home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-06 | 207.4 KB |
open in: 
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 38 00 |.DP1.1..|......8.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 34 03 00 00 |......00|....4...|
|00000020| ce 0f 00 00 30 31 00 00 | 00 01 02 13 00 00 06 12 |....01..|........|
|00000030| 00 00 30 32 00 00 00 01 | 08 25 00 00 1b 0d 00 00 |..02....|.%......|
|00000040| 30 33 00 00 00 01 23 32 | 00 00 c8 0e 00 00 30 34 |03....#2|......04|
|00000050| 00 00 00 01 eb 40 00 00 | 09 10 00 00 30 35 00 00 |.....@..|....05..|
|00000060| 00 01 f4 50 00 00 0e 0d | 00 00 30 36 00 00 00 01 |...P....|..06....|
|00000070| 02 5e 00 00 e3 0c 00 00 | 30 37 00 00 00 01 e5 6a |.^......|07.....j|
|00000080| 00 00 87 0f 00 00 30 38 | 00 00 00 01 6c 7a 00 00 |......08|....lz..|
|00000090| e6 11 00 00 31 30 00 00 | 00 01 52 8c 00 00 96 0e |....10..|..R.....|
|000000a0| 00 00 31 31 00 00 00 01 | e8 9a 00 00 5f 0c 00 00 |..11....|...._...|
|000000b0| 31 32 00 00 00 01 47 a7 | 00 00 2e 0d 00 00 31 33 |12....G.|......13|
|000000c0| 00 00 00 01 75 b4 00 00 | f4 0b 00 00 31 34 00 00 |....u...|....14..|
|000000d0| 00 01 69 c0 00 00 8e 0a | 00 00 31 35 00 00 00 01 |..i.....|..15....|
|000000e0| f7 ca 00 00 77 0e 00 00 | 31 36 00 00 00 01 6e d9 |....w...|16....n.|
|000000f0| 00 00 f4 0d 00 00 32 30 | 00 00 00 01 62 e7 00 00 |......20|....b...|
|00000100| bc 09 00 00 32 31 00 00 | 00 01 1e f1 00 00 ae 08 |....21..|........|
|00000110| 00 00 32 32 00 00 00 01 | cc f9 00 00 36 0f 00 00 |..22....|....6...|
|00000120| 32 33 00 00 00 01 02 09 | 01 00 57 0b 00 00 32 35 |23......|..W...25|
|00000130| 00 00 00 01 59 14 01 00 | 49 0d 00 00 32 36 00 00 |....Y...|I...26..|
|00000140| 00 01 a2 21 01 00 ec 0e | 00 00 33 30 00 00 00 01 |...!....|..30....|
|00000150| 8e 30 01 00 c4 12 00 00 | 33 31 00 00 00 01 52 43 |.0......|31....RC|
|00000160| 01 00 39 0f 00 00 33 32 | 00 00 00 01 8b 52 01 00 |..9...32|.....R..|
|00000170| d5 0f 00 00 33 33 00 00 | 00 01 60 62 01 00 04 0f |....33..|..`b....|
|00000180| 00 00 33 34 00 00 00 01 | 64 71 01 00 fc 0f 00 00 |..34....|dq......|
|00000190| 33 35 00 00 00 01 60 81 | 01 00 f1 0a 00 00 33 36 |35....`.|......36|
|000001a0| 00 00 00 01 51 8c 01 00 | 24 08 00 00 35 30 00 00 |....Q...|$...50..|
|000001b0| 00 01 75 94 01 00 1f 0b | 00 00 35 31 00 00 00 01 |..u.....|..51....|
|000001c0| 94 9f 01 00 37 10 00 00 | 35 32 00 00 00 01 cb af |....7...|52......|
|000001d0| 01 00 c2 0e 00 00 35 33 | 00 00 00 01 8d be 01 00 |......53|........|
|000001e0| 1f 15 00 00 35 34 00 00 | 00 01 ac d3 01 00 af 11 |....54..|........|
|000001f0| 00 00 35 35 00 00 00 01 | 5b e5 01 00 9c 10 00 00 |..55....|[.......|
|00000200| 35 36 00 00 00 01 f7 f5 | 01 00 cd 0f 00 00 35 37 |56......|......57|
|00000210| 00 00 00 01 c4 05 02 00 | 8f 11 00 00 35 38 00 00 |........|....58..|
|00000220| 00 01 53 17 02 00 81 0c | 00 00 35 39 00 00 00 01 |..S.....|..59....|
|00000230| d4 23 02 00 5d 11 00 00 | 36 30 00 00 00 01 31 35 |.#..]...|60....15|
|00000240| 02 00 ce 0d 00 00 36 31 | 00 00 00 01 ff 42 02 00 |......61|.....B..|
|00000250| 75 0b 00 00 36 32 00 00 | 00 01 74 4e 02 00 63 0e |u...62..|..tN..c.|
|00000260| 00 00 36 33 00 00 00 01 | d7 5c 02 00 fe 15 00 00 |..63....|.\......|
|00000270| 36 34 00 00 00 01 d5 72 | 02 00 24 0e 00 00 36 35 |64.....r|..$...65|
|00000280| 00 00 00 01 f9 80 02 00 | c8 0f 00 00 36 36 00 00 |........|....66..|
|00000290| 00 01 c1 90 02 00 b2 0d | 00 00 36 37 00 00 00 01 |........|..67....|
|000002a0| 73 9e 02 00 9c 0c 00 00 | 36 38 00 00 00 01 0f ab |s.......|68......|
|000002b0| 02 00 4b 0d 00 00 36 39 | 00 00 00 01 5a b8 02 00 |..K...69|....Z...|
|000002c0| 08 12 00 00 37 30 00 00 | 00 01 62 ca 02 00 a6 0e |....70..|..b.....|
|000002d0| 00 00 37 31 00 00 00 01 | 08 d9 02 00 37 14 00 00 |..71....|....7...|
|000002e0| 37 32 00 00 00 01 3f ed | 02 00 f7 0e 00 00 37 33 |72....?.|......73|
|000002f0| 00 00 00 01 36 fc 02 00 | f5 0c 00 00 37 34 00 00 |....6...|....74..|
|00000300| 00 01 2b 09 03 00 cd 0b | 00 00 37 35 00 00 00 01 |..+.....|..75....|
|00000310| f8 14 03 00 f3 15 00 00 | 37 36 00 00 00 01 eb 2a |........|76.....*|
|00000320| 03 00 9b 12 00 00 00 00 | 00 00 00 00 86 3d 03 00 |........|.....=..|
|00000330| 00 00 00 00 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |....$Uni|que_ID{Y|
|00000340| 52 42 30 38 36 30 30 7d | 0d 0a 24 54 69 74 6c 65 |RB08600}|..$Title|
|00000350| 7b 48 69 67 68 20 53 65 | 72 75 6d 20 43 6f 72 74 |{High Se|rum Cort|
|00000360| 69 73 6f 6c 20 4c 65 76 | 65 6c 73 20 69 6e 20 45 |isol Lev|els in E|
|00000370| 78 65 72 63 69 73 65 2d | 41 73 73 6f 63 69 61 74 |xercise-|Associat|
|00000380| 65 64 20 41 6d 65 6e 6f | 72 72 68 65 61 7d 0d 0a |ed Ameno|rrhea}..|
|00000390| 24 41 75 74 68 6f 72 7b | 0d 0a 44 69 6e 67 2c 20 |$Author{|..Ding, |
|000003a0| 4a 2d 48 0d 0a 53 68 65 | 63 6b 74 65 72 2c 20 43 |J-H..She|ckter, C|
|000003b0| 42 0d 0a 44 72 69 6e 6b | 77 61 74 65 72 2c 20 42 |B..Drink|water, B|
|000003c0| 4c 0d 0a 53 6f 75 6c 65 | 73 2c 20 4d 52 0d 0a 42 |L..Soule|s, MR..B|
|000003d0| 72 65 6d 6e 65 72 2c 20 | 57 4a 7d 0d 0a 24 41 66 |remner, |WJ}..$Af|
