A quantitative study of endometrial development in the luteal phase: comparison between women with unexplained infertility and normal fertility

Article Abstract:

Defects in the secretion of hormone from the pituitary gland and the ovaries can cause infertility. During the luteal phase of the menstrual cycle, the ovary is stimulated by luteinizing hormone (LH) secreted from the pituitary gland to form the corpus luteum from an ruptured egg follicle (ovulation). After ovulation the corpus luteum secretes progesterone, the hormone responsible for preparing the lining of the uterus (endometrium) for embryo implantation. Later, if pregnancy occurs, the secretion of progesterone is taken over by the placenta. Since progesterone is essential in achieving and maintaining pregnancy, defects in the luteal phase can prevent pregnancy by an creating an unfavorable uterine environment. It is unclear how often an abnormal endometrium causes infertility. Traditionally, the lining of the uterus is assessed by microscopic examination of cells obtained from the uterus at a specific point in the menstrual cycle (endometrial biopsy). An accurate diagnosis of luteal phase defect requires that sampling of endometrial tissue take place at the time of LH surge. Inaccurate diagnosis can occur because menstrual dating (based on the assumed next menstrual period) is approximated and histology of uterine cells varies among investigators. To help identify luteal phase defects in menstruating women with unexplained infertility, a more precise technique of dating LH surges was used in conjunction with endometrial cell sampling. The endometrial lining was biopsied on the exact day of the LH surge in 30 women with unexplained infertility and 70 women with normal fertility. Abnormal endometrial development was detected in 20 percent of the women with unexplained infertility and three percent of the women with normal fertility. The women with unexplained infertility deviated significantly from the norm in five of the 14 histological features used to assess the cells of the endometrium. Four of these features were related to the secretion of glandular cells of the endometrium. The abnormal endometrium is not thought to be caused by a deficiency in progesterone secreted by the corpus luteum, but rather by an abnormal response of cells in the endometrial lining. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Progesterone, Luteal phase defects, Luteal phase

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An analysis of factors influencing the outcome of 232 consecutive tubal microsurgery cases

Article Abstract:

Tubal damage (damage to the fallopian tubes, through which the egg travels on its way to the uterus) may cause as much as half of all infertility in women. However, the results of salpingostomy, a procedure to surgically open and reconstruct the tubes, are not encouraging. Microsurgical salpingostomy (a newer surgical technique) may produce better results. To learn more about the outcome of microsurgery in treating tubal infertility, records from 232 women treated at one university medical center were reviewed. The women were aged 30.4 years (on average) and had been infertile for slightly more than five years. They underwent microsurgery and received antibiotics postoperatively. Results showed that pelvic adhesions (growth of connective tissue around the reproductive organs) were the cause of infertility in 78 cases; these women had open fallopian tubes. Forty-six percent of these women ultimately conceived. Ninety-seven women were treated with salpingostomy; in this group, the intrauterine conception rate was 40 percent after 36 months. The pregnancy rate increased in this group during the second year after surgery. Pregnancy rates were not affected by the woman's age or number of children previously borne, but women with longer periods of infertility were less likely to conceive after surgery. Other causes of infertility that were identified are discussed. The presence of a large hydrosalpinx (dilated fallopian tube due to accumulated fluid) lowered the probability of conception, as did the presence of adhesions. The overall rate of delivery for the whole group was 29 percent, which is better than some other reports. When patients are selected appropriately, it appears that tubal microsurgery is more cost-effective than in vitro fertilization (in which the egg is fertilized under laboratory conditions, then implanted into the uterus). (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgery, Fallopian tubes, Salpingostomy

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The variation of endometrial response to a standard hormone replacement therapy in women with premature ovarian failure. An ultrasonographic and histological study

Article Abstract:

Women whose menstrual periods stop prematurely (before the age of 40) because their ovaries have ceased functioning are said to suffer from premature ovarian failure, and many require hormone replacement therapy (HRT) with female hormones to prevent disease, such as osteoporosis and atherosclerosis, and to alleviate the symptoms of estrogen deficiency, such as vaginal dryness. The effects of HRT on the endometrium (the lining of the uterus) have not been completely characterized. To learn more about this issue, 18 women with premature ovarian failure who had been on HRT for varying times were studied. Ovarian failure was idiopathic (due to unknown causes) in 10 cases, the result of chemotherapy for malignant conditions in four cases, or the result of Turner's syndrome (a chromosomal abnormality) in four cases. Hormone levels were monitored and the thickness of the uterus and endometrium were measured during two cycles of treatment with hormones. Biopsies were also taken of endometrial tissue. Results showed that all biopsy specimens showed signs of secretory activity (usually associated with the phase of the menstrual cycle that occurs after ovulation). The women with Turner's syndrome had the least developed endometrium, while the women in the other groups were similar. The results imply that women with premature ovarian failure do not represent a homogeneous group, but respond differently to HRT. Analysis of the hormone levels in these women suggests that the dose of estrogen administered according to this protocol may be too high. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hormone therapy

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