Faculty Bibliography

OBJECTIVE: To test the hypothesis that elevated E2 levels on day 3 of IVF cycles without GnRH agonist (GnRH-a) are associated with reduced oocyte numbers and pregnancy rates (PRs). DESIGN: Day 3 levels of E2 and FSH were obtained from patients undergoing controlled ovarian hyperstimulation without GnRH analogue for IVF. PATIENTS: Five hundred ninety-two consecutive IVF cycles. RESULTS: Patients were grouped according to their day 3 E2 levels (< 30, 31 to 45, 46 to 60, 61 to 75, and > 75 pg/mL [conversion factor to SI unit, 3.671]). The ongoing PR per retrieval for patients with E2 levels < 30 pg/mL was significantly higher than for patients with E2 levels 31 to 75 pg/mL. There were no pregnancies if the E2 level was > 75 pg/mL. The mean number of oocytes per retrieval was significantly lower in patients from the E2 groups with E2 > 60 pg/mL compared with patients in groups with E2 < 60 pg/mL. Day 3 FSH and E2 levels also were evaluated simultaneously. In patients with the lowest levels of FSH and E2, the PR was the highest. No pregnancies occurred if the FSH level was > 17 mIU/mL (conversion factor to SI unit, 1.00) and the E2 level was > 45 pg/mL on day 3. CONCLUSIONS: For patients undergoing IVF without GnRH analogue, oocyte numbers and PRs decrease with increasing levels of day 3 E2. Combining day 3 FSH and E2 improved the prognostic ability of either of these hormones used alone

The current study was initiated to estimate the use of oral contraceptives and estrogen replacement therapy in women with systemic lupus erythematosus (SLE). Four hundred and four patients were surveyed from five medical centers. Two hundred and twenty four (55%) had ever used oral contraceptives, however, only 51 (13%) were taking oral contraceptives at the time SLE was diagnosed. Fifty five (14%) used oral contraceptives after their disease was diagnosed. Only seven (13%) reported an exacerbation of disease activity, mostly confined to the musculoskeletal system. In one substudy, there were no significant differences observed between women with or without SLE with regard to the frequency of ever-use of oral contraceptives. In contrast, significantly fewer women with established SLE were taking oral contraceptives at the time of interview compared with healthy women, p < 0.02. In a second substudy, information on past and present usage of estrogen replacement therapy was obtained in women followed at two of the sites included in the main study. Fifty-five (59%) of the 94 postmenopausal patients at these centers had ever taken estrogen therapy, 23 (24%) at the time of diagnosis. Forty-eight women (51%) began or remained on estrogen therapy after the diagnosis of SLE, four (8%) of whom reported exacerbations of disease activity. A significantly higher percentage of Caucasian women had taken or were taking estrogen replacement compared with other ethnic groups. This study suggests that exogenous hormones were generally well tolerated by women with SLE; this preliminary observation is based on patient recall. The low frequency of current oral contraceptive use in lupus patients of reproductive age may reflect, in part, bias of the managing rheumatologists and obstetricians/gynecologists. Given the health needs of and potential benefits for women with SLE, these observations suggest that larger prospective studies are critical and are likely to change prescribing practices for exogenous estrogen

Objective: To evaluate the clinical and pathologic presentation of mature cystic teratomas and the trends in management over a 14-year study period. Methods: Tumor registry data and medical records between January 1, 1975 and December 31, 1989 were analyzed with respect to patient age, tumor size, bilaterality, malignant transformation, and treatment. Results: Five hundred seventy-three tumors were removed from 517 patients. The median and mean (+/- standard deviation) age was found to be 30 and 32 +/- 11.3 years, respectively. Three hundred ten (60%) of the patients were asymptomatic. The mean tumor size was 6.4 +/- 3.5 cm. The bilaterality rate was 10.8%. The rate of torsion was 3.5%; larger tumors underwent torsion more frequently than smaller tumors (P = .029). The rate of malignant transformation was 0.17%. The mean cyst diameter for patients undergoing cystectomy was 5.7 +/- 2.4 cm; for oophorectomy, 8.0 +/- 4.1 cm; and for hysterectomy, 6.1 +/- 3.8 cm. Oophorectomies were performed for larger tumors when compared to cystectomies (P = .01). The number of hysterectomies was stable throughout the study period, whereas the number of oophorectomies decreased and the number of cystectomies increased markedly. Contralateral ovarian biopsy was common (48.5%) early in the study period. By 1989, the biopsy rate was less than 1%. Conclusions: We found the prevalence rates of symptomatic tumors, torsion, and malignant degeneration to be less than those previously reported by most other investigators. In addition, there has been an important change over the past 14 years in the management of these neoplasms, with an increased tendency for ovarian preservation, as evidenced by the more frequent use of cystectomy and a decrease in contralateral ovarian biopsy

BACKGROUND: Many couples undergo in vitro fertilization due to occlusion of the fallopian tubes. Chlamydia trachomatis infections are a major cause of this tubal damage. Since this organism has also been associated with poor pregnancy outcome, we investigated whether a past exposure to C. trachomatis was associated with spontaneous abortion following in vitro fertilization and embryo transfer. METHODS: Sera from 145 women undergoing IVF were diluted 1:128 and tested for IgG antibodies to C. trachomatis by an immunoperoxidase assay, using infected cells fixed to slides. All subjects and their partners were negative for C. trachomatis by culture or by DNA hybridization. RESULTS: Serological evidence of a past chlamydial infection was observed in 33.8% of the women. The incidence of antichlamydial IgG was greater (P less than 0.001) in women whose infertility was due to known tubal disease (37 of 78; 47.4%) than in women whose infertility was due to other causes (12 of 67; 17.9%). Spontaneous abortions after embryo transfer occurred in 20% of the subjects. The incidence of antichlamydial IgG in aborting women (20 of 29; 69.0%) was greater (P less than 0.001) than the incidence in either women with successful pregnancies (9 of 38; 23.7%) or women who did not become pregnant (20 of 78; 25.6%) after IVF. No relation was observed between antichlamydial antibody status and maternal age, the number of oocytes aspirated, the number of oocytes fertilized, and the number of embryos transferred. CONCLUSIONS: A previous infection with C. trachomatis may increase susceptibility to subsequent spontaneous abortion, even in the absence of a detectable current infection