In 1673 treatment cycles stimulated with buserelin and HMG, for IVF, GIFT or ZIFT, the severe ovarian hyperstimulation syndrome (OHSS) occurred in 10 cycles (0.6%). Eight patients were hyperandrogenic and showed an increased ovarian response to HMG. After replacement of a maximum of three embryos or zygotes, seven women became pregnant. Three women had a multiple gestation. All patients recovered uneventfully with conservative treatment. Support with progesterone or continuation of the agonist during the luteal phase did not prevent OHSS, confirming that the ovulatory HCG dose is the most important factor in inducing this severe complication. Luteal supplementation with HCG and/or HCG production during implantation could exacerbate OHSS.
Pituitary gonadotrophin reserve and basal gonadotrophin secretion were tested during the luteal phase in women superovulated with buserelin/human menopausal gonadotrophin (HMG) in a desensitization (n = 17) or flare-up protocol (n = 7). In the desensitization protocol the luteinizing hormone-releasing hormone (LHRH) stimulated serum LH and follicle stimulating hormone (FSH) concentrations remained impaired at least until day 14 after arrest of the agonist. In the flare-up protocol basal and stimulated LH secretion was still abnormal on days 14 and 15 after human chorionic gonadotrophin (HCG) injection. Normal basal serum FSH concentrations were measured at the end of the luteal phase in the flare-up protocol, but the response of FSH to LHRH injection was still subnormal. We conclude that gonadotrophin function remained impaired until the end of the luteal phase after desensitization and flare-up GnRH-agonist and HMG stimulation protocols. Corpus luteum stimulation with exogenous HCG or substitution therapy using natural progesterone are required to prevent the possible negative effects resulting from pituitary dysfunction after GnRH-agonist treatment.
The duration of tick feeding is an important indicator to evaluate the risk of Borrelia burgdorferi sensu lato transmission, which increases considerably with the blood meal duration. This blood meal duration may be estimated from scutal index, the ratio between body length (idiosoma) and scutum width. For the estimation of blood meal duration in Ixodes ricinus, nymphal and adult female ticks were detached at predetermined intervals (24, 48, 72, and 96 h) from laboratory mice and rabbits and their scutal index calculated. From this, non-linear regression equations were developed to determine the duration of attachment for nymphal and adult female I. ricinus ticks. As part of an epidemiological study addressing the risk of subclinical (seroconversion) and clinical infections after a tick bite in the Neuchaˆtel area (Switzerland) over 3 years (2003)(2004)(2005), duration of tick attachment and anatomical site of bites collected on participants as well as seasonal distribution of tick bites were studied. Tick attachment duration was estimated in all ticks collected during this study (n ¼ 261). Nymphs were attached for a mean (7 standard error, SE) of 31.6 h (72.6) and females for a mean (7SE) of 29.6 h (73.2). Most nymphs were removed after 24 h of blood meal whereas most females were removed before 24 h. Legs were the major anatomical sites of bites for women (40.7%), men (44.4%), and almost all age classes. Only children o10 years old were bitten more frequently on the head (41.2%) and on the neck (38.5%) than participants 410 years. The majority of tick bites were recorded from May to July during the 3 years. Attachment sites can influence the discovery of ticks, hence the duration of the tick bite. A detailed body examination after each outing in forest and an early withdrawal of an attached tick is an effective way to prevent Lyme borreliosis.
In human cycles stimulated for ovulation with gonadotrophin-releasing hormone (GnRH) agonists and human menopausal gonadotrophin (HMG), a luteal phase defect has been described. To evaluate the influence on the endometrium, endometrial development in GnRH agonist/HMG stimulated cycles was assessed in cycles with and without luteal phase supplementation. Endometrial histological maturation, ultrastructure and oestrogen receptor (ER) and progesterone receptor (PR) status were analysed in the mid-luteal phase. Serum concentrations of oestradiol and progesterone were measured daily from days 1-5 of the luteal phase. Supplementation of the luteal phase was achieved with either human chorionic gonadotrophin or natural progesterone, administered intramuscularly or intravaginally. In non-supplemented cycles all endometrial features were consistent with an impaired progesterone bioavailability. After supplementation of the luteal phase, fewer signs of luteal phase deficiency were visible, especially with the intravaginal route of progesterone administration. We concluded that the endometrial parameters confirm the need for luteal support in GnRH agonist/HMG stimulated cycles.
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