Hormone replacement therapy by the transdermal administration of oestradiol and norethisterone.

The objective was to assess the efficacy and acceptability of a new transdermal norethisterone device as part of a hormone replacement therapy (HRT) regimen. The design was an open prospective clinical assessment for 6 months. The setting was the Academic Unit of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel, London. Eighteen patients of confirmed menopausal status were recruited. Therapy consisted of continuous application of Estraderm TTS 50 (Ciba Laboratories) for a 28-day period, with the additional application of two norethisterone acetate patches in the last 12 days of this period. This schedule was repeated for six cycles. The main outcome measures were symptom and menstrual data--haematological indices, hepatic and renal function; lipid parameters; endometrial biopsy. The results showed a significant improvement in the patients' symptoms of hot flushes and sweating (P = 0.03). Of the 15 women who completed at least 6 months of medication, withdrawal vaginal bleeding was established at regular intervals in 9. One patient had a local irritant reaction to the patch. There were no significant changes observed in haematological indices, hepatic and renal function. There was a slight but not statistically significant decrease in the HDL cholesterol fraction when the patient was in the norethisterone phase of the cycle, but no change was observed between the beginning and end of the study. Histological examination of the endometrial biopsies showed features of secretory activity in 56% of samples after 6 months. There was no evidence of hyperplasia, pre-malignant or malignant changes in the remaining biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum CA 125 in a pregnancy generated by ovum donation.

Serum CA 125 was measured by radioimmunoassay during the first trimester at intervals of 2 weeks in a woman with Turner's syndrome, who conceived following ovum donation from a healthy anonymous donor. Serum CA 125 concentrations were lower than or at the 10th percentile of the normal range. These findings imply that CA 125 may be secreted from the ovary in the first trimester, or produced at another site in response to stimuli from the ovary.

Regulation of corpus luteum function.

The effects have been studied of different ovulation induction regimens [either clomiphene citrate or buserelin in combination with human menopausal gonadotrophin (HMG)] on the circulating concentrations of progesterone, oestradiol, relaxin and human chorionic gonadotrophin (HCG) during the first trimester of pregnancy. Ovulation induction with clomiphene resulted in elevated concentrations of gonadotrophins in both phases of the cycle, while during ovulation induction with buserelin, gonadotrophin concentrations were elevated in the follicular phase only. The concentrations of all corpus luteum products were greater in clomiphene pregnancies compared with spontaneous pregnancies, but only oestradiol and relaxin concentrations were greater in clomiphene pregnancies compared with buserelin pregnancies. The concentrations of HCG were significantly reduced in clomiphene pregnancies compared to natural pregnancies. Relaxin concentrations were significantly higher from 7 weeks gestation in buserelin compared with spontaneous pregnancies, while progesterone, oestradiol and HCG concentrations were not consistently different. Consistent associations were found between relaxin and HCG concentrations in spontaneous pregnancies and between the concentrations of relaxin and both progesterone and oestradiol in pregnancies achieved after ovulation induction.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum placental protein 14 concentrations in the first trimester of ovum donation pregnancies.

The concentration of the endometrial glycoprotein placental protein 14 (PP14) has been measured at weekly intervals during the first trimester in serum obtained from women who had become pregnant naturally (n = 15, all singleton) or following ovum donation (n = 16, 15 singleton and one twin) after ovarian failure (n = 13), Turner's syndrome (n = 2) or post-chemotherapy (n = 1). The concentration of PP14 failed to rise in ovum donation pregnancies, and was significantly reduced compared to the concentration in natural conceptions from 5 to 13 weeks gestation (P < 0.05-0.01). These findings demonstrate that the corpus luteum is essential for the normal increase in serum PP14 in the first trimester. Furthermore, they suggest that progesterone is not the major stimulus to PP14 synthesis in early pregnancy.

Circulating placental protein 14: in the first trimester of spontaneous and IVF pregnancies.

Circulating placental protein 14 (PP14) levels were measured during the first trimester in three groups of pregnant women: (i) natural conception (n = 15); (ii) pituitary desensitization with buserelin and ovarian stimulation with human menopausal gonadotrophin (HMG) followed by in-vitro fertilization and embryo transfer (IVF-ET) (n = 15); and (iii) ovarian stimulation with clomiphene citrate and HMG, followed by IVF-ET (n = 16). A 7- to 8-fold increase in serum PP14 levels was observed in normal pregnancies between weeks 4 and 10. This increase was earlier and less marked in group (ii) and absent in group (iii). These findings support the concept that endometrial function is altered in pregnancies achieved following ovarian stimulation. Alternatively, if the ovary is an important source of PP14, then these data suggest that in contrast to ovarian synthesis of steroids and the peptide relaxin, ovarian stimulation results in an impairment of PP14 synthesis, and that this is most marked when clomiphene citrate has been used.