|000003e0| 66 69 6c 69 61 74 69 6f | 6e 7b 55 6e 69 76 20 6f |filiatio|n{Univ o|
|000003f0| 66 20 57 61 73 68 69 6e | 67 74 6f 6e 2c 20 56 41 |f Washin|gton, VA|
|00000400| 20 4d 65 64 20 43 74 72 | 2c 20 50 61 63 69 66 69 | Med Ctr|, Pacifi|
|00000410| 63 20 4d 65 64 20 43 74 | 72 2c 20 53 65 61 74 74 |c Med Ct|r, Seatt|
|00000420| 6c 65 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 41 6d |le}..$Su|bject{Am|
|00000430| 65 6e 6f 72 72 68 65 61 | 2c 20 65 78 65 72 63 69 |enorrhea|, exerci|
|00000440| 73 65 2d 61 73 73 6f 63 | 69 61 74 65 64 2c 20 63 |se-assoc|iated, c|
|00000450| 6f 72 74 69 73 6f 6c 20 | 6c 65 76 65 6c 73 20 69 |ortisol |levels i|
|00000460| 6e 0d 0a 43 6f 72 74 69 | 73 6f 6c 2c 20 69 6e 20 |n..Corti|sol, in |
|00000470| 61 6d 65 6e 6f 72 72 68 | 65 61 2c 20 65 78 65 72 |amenorrh|ea, exer|
|00000480| 63 69 73 65 2d 61 73 73 | 6f 63 69 61 74 65 64 0d |cise-ass|ociated.|
|00000490| 0a 45 78 65 72 63 69 73 | 65 2c 20 2d 61 73 73 6f |.Exercis|e, -asso|
|000004a0| 63 69 61 74 65 64 20 61 | 6d 65 6e 6f 72 72 68 65 |ciated a|menorrhe|
|000004b0| 61 2c 20 63 6f 72 74 69 | 73 6f 6c 20 6c 65 76 65 |a, corti|sol leve|
|000004c0| 6c 73 20 69 6e 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c |ls in}..|$Journal|
|000004d0| 7b 41 6e 6e 20 49 6e 74 | 65 72 6e 20 4d 65 64 7d |{Ann Int|ern Med}|
|000004e0| 0d 0a 24 56 6f 6c 75 6d | 65 7b 31 30 38 7d 0d 0a |..$Volum|e{108}..|
|000004f0| 24 50 61 67 65 7b 35 33 | 30 2d 35 33 34 7d 0d 0a |$Page{53|0-534}..|
|00000500| 24 44 61 74 65 7b 41 70 | 72 69 6c 20 31 39 38 38 |$Date{Ap|ril 1988|
|00000510| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00000520| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 49 6e 66 65 |ear Book| of Infe|
|00000530| 72 74 69 6c 69 74 79 7d | 0d 0a 24 43 68 61 70 74 |rtility}|..$Chapt|
|00000540| 65 72 7b 31 2d 39 7d 0d | 0a 24 59 42 45 64 69 74 |er{1-9}.|.$YBEdit|
|00000550| 6f 72 7b 44 72 73 2e 20 | 4d 69 73 68 65 6c 6c 2c |or{Drs. |Mishell,|
|00000560| 20 50 61 75 6c 73 65 6e | 2c 20 61 6e 64 20 4c 6f | Paulsen|, and Lo|
|00000570| 62 6f 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |bo}..$Ta|ble{}..$|
|00000580| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 52 2e 41 2e |Commenta|tor{R.A.|
|00000590| 20 4c 6f 62 6f 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a | Lobo, M|.D.}....|
|000005a0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|000005b0| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|000005c0| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|000005d0| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 38 20 59 |, 1989..|..1988 Y|
|000005e0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 49 6e 66 65 |ear Book| of Infe|
|000005f0| 72 74 69 6c 69 74 79 20 | 28 52 29 0d 0a 0d 0a 43 |rtility |(R)....C|
|00000600| 68 61 70 74 65 72 20 31 | 2d 2d 52 65 70 72 6f 64 |hapter 1|--Reprod|
|00000610| 75 63 74 69 76 65 20 45 | 6e 64 6f 63 72 69 6e 6f |uctive E|ndocrino|
|00000620| 6c 6f 67 79 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |logy....|--------|
|00000630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000640| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000650| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000660| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000670| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 48 69 67 68 20 53 |--------|..High S|
|00000680| 65 72 75 6d 20 43 6f 72 | 74 69 73 6f 6c 20 4c 65 |erum Cor|tisol Le|
|00000690| 76 65 6c 73 20 69 6e 20 | 45 78 65 72 63 69 73 65 |vels in |Exercise|
|000006a0| 2d 41 73 73 6f 63 69 61 | 74 65 64 20 41 6d 65 6e |-Associa|ted Amen|
|000006b0| 6f 72 72 68 65 61 0d 0a | 0d 0a 44 69 6e 67 20 4a |orrhea..|..Ding J|
|000006c0| 2d 48 3b 20 53 68 65 63 | 6b 74 65 72 20 43 42 3b |-H; Shec|kter CB;|
|000006d0| 20 44 72 69 6e 6b 77 61 | 74 65 72 20 42 4c 3b 20 | Drinkwa|ter BL; |
|000006e0| 53 6f 75 6c 65 73 20 4d | 52 3b 20 42 72 65 6d 6e |Soules M|R; Bremn|
|000006f0| 65 72 20 57 4a 0d 0a 28 | 55 6e 69 76 20 6f 66 20 |er WJ..(|Univ of |
|00000700| 57 61 73 68 69 6e 67 74 | 6f 6e 2c 20 56 41 20 4d |Washingt|on, VA M|
|00000710| 65 64 20 43 74 72 2c 20 | 50 61 63 69 66 69 63 20 |ed Ctr, |Pacific |
|00000720| 4d 65 64 20 43 74 72 2c | 20 53 65 61 74 74 6c 65 |Med Ctr,| Seattle|
|00000730| 29 0d 0a 41 6e 6e 20 49 | 6e 74 65 72 6e 20 4d 65 |)..Ann I|ntern Me|
|00000740| 64 20 31 30 38 3a 35 33 | 30 2d 35 33 34 2c 20 41 |d 108:53|0-534, A|
|00000750| 70 72 69 6c 20 31 39 38 | 38 0d 0a 2d 2d 2d 2d 2d |pril 198|8..-----|
|00000760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|000007b0| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|000007c0| 52 65 70 72 6f 64 75 63 | 74 69 76 65 20 64 65 66 |Reproduc|tive def|
|000007d0| 65 63 74 73 2c 20 69 6e | 63 6c 75 64 69 6e 67 20 |ects, in|cluding |
|000007e0| 64 65 6c 61 79 65 64 20 | 6d 65 6e 61 72 63 68 65 |delayed |menarche|
|000007f0| 2c 20 73 68 6f 72 74 65 | 6e 65 64 20 6c 75 74 65 |, shorte|ned lute|
|00000800| 61 6c 20 70 68 61 73 65 | 73 2c 0d 0a 61 6e 64 20 |al phase|s,..and |
|00000810| 61 6d 65 6e 6f 72 72 68 | 65 61 2c 20 6d 61 79 20 |amenorrh|ea, may |
