Peyman Saadat

Treatment-Associated Serum FSH Levels in Very Poor Responders to Ovarian Stimulation

AbstractPurpose: To compare treatment-associated follicle-stimulating hormone (FSH) response in patients undergoing controlled ovarian hyperstimulation with either microdose flare (MDF) leuprolide acetate or clomiphene citrate and human menopausal gonadotropin (CC/hMG). Methods: Thirteen patients who were deemed poor responders underwent stimulation with one of two poor responder stimulation protocols (MDF group: n = 8; CC/hMG group: n = 5). Serum FSH, estrone (E1), estrone sulfate (E1S), and estradiol (E2) levels were measured at baseline, day 5 of medication, and on day of hCG administration. Ovarian and uterine responses were evaluated by ultrasound. Results: Treatment-associated FSH levels were consistently higher in the group that took CC/hMG. However, serum E1, E1S, and E2 values were similar in both groups as were the number of oocytes retrieved and the endometrial echo complex. There were no differences between the two groups with regards to the quality of the oocytes obtained, fertilization rate, or the quality of the embryos. Conclusion: Clomiphene citrate, when administered in conjunction with exogenous hMG, is a more potent stimulator of FSH production than MDF leuprolide acetate among poor responders to ovarian stimulation. However, the number of oocytes is not increased.

Spontaneous twin gestation after vaginal dilation in a woman with uterus didelphys and bladder exstrophy.

BACKGROUND Bladder exstrophy is an uncommon anomaly rarely associated with uterus didelphys. Fertility is limited by associated vaginal malformations, which have traditionally required surgical reconstruction. CASE A woman with a history of bladder exstrophy and hypoplastic vagina presented complaining of painful intercourse. The patient underwent vaginal dilator treatment after corrective surgery for the bladder defect. Without any further fertility therapy she subsequently conceived twins, with one implantation in each horn of a didelphic uterus. CONCLUSION Bladder exstrophy, uterus didelphys, and vaginal hypoplasia share a common embryological development, and the finding of one anomaly can alert to the presence of another. Vaginal dilators may be used in place of surgical reconstruction to allow conception.

Alterations in gonadotropin levels following oral and vaginal administration of the Yuzpe regimen and plan B for emergency contraception

There is increasing use of the Yuzpe regimen [500g levonorgestrel (LNG)/100g ethinyl estradiol] and Plan B (750g LNG) for emergency contraception. These regimens are believed to act by delay of ovulation in conjunction with a local effect on the endometrium; however the exact mechanism of action is unknown. Furthermore data regarding vaginal administration of both regimens are lacking. The objective of this study was to determine the effects of Plan B and Yuzpe regimens administered orally or vaginally on serum gonadotropin levels at peak and nadir LNG levels. There was no significant difference in LH and FSH suppression between Plan B and the Yuzpe regimens suggesting that when high doses of LNG are used (Plan B) the addition of EE as in the Yuzpe regimen contributes little to further gonadotropin suppression. Vaginally administered Plan B and Yuzpe regimens did not differ significantly from the same regimens administered orally in suppression of LH and FSH suggesting that vaginal administration of such regimens may be as efficacious as oral ones in delaying ovulation. (excerpt)

FETAL LUNG MATURATION : COMPARISON OF BIOCHEMICAL INDICES IN GESTATIONAL DIABETIC AND NONDIABETIC PREGNANCIES

OBJECTIVE To compare the biochemical maturation of the components of the lung profile according to gestational age between reliably dated gestational diabetic and nondiabetic pregnancies. STUDY DESIGN Lung maturation was compared in reliably dated pregnancies in 501 gestational diabetic women and 561 nondiabetic women. Lecithin/sphingomyelin ratio (L/S) and phosphatidylglycerol (PG) were evaluated by analysis of variance according to the presence or absence of diabetes and weeks of gestational age. The effect of gestational diabetes on fetal lung maturation was determined by analysis of variance. RESULTS The gestational diabetic group had no clinical or statistical differences in L/S ratios as compared to the nondiabetic patients at any gestational age. There were no differences in mean percent PG between the diabetic and nondiabetic groups at any gestational age. By 37 completed weeks, 86% of the L/S ratios and 78% of the PG values were mature in the diabetic group as compared to 80% of the L/S ratios and 78% of the PG values in the control group (P = .33 and .43, respectively). CONCLUSION In reliably dated gestational diabetic pregnancies, biochemical maturation of the fetal lung strongly correlates with gestational age and does not appear to be significantly delayed when compared to a nondiabetic control group.