Induction of amenorrhea during hormone replacement therapy: optimal micronized progesterone dose. A multicenter study.

The effects of oral micronized progesterone on the endometrium and bleeding pattern have been assessed in a multicenter study of 101 postmenopausal patients. During a minimum of 6 cycles, the participants received either percutaneous 17 beta-estradiol (1.5 mg/day) associated with micronized progesterone (100 mg/day), given at bedtime for 21/28 days or 25 days/calendar month (n = 98) [1], or E2 (3 mg/day) for 25 days associated with progesterone (300 mg/day), from day 16 to day 25 (n = 3) [2], according to their willingness to induce, or not, cyclic withdrawal bleeding. Each endometrial biopsy performed at 6-month minimum was assessed by two independent pathologists: results showed 61% quiescent without mitosis, 23% mildly active with very rare mitoses and 8% partial secretory endometrium. The remaining biopsies showed inadequate tissue (4%) or a sub-atrophy (4%). No hyperplasia was found by any pathologist. In the case of inadequate material, the mean thickness of endometrial mucosa measured by ultrasonography was 3.9 mm. Amenorrhea incidence was 93.3 and 91.6% at the 3rd and 6th month of therapy, respectively. No bleeding occurred in more than 80% of women. The results show that a low dose of oral progesterone (100 mg/day), given during 25 days, efficiently protects the endometrium by fully inhibiting mitoses and induces amenorrhea in the majority of postmenopausal women, allowing better compliance to long-term therapy.

Uterine anomalies and in vitro fertilization: what are the results?

OBJECTIVE: To evaluate the influence of uterine anomalies on the implantation rates after embryo transfer. STUDY DESIGN: A retrospective, multicentric study. This study compare patients presenting a uterine anomaly (septate uterus, umicornuate, pseudonicornuate, bicornuate uterus) having attempted FIVETE between 1987 and 1992 with the normal population treated by IVF, as well as with FIVNAT results. RESULTS: Thirty-eight patients were part of the studied population and total 119 oocyt retrievals which lead to 103 embryo transfers (corresponding to 1.35% of the realised transfers during the same period in the three centers of the study). The pregnancy rate obtained by these patients is significantly lower than those obtained by the control group (11.7% pregnancies by retrievals vs. 19.1%, and 13.6% pregnancies by transfer vs. 24.9%). The implantation rate by embryo transfer is 5.8% in the population studied vs. 11.7% in the control group (P < 0.01). These results significantly improve when the uterine anomaly can be treated (septate uterus). CONCLUSION: The uterine anomalies are associated with a lowered rate of embryo implantation. This implantation rate improves when the anomaly can be treated (septate uterus).

[The results of cone biopsy of the cervix in women who have not yet reached the menopause ]. / Conséquences de la conisation chez la femme non ménopausée.

The authors have studied the post-operative gynaecological and obstetrical results of conisation of the cervix in young women. Their study is of 143 conisations of which part of the subject is found in 81 cases where conisation was the only treatment for the cervical lesion. Haemorrage was an important complication occurring in 3 out of the 81 cases. Conisation does not alter the fertility of these women, who will require contraceptive measures to be taken if they want to avoid terminations of pregnancy. Pregnancy when it does continue in these patients after conisation is sometimes beset by complications due to this operation. Abortion occurs in 18% of cases and premature labour in 6%. The incidence of these complications is directly related to the amount of tissue cut out. When conisation is carried out during pregnancy the results can be bad. In these cases a limited conisation must be performed, or if possible this surgical manoeuvre should be done only after delivery.

[Cleaning protocol for endoscopic instruments in gynecology]. / Protocole d'hygiène du matériel endoscopique en gynécologie.

The procedure for cleaning endoscopic material include successive step which must be applied correctly: preliminary treatment, predisinfection or cleaning, rinsing, sterilization or disinfection. If sterilization is performed, the material is stocked until its next use. If cold disinfection is performed, the material is rinsed then stocked but cold disinfection must be performed again before using the material again. Personnel who manipulate must of course wear gloves. Cold disinfection is insufficient. Material used for endoscopic gynaecological surgery should be sterilized with an autoclave since it is the only method which can prevent infection.

