引用Ultrasonographic

S.M. Chitlange *, R.S. Shah, K.T. Hazari, T.C. Anandkumar,
Institute for Research in Reproduction (ICMR), Bombay, India Received 3 August 1995; revision received 15 October 1995; accepted 1 November
than 50%. The ovarian scans were defined as follows: (1) ovulation: normal follicular development with ultrasound evidence of ovulation; (2) follicular cyst: persistent, bizarre growth of follicle >25 mm in diameter which failed to rupture; (3) luteinized unruptured follicle (LUF): normal follicular growth up to 25 mm with normal serum estradiol and progesterone levels without follicular rupture; (4) immature follicles: small follicles c 10 mm in diameter seen in both ovaries but with no evidence of ovulation on ultrasonography. 2.3. Collection of blood samples Blood samples (approximately 5 ml) were collected once daily during one pretreatment, two treatment and one post-treatment cycle from day 8 to day 24 of the menstrual cycle and thereafter on alternate days until the onset of menstruation. Serum was separated and kept at -20°C until further processed. Serum levels of estradiol, progesterone, luteinizing hormone and folliclestimulating hormone were measured by specific radioimmunoassay as described earlier [l]. 3. Results A total of 32 treatment cycles were studied, 16 in each group. Table 1 shows the effect of oral and intranasal NET on ovarian follicular growth as evaluated by ultrasonography. 3.1. Intranasal group All eight women (eight cycles) had ultrasonographic evidence of normal ovulation in the pretreatment cycle. Their follicular diameter ranged from 17 to 25 mm before rupture. A total of 16 treatment cycles were studied. Treatment with NET had no apparent effect on ovarian follicular growth in seven cycles (Table l), during which normal follicular growth and ovulation were observed. In six of these cycles, the opposite ovary appeared normal but without follicles, whereas in one cycle (second cycle of volunteer no, 9) with normal ovulation in the left ovary, a growing follicular cyst was seen in the right ovary. The size of the cyst grew to 29 mm before it disappeared in the middle of the post-treatment cycle. The remaining nine cycles were anovulatory. In seven cycles a growing follicular cyst was seen, the
GYNECOLOGY
International Journal of Gynecology & Obstetrics 53 (1996) 31-34
& OBSTETRICS
Article
Ultrasonographic monitoring of ovarian follicles in women . using norethisterone for contraception
In earlier studies the effect of NET on ovulation was mainly judged according to the endocrine profile. Now that high-resolution ultrasound scanning techniques are available, ovarian follicular events can be better studied when combined with hormonal parameters [lo]. Although an in-depth study was carried out to examine the effect of oral and intranasal NET on ovarian folliculogenesis, endocrine profile (plasma gonadotropins, estradiol and progesterone), cervical mucus and endometrial histology, this paper describes the ovarian function with serial ultrasound monitoring of the follicles. 2. Materials and methods Sixteen healthy, sterilized women aged 28-39 years, weighing between 46 and 54 kg and having regular menstrual cycles of 24-32 days volunteered for the study. Each woman underwent a complete gynecologic (including Pap smear) and medical examination. Blood samples were analyzed to assess hepatic and renal function. Women receiving intranasal NET also had an otorhinolaryngological examination. 2. I. Drug dose regimen NET 300 pg was administered orally (n = 8) or intranasally (n = 8) once daily starting from day 1 of the menstrual cycle and lasting for two consecutive cycles until the last day of the cycle. 2.2. Ultrasonography Each woman was scanned during four consecutive menstrual cycles comprising one pretreatment (control), two treatment and one post-treatment cycle. During control and posttreatment cycles, no drug (NET) was administered. Serial pelvic ultrasonography was performed beginning on day 7 of the menstrual cycle using a Philips scanner (model SDR 1550 X R, Bombay, India) with a 3-MHz sector transducer. The scans were performed with a full bladder until the growing follicle collapsed/ disappeared, or throughout the menstrual cycle if a follicular cyst was observed. The size of the follicle was reported as the mean of the two largest diameters. Follicular rupture was diagnosed when the follicle disappeared or decreased in diameter by more