A randomized study of dexamethasone in ovulation induction with clomiphene citrate.

Improved understanding of follicular dynamics has led to a reevaluation of suppression of adrenal androgens in ovulation induction. To test whether adrenal suppression during clomiphene citrate (CC) therapy would improve ovulation/pregnancy rates, 64 anovulatory patients who had not previously received CC were randomly assigned to receive either 50 mg CC on days 5 to 9 alone or with 0.5 mg dexamethasone (CC + DEX). Patients were then screened for dehydroepiandrosterone sulfate (DHEA-S) (normal range, 80 to 320 micrograms/dl), prolactin, testosterone, and semen analysis of the partner. Nine patients discontinued participation prior to completing the first treatment cycle, and ten patients were found to have either elevated prolactin (4), severe male factors (3), or tubal disease (3) and were discontinued. CC was increased 50 mg/day per cycle through 150 mg/day until ovulation occurred. Once the patient was ovulatory on therapy, a properly timed postcoital test and endometrial biopsy for luteal phase defect were performed. If anovulatory at 150 mg/day of CC or demonstrating abnormal postcoital test or endometrial biopsy at 150 mg/day of CC, patients were crossed to the other arm of the treatment protocol. The results revealed a significantly higher rate of ovulation (P less than 0.01) and conception (P less than 0.05) in the CC + DEX-treated group. When correlated with DHEA-S levels, this improvement occurred in patients with DHEA-S greater than 200 micrograms/dl (P less than 0.05).

The significance of lymphocytic-leukocytic infiltrates in interpreting late luteal phase endometrial biopsies.

The effectiveness of the endometrial biopsy in diagnosing luteal phase defects as a cause of infertility depends upon the accurate determination of a histologic date based on the morphologic features of tissue. The criteria--edema, predecidual reaction, stromal mitosis, and lymphocytic-leukocytic infiltrate--used to interpret such biopsies were based on changes occurring in the normal ideal menstrual cycle. The present study examines the criteria used for dating endometrium as applied to endometrial biopsies for luteal phase deficiency. It was determined that one of these criteria, lymphocytic and leukocytic infiltration, correlated with subsequent onset of menses and not with the other indications of histologic maturity during the late secretory phase.

Prolactin production by luteal phase defect endometrium.

The production of prolactin (PRL) by explants of late secretory endometrium obtained during normal cycles (n = 61) and that by similar explants obtained during luteal phase deficient (n = 17) cycles was compared. The amount of prolactin produced in vitro correlated with the degree of histologic decidualization in both normal and luteal phase defect endometria. However, samples of luteal phase defect endometrium produced significantly less prolactin (p less than 0.01) than did control tissues of the same ideal menstrual dates. These data indicate that the amount of prolactin produced by late secretory endometrium in explant culture can be used as an additional criterion for the diagnosis of luteal phase defects and may also provide a method for evaluating the response of the endometrium to progesterone.

Ripening of the term cervix with laminaria.

Laminaria tents were used to ripen the cervix in cases where induction of labor was indicated and the Bishop score was less than or equal to 5. Induction of labor was significantly more successful in these cases as compared with a matched control group where the cervix had not been ripened.