Experience with bromocriptine for the treatment of female infertility due to hyperprolactinemia.

From July 1981 to September 1988, 106 infertile patients with hyperprolactinemia treated with bromocriptine were reviewed retrospectively with special attention to the dosage of bromocriptine and the evaluation of infertility before treatment. 84 patients (79.2%) became pregnant. The 106 patients were divided into 3 groups according to the following doses: 7.5, 5.0, and less than 5.0 mg/day. The pregnancy rate was 90.7%, 84.6%, and 66.7% respectively with the highest at 7.5 mg/day, which was significantly higher than that at less than 5.0 mg/day (P less than 0.02). The average duration from treatment to pregnancy was 3.6, 3.4 and 7.4 months respectively. The longest duration in the less than 5 mg/day group was twice that in the other two groups. 85% of the pregnancies occurred within 6 months of treatment. Pretreatment of organic lesions and additional therapy for induction of ovulation were given to 29.8% of the pregnancies. The causes of infertility other than hyperprolactinemia were evaluated systemically before the use of bromocriptine. The optimal dose was 5-7.5 mg/day. Macroprolactinomas can be treated with bromocriptine, but should be followed up closely for the development of symptoms of intracranial pressure during pregnancy.

The effect of low-dose estrogen and progestogen on menopausal symptoms and urinary excretion of calcium.

The effects of low-dose estrogen and progestogen on menopausal symptoms were studied with Kuppermen score and urinary excretion of calcium as fasting morning urine Ca/Cr ratio in 69 perimenopausal women. The subjects were divided into 3 groups: amenorrhea less than 1 year (14 women); post menopause 1-3 years (19); and post menopause more than 3 years (36). Fasting urine Ca/Cr ratio in the post menopause 1-3 years group was 0.19 +/- 0.01, significantly higher than that (0.14-0.01) in the amenorrhea less than 1 year group and (0.11 +/- 0.006) the post menopause more than 3 years group. 18 women had 4 patterns of low-dose oral estrogen and progestogen: MPA 2 mg QOD, EE 5 micrograms QD, EE 5 micrograms QOD, and EE 5 micrograms and MPA 2 mg QOD. Each pattern was used in turn for 3 weeks, and discontinued for 2 weeks, then the next pattern started and so on. EE 5 micrograms and MPA 2 mg QOD alternately gave the best results both in improving symptoms and lowering urine Ca/Cr ratio. Seven women given intermittent large dose, namely, EE 50 micrograms every 10 days or premarin 2.5 mg every 7 days had symptoms relieved but inconsistent decrease of urine Ca/Cr ratio.

[Effects of 17 beta-estradiol on the release of nitric oxide from HUVEC].

OBJECTIVE: The protective mechanism of 17 beta-estradiol on blood vessels was investigated to provide evidences for clinical use of hormone replacement therapy in postmenopausal women. METHODS: To observe the effects of 17 beta-estradiol (17 beta-E2), testosterone (T), homocysteine (Hcy), 17 beta-E2 combined with T and 17 beta-E2 combined with Hcy on the production of nitric oxide (NO) released from cultured human umbilical endothelial cells (HUVEC) in vitro. RESULTS: Preincubation with 10(-9) mol/L 17 beta-E2 8-48 hours significantly enhanced the release of nitric oxide from HUVEC versus the control, but 10(-9) mol/L T had no effects within 48 hours. Pretreatment with 10(-9)-10(-7) mol/L testosterone for 24 hours had no effects on the release of NO from HUVEC versus the control, but 10(-6), 10(-5) mol/L T significantly reduced the release of NO from HUVEC. HUVEC were treated by 10(-9)-10(-5) mol/L 17 beta-E2 and 10(-9)-10(-5) mol/L T respectively for 24 hours. 10(-9), 10(-8) mol/L T had no effects on the beneficial effect of 17 beta-E2 with regard to the production of NO from HUVEC, while 10(-5) mol/L T greatly attenuated the beneficial effect of 17 beta-E2 with regard to the production of NO from HUVEC. Pretreatment with 10(-4)-10(-3) mol/L Hcy for 24 hours greatly inhibited the release of NO from HUVEC. If treated HUVEC with various concentrations of 17 beta-E2 (10(-9), 10(-7), 10(-5) mol/L) and Hcy for 24 hours simultaneously, 10(-9)-10(-7) mol/L 17 beta-E2 can partly eliminate the effects of Hcy on the released of NO from HUVEC. CONCLUSIONS: T can not enhance the release of NO from HUVECs. The effect of 17 beta-E2 combined with T on the release of NO depends on the concentration of both 17 beta-E2 and T. When 17 beta-E2 and T are in low dose, HUVEC can release more NO. Hcy can inhibit the release of NO from HUVEC, concomitant treatment with a low dose of 17 beta-E2 may eliminate the effects of Hcy on HUVEC.

Sex chromosome and chromatin examination in gynecology.

Sex chromosome and chromatin examinations with hormone determinations were done on 41 cases seen at the gynecologic clinic suspected of having sexual developmental abnormalities. 22 (53.7%) had genetic, gonadal or hormonal abnormalities, including ovarian dysgenesis 9 cases, superfemale 1 case, XY pure gonadal dysgenesis 4 cases, 3 of whom had already developed gonadal malignancy, pseudovaginal perineoscrotal hypospadias 1 case, androgen insensitivity syndrome 2 cases and congenital adrenal hyperplasia 3 cases. The values and limitations of sex chromosome and chromatin examinations as well as the prevention of gonadal malignancy are discussed.