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OBJECTIVE: To study the effects of pretreatment with triptorelin on uterine fibroid before abdominal hysterectomy. METHODS: Fifteen premenopausal Chinese women with symptomatic uterine fibroids requiring hysterectomy were recruited in the study. All patients received monthly intramuscular injections of 3.75 mg triptorelin for three months prior to abdominal hysterectomy. RESULTS: There was significant reduction in the serum levels of oestradiol (68.6%), progesterone (95.6%) and luteinizing hormone (73.9%) and in uterine (45.0%) and fibroid (68.0%) volumes. The serum level of follicle-stimulating hormone and haemoglobin concentration were not significantly different. CONCLUSIONS: Shrinkage of uterine fibroids can be achieved in women who are rendered hypoestrogenic with monthly injections of triptorelin for three months. This treatment modality may be of value prior to hysterectomy or myomectomy especially when the fibroid is large.

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OBJECTIVES: The aims of this study were to estimate the dietary intake of phytoestrogens and to measure urinary phytoestrogen excretion in postmenopausal Chinese women. METHODS: Postmenopausal Chinese women were recruited from the hormone replacement clinic of the Prince of Wales Hospital. Dietary intake of phytoestrogen-rich foods was estimated using a food frequency questionnaire. Urinary output of the isoflavonoids daidzein and genistein and the metabolite of daidzein, equol, was measured using high-performance liquid chromatography. RESULTS: The mean daily excretion of daidzein, genistein and equol was 3.24 (+/- 3.63), 1.47 (+/- 1.75) and 0.64 (+/- 1.53) mumol, respectively. The total mean daily isoflavonoid excretion was 5.36 (+/- 5.27) mumol. CONCLUSIONS: Urinary excretion of isoflavonoid phytoestrogens in this Chinese population was lower than that reported in Japanese subjects. This may be due to the higher consumption of legumes, especially soy products, in the Japanese compared to the Chinese diet. The intake of green vegetables was higher in the Chinese subjects, and this food group may be the main contributor to their total phytoestrogen intake.

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OBJECTIVE: To evaluate the efficacy of subzonal insemination (SUZI) as applied to unfertilized oocytes after initial insemination. METHODS: Unfertilized oocytes at metaphase II obtained after conventional IVF from 14 patients were selected for reinsemination by SUZI. The fertilization rate and pregnancy outcome were assessed. RESULTS: Of the 57 unfertilized oocytes at metaphase II, 10 (17.5%) became fertilized after SUZI. Eight of the 10 (80%) oocytes showed normal fertilization with two pronuclei while the other two (20%) oocytes were polyspermic. Five (35.7%) of the 14 patients had embryo transfer resulting in two (14.3%) pregnancies. One patient had a spontaneous abortion and the other had a live birth at term. CONCLUSION: Reinsemination of unfertilized oocytes by SUZI could be of value when fertilization fails after initial insemination.

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Two cell lines, the less differentiated CC2/CUHK2 and the more differentiated CC3/CUHKE3, were used to study the difference in nuclear matrix stability against DNase 1 digestion. The nuclear matrix was almost totally extracted when the CC3/CUHK3 cells were digested with 100 micrograms/ml DNase 1, while that of the CC2/CUHK2 cells was still present even when 200 micrograms/ml DNase 1 was used. It is suggested that more differentiated cells have a less stable nuclear matrix while the less differentiated ones have a more stable nuclear matrix. The same phenomenon was also observed in normal human and rat cervical epithelia. The nuclear matrix of the poorly differentiated basal cells was more stable than that of the more differentiated superficial cells. This cell differentiation stage dependent stability of the nuclear matrix is probably related to the nuclear activity and gene expression.

