[Size reduction of uterine myomas with monthly administered leuprolide acetate]. / Disminución del tamaño de miomas uterinos con acetato de leuprolide administrado mensualmente.

Six patients with symptomatic leiomyomata uteri and in whom surgical treatment was indicated received, during 3 months, intramuscular leuprolide acetate, 3,75 mg monthly, in order to 1) achieve a reduction of myomata size and 2) recover an anemic patient before surgery. In every patient, amenorrhea was induced since the second month of treatment. A significant decrease of myomas sizes was achieved. The reduction of the volume of the largest myoma in each case, varied between 51% and 77% (x = 60% +/- ES 4,3) LH and estradiol plasma levels diminished significantly and FSH did not changed in response to treatment. Side effects were well tolerated. Hot flashes were present in all patients, headaches in 2 and loss of strength in 2. Surgery was accomplished after 3 months of treatment. Myomectomy was performed in 5 cases and total hysterectomy in 1. Uterine shrinkage and the period of amenorrhea induced by Lupron-depot facilitated hysterectomy and myomectomy techniques and the recovery of one patient with a severe anemia.

[The results of a program of in vitro fertilization and tubal embryo transfer (ZIFT)]. / Resultados de un programa de fertilización in vitro y transferencia de embriones a la trompa (ZIFT).

Twenty-one sterile couples, between September 1989, and August 1991, were treated for ovulation stimulation of their cycles, in order to practice in them, a in vitro fertilization and tube embryo transfer (ZIFT). Two protocols of ovulation induction were used, both with leuprolide acetate (Lupron), one in the luteal phase and the other in follicular phase and since the second or the fourth day of the cycle, respectively, gonadotropins were added (Metrodine and Pergonal). Out of all the twenty-nine initiated cycles, twenty-seven were aspirated (93.1%) and twenty-four reached an embryo transfer (82.8%). Seven clinic pregnancies were obtained (29.17% per transfer) and four deliveries (16.67% per transfer). The sterility period average was 69.64 +/- 36.6 months and the patients age average was 34.1 +/- 4.38 years. The global rate of fertilization was 63.53%. With luteal phase Lupron best results were got (pregnancy rate of 38.46% per transfer) and there were not considerable difference in the number of gonadotropins ampulla employed. When embryos were transfer to the tubes and the uteri the pregnant rate was 50% per transfer, in comparison to 18.75% when transfer was made only in the tubes.

[What results can be expected from in vitro fertilization and other technics of assisted fertilization?]. / Qué resultados se pueden esperar de la fertilización "in vitro" y de otras técnicas de fertilización asistida?

Results of assisted reproductive techniques (IV, GIFT and ZIFT) have improved progressively during the last years but they are still not satisfactory specially when they are analyzed in terms of cost efficacy. During 1990, in the world literature, the following successful results were reported: pregnancy rates of 20% and delivery rates of 15% for IVF-ET, 29% and 22% for GIFT and 21% and 16% for ZIFT. In spite of the small number of cases reported in Chile, results are similar to those of USA and Europe. Results of assisted fertilization techniques have improved with the use of Gn-RH agonists and are worse in patients older than 35 years of age than in younger ones. Pregnancies rates are higher when the number of transferred ovocytes increases although transfer of more than 3 or 4 ovocytes or embryos is contraindicated because of the risks of multiple pregnancies. When more than 3 or 4 embryos are obtained those not transferred are usually cryopreserved. IVF-ET is the first choice of treatment in cases of infertility due to severe tubal damage and/or extensive and dense pelvic adhesions. In cases of infertility with normal tubes, intrauterine inseminations in 3 to 4 controlled hyperstimulated cycles are recommended before indicating an assisted fertilization procedure. The most risky complication of assisted reproduction, besides multiple pregnancy, is severe ovarian hyperstimulation syndrome (SOHS). This syndrome is prevented by not injecting HCG or by not transferring ovocytes or embryos in cases of high estradiol levels after HMG and/or FSH administration.

Ultrastructure of a 4-cell human embryo developed in vivo.

The ultrastructure of a 4-cell human embryo undergoing development in vivo is described. The embryo recovered from the Fallopian tube 130 h after a single episode of intercourse and 70 h after the luteinizing hormone peak in plasma, was partially surrounded by cumulus cells. The blastomeres, of even size, were nucleated and had a similar distribution of cytoplasmic organelles. No signs of abnormality or cellular degeneration were observed. Transmission electron microscopy of serial sections revealed the presence of primitive desmosomes between cells, abundant vesicles within the blebs of the outer sheet of the nuclear membrane, blebbing of the inner sheet of the nuclear membrane and close association between the inner sheet of the nuclear membrane and the intranuclear annulate lamellae. Nucleolar precursors lacking the structural organization of mature nucleoli were also found. Similarities and differences between this and other preimplantation human embryos reported earlier are analysed.

