Premature ovarian failure and ovarian autoimmunity

Premature ovarian failure (POF) is defined as a syndrome characterized by menopause before the age of 40 yr. The patients suffer from anovulation and hypoestrogenism. Approximately 1% of women will experience menopause before the age of 40 yr. POF is a heterogeneous disorder with a multicausal pathogenesis involving chromosomal, genetic, enzymatic, infectious, and iatrogenic causes. There remains, however, a group of POF patients without a known etiology, the so-called "idiopathic" form. An autoimmune etiology is hypothesized for the POF cases with a concomitant Addison's disease and/or oophoritis. It is concluded in this review that POF in association with adrenal autoimmunity and/or Addison's disease (2-10% of the idiopathic POF patients) is indeed an autoimmune disease. The following evidence warrants this view: 1) The presence of autoantibodies to steroid-producing cells in these patients; 2) The characterization of shared autoantigens between adrenal and ovarian steroid-producing cells; 3) The histological picture of the ovaries of such cases (lymphoplasmacellular infiltrate around steroid-producing cells); 4) The existence of various autoimmune animal models for this syndrome, which underlines the autoimmune nature of the disease. There is some circumstantial evidence for an autoimmune pathogenesis in idiopathic POF patients in the absence of adrenal autoimmunity or Addison's disease. Arguments in support of this are: 1) The presence of cellular immune abnormalities in this POF patient group reminiscent of endocrine autoimmune diseases such as IDDM, Graves' disease, and Addison's disease; 2) The more than normal association with IDDM and myasthenia gravis. Data on the presence of various ovarian autoantibodies and anti-receptor antibodies in these patients are, however, inconclusive and need further evaluation. A strong argument against an autoimmune pathogenesis of POF in these patients is the nearly absent histological confirmation (the presence of an oophoritis) in these cases (< 3%). However, in animal models using ZP immunization, similar follicular depletion and fibrosis (as in the POF women) can be detected. Accepting the concept that POF is a heterogenous disorder in which some of the idiopathic forms are based on an abnormal self-recognition by th

COMPARISON OF MATERNAL SERUM ESTRADIOL AND PROGESTERONE LEVELS IN PREGNANCIES AFTER INDUCED AND SPONTANEOUS OVULATION

Maternal serum estradiol and progesterone levels during the early 6th to 15th weeks of gestation, were measured by radioimmunoassay in 140 pregnancies following induction of ovulation with gonadotropins or clomiphene citrate. The levels were compared with those observed in 79 spontaneous pregnancies. Significantly higher levels were observed in gonadotropin and clomiphene citrate induced pregnancies (both P values &lt; 0.001) between the 6th to 9th week of gestation as compared to spontaneous pregnancies. Steroid levels were similar in the two groups from the 9th week onwards. No statistically significant differences in steroid hormone values were observed in aborted and successful pregnancies within each group studied. We conclude that ovulation induction is associated with higher estradiol and progesterone levels until placental steroidogenesis starts

THE ROLE OF ANDROGENS IN THE LATE-PREMENOPAUSAL WOMAN WITH ADENOMATOUS HYPERPLASIA OF THE ENDOMETRIUM

To examine the possible role of androgens in hyperplasia of the endometrium, the concentrations of testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH), were measured in peripheral venous serum obtained from 42 premenopausal women with adenomatous hyperplasia of the endometrium (group A) and from 18 women without hyperplasia (group B). In patients with hyperplasia of the endometrium, significantly higher peripheral venous concentrations were found for all androgens (P &lt; 0.05) and estradiol (P &lt; 0.001) than in control patients. In contrast, there was no statistically significant difference in the mean serum values of SHBG as well as in gonadotropins among the population of compared groups. We conclude that apart from the increased estrogenic activity in patients with adenomatous hyperplasia of the endometrium, androgens may play a significant role

The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain

Objective: To discriminate the etiology in 2365 patients with acute and chronic pelvic pain (APP, CPP). Methods: Diagnostic laparoscopy was carried out in 736 patients (31.1%) with APP and in 1629 (68.9%) with CPP. In 315 patients (13.3%) the diagnostic procedure was extended to operative laparoscopy. Results: The most frequent laparoscopic findings in patients with APP were acute salpingitis and pelvic adhesions (22.8%) and ectopic pregnancy (19%), while in patients with CPP the most frequent findings were pelvic adhesions (35.4%) and endometriosis (24.6%). In 7.5% of patients with APP and 24% with CPP, laparoscopy did not reveal any pathological finding in the pelvis. Among the 315 patients in whom operative laparoscopy was carried out, 40% suffered from Apr and 60% from CPP. In the 446 patients (18.9%) without laparoscopic findings no treatment was given, while of the remaining 905 patients 40% were subjected to laparotomy and 60% received conservative treatment. The total incidence of side effects reached 4.7% and serious side effects resulting from emergency laparotomy occurred in 0.15% of patients with pelvic pain. Conclusion: Our results in a large group of patients with pelvic pain show that there are discrepancies in the incidence of laparoscopic findings between patients with APP and CPP. Discrepancies between the two groups of patients were also found during operative laparoscopy, the treatment administered after laparoscopic diagnosis and the complications encountered

Sonographic incidence of polycystic ovaries in a gynecological population

The prevalence of polycystic ovaries in a large population of 1078 women of reproductive age was determined by pelvic ultrasonography. The ovarian ultrasonic appearance of 183 (17%) women met the morphological criteria of polycystic ovaries. Of these women, 147 (80.3%) had irregular cycles (group A) and 36 (19.70%) had normal cycles (group B). The remaining women constituted the control group. Ovarian volume was calculated in all women in whom at least one ovary was visualized. Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were measured in 124 women from group A, 25 from group B and 50 controls. Mean ovarian volume was statistically higher in both group A (13.4 ml) and group B (11.8 ml) than in the control group (6.2 ml). Mean LH/FSH ratio and mean testosterone values were statistically higher in group A only (2.1 and 1.1 ng/ml, respectively) compared with the mean values in the control group (0.7 and 0.7 ng/ml, respectively). Obesity and hirsutism were more common in group A than in group B and the controls. Screening the ovaries in women of reproductive age and subsequent assessment of morphology in polycystic ovaries can aid in the diagnosis of this condition in patients who may have a varied clinical presentation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecolog

The effect of early second stage bradycardia on newborn status

In the present study 45 patients with intrapartum cardiotocograms showing prolonged fetal bradycardia during the early second stage of labor were included. Bradycardia persisted for 180 s or more with either rapid or prolonged return to baseline, without loss of variability and rise of baseline fetal heart sate (FHR). The mean duration of bradycardia was 5.0 +/- 1.3 min. In the group with normal FHR tracings the rate of normal delivery (73.3%) was significantly higher than that of the group with fetal bradycardia (26.7%, P &lt; 0.0001). We also noted a significantly higher rate of cesarean section (44.4%) in patients with abnormal FHR tracings, compared to that (11.1%) of parturients with normal FHR tracings (P &lt; 0.001). In all cases blood samples were obtained from the umbilical cord artery, immediately after delivery. Only in two cases with abnormal FHR tracing umbilical cord artery was the pH less than 7.20. We conclude that in most cases, prolonged fetal bradycardia in the early second stage with the characteristics described above is well tolerated by a mature fetus. (C) 1997 Elsevier Science Ireland Ltd