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OBJECTIVE: The intent of this study was to ascertain if there was a correlation between insulin and cholesterol levels in follicular fluid and oocyte fertilizability and developmental potential. MATERIALS AND METHODS: The levels of immunoreactive cholesterol, total cholesterol, high-density lipoprotein-cholesterol, very-low-density lipoprotein-cholesterol were determined in follicular lipoprotein-cholesterol were determined in follicular fluid samples obtained during transabdominal-transvesicular aspiration of follicles under ultrasound guidance, from patients treated with clomiphene citrate and human menopausal gonadotropin for in vitro fertilization. Insulin was measured by radioimmunoassay and cholesterol by an enzymatic method. RESULTS: Follicles containing oocytes with better fertilizability and greater developmental potential possessed lower concentrations of immunoreactive insulin and high-density lipoprotein-cholesterol, and higher concentrations of low-density lipoprotein- and very-low-density lipoprotein-cholesterol. CONCLUSION: These lipoprotein- and very-low-density lipoprotein-cholesterol. CONCLUSION: These changes in the level of cholesterol carried by the various lipoproteins in the follicular fluid strongly suggest that oocyte maturation is influenced by insulin-dependent steroidogenesis.

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Severe ovarian hyperstimulation syndrome is an uncommon but potentially lethal complication of treatment with in vitro fertilization and other assisted reproductive technologies. We describe such a case which was atypical in that ascites and hydrothorax occurred despite the absence of ovarian enlargement. Whilst the pathophysiology of the syndrome remains unclear, the clinician must remain alert to the possibility of such an unusual presentation of this syndrome.

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The haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin, haematocrit, serum iron and total iron binding capacity, and serum ferritin concentrations in umbilical cord blood samples taken from 96 appropriate-for-gestational age infants delivered at term were measured and compared to the respective maternal values measured at 36 weeks' gestation. All the values were higher in cord blood. Only maternal mean corpuscular volume and mean corpuscular haemoglobin were correlated with cord serum iron. Cord blood haematological indices were not correlated with either gestation at delivery or birth weight. However, newborn serum ferritin was positively correlated with gestation at delivery, while the maternal:newborn ferritin ratio was inversely correlated with gestation and birth weight. The results suggest that maternal haematological and iron indices are not predictive of the haemoglobin or iron status of the newborn, and that the fetus continues to take up iron from the mother until delivery.

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Fifteen patients who had had previous unsuccessful in vitro fertilization and embryo transfer (IVF) cycles were treated with intranasal buserelin, a gonadotropin releasing hormone agonist (GnRH-a), commencing in the mid-luteal phase prior to ovarian stimulation in the next cycle. The use of buserelin was associated with the suppression of spontaneous luteinizing hormone (LH) surges (nil versus 6), an increase in gonadotropin requirements (27.3 versus 13.7 ampoules), higher serum estradiol peak levels (8, 154 versus 4,446 pmol/l), more oocytes retrieved (87 versus 20) as well as more embryos being transferred (28 versus 7). In buserelin-treated cycles, 2 pregnancies resulted but no oocyte was recovered in 2 of the 3 poor responders.

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Medical treatment with an LH-RH agonist may be used in selected cases of uterine fibroids. Although rare, rapid increase in uterine or fibroid volume may suggest an underlying leiomyosarcoma that would require prompt surgical intervention. Close monitoring of the response to treatment with an LH-RH agonist is essential.

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The closure time of the ductus arteriosus was investigated in 29 full term babies born vaginally after induction with prostaglandin E2 and in 22 controls. Serial Doppler echocardiography studies showed a significantly prolonged closure time in babies induced by prostaglandin E2. Whether the difference is related to changes in fetal prostaglandin E2 concentration remains to be established.

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Human oocytes that failed to cleave after insemination were examined for the presence of fucosyl glycoconjugates in the perivitelline space by staining with Ulex europeaus lectin conjugated to fluorescein isothiocynate. Oocytes that formed two or three pronuclei following first insemination always exhibited positive lectin staining similar to that observed with in vitro fertilized mouse oocytes. Among those oocytes that failed to form any pronuclei after the first insemination attempt, only 5% contained lectin positive substances in the perivitelline space. Upon reinsemination, a higher percentage of those oocytes produced lectin-positive materials, although pronuclei were still absent. The appearance of fucosyl glycoconjugates in these oocytes might be the result of the release of cortical granules triggered by sperm penetration or, more likely, due to spontaneous granule discharge in senescent oocytes.