|00000820| 64 65 76 65 6c 6f 70 20 | 69 6e 20 77 6f 6d 65 6e |develop |in women|
|00000830| 20 77 68 6f 20 65 78 65 | 72 63 69 73 65 20 73 74 | who exe|rcise st|
|00000840| 72 65 6e 75 6f 75 73 6c | 79 2e 20 20 54 68 65 20 |renuousl|y. The |
|00000850| 73 70 65 63 69 66 69 63 | 0d 0a 63 61 75 73 65 73 |specific|..causes|
|00000860| 20 6f 66 20 74 68 65 73 | 65 20 70 72 6f 62 6c 65 | of thes|e proble|
|00000870| 6d 73 20 61 72 65 20 75 | 6e 6b 6e 6f 77 6e 2e 20 |ms are u|nknown. |
|00000880| 20 54 68 65 72 65 20 69 | 73 20 73 6f 6d 65 20 65 | There i|s some e|
|00000890| 76 69 64 65 6e 63 65 20 | 74 68 61 74 20 65 6c 65 |vidence |that ele|
|000008a0| 76 61 74 65 64 0d 0a 62 | 61 73 61 6c 20 63 6f 72 |vated..b|asal cor|
|000008b0| 74 69 73 6f 6c 20 6c 65 | 76 65 6c 73 20 6d 61 79 |tisol le|vels may|
|000008c0| 20 62 65 20 69 6d 70 6c | 69 63 61 74 65 64 2e 20 | be impl|icated. |
|000008d0| 20 43 6f 72 74 69 73 6f | 6c 2c 20 65 73 74 72 61 | Cortiso|l, estra|
|000008e0| 64 69 6f 6c 2c 20 70 72 | 6f 67 65 73 74 65 72 6f |diol, pr|ogestero|
|000008f0| 6e 65 2c 20 61 6e 64 0d | 0a 70 72 6f 6c 61 63 74 |ne, and.|.prolact|
|00000900| 69 6e 20 6c 65 76 65 6c | 73 20 77 65 72 65 20 6d |in level|s were m|
|00000910| 65 61 73 75 72 65 64 20 | 69 6e 20 61 6d 65 6e 6f |easured |in ameno|
|00000920| 72 72 68 65 69 63 20 61 | 74 68 6c 65 74 65 73 2c |rrheic a|thletes,|
|00000930| 20 65 75 6d 65 6e 6f 72 | 72 68 65 69 63 20 61 74 | eumenor|rheic at|
|00000940| 68 6c 65 74 65 73 2c 0d | 0a 61 6e 64 20 63 6f 6e |hletes,.|.and con|
|00000950| 74 72 6f 6c 20 70 65 72 | 73 6f 6e 73 20 74 6f 20 |trol per|sons to |
|00000960| 64 65 74 65 72 6d 69 6e | 65 20 77 68 65 74 68 65 |determin|e whethe|
|00000970| 72 20 62 61 73 61 6c 20 | 63 6f 72 74 69 73 6f 6c |r basal |cortisol|
|00000980| 20 6c 65 76 65 6c 73 20 | 61 72 65 20 69 6e 63 72 | levels |are incr|
|00000990| 65 61 73 65 64 20 69 6e | 0d 0a 61 6d 65 6e 6f 72 |eased in|..amenor|
|000009a0| 72 68 65 69 63 20 61 74 | 68 6c 65 74 65 73 2e 20 |rheic at|hletes. |
|000009b0| 20 4c 75 6d 62 61 72 20 | 62 6f 6e 65 20 6d 69 6e | Lumbar |bone min|
|000009c0| 65 72 61 6c 20 64 65 6e | 73 69 74 79 20 77 61 73 |eral den|sity was|
|000009d0| 20 61 6c 73 6f 20 6d 65 | 61 73 75 72 65 64 20 74 | also me|asured t|
|000009e0| 6f 0d 0a 64 65 74 65 72 | 6d 69 6e 65 20 77 68 65 |o..deter|mine whe|
|000009f0| 74 68 65 72 20 65 6c 65 | 76 61 74 65 64 20 63 6f |ther ele|vated co|
|00000a00| 72 74 69 73 6f 6c 20 6c | 65 76 65 6c 73 20 61 72 |rtisol l|evels ar|
|00000a10| 65 20 61 73 73 6f 63 69 | 61 74 65 64 20 77 69 74 |e associ|ated wit|
|00000a20| 68 20 64 65 63 72 65 61 | 73 65 64 20 62 6f 6e 65 |h decrea|sed bone|
|00000a30| 0d 0a 64 65 6e 73 69 74 | 79 20 69 6e 20 77 6f 6d |..densit|y in wom|
|00000a40| 65 6e 20 61 74 68 6c 65 | 74 65 73 2e 0d 0a 20 20 |en athle|tes... |
|00000a50| 20 20 20 53 65 76 65 6e | 74 79 2d 6f 6e 65 20 77 | Seven|ty-one w|
|00000a60| 6f 6d 65 6e 20 77 65 72 | 65 20 67 72 6f 75 70 65 |omen wer|e groupe|
|00000a70| 64 20 62 79 20 6d 65 6e | 73 74 72 75 61 6c 20 61 |d by men|strual a|
|00000a80| 6e 64 20 61 63 74 69 76 | 69 74 79 20 68 69 73 74 |nd activ|ity hist|
|00000a90| 6f 72 69 65 73 20 69 6e | 74 6f 0d 0a 61 6d 65 6e |ories in|to..amen|
|00000aa0| 6f 72 72 68 65 69 63 20 | 61 74 68 6c 65 74 65 73 |orrheic |athletes|
|00000ab0| 2c 20 65 75 6d 65 6e 6f | 72 72 68 65 69 63 20 61 |, eumeno|rrheic a|
|00000ac0| 74 68 6c 65 74 65 73 2c | 20 61 6e 64 20 6e 6f 6e |thletes,| and non|
|00000ad0| 61 74 68 6c 65 74 69 63 | 20 77 6f 6d 65 6e 2e 20 |athletic| women. |
|00000ae0| 20 54 68 65 20 70 72 69 | 6d 61 72 79 0d 0a 73 70 | The pri|mary..sp|
|00000af0| 6f 72 74 73 20 61 63 74 | 69 76 69 74 79 20 6f 66 |orts act|ivity of|
|00000b00| 20 6d 6f 73 74 20 61 74 | 68 6c 65 74 65 73 20 77 | most at|hletes w|
|00000b10| 61 73 20 72 75 6e 6e 69 | 6e 67 2e 20 20 41 66 74 |as runni|ng. Aft|
|00000b20| 65 72 20 61 20 36 2d 6d | 6f 6e 74 68 20 66 6f 6c |er a 6-m|onth fol|
|00000b30| 6c 6f 77 2d 75 70 20 70 | 65 72 69 6f 64 2c 0d 0a |low-up p|eriod,..|
|00000b40| 74 68 65 20 77 6f 6d 65 | 6e 20 77 65 72 65 20 72 |the wome|n were r|
|00000b50| 65 67 72 6f 75 70 65 64 | 3a 20 31 39 20 61 6d 65 |egrouped|: 19 ame|
|00000b60| 6e 6f 72 72 68 65 69 63 | 20 61 74 68 6c 65 74 65 |norrheic| athlete|
|00000b70| 73 2c 20 33 35 20 65 75 | 6d 65 6e 6f 72 72 68 65 |s, 35 eu|menorrhe|
|00000b80| 69 63 20 61 74 68 6c 65 | 74 65 73 2c 20 31 30 0d |ic athle|tes, 10.|
|00000b90| 0a 6e 6f 6e 61 74 68 6c | 65 74 69 63 20 77 6f 6d |.nonathl|etic wom|
|00000ba0| 65 6e 2c 20 61 6e 64 20 | 37 20 74 72 61 6e 73 69 |en, and |7 transi|
|00000bb0| 74 69 6f 6e 20 61 74 68 | 6c 65 74 65 73 2c 20 77 |tion ath|letes, w|
|00000bc0| 68 6f 20 77 65 72 65 20 | 61 6d 65 6e 6f 72 72 68 |ho were |amenorrh|
|00000bd0| 65 69 63 20 77 6f 6d 65 | 6e 20 77 68 6f 0d 0a 72 |eic wome|n who..r|
|00000be0| 65 73 75 6d 65 64 20 6d | 65 6e 73 65 73 20 64 75 |esumed m|enses du|
|00000bf0| 72 69 6e 67 20 74 68 65 | 20 73 74 75 64 79 2e 20 |ring the| study. |
|00000c00| 20 46 6f 75 72 20 77 65 | 65 6b 6c 79 20 62 6c 6f | Four we|ekly blo|
|00000c10| 6f 64 20 73 61 6d 70 6c | 65 73 20 77 65 72 65 20 |od sampl|es were |