[Benzalkonium chloride tampons. Local tolerance and effects on cervix mucus]. / Les tampons au chlorure de benzalkonium. Tolérance locale et effets sur la glaire cervicale.

Cylinders of soft polyvinyl soaked in benzalkonium chloride have been used as contraceptive tampons. Benzalkonium chloride is a powerful spermicide which belongs to the cationic or saponium detergents. It does not enter the blood stream. These contraceptive sponges are more efficient and better accepted by patients than spermicides used by themselves. One of the principal advantages of the method is to be able to place the tampon in position hours before sexual intercourse. The authors wanted to test if wearing a tampon for a long time did not have an adverse effect on the cervico-vaginal epithelium. 27 women were seen before and after having worn one of these contraceptive tampons for 24 hours: neither the smears nor colposcopy had changed. 21 vaginal biopsies were taken after the tampon had been removed from the area where it had been lying. Vaginal epithelium tolerates the prolonged presence of the sponge well. The authors carried out bacteriological controls before and immediately after removing the tampon 24 hours later. Commensals were still present. Pathogenic sexually transmitted organisms are moderately sensitive to bactericidal action of benzalkonium chloride except for candida albicans, which is resistant. There was no increase in the number of germs in 69 cases studied. The authors carried out scanning electromicroscopy at different magnifications to see the effect on normal cervical mucus at the time of ovulation when it came into contact with benzalkonium chloride. Ovulatory mucus which had been translucent and fluid became thicker and coagulated and the reticulated web took on the appearance of a bunched up web.(ABSTRACT TRUNCATED AT 250 WORDS)

[Economic advantages of celioscopic treatment of extra-uterine pregnancy]. / Avantages économiques du traitement coelioscopique de la grossesse extra-utérine.

Laparoscopic surgery has numerous advantages over laparotomy in the treatment of some benign gynaecological conditions and in particular those connected with reproduction. Laparoscopic surgery in ectopic pregnancy seems to be a good example of a condition in which the cost/efficiency ratio can be improved. In 109 cases the mean length of hospital stay was reduced by 4.23 days per case. This led to a saving of 8,954 francs. The mean time off work after operation was reduced by 22 days per patient. This is a considerable economic saving for the population because the numbers ectopic pregnancies have risen considerably.

[Distal tubal surgery using laparoscopy]. / Chirurgie tubaire distale par coelioscopie.

Between January 1987 and May 1990, forty-four women were treated in our department by laparoscopic surgery for distal tubal pathology. Among them, 10 had an intrauterine pregnancy (22.7%) and 2 had an ectopic pregnancy (4.5%) within 28 months after surgery. Subsequently, our results were expressed in terms of the type of operation performed (fimbrioplasty or neosalpingostomy) and according to the tubal and adhesion scores (Mage and Bruhat). We found that most pregnancies were obtained within the first 16 months, that fimbrioplasty gave better results than neosalpingostomy (35.7% versus 16.6%) and that the tubal score was fairly predictive and more so than the adhesion score. These results enabled us to keep as indication of distal tubal laparoscopic surgery those patients who had pure distal tubal lesions with a tubal core of 1 to 2 and normal other parameters of infertility. In case of failure, i.e. if the woman does not become pregnant within 12 months post-laparoscopic surgery, in vitro fertilization is advised.

[Threatened premature labor. Account of our recent experience]. / Menaces d'accouchement prématuré. Bilan actuel de notre expérience

We have been using two products, one an alpha-blocker (Vadilex) and the other a beta-stimulating drug (Ritodrine) to treat cases with threatened premature labour. Our experience is with 93 women who were treated in a continuous series. The overall result of our treatment show that 72 per cent of the cases were treated successfully and 28 failed. Analysing these preliminary figures in greater detail we have observed that the prognosis depends mainly on the state of the cervix at the time treatment is started in cases of threatened premature labour. The chances for success are much greater if the cervix is long and closed that if it is taken up or open. Since the trial was not carried out with a "double blind" control, we cannot really tell which of the two products we used was more efficacious.

