L. Rosenborg

Adrenocortical steroids, bone mineral content and endometrial condition in post-menopausal women

In 23 post-menopausal women, serum levels of cortisol, unconjugated dehydroepiandrosterone (DHA), dehydroepiandrosterone sulphate (DHAS), testosterone, unconjugated and total oestrone and prolactin were measured before and during an ACTH test. Significant positive correlations were found between basal levels of DHA and DHAS; DHA and unconjugated oestrone; DHA and total oestrone; testosterone and total oestrone and between unconjugated and total oestrone. ACTH significantly raised the levels of the steroids but not of prolactin. Significant positive correlations were found between basal levels and ACTH induced increments in DHA; between basal DHAS and increments in DHA and between increments in DHA and DHAS. A significant negative correlation was found between basal levels and increments in cortisol. No significant correlations were found between other combinations of hormone basal levels and/or increments. Significant positive correlations were found between basal levels of DHAS and the DHA response to ACTH respectively, and trabecular bone mineral content of the distal forearm. A significant correlation was also found between bone mineral content and pre-cancerous/cancerous state of the uterine epithelium. The results are a further support to the concept of a link between adrenal androgens and bone mineral density, and do also indicate a relation to endometrial pathology. The lack of correlation between cortisol and other steroids indicate different regulatory mechanisms. Prolactin does not seem to be involved in the regulation of the adrenal androgen synthesis.

Peripheral Hormone Levels and the Endometrial Condition in Postmenopausal Women

Abstract. Thirteen postmenopausal women with benign endometrial changes including proliferative, secretory and polypous endometrium, endometrial hyperplasia and atypia (group I) and 13 randomly selected age‐matched controls with normal atrophic endometrium (group II) were studied with respect to serum levels of dehydroepiandrosterone (DHA) and its sulfate (DHAS), testosterone, total estrone, estradiol‐17β, progesterone, FSH and prolactin. Serum levels of DHA, DHAS, testosterone and total estrone were significantly higher in group I than in group II; otherwise no significant differences Were found. Mean values for body weight and for Brocas index, respectively, were almost identical in the two groups.

Scheduled Intermittent Periods of in vitro Fertilization Treatments

Organization and results of an in vitro fertilization program at the Huddinge University Hospital are given from its beginning in August 1985: 6 months in advance a scheme is scheduled with 2 weeks open for treatment followed by free intervals of 3-4 weeks. Follicular development is stimulated with clomiphene citrate and hMG, and assessed by analyses of estradiol and LH in serum combined with ultrasound examinations. Following the administration of hCG, eggs are collected by transvesical aspiration guided by ultrasound. The ova are inseminated with about 50,000 motile spermatozoa, and cultured for 48 h. Up to four eggs are transferred transcervically to the uterine cavity. 158 egg pickups have been performed (August 1985 to December 1987) in 106 patients resulting in fourteen intrauterine and two ectopic pregnancies, biochemical pregnancies not counted. This protocol has restricted routine work load allowing these treatments to be part of the clinical routine. It has also allowed the application of research programs and thus optimized limited resources.

Surgical Correction of Female Infertility: An Analysis of Results and Failures in 101 Cases

During the 1970s, surgery undertaken to remedy infertility at Sabbatsberg Hospital in Stockholm involved macrosurgical techniques. the patients described here had the same pathology on either side. Sixty‐three underwent different procedures for the correction of tubal pathology at laparotomy, while 20 patients had lysis of adhesions performed at laparoscopy. a further 18 patients were operated on for ovarian endometriosis. the results in terms of conceptions (ranging from 43 to 60%, depending upon the type of operation) were similar to those reported from microsurgery, but the incidence of ectopic pregnancy was higher. Second‐look laparoscopy revealed the presence of adhesions and tubal block in a significant number of patients, though less often in those who ultimatively conceived. There was no difference in semen findings between patients who conceived and those who did not. Postoperative adhesions are responsible for many surgical failures, but refined methods of surgery may reduce the risk of future ectopic gestation. Only a limited number of cases remain where persistence of infertility may be due to minor anatomical or functional defects not amenable to present‐day clinical evaluation.

A scheduled in vitro fertilization program at Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden

embryos were transferred per patient. Twenty-four ongoing pregnancies have been established, for a pregnancy rate of 17.1%. Nine women have delivered, including two sets of twins. Of the 143 women undergoing laparoscopy for GIFT, 41 pregnancies have been established, resulting in a clinical pregnancy rate of 29%. Two ectopic pregnancies have occurred. Sixteen pregnancies have been delivered, including four sets of twins. Our 1987 pregnancy rate is 23% for IVF and 35% for GIFT. We are currently accepting 70 couples per month into our program. Embryo cryopreservation and gamete and embryo donation are options which are also available.

Successful Tubal Reimplantation After Rupture of the Uterus

A 29‐year‐old woman with primary infertility caused by bilateral isthmical tubal block was operated upon with bilateral cornual resection and tubal implantation. After one uncomplicated childbirth a second fullterm pregnancy ended in fetal catastrophe: the uterus ruptured at both sites of tubal implantation and a stillborn fetus was delivered by emergency cesarean section. One oviduct was detached from the uterus and the other one had to be removed. However, the maternal condition never became critical. Later on, a second tubal reimplantation was performed on the remaining side, and after a first‐trimester spontaneous abortion a second healthy infant was born at elective cesarean section.