|00000c20| 6d 65 61 73 75 72 65 64 | 20 66 6f 72 0d 0a 63 6f |measured| for..co|
|00000c30| 72 74 69 73 6f 6c 2c 20 | 65 73 74 72 61 64 69 6f |rtisol, |estradio|
|00000c40| 6c 2c 20 70 72 6f 67 65 | 73 74 65 72 6f 6e 65 2c |l, proge|sterone,|
|00000c50| 20 61 6e 64 20 70 72 6f | 6c 61 63 74 69 6e 20 6c | and pro|lactin l|
|00000c60| 65 76 65 6c 73 2e 20 20 | 44 75 61 6c 2d 70 68 6f |evels. |Dual-pho|
|00000c70| 74 6f 6e 0d 0a 64 65 6e | 73 69 74 6f 6d 65 74 72 |ton..den|sitometr|
|00000c80| 79 20 77 61 73 20 75 73 | 65 64 20 74 6f 20 6d 65 |y was us|ed to me|
|00000c90| 61 73 75 72 65 20 6c 75 | 6d 62 61 72 20 62 6f 6e |asure lu|mbar bon|
|00000ca0| 65 20 6d 69 6e 65 72 61 | 6c 20 64 65 6e 73 69 74 |e minera|l densit|
|00000cb0| 79 2e 0d 0a 20 20 20 20 | 20 4d 65 61 6e 20 63 6f |y... | Mean co|
|00000cc0| 72 74 69 73 6f 6c 20 6c | 65 76 65 6c 73 20 77 65 |rtisol l|evels we|
|00000cd0| 72 65 20 68 69 67 68 65 | 72 20 69 6e 20 61 6d 65 |re highe|r in ame|
|00000ce0| 6e 6f 72 72 68 65 69 63 | 20 61 74 68 6c 65 74 65 |norrheic| athlete|
|00000cf0| 73 20 74 68 61 6e 20 69 | 6e 20 61 6e 79 20 6f 74 |s than i|n any ot|
|00000d00| 68 65 72 0d 0a 67 72 6f | 75 70 2e 20 20 4f 66 20 |her..gro|up. Of |
|00000d10| 39 20 77 6f 6d 65 6e 20 | 77 69 74 68 20 61 62 6e |9 women |with abn|
|00000d20| 6f 72 6d 61 6c 6c 79 20 | 68 69 67 68 20 63 6f 72 |ormally |high cor|
|00000d30| 74 69 73 6f 6c 20 6c 65 | 76 65 6c 73 2c 20 38 20 |tisol le|vels, 8 |
|00000d40| 77 65 72 65 20 61 6d 65 | 6e 6f 72 72 68 65 69 63 |were ame|norrheic|
|00000d50| 0d 0a 61 74 68 6c 65 74 | 65 73 2c 20 61 6e 64 20 |..athlet|es, and |
|00000d60| 31 20 77 61 73 20 61 20 | 65 75 6d 65 6e 6f 72 72 |1 was a |eumenorr|
|00000d70| 68 65 69 63 20 61 74 68 | 6c 65 74 65 2e 20 20 41 |heic ath|lete. A|
|00000d80| 6d 65 6e 6f 72 72 68 65 | 69 63 20 61 74 68 6c 65 |menorrhe|ic athle|
|00000d90| 74 65 73 20 68 61 64 20 | 6c 6f 77 65 72 20 62 6f |tes had |lower bo|
|00000da0| 6e 65 0d 0a 6d 69 6e 65 | 72 61 6c 20 64 65 6e 73 |ne..mine|ral dens|
|00000db0| 69 74 69 65 73 20 74 68 | 61 6e 20 74 68 65 20 6f |ities th|an the o|
|00000dc0| 74 68 65 72 20 33 20 67 | 72 6f 75 70 73 2e 0d 0a |ther 3 g|roups...|
|00000dd0| 20 20 20 20 20 45 6c 65 | 76 61 74 65 64 20 67 6c | Ele|vated gl|
|00000de0| 75 63 6f 63 6f 72 74 69 | 63 6f 69 64 20 6c 65 76 |ucocorti|coid lev|
|00000df0| 65 6c 73 20 6d 61 79 20 | 62 65 20 69 6e 76 6f 6c |els may |be invol|
|00000e00| 76 65 64 20 69 6e 20 74 | 68 65 20 63 61 75 73 65 |ved in t|he cause|
|00000e10| 20 6f 66 0d 0a 65 78 65 | 72 63 69 73 65 2d 61 73 | of..exe|rcise-as|
|00000e20| 73 6f 63 69 61 74 65 64 | 20 61 6d 65 6e 6f 72 72 |sociated| amenorr|
|00000e30| 68 65 61 20 61 6e 64 20 | 63 6f 75 6c 64 20 61 6c |hea and |could al|
|00000e40| 73 6f 20 63 6f 6e 74 72 | 69 62 75 74 65 20 74 6f |so contr|ibute to|
|00000e50| 20 64 65 63 72 65 61 73 | 65 64 20 62 6f 6e 65 0d | decreas|ed bone.|
|00000e60| 0a 64 65 6e 73 69 74 79 | 2e 20 20 48 79 70 65 72 |.density|. Hyper|
|00000e70| 63 6f 72 74 69 73 6f 6c | 65 6d 69 61 20 69 6e 20 |cortisol|emia in |
|00000e80| 61 6e 20 61 6d 65 6e 6f | 72 72 68 65 69 63 20 61 |an ameno|rrheic a|
|00000e90| 74 68 6c 65 74 65 20 6d | 61 79 20 73 69 67 6e 69 |thlete m|ay signi|
|00000ea0| 66 79 20 61 20 68 69 67 | 68 20 72 69 73 6b 0d 0a |fy a hig|h risk..|
|00000eb0| 66 6f 72 20 61 20 70 72 | 6f 6c 6f 6e 67 65 64 2c |for a pr|olonged,|
|00000ec0| 20 61 63 79 63 6c 69 63 | 20 73 74 61 74 65 2e 0d | acyclic| state..|
|00000ed0| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00000ee0| 0a 0d 0a 20 20 20 20 20 | 54 68 65 72 65 20 68 61 |... |There ha|
|00000ef0| 76 65 20 62 65 65 6e 20 | 73 65 76 65 72 61 6c 20 |ve been |several |
|00000f00| 72 65 63 65 6e 74 20 72 | 65 70 6f 72 74 73 20 69 |recent r|eports i|
|00000f10| 6e 64 69 63 61 74 69 6e | 67 20 74 68 61 74 20 63 |ndicatin|g that c|
|00000f20| 6f 72 74 69 73 6f 6c 20 | 73 65 63 72 65 74 69 6f |ortisol |secretio|
|00000f30| 6e 0d 0a 69 73 20 65 6c | 65 76 61 74 65 64 20 69 |n..is el|evated i|
|00000f40| 6e 20 77 6f 6d 65 6e 20 | 77 69 74 68 20 68 79 70 |n women |with hyp|
|00000f50| 6f 74 68 61 6c 6d 69 63 | 20 61 6d 65 6e 6f 72 72 |othalmic| amenorr|
|00000f60| 68 65 61 2e 20 20 54 68 | 69 73 20 72 65 70 6f 72 |hea. Th|is repor|
|00000f70| 74 20 70 65 72 74 61 69 | 6e 73 20 74 6f 20 77 6f |t pertai|ns to wo|
|00000f80| 6d 65 6e 0d 0a 61 74 68 | 6c 65 74 65 73 20 77 68 |men..ath|letes wh|
|00000f90| 6f 20 70 61 72 74 69 63 | 69 70 61 74 65 64 20 69 |o partic|ipated i|
|00000fa0| 6e 20 76 61 72 69 6f 75 | 73 20 74 79 70 65 73 20 |n variou|s types |
|00000fb0| 6f 66 20 73 74 72 65 6e | 75 6f 75 73 20 77 65 69 |of stren|uous wei|
|00000fc0| 67 68 74 2d 62 65 61 72 | 69 6e 67 20 65 78 65 72 |ght-bear|ing exer|
|00000fd0| 63 69 73 65 2e 0d 0a 41 | 6c 74 68 6f 75 67 68 20 |cise...A|lthough |
|00000fe0| 74 68 65 20 65 78 61 63 | 74 20 6d 65 63 68 61 6e |the exac|t mechan|
|00000ff0| 69 73 6d 20 72 65 6c 61 | 74 69 6e 67 20 65 78 65 |ism rela|ting exe|
|00001000| 72 63 69 73 65 20 74 6f | 20 61 6d 65 6e 6f 72 72 |rcise to| amenorr|
|00001010| 68 65 61 20 68 61 73 20 | 6e 6f 74 20 62 65 65 6e |hea has |not been|
