was significantly longer in women over 30 years of age than in the younger women, approximately 7 months in the latter and exceeding 10 months around the age of 40 years. Body mass index and chronic medical illness did not influence the interpregnancy intervals. The incidence of spontaneous abortions increased after the age of 30 years. It was 6% until 30 years, 10% between 31 and 35 years, and 25% after 40 years. CONCLUSIONS In this retrospective longitudinal review, the reproductive capacity of fertile couples remains rather sound until premenopausal age. The data suggest that a womans delivery capacity could be 25 births between 16 and 45 years of age.

Long gonadotrophin releasing hormone agonist/human menopausal gonadotrophin protocol for ovarian stimulation in intrauterine insemination treatment

OBJECTIVE This prospective study was undertaken to examine the usefulness of a long gonadotrophin releasing hormone agonist (GnRH-a)/human menopausal gonadotrophin (hMG) protocol in intrauterine insemination (IUI) treatment. The results were compared to those of clomiphene citrate (CC)/hMG/IUI. STUDY DESIGN Seventy-five patients were recruited to a GnRH-a/hMG group (group 1) while 88 patients underwent CC/hMG stimulation and served as controls (group 2). The study subjects were stimulated with a long GnRH-a/hMG regimen. IUI was performed 36 h after the administration of human chorionic gonadotrophin. RESULTS The number of preovulatory follicles, the thickness of endometrium and sperm parameters were similar in both groups. The hMG requirements were significantly higher in group 1 than in group 2 (21.2 +/- 5.1 vs. 8.1 +/- 3.1 ampoules). The pregnancy rate was 20% in group 1 and 12.5% in group 2, the difference being not significant. CONCLUSION The pregnancy rates were not significantly different between the GnRH-a/hMG/ IUI and CC/hMG/IUI groups. In addition, GnRH-a/hMG stimulation is notably more expensive than CC/hMG, and for these reasons, GnRH-a/hMG stimulation is not cost-effective in routine IUI therapy.

Partogram of a grand multipara: different descent slope compared with an ordinary parturient

Partograms of 42 grand multipara women (mean 10 previous deliveries) were analyzed and compared with the partograms of nulli- or second-/thirdpara women. All these full-term pregnancies were normal and the vaginal deliveries were spontaneous and non-instrumental. The grand multiparas had the shortest duration of the latent phase and the second stage of the delivery, but the active slope of the cervical dilation was in all groups same, on the average 2.8 cm/hour. The station of the presenting part of the fetus remained in the grand multipara group significantly higher than in the other parturients for the whole first stage of labor. During this delayed descent the normal rotation of the fetal head from occiput transverse to occiput anterior position was delayed and fetuses were often delivered in a low transverse head position. The cephalopelvic disproportion need not be the most obvious reason for a slow descent in a grand multipara delivery, but slow descent can be caused by the physiological changes due to the great number of previous pregnancies.

Partogram of a Grand Multipara: Different Descent Slope Compared With an Ordinary Parturient

Partograms of 42 grand multipara women (mean 10 previous deliveries) were analyzed and compared with the partograms of nulli- or second-/thirdpara women. All these full-term pregnancies were normal and the vaginal deliveries were spontaneous and non-instrumental. The grand multiparas had the shortest duration of the latent phase and the second stage of the delivery, but the active slope of the cervical dilation was in all groups same, on the average 2.8 cm/hour. The station of the presenting part of the fetus remained in the grand multipara group significantly higher than in the other parturients for the whole first stage of labor. During this delayed descent the normal rotation of the fetal head from occiput transverse to occiput anterior position was delayed and fetuses were often delivered in a low transverse head position. The cephalopelvic disproportion need not be the most obvious reason for a slow descent in a grand multipara delivery, but slow descent can be caused by the physiological changes due to the great number of previous pregnancies.

Polycystic Ovaries and Hyperandrogenism in Women Taking Valproate for Epilepsy

BACKGROUND Reproductive endocrine disorders are more common among women with epilepsy than among normal women. These disorders have been attributed to epilepsy itself, but could be related to antiepileptic-drug therapy. METHODS We studied 238 women with epilepsy who were seen regularly at the Outpatient Department of the University Hospital, Oulu, Finland. Their mean age was 33 years (range, 18 to 45), and the mean duration of therapy was 9 years (range, 0 to 31). Twenty-nine (12 percent) were treated with valproate, 120 (50 percent) with carbamazepine, 12 (5 percent) with valproate and carbamazepine, and 62 (26 percent) with other medications; 15 (6 percent) were untreated. Vaginal ultrasonography was performed to determine ovarian size, and serum sex-hormone concentrations were measured in 41 women with epilepsy and menstrual disturbances, 57 women with epilepsy and regular menstrual cycles, and 51 normal women. RESULTS Menstrual disturbances were present in 13 of the women receiving valproate alone (45 percent), 3 of the women receiving valproate in combination with carbamazepine (25 percent), 23 of the women receiving carbamazepine (19 percent), and 8 of those receiving other medications (13 percent). Forty-three percent of the women receiving valproate had polycystic ovaries, and 17 percent had elevated serum testosterone concentrations without polycystic ovaries; 50 percent of the women receiving valproate and carbamazepine had polycystic ovaries, and 38 percent had elevated serum testosterone concentrations without polycystic ovaries. Eighty percent of the women treated with valproate before the age of 20 years had polycystic ovaries of hyperandrogenism. CONCLUSIONS Menstrual disturbances, polycystic ovaries, and hyperandrogenism are often encountered in women taking valproate for epilepsy.