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Salivary oestradiol (E2) and progesterone (P) levels have been shown to reflect the biologically active fractions in the serum. The luteal-phase status of stimulated cycles was investigated after in vitro fertilization and embryo transfer (IVF-ET). Thirty patients were randomly allocated to one of three luteal therapy groups: group A had no support, group B had intramuscular P and group C had intramuscular P and human chorionic gonadotrophin (hCG). One pregnancy was achieved in group A, two in group B and three in group C. Significant correlations between salivary and serum levels of E2 and of P in matched samples during luteal phase were found. Salivary E2 levels from luteal day 8 through day 14 and P levels from day 3 through day 14 were significantly higher in the pregnant than in the nonpregnant cycles. Among the nonpregnant cycles, salivary E2 and P levels were significantly higher in group C than in group A or B. These findings suggest that, in stimulated cycles for IVF-ET, determination of salivary E2 and P levels may be used as reliable alternatives to serum concentrations for assessing the luteal phase. Also, the additional hCG has an enhanced luteotrophic effect, as reflected by the higher salivary E2 and P levels, which may lead to a better pregnancy rate.

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We describe a unilateral hematometra with an associated hematosalpinx causing acute retention of urine in a female adolescent. Normal menstruation had occurred from the uterine cavity on the unaffected side. Treatment was by abdominal metroplasty with complete excision of the uterine septum and a terminal cuff salpingostomy. Urological investigation revealed ipsilateral renal agenesis.

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Salivary and serum levels of estradiol and progesterone were measured by radioimmunoassay in 10 Chinese women during their normal menstrual cycles. Changes in salivary estradiol and progesterone levels followed a similar pattern to that in the serum. Significant correlation was found between salivary and serum levels of estradiol and progesterone (p less than 0.001). Measurements of these salivary steroids may be used to assess follicular dynamics. Moreover, salivary sampling is simple, convenient and stress free.

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The relationship between zinc status and birth weight in uncomplicated pregnancies was studied in 59 nulliparous and 27 multiparous Chinese women with singleton pregnancies, delivered at term. Maternal and umbilical cord blood, maternal pubic hair and a segment of the umbilical cord were collected at delivery for analysis. The zinc concentration was significantly higher (p less than 0.0001) in the plasma of newborn infants (13.9 +/- 2.8 mumol/l) than in maternal plasma (9.3 +/- 2.2 mumol/l), while the converse was found in tissue (60.8 +/- 17.0 vs 208.1 +/- 96.2 micrograms/g, p less than 0.0001). There was no significant correlation between birth weight and either maternal or newborn plasma or tissue zinc concentrations. Parity had no significant effect on maternal or newborn zinc concentrations in tissue and plasma.

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Patients admitted for treatment of in vitro fertilization (IVF) were subjected to a semen investigation about 1-2 weeks prior to actual IVF and again during IVF. In addition to routine semen analyses, the recovery efficiency of motile spermatozoa by swim-up technique and Percoll gradient separation, the level of semen lactate dehydrogenase and the viability of the spermatozoa in the insemination medium were also studied. There is a significant correlation between the results of the pre-IVF analyses and that observed during IVF suggesting that a prior investigation of semen profile and sperm function is useful to screen potential IVF candidates. Among the various parameters, sperm motility in the semen and the swim-up preparation, percent normal spermatozoa and in vitro viability were significantly related to the outcome of IVF.

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In 1986 a study was made on the prevalence of cervical colonization by cytomegalovirus (CMV) in normal third trimester pregnant Chinese women in Hong Kong. Seven out of 95 unselected subjects had positive CMV culture, making a prevalence of 7.4%. This is a low prevalence when compared with the prevalence found in other people of Asian origin and similar to the prevalence found in the Caucasians.

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