|00001020| 0d 0a 64 65 74 65 72 6d | 69 6e 65 64 2c 20 69 74 |..determ|ined, it|
|00001030| 20 69 73 20 70 6f 73 74 | 75 6c 61 74 65 64 20 74 | is post|ulated t|
|00001040| 6f 20 62 65 20 61 6e 61 | 6c 6f 67 6f 75 73 20 74 |o be ana|logous t|
|00001050| 6f 20 74 68 65 20 73 74 | 72 65 73 73 2d 69 6e 64 |o the st|ress-ind|
|00001060| 75 63 65 64 20 74 79 70 | 65 73 20 6f 66 0d 0a 68 |uced typ|es of..h|
|00001070| 79 70 6f 74 68 61 6c 6d | 69 63 20 61 6d 65 6e 6f |ypothalm|ic ameno|
|00001080| 72 72 68 65 61 2e 20 20 | 54 68 69 73 20 66 65 61 |rrhea. |This fea|
|00001090| 74 75 72 65 73 20 61 6e | 20 69 6e 63 72 65 61 73 |tures an| increas|
|000010a0| 65 20 69 6e 20 63 6f 72 | 74 69 63 6f 74 72 6f 70 |e in cor|ticotrop|
|000010b0| 69 6e 2d 72 65 6c 65 61 | 73 69 6e 67 0d 0a 68 6f |in-relea|sing..ho|
|000010c0| 72 6d 6f 6e 65 2d 6d 65 | 64 69 63 61 74 65 64 20 |rmone-me|dicated |
|000010d0| 72 65 6c 65 61 73 65 20 | 6f 66 20 6f 70 69 6f 69 |release |of opioi|
|000010e0| 64 20 70 65 70 74 69 64 | 65 73 20 61 6e 64 20 61 |d peptid|es and a|
|000010f0| 64 72 65 6e 6f 63 6f 72 | 74 69 63 6f 74 72 6f 70 |drenocor|ticotrop|
|00001100| 69 63 20 68 6f 72 6d 6f | 6e 65 2e 0d 0a 4f 70 69 |ic hormo|ne...Opi|
|00001110| 6f 69 64 20 70 65 70 74 | 69 64 65 73 2c 20 73 70 |oid pept|ides, sp|
|00001120| 65 63 69 66 69 63 61 6c | 6c 79 20 62 65 74 61 2d |ecifical|ly beta-|
|00001130| 65 6e 64 6f 72 70 68 69 | 6e 2c 20 69 6e 68 69 62 |endorphi|n, inhib|
|00001140| 69 74 20 68 79 70 6f 74 | 68 61 6c 6d 69 63 20 47 |it hypot|halmic G|
|00001150| 6e 52 48 20 61 6e 64 20 | 74 68 75 73 0d 0a 6d 65 |nRH and |thus..me|
|00001160| 6e 73 74 72 75 61 6c 20 | 69 72 72 65 67 75 6c 61 |nstrual |irregula|
|00001170| 72 69 74 69 65 73 20 6f | 72 20 61 6d 65 6e 6f 72 |rities o|r amenor|
|00001180| 72 68 65 61 20 65 6e 73 | 75 65 73 2e 20 20 54 68 |rhea ens|ues. Th|
|00001190| 65 20 69 6e 63 72 65 61 | 73 65 20 69 6e 20 63 6f |e increa|se in co|
|000011a0| 72 74 69 73 6f 6c 2c 0d | 0a 74 68 65 72 65 66 6f |rtisol,.|.therefo|
|000011b0| 72 65 2c 20 69 73 20 70 | 72 6f 62 61 62 6c 79 20 |re, is p|robably |
|000011c0| 6e 6f 74 20 74 68 65 20 | 63 61 75 73 65 20 6f 66 |not the |cause of|
|000011d0| 20 74 68 65 20 61 6d 65 | 6e 6f 72 72 68 65 61 20 | the ame|norrhea |
|000011e0| 61 73 20 73 75 67 67 65 | 73 74 65 64 20 62 79 20 |as sugge|sted by |
|000011f0| 74 68 65 0d 0a 61 75 74 | 68 6f 72 73 2c 20 62 75 |the..aut|hors, bu|
|00001200| 74 20 69 73 20 6d 65 72 | 65 6c 79 20 61 20 6d 61 |t is mer|ely a ma|
|00001210| 72 6b 65 72 20 6f 66 20 | 63 65 6e 74 72 61 6c 20 |rker of |central |
|00001220| 63 6f 72 74 69 63 6f 74 | 72 6f 70 69 6e 2d 72 65 |corticot|ropin-re|
|00001230| 6c 65 61 73 69 6e 67 20 | 68 6f 72 6d 6f 6e 65 0d |leasing |hormone.|
|00001240| 0a 62 65 74 61 2d 65 6e | 64 6f 72 70 68 69 6e 20 |.beta-en|dorphin |
|00001250| 72 65 6c 65 61 73 65 2e | 20 20 48 6f 77 65 76 65 |release.| Howeve|
|00001260| 72 20 74 68 65 20 63 6f | 72 74 69 73 6f 6c 20 6d |r the co|rtisol m|
|00001270| 61 79 20 62 65 20 69 6d | 70 6f 72 74 61 6e 74 20 |ay be im|portant |
|00001280| 69 6e 20 63 6f 6e 74 72 | 69 62 75 74 69 6e 67 0d |in contr|ibuting.|
|00001290| 0a 74 6f 20 74 68 65 20 | 6f 73 74 65 6f 70 65 6e |.to the |osteopen|
|000012a0| 69 61 20 6f 66 20 68 79 | 70 6f 74 68 61 6c 6d 69 |ia of hy|pothalmi|
|000012b0| 63 20 61 6d 65 6e 6f 72 | 72 68 65 61 2c 20 70 61 |c amenor|rhea, pa|
|000012c0| 72 74 69 63 75 6c 61 72 | 6c 79 20 69 6e 20 74 68 |rticular|ly in th|
|000012d0| 65 20 70 72 65 73 65 6e | 63 65 20 6f 66 0d 0a 68 |e presen|ce of..h|
|000012e0| 79 70 6f 65 73 74 72 6f | 67 65 6e 69 73 6d 2e 2d |ypoestro|genism.-|
|000012f0| 2d 52 2e 41 2e 20 4c 6f | 62 6f 2c 20 4d 2e 44 2e |-R.A. Lo|bo, M.D.|
|00001300| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|00001310| 30 38 36 30 31 7d 0d 0a | 24 54 69 74 6c 65 7b 49 |08601}..|$Title{I|
|00001320| 6e 63 69 64 65 6e 63 65 | 20 6f 66 20 45 61 72 6c |ncidence| of Earl|
|00001330| 79 20 4c 6f 73 73 20 6f | 66 20 50 72 65 67 6e 61 |y Loss o|f Pregna|
|00001340| 6e 63 79 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 0d 0a |ncy}..$A|uthor{..|
|00001350| 57 69 6c 63 6f 78 2c 20 | 41 4a 0d 0a 57 65 69 6e |Wilcox, |AJ..Wein|
|00001360| 62 65 72 67 2c 20 43 52 | 0d 0a 4f 27 43 6f 6e 6e |berg, CR|..O'Conn|
|00001370| 6f 72 2c 20 4a 46 0d 0a | 42 61 69 72 64 2c 20 44 |or, JF..|Baird, D|
|00001380| 44 0d 0a 53 63 68 6c 61 | 74 74 65 72 65 72 2c 20 |D..Schla|tterer, |
|00001390| 4a 50 0d 0a 43 61 6e 66 | 69 65 6c 64 2c 20 52 45 |JP..Canf|ield, RE|
|000013a0| 0d 0a 41 72 6d 73 74 72 | 6f 6e 67 2c 20 45 47 0d |..Armstr|ong, EG.|
|000013b0| 0a 4e 69 73 75 6c 61 2c | 20 42 43 7d 0d 0a 24 41 |.Nisula,| BC}..$A|
|000013c0| 66 66 69 6c 69 61 74 69 | 6f 6e 7b 4e 61 74 6c 20 |ffiliati|on{Natl |
|000013d0| 49 6e 73 74 20 6f 66 20 | 45 6e 76 69 72 6f 6e 6d |Inst of |Environm|
|000013e0| 65 6e 74 61 6c 20 48 65 | 61 6c 74 68 20 53 63 69 |ental He|alth Sci|
|000013f0| 65 6e 63 65 73 2c 20 52 | 65 73 65 61 72 63 68 20 |ences, R|esearch |
|00001400| 54 72 69 61 6e 67 6c 65 | 20 50 61 72 6b 2c 20 4e |Triangle| Park, N|
|00001410| 43 3b 20 43 6f 6c 75 6d | 62 69 61 20 55 6e 69 76 |C; Colum|bia Univ|