[Effect of bromocryptin in polycystic ovary syndrome]. / Efecto de la bromocriptina en el síndrome de ovario poliquístico.

Ten patients with polycystic ovarian disease and normoprolactinemia received bromocriptine 5 mg daily for up to 4 months. The following parameters were evaluated before treatment and at monthly intervals menstrual patterns, hirsutism score, weight, and blood pressure and LH, FSH, prolactine, unbound and total testosterone in plasma. In 5 out of 10 subjects with oligomenorhea or amenorhea normal menstruations were observed; 3 additional subjects got more frequent but not normal menstruation and 2 patients got pregnant. No changes in LH, FSH and androgens were observed. Prolactin levels fell significantly in all subjects. No clinical nor biochemical parameter predicted the improvement in menstrual patterns. Bromocriptine may have a place in the treatment of polycystic ovarian diseases with normoprolactinemia though its mechanism of action is unclear.

[In vitro fertilization program. Preliminary results]. / Programa de fecundación in vitro. Resultados preliminares.

Three infertile couples were submitted to in vitro fertilization and uterine embryo transfer (IVF+ET) and 7 to in vitro fertilization and pronuclear stage tubal transfer (IVF+PROST). In order to programmed menstruation Norethisterone, 10 mg daily, were administered during the cycle preceding the one of controlled ovarian hyperstimulation. In order to inhibit endogenous production of FSH and LH, leuprolide acetate, a Gn-RH agonist, was injected subcutaneously 1 mg daily during 6 days and 0.5 mg fowardly from the luteal phase of the cycle proceeding the one of hyperstimulation until the day of HCG administration. To achieve superovulation pure FSH (Metrodine), HMG (Pergonal) and HCG (Endocorion) were used. Oocyte retrieval was performed through transvaginal puncture under ultrasonographic control. For oocyte and embryo identification and classification, spermatozoa separation and capacitation and gamete insemination and incubation procedures habitual techniques were employed. Pronuclear embryo tubal transfer was performed through a laparoscope 17 hours after insemination and embryo transfer to the uterine cavity after 48 hours. Nine of 10 patients responded to gonadotrophin hyperstimulation and were submitted to ovarian puncture. 69 oocytes (7, per patient) were obtained, 59 (81.15% of which were mature. 74.55% of the inseminated oocytes fertilized. Two patients got pregnant: one, submitted to IVF+PROST, presently has a multiple pregnancy with triplets and the second, submitted to IVF+UT, had a missed abortion at 8 weeks of pregnancy.

The secretion of progesterone during the periovulatory period in women with certified ovulation.

A pre-LH peak rise of progesterone in peripheral blood has been found in 13 normal cycling women whose ovulation was confirmed by biopsy of the corpus luteum through serial determination of progesterone and LH performed every 8 h during the periovulatory period. The progesterone rise began as an average 22 h (16-40 h) prior to the LH peak. The maximal preovulatory rise took place 9.6 h (0-24 h) before the LH zenith, remaining low for approximately 17 h when an abrupt rise of progesterone took place. The progesterone peak was detected in the morning samples in 11 of 13 patients studied. The progesterone rise was always followed by an LH peak and the highest peak of progesterone was trailed by the highest LH peak in all the patients except one.

Correlation between catecholamine content of the human Fallopian tube and the uterus and plasma levels of estradiol and progesterone.

The content of catecholamines in the Fallopian tube and the uterus and the plasma levels of estradiol and progesterone were studied in cycling women. During the follicular phase norepinephrine levels were 33.4+/-7.1, 50.5+/-8.0, and 145.7+/-43.6 ng. per gram of wet tissue in the external, middle, and internal segments of the Fallopian tube, respectively. During the luteal phase norepinephrine content increased significantly in the external and middle portions (219.3+/-57.0 and 206.2+/-34.3 ng. per gram) whereas it remained unchanged in the internal one (185.2+/-53.6 ng. per gram). The NE content of the external and middle segments correlated significantly with plasma progesterone levels (r = 0.76 and 0.82, respectively, whereas oviductal epincphrine levels did not show significant changes as a function of the stage of the menstrual cycle. Uterine epinephrine content decreased by 67 per cent during the luteal phase whereas norepinephrine remained unchanged.