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Assessment of follicular development and endometrial growth using transvaginal sonography in spontaneous and clomiphene citrate (CC) cycles with a spontaneous luteinizing hormone surge.

Prospective study of a spontaneous cycle followed by a CC cycle to compare paired data.

Institutional tertiary referral infertility clinic.

Eighteen couples with primary unexplained infertility voluntarily recruited from the infertility clinic.

Daily transvaginal sonography and endocrine monitoring. Clomiphene citrate (150 mg) was administered on days 5 to 9 of CC cycle.

Leading follicular diameter and endometrial thickness.

The growth rate of the leading follicle was similar in both study cycles, although in CC cycles the leading follicle diameter was significantly larger. Endometrial thickness was reduced in CC cycles.

Follicular development and endometrial thickness are altered in CC cycles.

The purpose of the study was to describe and to compare the rate of rise of human chorionic gonadotropin (hCG) in vanishing twin and normally progressing twin pregnancies during the first trimester.

All patients with twin pregnancies between 1985 and 1989 were prospectively studied. Human chorionic gonadotropin was measured one to three times per week between days 12 and 52 after luteinizing hormone (LH) surge or day of hCG administration (day 0). Pelvic ultrasound (US) was performed weekly beginning on day 24.

The study was performed at Rush-Presbyterian-St. Luke's Medical Center in an academic private practice setting of the Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology.

Forty patients who conceived after treatment of infertility and who had two gestational sacs on US examination were included in the study after the following criteria were met: (1) both sacs progressed to exhibit a fetal pole and (2) day of LH surge and/or day of hCG administration was known.

The rate of rise of hCG was slower in vanishing twin pregnancies than in normally progressing twin gestations for the entire time period studied (P less than 0.05).

A vanishing twin occurred in one third of the twin pregnancies. Forty-six percent of these losses occurred after fetal heart activity had been established.

Vanishing twin phenomenon occurred in a large proportion of twin pregnancies in this infertility population. Fetal heart activity was not a reliable predictor of continuing fetal viability in early twin gestations. Vanishing twin conceptions were characterized by a slower rate of rise of hCG than normally progressing twin pregnancies.

Between 1987 and 1989 data were collected to evaluate risk factors for pelvic endometriosis.

A case-control study was conducted on 241 cases with laparoscopically or laparotomically confirmed peritoneal or ovarian endometriosis consecutively admitted to three teaching hospitals in Northern Italy. The control group consisted of 437 women admitted to hospitals for acute conditions covering similar catchment areas.

Compared with nulliparous women, the risk of endometriosis decreased with increasing number of births: the point estimates were 0.4 and 0.3, respectively, for those with one and two or more births (X2(1) trend = 50.3, P less than 0.001). No relation emerged with age at first birth and spontaneous miscarriages. Relative to women whose menarche occurred at age 11 or younger, the risk of endometriosis was slightly lower in those who experienced later menarche, but the trend in risk was not significant. Women with irregular menstrual cycles showed a lower frequency of the disease (relative risk, 0.3; 95% confidence interval, 0.2 to 0.5). The role of various factors was largely similar for different disease locations (ovary, peritoneum, and both) and indication for diagnostic surgery (sterility, pelvic pain, and other reasons).

This study found that parity and irregular/long menses lower the risk of endometriosis. These findings were similar in different subgroups of disease location and indication for surgery, giving strong evidence of the consistency of the general results.

To identify and characterize the antiendometrial tissue specific antibody response in endometriosis patients.

Retrospective.

Industrial research laboratory.

Twenty untreated women with laparoscopically diagnosed endometriosis, 10 healthy women without symptoms of endometriosis, 12 women in whom laparoscopy failed to yield evidence of endometriosis, 10 healthy men, and 4 individuals with elevated titers of serum antinuclear antibodies.

Several immunological methods have been employed including immunofluorescence, hemagglutination, enzyme-linked immunoabsorbent assays, and protein blotting. Contrary to reports in the literature, results of these analyses have failed to demonstrate the presence of detectable levels of antiendometrial immunoreactivity in sera from patients with endometriosis.

The association of endometrial autoimmunity with endometriosis remains to be established.

To characterize the extent and sources of imprecision in histologic dating of the endometrial biopsy.

Duplicate endometrial biopsies from 25 women were dated by five evaluators on two separate occasions to evaluate the overall precision of the measure. Using variance component analysis, estimates of intrauterine, intraevaluator, and interevaluator variability were determined.

Samples were obtained during outpatient fertility testing. Evaluators were colleagues at the same institution.

Women presenting with infertility undergoing routine evaluation.

None.

Variability in histologic dating of the endometrium.

Inconsistencies between evaluators accounted for 65% of the observed variability, whereas 27% was because of inconsistencies in duplicate readings by the same evaluator. Regional differences in the uteru