|00001420| 3b 20 4e 61 74 6c 20 49 | 6e 73 74 20 6f 66 20 43 |; Natl I|nst of C|
|00001430| 68 69 6c 64 20 48 65 61 | 6c 74 68 20 61 6e 64 20 |hild Hea|lth and |
|00001440| 48 75 6d 61 6e 20 44 65 | 76 65 6c 6f 70 6d 65 6e |Human De|velopmen|
|00001450| 74 2c 20 42 65 74 68 65 | 73 64 61 2c 20 4d 64 7d |t, Bethe|sda, Md}|
|00001460| 0d 0a 24 53 75 62 6a 65 | 63 74 7b 50 72 65 67 6e |..$Subje|ct{Pregn|
|00001470| 61 6e 63 79 2c 20 6c 6f | 73 73 2c 20 65 61 72 6c |ancy, lo|ss, earl|
|00001480| 79 2c 20 69 6e 63 69 64 | 65 6e 63 65 7d 0d 0a 24 |y, incid|ence}..$|
|00001490| 4a 6f 75 72 6e 61 6c 7b | 4e 20 45 6e 67 6c 20 4a |Journal{|N Engl J|
|000014a0| 20 4d 65 64 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 | Med}..$|Volume{3|
|000014b0| 31 39 7d 0d 0a 24 50 61 | 67 65 7b 31 38 39 2d 31 |19}..$Pa|ge{189-1|
|000014c0| 39 34 7d 0d 0a 24 44 61 | 74 65 7b 4a 75 6c 79 20 |94}..$Da|te{July |
|000014d0| 32 38 2c 20 31 39 38 38 | 7d 0d 0a 24 59 42 56 6f |28, 1988|}..$YBVo|
|000014e0| 6c 7b 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |l{1989 Y|ear Book|
|000014f0| 20 6f 66 20 49 6e 66 65 | 72 74 69 6c 69 74 79 7d | of Infe|rtility}|
|00001500| 0d 0a 24 43 68 61 70 74 | 65 72 7b 32 2d 33 7d 0d |..$Chapt|er{2-3}.|
|00001510| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00001520| 4d 69 73 68 65 6c 6c 2c | 20 50 61 75 6c 73 65 6e |Mishell,| Paulsen|
|00001530| 2c 20 61 6e 64 20 4c 6f | 62 6f 7d 0d 0a 24 54 61 |, and Lo|bo}..$Ta|
|00001540| 62 6c 65 7b 54 61 62 6c | 65 20 4f 6d 69 74 74 65 |ble{Tabl|e Omitte|
|00001550| 64 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |d}..$Com|mentator|
|00001560| 7b 44 2e 52 2e 20 4d 69 | 73 68 65 6c 6c 2c 20 4a |{D.R. Mi|shell, J|
|00001570| 72 2e 2c 20 4d 2e 44 2e | 7d 0d 0a 0d 0a 43 6f 70 |r., M.D.|}....Cop|
|00001580| 79 72 69 67 68 74 20 28 | 63 29 20 59 65 61 72 20 |yright (|c) Year |
|00001590| 42 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |Book Med|ical Pub|
|000015a0| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|000015b0| 39 38 39 0d 0a 0d 0a 31 | 39 38 38 20 59 65 61 72 |989....1|988 Year|
|000015c0| 20 42 6f 6f 6b 20 6f 66 | 20 49 6e 66 65 72 74 69 | Book of| Inferti|
|000015d0| 6c 69 74 79 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |lity (R)|....Chap|
|000015e0| 74 65 72 20 32 2d 2d 45 | 70 69 64 65 6d 69 6f 6c |ter 2--E|pidemiol|
|000015f0| 6f 67 79 20 6f 66 20 49 | 6e 66 65 72 74 69 6c 69 |ogy of I|nfertili|
|00001600| 74 79 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ty....--|--------|
|00001610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001640| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001650| 2d 2d 2d 2d 2d 2d 0d 0a | 49 6e 63 69 64 65 6e 63 |------..|Incidenc|
|00001660| 65 20 6f 66 20 45 61 72 | 6c 79 20 4c 6f 73 73 20 |e of Ear|ly Loss |
|00001670| 6f 66 20 50 72 65 67 6e | 61 6e 63 79 0d 0a 0d 0a |of Pregn|ancy....|
|00001680| 57 69 6c 63 6f 78 20 41 | 4a 3b 20 57 65 69 6e 62 |Wilcox A|J; Weinb|
|00001690| 65 72 67 20 43 52 3b 20 | 4f 27 43 6f 6e 6e 6f 72 |erg CR; |O'Connor|
|000016a0| 20 4a 46 3b 20 42 61 69 | 72 64 20 44 44 3b 20 53 | JF; Bai|rd DD; S|
|000016b0| 63 68 6c 61 74 74 65 72 | 65 72 20 4a 50 3b 20 43 |chlatter|er JP; C|
|000016c0| 61 6e 66 69 65 6c 64 20 | 52 45 3b 0d 0a 41 72 6d |anfield |RE;..Arm|
|000016d0| 73 74 72 6f 6e 67 20 45 | 47 3b 20 4e 69 73 75 6c |strong E|G; Nisul|
|000016e0| 61 20 42 43 0d 0a 28 4e | 61 74 6c 20 49 6e 73 74 |a BC..(N|atl Inst|
|000016f0| 20 6f 66 20 45 6e 76 69 | 72 6f 6e 6d 65 6e 74 61 | of Envi|ronmenta|
|00001700| 6c 20 48 65 61 6c 74 68 | 20 53 63 69 65 6e 63 65 |l Health| Science|
|00001710| 73 2c 20 52 65 73 65 61 | 72 63 68 20 54 72 69 61 |s, Resea|rch Tria|
|00001720| 6e 67 6c 65 20 50 61 72 | 6b 2c 20 4e 43 3b 0d 0a |ngle Par|k, NC;..|
|00001730| 43 6f 6c 75 6d 62 69 61 | 20 55 6e 69 76 3b 20 4e |Columbia| Univ; N|
|00001740| 61 74 6c 20 49 6e 73 74 | 20 6f 66 20 43 68 69 6c |atl Inst| of Chil|
|00001750| 64 20 48 65 61 6c 74 68 | 20 61 6e 64 20 48 75 6d |d Health| and Hum|
|00001760| 61 6e 20 44 65 76 65 6c | 6f 70 6d 65 6e 74 2c 20 |an Devel|opment, |
|00001770| 42 65 74 68 65 73 64 61 | 2c 20 4d 64 29 0d 0a 4e |Bethesda|, Md)..N|
|00001780| 20 45 6e 67 6c 20 4a 20 | 4d 65 64 20 33 31 39 3a | Engl J |Med 319:|
|00001790| 31 38 39 2d 31 39 34 2c | 20 4a 75 6c 79 20 32 38 |189-194,| July 28|
|000017a0| 2c 20 31 39 38 38 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1988..|--------|
|000017b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017f0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|00001800| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 54 68 65 |ract....| The|
|00001810| 20 63 6f 6e 74 72 69 62 | 75 74 69 6f 6e 20 6f 66 | contrib|ution of|
|00001820| 20 65 61 72 6c 79 20 6c | 6f 73 73 20 6f 66 20 70 | early l|oss of p|
|00001830| 72 65 67 6e 61 6e 63 79 | 20 74 6f 20 69 6e 66 65 |regnancy| to infe|
|00001840| 72 74 69 6c 65 20 63 79 | 63 6c 65 73 20 64 75 72 |rtile cy|cles dur|
|00001850| 69 6e 67 0d 0a 61 74 74 | 65 6d 70 74 65 64 20 63 |ing..att|empted c|
|00001860| 6f 6e 63 65 70 74 69 6f | 6e 20 69 73 20 6e 6f 74 |onceptio|n is not|
