No abstract

Ovarian steroid replacement therapy in the ovariectomized ewe, given in the correct sequence to mimic endogenous steroid changes in the normal ovulatory cycle, allows the development of embryos transferred in utero. A similar type of sequential therapy was designed for steroid replacement in women with primary ovarian failure. This produces the histological changes in uterine endometrial morphology and plasma oestradiol and progesterone similar to those observed in the normal ovulatory cycle. We now report that in one of these women a donated oocyte, fertilized by her husband's spermatozoa and cultured to the two-cell stage in vitro, was transferred in utero, resulting in a normal pregnancy and the delivery of a healthy child. Oestrogen therapy was withdrawn at 12 weeks and progesterone at 19 weeks gestation. This technique allows the treatment of human infertility due to primary ovarian failure.

The treatment of adenomyosis has been limited by the difficulty and delay associated with the diagnosis, often not until after hysterectomy. Magnetic resonance imaging, high resolution vaginal ultrasound and uterine biopsy have improved early detection of adenomyosis. Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in >50% of patients, although follow-up has been restricted to 3 years. Hysterectomy will still be necessary in severe cases of adenomyosis. Early diagnosis may improve treatment. Investigations are indicated in women with menstrual pain or menorrhagia not responding to drug therapy.

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Deficits in executive functions related to spatial working memory do occur in children with ADHD, although the magnitude of these deficits is not related to the child's age or the level of ADHD symptoms. These deficits were not present in the current sample of children who were receiving psychostimulant medication.