ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In the developed world, deferment of marriage and postponement of child-bearing in marriage are resulting in unprecedented numbers of couples who desire pregnancy relatively late in life. These factors combine with a decline in fertility and an increase in pregnancy wastage with advancing age to present new challenges for the clinician treating infertility. Experience with young oocytes donated to older women indicates that the major responsibility for the decline in fertility with age can be attributed to aging oocytes. Oocyte donation offers new hope for infertile older woman, but important moral and social questions remain unanswered.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The corpus luteum is controlled by luteinizing hormone (LH) and intra-ovarian morphofunctional specialization and autocrine/paracrine mechanisms. Corpus luteal insufficiency produces luteal phase defects (LPD). The poor precision and validation of endometrial histologic dating and single or random multiple serum progesterone measurements produce widely variable diagnoses. The true prevalence rate of LPD may be only 3–5% similar to that due to chance. The role of LPD in causing infertility can be challenged because the diagnosis is not predictive of recurrence in subsequent cycles, and other causes of infertility are not controlled for. Intraobserver and interobserver variability, uterine site of biopsy, luteal phase length, time of ovulation, and luteal phase timing of biopsy have been examined and have confirmed the imprecision of dating as a sensitive and reliable assessment of luteal insufficiency. There is support for either early or late luteal phase biopsy. Endometrial dating using LH timing as a reference point is relatively more reliable. Integrated luteal progesterone is the only currently accurate assessment of luteal sufficiency. Clomiphene does not increase LPD but increases serum progesterone, integrated progesterone, corpus luteum LH/human chorionic gonadotropin (hCG), and insulin-like growth factor-1 (IGF-1) receptors, all of which promote increased progesterone production and do not affect endometrial estrogen and progesterone receptors. hCG is more likely to stimulate progesterone production if given at the mid rather than early luteal phase corresponding to the phase with highest total and available (unoccupied) corpus luteal LH receptors. Careful analysis of published studies on treatment of LPD revealed only one randomized controlled study, and, statistically, all studies revealed no better outcome with progesterone treatment.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Our capacity to diagnose the functional competence of human spermatozoa has been facilitated by recent advances in our understanding of sperm physiology. This review focuses on two important developments, namely the role of lipid peroxidation in the pathophysiology of impaired sperm function and the extragenomic action of progesterone in controlling sperm activation.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The emphasis of this review is placed on the treatment of clomiphene-resistant women with polycystic ovary syndrome (PCOS) or with hypogonadotropic hypogonadism. There has been an increasing awareness of the need to avoid the consequences of multiple folliculogenesis, and this is reflected in the more widespread use of low-dose regimens for induction of ovulation, particularly in PCOS. The past 12 months have seen the first reports of the clinical applications of recombinant human follicle-stimulating hormone (FSH), and there is an intriguing suggestion that long-acting opiate agonists may have a part to play in the management of anovulation of hypothalamic origin.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This review provides an update on the role of operative laparoscopy in infertility treatment. The areas of discussion include laparoscopic surgery for proximal and distal tubale disease, polycystic ovarian syndrome, endometriosis, and assisted reproduction.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Laparoscopic removal of the products of conception remains the treatment of choice for ectopic pregnancy (EP). Systemic administration of methotrexate (MTX) is a promising new treatment; however, its efficacy has to be established in clinical trials. Local treatment by laparoscopy with MTX, prostaglandin, or other substances is not as effective as laparoscopic salpingostomy.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Recurrent spontaneous abortion is seen often. Although many causes of this condition have been identified, there is still a large proportion in which no cause can be found. This review highlights some of the newly described proposed causes. Several reports have linked reproductive inefficiency to hypersecretion of luteinizing hormone (LH) in the follicular phase. It is apparent that the presence of inappropriate elevation of LH, and not the ultrasonographic appearance of polycystic ovaries, is the critical factor in determining the risk of abortion. Consequently, by lowering the LH levels one can expect a better reproductive outcome. This hypothesis awaits testing through clinical trials. The role of ultrasonography in evaluating the luteal phase, by assessing the image of the endometrium, has been studied by many investigators. This non-invasive technique is not yet able to replace the endometrial biopsy. The association between antisperm antibodies in the female serum and recurrent spontaneous abortion requires re-evaluation in light of more recent evidence; however, the role of semen abnormalities, especially severe oligospermia in this disorder, points towards a factor in the male partner that should be identified. Oligomenorrhea has been identified by mathematical modeling as a potential risk factor for recurrent abortion, although the mechanism has not been clearly elucidated. Chromosome heteromorphisms, particularly inv (9)(p11 q12), appear to be associated, more frequently, with recurrent abortion. Similarly, associations were observed with factor-XII deficiency and high titers of immunoglobulin G (IgG) antibody to Chlamydia trachomatis. Although exposure to video display terminals (VDTs) has not been consistently found to be associated with recurrent abortion, more recent evidence suggests that exposure to the low frequency magnetic fields of VDTs may be a causal factor. Finally, the high prevalence of chromosomal abnormality in the abortuses of women with recurrent abortion indicates that every attempt should be made to perform karyotypic analyses on abortuses from these women.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In the past decade, oocyte donation has become a widely used assisted reproduction technique with reported pregnancy rates often higher than those for conventional in-vitro fertilization. Recipients of donated oocytes include women with premature ovarian failure or severe genetic disorders, those who respond poorly to ovarian hyperstimulation, women over 40 years of age, and, recently, postmenopausal women. The donation of oocytes to older women raises many medical and social issues which have to be addressed.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although the use of luteinizing hormone-releasing hormone (LHRH) agonists and human menopausal gonadotropin (hMG) for ovarian stimulation in assisted reproduction has gained widespread popularity, a number of major issues regarding their use remain unresolved. Some of these issues are examined in the light of recent developments. The routine use of LHRH agonists produces significantly higher pregnancy and livebirth rates compared with conventional methods of ovarian stimulation. A number of prospective, randomized studies have shown that the long protocol of LHRH agonist administration is superior to the short and ultrashort protocols, and it appears that early follicular phase initiation of the long protocol may be particularly beneficial. Another major advantage of the long protocol of LHRH agonist administration is that, with its use, precise timing of human chorionic gonadotropin (hCG) administration is not important. It would, therefore, appear that the routine use of LHRH agonists has both medical as well as practical advantages.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID