Pituitary-ovarian axis during lactational amenorrhoea. II. Longitudinal assessment of serum FSH polymorphism before and after recovery of menstrual cycles.

BACKGROUND: The association of normal serum levels of immunoassayable gonadotrophins with anovulation during lactational amenorrhoea (LA) has not been fully explained. METHODS: Serum FSH polymorphism was analysed in 10 women during LA between days 60 and 70 post-partum and again, in the mid-follicular phase (MFP), after resuming menstrual cyclicity. FSH microheterogeneity was characterized according to charge, using preparative isoelectric focusing, and according to the inner structure of carbohydrate chains, using lectin chromatography. RESULTS: A significantly higher proportion of FSH charge isoforms isolated below pH 4.10 and a lower proportion of FSH isoforms bearing highly branched oligosaccharides were observed during LA when compared to MFP. Further analysis with higher resolution showed that FSH charge isoforms, isolated in the lower pH range in LA, corresponded to FSH molecules bearing highly branched and biantennary oligosaccharides. FSH isoforms bearing hybrid-type oligosaccharides were only present during LA. The circulating FSH isoform mix was significantly less bioactive in LA than in MFP. LA is characterized by a more acidic mix of FSH isoforms, containing hormone bearing less processed oligosaccharides, with decreased biopotency in comparison with the follicular phase. CONCLUSIONS: This FSH microheterogeneity may be one of the critical factors contributing to incomplete follicular development and anovulation during LA.

Pituitary-ovarian axis during lactational amenorrhoea. I. Longitudinal assessment of follicular growth, gonadotrophins, sex steroids and inhibin levels before and after recovery of menstrual cyclicity.

BACKGROUND: Comparisons of follicular development and hormonal profile in the same women during and after lactational amenorrhoea (LA) are scarce. We report follicular growth, pituitary and ovarian hormone serum levels in the same women during LA and in follicular phases after resumption of menstrual cyclicity. METHODS: Serum samples were obtained from 10 women during LA between days 60 and 89 post-partum and between days 1 and 4 (early follicular phase; EFP) and 7 and 10 (mid-follicular phase; MFP) of the second and third cycles after LA. RESULTS: The number of follicles >3 mm and diameter of the largest follicle were significantly higher during LA when compared to EFP and MFP. Serum levels of inhibin B were similar in LA and EFP and increased significantly in MFP. Pro-alphaC was significantly higher in EFP than in LA and MFP. Estradiol was similar during all stages. In comparison with EFP and MFP, LA is associated with higher prolactin levels, normal or slightly elevated gonadotrophins and increased number and size of follicles without a parallel increase in estradiol, inhibin B and Pro-alphaC. CONCLUSIONS: During LA, there is a profound dissociation between follicular growth and follicular endocrine activity, which suggests an alteration in the stimulus-response relationship at the follicular level.

Clinical assessment and serum hormonal profile in prepubertal hypertrichosis.

Twenty-two prepubertal girls with hypertrichosis were studied and compared to 10 prepubertal normal girls. Hypertrichosis was assessed according to a score that considers the amount and the distribution of vellus hair in androgen- and non-androgen-sensitive areas. Serum androgen profile and free androgen index (FAI) were determined in both groups. The hypertrichosis score was higher in patients than in the normal girls. Testosterone levels and FAI were increased in patients when compared to control; 3alpha-androstanediol glucuronide levels above 2 SD from the control mean were found in 10 girls and all hormonal parameters falling in the normal range were found in 4 girls. The new score designed to assess the degree of hypertrichosis was useful to differentiate between normal and pathological hair growth. Although most of the girls with prepubertal hypertrichosis showed an increased androgen bio-availability, a slight increase in peripheral 5alpha-reductase activity and a completely normal androgen profile was also associated with a pathological hair growth.

Efficacy assessment of highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotropin during pituitary suppression in patients undergoing GIFT for unexplained infertility.

The purpose of this study was to compare the efficacy of highly purified follicle-stimulating hormone (FSH-HP) alone versus the combination of FSH-HP + human menopausal gonadotropin (hMG) treatment during pituitary suppression with gonadotropin-releasing hormone (GnRH) analog on the clinical outcome and endocrine parameters in 120 randomized women undergoing gamete intra-Fallopian transfer (GIFT) for unexplained infertility. Our data did not show any significant difference between the two groups as regards dose of administered gonadotropins, duration of treatment, estradiol 17 beta 17 beta increase curves, number of follicles > 16 mm, number of recruited and transferred oocytes, and endometrial thickness. The percentages of clinical pregnancies (33.3% with FSH-HP and 31.6% with FSH-HP + hMG), of miscarriages and twin gestations were also similar in the two groups. It is concluded that, during GnRH analog suppression, FSH-HP treatment alone is effective in inducing normal follicular steroidogenesis and adequate oocyte maturation, but no detrimental effect of luteinizing hormone (LH) activity of hMG on the outcome of the outcome of ovarian stimulation was found.

Social marketing and diffusion-based strategies for communicating with unique populations: HIV prevention in San Francisco.

We conducted a 2-year investigation of the extent to which strategies based on social marketing and diffusion of innovations concepts are used in preventive health communication with unique (highly ostracized) populations. Of the 49 organizations in San Francisco that operate HIV prevention programs (N = 100), programs that most highly targeted unique populations were surveyed. Personal interviews were then conducted with 38 staff leaders who operated the most and least effective programs. Audiotapes and transcripts were content analyzed to identify the strategies used by program staff. Strategies based on social marketing concepts were more prevalent than strategies based on the diffusion of innovations: More effective programs were characterized by emphasis on homophily, audience segmentation, compatibility-based strategies, and interorganizational collaboration.

[Surgical treatment of ovarian cysts: economic analysis as a means for the evaluation of alternative technics. Results of a biennial study]. / Trattamento chirurgico di cisti ovariche: analisi economica come strumento di programmazione e di valutazione di tecniche. Risultati di un'indagine su un biennio.

The large use of new gynaecological technologies such as the operative laparoscopy, requires both efficacy and efficiency evaluation. The aim of this work is to compare costs of the surgical treatment of ovarian cysts between two groups of patients--35 patients undergone to laparotomic cystectomy (age: mean 27.5) and 34 operated by laparoscopic technique (age: mean 27). The analysis of the costs, related to three steps of health care (pre-operative, operative, post-operative) shows that the laparoscopic cystectomy results the more efficient intervention (L. 6,244,808 vs L. 8,310,002). This economic analysis may offer a planning tool for health care to hospital managers and represent an efficiency evaluation criterion of surgical techniques employed by the gynaecologists.