epimestrol and Abortion--Spontaneous

Female dysendocrine sterility has displayed a statistical incidence of 3.4% since 1967 in Milan's fertility and sterility centres. It is always marked by clear-cut clinical situations. Of these, particular interest is attached to anovulation (62.4% of cases), both with the cycle and with anovularity, ovarian micropolycystosis (2.7%), both as Stein ovary and as micropolycystic ovary, disturbances of ovary endocrine secretion: lutein deficiencies (21.2%) in the form of both brief and inadequate luteal phase. Treatment is aimed at possibly discontinuous reinstatement of ovulation. Clinical and pharmacological experiments over the last twenty years have put forward many "inducers". Mention is made of four personal approaches: --clinical employment of homologous gonadotropins (hMG + hCG), sequentially rather than paired, when poor gonadotropin secretion accompanied by insufficient endogenous oestrogenic activity is the main feature. Investigation from June 1964 to December 1981, coupled with monitorisation and personalisation of the treatment, initially through daily checks of total and fractionated oestrogenuria, and in recent years preferably through plasma 17-beta oestradiol or urinary enzyme determinations, has given a different slant to the reported disadvantages of gonadotropic management: hyperstimulation frequent multiple pregnancies, frequent multiple miscarriages; --employment of GnRH or its analogues (indications virtually those for paired gonadotropins). Some uncertainties however, exist with regard to the contraceptive action displayed by the agonist and antagonist analogues at certain doses, and with regard to the antigonadic action GnRH appears to have, both in the depression of oestrogen and progesterone production and in the arrest of follicular maturation an ovulation; --a preference for clomiphene among the antioestrogens in cases of primarily hypothalamic dysfunction and in ovarian micropolycystosis, provided endogenous oestrogenic activity is within normal limits; --a preference for hypoprolactinaemic drugs (bromoergocriptine, lysuride) in PRL-dependency, marked solely by an appreciable increase in serum LTH, screened as functional by means of selective tests; --experimentation of epimestrol, mainly in cases of sterility due to lutein deficiency.

Topics: Abortion, Spontaneous; Adrenal Cortex Hormones; Bromocriptine; Drug Administration Schedule; Epimestrol; Estrogen Antagonists; Female; Gonadotropins; Humans; Infertility, Female; Lisuride; Pituitary Hormone-Releasing Hormones; Pregnancy; Pregnancy, Multiple

In a gynaecological practice 49 patients were treated for primary or secondary infertility with epimestrol between January 1977 and June 1979. The selected group all had normogonadotropic, normoprolactinaemic anovulatory cycles (group II of the WHO scientific group 1976). Therapeutic measures extended over a total of 176 cycles in which 5 mg epimestrol (1 tablet Stimovul) were prescribed from the 5th to the 14th day. This procedure led to at least one ovulation in 86% of the cases and to pregnancy in 30 of the women. 23 pregnancies were without major complications. The abortion rate was 23%. Side effects of epimestrol treatment were only seen in occasional cases and only at the beginning of treatment.

Topics: Abortion, Spontaneous; Anovulation; Epimestrol; Estrenes; Female; Germany, West; Humans; Infertility, Female; Pregnancy

Ovulation induction has been used regularly in our department for several years to treat functional sterility. 4. various preparations and methods have been applied. The success rate is 31.3%. Altogether there have been 400 pregnancies, 274 of them have come to term, 126 patients are still pregnant. In 50% of the cases the pregnancy was uncomplicated and in 48.7% labour was normal. The number of abortions and premature labour is high and the prophylactic gestagene therapy has been successful in protecting the pregnancy. There have been more pathologies during labour, so the frequency of interventions is higher. The perinatal mortality of the mature newborn is 2.3%, but the perinatal mortality in premature labour is very high (14.7%). The total perinatal loss is 9.8%. The frequency of malformations is not higher as was previously suspected.

Topics: Abortion, Spontaneous; Cesarean Section; Clomiphene; Epimestrol; Female; Fetal Death; Gonadotropins; Humans; Infertility, Female; Obstetric Labor Complications; Ovulation Induction; Pregnancy; Risk

155 patients have been treated with epimestrol during 593 menstrual cycles in a daily dosage of 5, 10 or 2.5 mg from the 1st to the 10th or from the 5th to the 14th day of the cycle. 143 patients with secondary amenorrhoea, anovulatory cycles, ovulatory oligomenorrhoea, corpus luteum insufficiency, and normal cycles received epimestrol after an average period of 2.4 years of involuntary infertility. The pregnancy rate was 21% (n = 30), the spontaneous abortion rate 13% (n = 4). Twelve further patients not seeking pregnancy were treated with epimestrol because of secondary amenorrhoea and (or) anovulatory bleeding. The results were as follows: 1) In eugonadotropic secondary amenorrhoea 8 out of 12 patients ovulated, 5 out of 10 patients wanting children became pregnant. No patient with hypogonadotropism ovulated. 2) Out of 25 patients with anovulatory cycles or bleeding 13 ovulated and 4 became pregnant. 3) 17 out of 68 oligomenorrhoeic patients became pregnant. 4) In 12 out of 24 patients with corpus luteum insufficiency the hyperthermic phase improved and four patients became pregnant. 5) In 12 patients without anomalous cycles these remained unchanged and there were no pregnancies. 6) No side effects could be observed.. 155 women (593 cycles) were treated for sterility with daily doses of 5, 10, or 2.5 mg of epimestrol, from the 1st to the 10th or from the 5th to the 14th day of the cycle. 143 of these patients suffered from secondary amenorrhea, anovulatory cycles, ovulatory oligomenorrhea, corpus luteal insufficiency, and even normal cycles, which resulted in an average of 2.4 years of involuntary sterility. The pregnancy rate was 21% (n = 30) and the rate of spontaneous abortion 13% (n = 4). 12 other women were treated with epimestrol because of secondary amenorrhea or anovulatory bleeding. In those patients with eugonadotropic secondary amenorrhea, 8 of 12 ovulated and 5 of 10 desiring children became pregnant. No patients with hypogonadotropism ovulated. Of 25 patients with anovulatory cycles or bleeding, 13 ovulated and 4 became pregnant. Of those with oligomenorrhea, 17 out of 68 became pregnant. 12 out of 24 patients with corpus luteal insufficiency showed in improvement in the hyperthermic phase and 4 became pregnant. 12 patients with normal cycles showed no change and did not become pregnant. No side effects were experienced.

Topics: Abortion, Spontaneous; Amenorrhea; Anovulation; Berlin; Epimestrol; Estrenes; Female; Humans; Infertility, Female; Oligomenorrhea; Pregnancy; Time Factors