|00001870| 20 6b 6e 6f 77 6e 2e 20 | 20 54 68 65 20 72 69 73 | known. | The ris|
|00001880| 6b 20 6f 66 20 65 61 72 | 6c 79 20 6c 6f 73 73 20 |k of ear|ly loss |
|00001890| 6f 66 20 70 72 65 67 6e | 61 6e 63 79 20 64 75 72 |of pregn|ancy dur|
|000018a0| 69 6e 67 0d 0a 61 74 74 | 65 6d 70 74 65 64 20 63 |ing..att|empted c|
|000018b0| 6f 6e 63 65 70 74 69 6f | 6e 20 77 61 73 20 65 78 |onceptio|n was ex|
|000018c0| 61 6d 69 6e 65 64 20 69 | 6e 20 32 32 31 20 68 65 |amined i|n 221 he|
|000018d0| 61 6c 74 68 79 20 77 6f | 6d 65 6e 20 62 79 20 64 |althy wo|men by d|
|000018e0| 61 69 6c 79 20 63 6f 6c | 6c 65 63 74 69 6f 6e 20 |aily col|lection |
|000018f0| 6f 66 0d 0a 75 72 69 6e | 65 20 73 61 6d 70 6c 65 |of..urin|e sample|
|00001900| 73 2e 20 20 54 68 65 20 | 63 6f 6e 63 65 6e 74 72 |s. The |concentr|
|00001910| 61 74 69 6f 6e 20 6f 66 | 20 68 75 6d 61 6e 20 63 |ation of| human c|
|00001920| 68 6f 72 69 6f 6e 69 63 | 20 67 6f 6e 61 64 6f 74 |horionic| gonadot|
|00001930| 72 6f 70 69 6e 20 28 68 | 47 43 29 20 69 6e 20 74 |ropin (h|GC) in t|
|00001940| 68 65 0d 0a 75 72 69 6e | 65 20 77 61 73 20 6d 65 |he..urin|e was me|
|00001950| 61 73 75 72 65 64 20 77 | 69 74 68 20 61 6e 20 69 |asured w|ith an i|
|00001960| 6d 6d 75 6e 6f 72 61 64 | 69 6f 6d 65 74 72 69 63 |mmunorad|iometric|
|00001970| 20 61 73 73 61 79 20 74 | 68 61 74 20 63 61 6e 20 | assay t|hat can |
|00001980| 73 70 65 63 69 66 69 63 | 61 6c 6c 79 20 64 65 74 |specific|ally det|
|00001990| 65 63 74 0d 0a 30 2e 30 | 31 20 6e 67 2f 6d 6c 20 |ect..0.0|1 ng/ml |
|000019a0| 6f 66 20 68 47 43 2e 0d | 0a 20 20 20 20 20 45 61 |of hGC..|. Ea|
|000019b0| 72 6c 79 20 70 72 65 67 | 6e 61 6e 63 79 20 77 61 |rly preg|nancy wa|
|000019c0| 73 20 64 65 66 69 6e 65 | 64 20 62 79 20 63 6f 6d |s define|d by com|
|000019d0| 70 61 72 69 73 6f 6e 20 | 6f 66 20 68 47 43 20 6c |parison |of hGC l|
|000019e0| 65 76 65 6c 73 20 77 69 | 74 68 20 61 20 67 72 6f |evels wi|th a gro|
|000019f0| 75 70 20 6f 66 20 32 38 | 0d 0a 77 6f 6d 65 6e 20 |up of 28|..women |
|00001a00| 77 68 6f 20 68 61 64 20 | 75 6e 64 65 72 67 6f 6e |who had |undergon|
|00001a10| 65 20 74 75 62 61 6c 20 | 6c 69 67 61 74 69 6f 6e |e tubal |ligation|
|00001a20| 2e 20 20 54 68 65 20 68 | 47 43 20 6c 65 76 65 6c |. The h|GC level|
|00001a30| 20 74 68 61 74 20 77 61 | 73 20 63 6f 6e 73 69 64 | that wa|s consid|
|00001a40| 65 72 65 64 0d 0a 6e 65 | 63 65 73 73 61 72 79 20 |ered..ne|cessary |
|00001a50| 66 6f 72 20 70 72 65 67 | 6e 61 6e 63 79 20 77 61 |for preg|nancy wa|
|00001a60| 73 20 30 2e 30 32 35 20 | 6e 67 2f 6d 6c 2e 20 20 |s 0.025 |ng/ml. |
|00001a70| 41 6d 6f 6e 67 20 74 68 | 65 20 32 32 31 20 77 6f |Among th|e 221 wo|
|00001a80| 6d 65 6e 2c 20 31 39 38 | 20 70 72 65 67 6e 61 6e |men, 198| pregnan|
|00001a90| 63 69 65 73 0d 0a 77 65 | 72 65 20 69 64 65 6e 74 |cies..we|re ident|
|00001aa0| 69 66 69 65 64 20 62 79 | 20 61 6e 20 69 6e 63 72 |ified by| an incr|
|00001ab0| 65 61 73 65 20 69 6e 20 | 68 43 47 20 6c 65 76 65 |ease in |hCG leve|
|00001ac0| 6c 73 2e 20 20 4f 66 20 | 74 68 65 20 31 39 38 20 |ls. Of |the 198 |
|00001ad0| 70 72 65 67 6e 61 6e 63 | 69 65 73 2c 20 32 32 25 |pregnanc|ies, 22%|
|00001ae0| 20 65 6e 64 65 64 0d 0a | 62 65 66 6f 72 65 20 74 | ended..|before t|
|00001af0| 68 65 20 63 6c 69 6e 69 | 63 61 6c 20 64 65 74 65 |he clini|cal dete|
|00001b00| 63 74 69 6f 6e 20 6f 66 | 20 70 72 65 67 6e 61 6e |ction of| pregnan|
|00001b10| 63 79 20 28 46 69 67 20 | 32 2d 31 29 2e 20 20 54 |cy (Fig |2-1). T|
|00001b20| 68 65 20 70 72 6f 62 61 | 62 69 6c 69 74 79 20 6f |he proba|bility o|
|00001b30| 66 0d 0a 63 6c 69 6e 69 | 63 61 6c 20 70 72 65 67 |f..clini|cal preg|
|00001b40| 6e 61 6e 63 79 20 28 64 | 69 61 67 6e 6f 73 65 64 |nancy (d|iagnosed|
|00001b50| 20 62 79 20 61 20 70 68 | 79 73 69 63 69 61 6e 29 | by a ph|ysician)|
|00001b60| 20 77 61 73 20 61 70 70 | 72 6f 78 69 6d 61 74 65 | was app|roximate|
|00001b70| 6c 79 20 32 35 25 20 70 | 65 72 20 63 79 63 6c 65 |ly 25% p|er cycle|
|00001b80| 0d 0a 66 6f 72 20 74 68 | 65 20 65 61 72 6c 79 20 |..for th|e early |
|00001b90| 63 79 63 6c 65 73 20 69 | 6e 20 74 68 69 73 20 73 |cycles i|n this s|
|00001ba0| 74 75 64 79 20 28 74 61 | 62 6c 65 29 2e 0d 0a 20 |tudy (ta|ble)... |
|00001bb0| 20 20 20 20 4d 6f 73 74 | 20 65 61 72 6c 79 20 70 | Most| early p|
|00001bc0| 72 65 67 6e 61 6e 63 79 | 20 6c 6f 73 73 65 73 20 |regnancy| losses |
|00001bd0| 64 65 74 65 63 74 65 64 | 20 69 6e 20 74 68 69 73 |detected| in this|
|00001be0| 20 73 74 75 64 79 20 77 | 6f 75 6c 64 20 6e 6f 74 | study w|ould not|
|00001bf0| 20 68 61 76 65 20 62 65 | 65 6e 0d 0a 64 65 74 65 | have be|en..dete|
|00001c00| 63 74 65 64 20 62 79 20 | 70 72 65 76 69 6f 75 73 |cted by |previous|
|00001c10| 20 73 74 75 64 69 65 73 | 20 75 73 69 6e 67 20 6c | studies| using l|
|00001c20| 65 73 73 20 73 65 6e 73 | 69 74 69 76 65 20 68 47 |ess sens|itive hG|
|00001c30| 43 20 61 73 73 61 79 73 | 2e 20 20 54 68 65 20 74 |C assays|. The t|
|00001c40| 6f 74 61 6c 20 72 61 74 | 65 20 6f 66 0d 0a 70 72 |otal rat|e of..pr|
|00001c50| 65 67 6e 61 6e 63 79 20 | 6c 6f 73 73 20 61 66 74 |egnancy |loss aft|
|00001c60| 65 72 20 69 6d 70 6c 61 | 6e 74 61 74 69 6f 6e 20 |er impla|ntation |