[Variation in plasma progesterone induced by the vaginal administration of Utrogestan]. / Variations de la progestérone plasmatique induites par l'administration vaginale d'Utrogestan.

The authors of this article have been trying to find out how natural progesterone contained in Utrogestan tablets are absorbed by the body when these tablets are placed in the vagina. To do this they conducted their studies on genitally active young women who had volunteered, who were not pregnant and who were not taking hormones. Several therapeutic protocols were tested. Vaginal administration of 100 mg of progesterone (1 Utrogestan tablet) resulted in an increase in blood progesterone levels within an hour. It reached its maximum level after 2 to 6 hours and lasted for 24 hours on an average. The average level was 3.7 ng/ml with a dose of 100 mg/day and 9.7 ng/ml with a dose of 200 mg/day. One capsule every 12 hours ensures that the least variation between individuals occurs. It is the most worth-while dosage and the one recommended by the authors of this article.

[Intraperitoneal insemination]. / Inséminations intrapéritonéales.

Intra-perineal insemination is a technique used in assisted reproduction. The principle is to stimulate the ovaries, to obtain the partner's sperm and to prepare it by similar techniques to those used in in-vitro fertilization so that the sperm can be placed near the ovaries in the Pouch of Douglas by a direct puncture of the posterior vaginal fornix without using anaesthesia. The woman's pelvis has to be absolutely normal. This technique is useful in cases of unexplained sterility, cervical sterility and inadequate sperm function.

[Spontaneous pregnancies in couples after failed or successful in vitro fertilization]. / Grossesses spontanées chez les couples après échec ou réussite de fécondation in vitro.

OBJECTIVE: To determinate the true incidence of treatment-independent pregnancy in an in vitro fertilization programme. To establish and to compare the characteristics of couples with and without spontaneous pregnancy. To analyze the outcome of pregnancies. TYPE OF STUDY: Retrospective. SETTING: In Vitro Fertilization Unit, Conception's Hospital, Marseille, France. SUBJECTS: 594 couples having attempted one or more IVF procedures. The study concerned low-fertility couples (484) ruling our true sterile couples (110). RESULTS: Spontaneous pregnancies occurred in 54 couples (11.2%). The characteristics of the two populations were not statistically different, except a shorter duration of infertility (p < 0.05) in spontaneous pregnancies. The rate of ectopic pregnancies in the spontaneous pregnancies was statistically higher than that observed in IVP pregnancies (12% versus 6.5%). The fertility rare of these couples was very low (0.38%). CONCLUSION: Spontaneous pregnancies in vitro fertilization programmes are not rare. The evaluation of the results of the in vitro fertilization requires taking the possible spontaneous pregnancies into account.

[Complications of gynecologic laparoscopy. Multicentric study of 7,604 laparoscopies]. / Complications de la coeliochirurgie gynécologique. Etude multicentrique à partir de 7,604 coelioscopies.

In a series of 7,604 laparoscopic procedures, the authors report one death and a rate of 2.76 per thousand (21 cases) for complications requiring laparotomy. When exclusively diagnostic laparoscopic procedures are considered (1,191 cases) this rate drops to 1.67 per thousand. The likelihood of laparotomy being required is directly related to the degree of importance of the laparoscopic surgical procedure. For major laparoscopic surgery the rate of laparotomy is 4.46 per thousand (18 cases), whereas it is only 0.42 per thousand (1 case) for minor laparoscopic surgery (p less than 0.01). Intestinal injuries represent 52.4% (11 out of 21) of cases requiring laparotomy. The main problem with this type of accident is to recognize them, because in almost half the cases (42.8%; 3 out of 7) the intestinal injury went unseen during the laparoscopic procedure and gave rise to peritonitis. Vascular complications are less frequent and required laparotomy in only 8 cases (38%; 8 out of 21). This low level of complications is yet further proof that laparoscopic surgery is a reliable technique and does not involve a high risk of laparotomy, provided that the surgeon has received specific training.