|00001c70| 77 61 73 20 33 31 25 2e | 20 20 54 68 65 72 65 20 |was 31%.| There |
|00001c80| 77 61 73 20 6e 6f 20 65 | 76 69 64 65 6e 63 65 20 |was no e|vidence |
|00001c90| 74 68 61 74 0d 0a 70 72 | 65 67 6e 61 6e 63 69 65 |that..pr|egnancie|
|00001ca0| 73 20 69 6d 6d 65 64 69 | 61 74 65 6c 79 20 61 66 |s immedi|ately af|
|00001cb0| 74 65 72 20 61 6e 20 65 | 61 72 6c 79 20 6c 6f 73 |ter an e|arly los|
|00001cc0| 73 20 77 65 72 65 20 61 | 74 20 68 69 67 68 65 72 |s were a|t higher|
|00001cd0| 20 72 69 73 6b 20 74 68 | 61 6e 20 6f 74 68 65 72 | risk th|an other|
|00001ce0| 0d 0a 70 72 65 67 6e 61 | 6e 63 69 65 73 2e 20 20 |..pregna|ncies. |
|00001cf0| 41 73 20 39 35 25 20 6f | 66 20 74 68 65 20 77 6f |As 95% o|f the wo|
|00001d00| 6d 65 6e 20 77 69 74 68 | 20 65 61 72 6c 79 20 70 |men with| early p|
|00001d10| 72 65 67 6e 61 6e 63 79 | 20 6c 6f 73 73 20 62 65 |regnancy| loss be|
|00001d20| 63 61 6d 65 20 63 6c 69 | 6e 69 63 61 6c 6c 79 0d |came cli|nically.|
|00001d30| 0a 70 72 65 67 6e 61 6e | 74 20 77 69 74 68 69 6e |.pregnan|t within|
|00001d40| 20 32 20 79 65 61 72 73 | 2c 20 6d 6f 73 74 20 6f | 2 years|, most o|
|00001d50| 66 20 74 68 65 73 65 20 | 77 6f 6d 65 6e 20 68 61 |f these |women ha|
|00001d60| 64 20 6e 6f 72 6d 61 6c | 20 66 65 72 74 69 6c 69 |d normal| fertili|
|00001d70| 74 79 2e 0d 0a 20 20 20 | 20 20 4e 65 61 72 6c 79 |ty... | Nearly|
|00001d80| 20 6f 6e 65 20 74 68 69 | 72 64 20 6f 66 20 61 6c | one thi|rd of al|
|00001d90| 6c 20 70 72 65 67 6e 61 | 6e 63 69 65 73 20 64 65 |l pregna|ncies de|
|00001da0| 74 65 63 74 65 64 20 69 | 6e 20 74 68 69 73 20 73 |tected i|n this s|
|00001db0| 74 75 64 79 20 77 65 72 | 65 20 6c 6f 73 74 20 62 |tudy wer|e lost b|
|00001dc0| 65 66 6f 72 65 0d 0a 64 | 65 6c 69 76 65 72 79 2e |efore..d|elivery.|
|00001dd0| 20 20 4f 66 20 74 68 65 | 73 65 2c 20 61 70 70 72 | Of the|se, appr|
|00001de0| 6f 78 69 6d 61 74 65 6c | 79 20 74 77 6f 20 74 68 |oximatel|y two th|
|00001df0| 69 72 64 73 20 77 65 72 | 65 20 6c 6f 73 74 20 62 |irds wer|e lost b|
|00001e00| 65 66 6f 72 65 20 63 6c | 69 6e 69 63 61 6c 0d 0a |efore cl|inical..|
|00001e10| 72 65 63 6f 67 6e 69 74 | 69 6f 6e 20 6f 66 20 70 |recognit|ion of p|
|00001e20| 72 65 67 6e 61 6e 63 79 | 2e 20 20 54 68 65 20 73 |regnancy|. The s|
|00001e30| 70 65 63 69 66 69 63 2c | 20 73 65 6e 73 69 74 69 |pecific,| sensiti|
|00001e40| 76 65 20 6d 65 61 73 75 | 72 65 6d 65 6e 74 20 6f |ve measu|rement o|
|00001e50| 66 20 75 72 69 6e 61 72 | 79 20 68 47 43 0d 0a 6c |f urinar|y hGC..l|
|00001e60| 65 76 65 6c 73 20 61 70 | 70 65 61 72 73 20 74 6f |evels ap|pears to|
|00001e70| 20 61 6c 6c 6f 77 20 74 | 68 65 20 64 65 74 65 63 | allow t|he detec|
|00001e80| 74 69 6f 6e 20 6f 66 20 | 70 72 65 67 6e 61 6e 63 |tion of |pregnanc|
|00001e90| 79 20 73 6f 6f 6e 20 61 | 66 74 65 72 20 69 6d 70 |y soon a|fter imp|
|00001ea0| 6c 61 6e 74 61 74 69 6f | 6e 2e 0d 0a 0d 0a 50 6f |lantatio|n.....Po|
|00001eb0| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00001ec0| 20 20 20 54 68 65 20 70 | 72 6f 63 65 73 73 20 6f | The p|rocess o|
|00001ed0| 66 20 68 75 6d 61 6e 20 | 70 72 6f 63 72 65 61 74 |f human |procreat|
|00001ee0| 69 6f 6e 20 69 73 20 72 | 65 6d 61 72 6b 61 62 6c |ion is r|emarkabl|
|00001ef0| 79 20 69 6e 65 66 66 69 | 63 69 65 6e 74 2e 20 20 |y ineffi|cient. |
|00001f00| 49 6e 20 74 68 69 73 20 | 73 74 75 64 79 0d 0a 6f |In this |study..o|
|00001f10| 66 20 61 20 67 72 6f 75 | 70 20 6f 66 20 70 72 65 |f a grou|p of pre|
|00001f20| 73 75 6d 61 62 6c 79 20 | 6e 6f 72 6d 61 6c 20 77 |sumably |normal w|
|00001f30| 6f 6d 65 6e 20 77 68 6f | 20 73 74 6f 70 70 65 64 |omen who| stopped|
|00001f40| 20 63 6f 6e 74 72 61 63 | 65 70 74 69 6f 6e 20 69 | contrac|eption i|
|00001f50| 6e 20 6f 72 64 65 72 20 | 74 6f 0d 0a 63 6f 6e 63 |n order |to..conc|
|00001f60| 65 69 76 65 2c 20 74 68 | 65 20 70 72 6f 62 61 62 |eive, th|e probab|
|00001f70| 69 6c 69 74 79 20 6f 66 | 20 63 6f 6e 63 65 69 76 |ility of| conceiv|
|00001f80| 69 6e 67 20 61 20 63 6c | 69 6e 69 63 61 6c 6c 79 |ing a cl|inically|
|00001f90| 20 72 65 63 6f 67 6e 69 | 7a 65 64 20 70 72 65 67 | recogni|zed preg|
|00001fa0| 6e 61 6e 63 79 20 69 6e | 20 74 68 65 0d 0a 66 69 |nancy in| the..fi|
|00001fb0| 72 73 74 20 33 20 63 79 | 63 6c 65 73 20 77 61 73 |rst 3 cy|cles was|
|00001fc0| 20 6f 6e 6c 79 20 61 62 | 6f 75 74 20 32 35 25 20 | only ab|out 25% |
|00001fd0| 70 65 72 20 63 79 63 6c | 65 2e 20 20 54 68 69 73 |per cycl|e. This|
|00001fe0| 20 72 61 74 65 2c 20 63 | 61 6c 6c 65 64 20 66 65 | rate, c|alled fe|
|00001ff0| 63 75 6e 64 69 62 69 6c | 69 74 79 2c 0d 0a 69 73 |cundibil|ity,..is|
|00002000| 20 61 20 6d 6f 72 65 20 | 61 63 63 75 72 61 74 65 | a more |accurate|
|00002010| 20 77 61 79 20 74 6f 20 | 64 65 74 65 72 6d 69 6e | way to |determin|
|00002020| 65 20 74 68 65 20 73 75 | 63 63 65 73 73 20 6f 66 |e the su|ccess of|
|00002030| 20 76 61 72 69 6f 75 73 | 20 74 72 65 61 74 6d 65 | various| treatme|
|00002040| 6e 74 73 20 6f 66 0d 0a | 69 6e 66 65 72 74 69 6c |nts of..|infertil|
|00002050| 69 74 79 20 69 6e 73 74 | 65 61 64 20 6f 66 20 74 |ity inst|ead of t|
|00002060| 68 65 20 74 6f 74 61 6c | 20 70 72 65 67 6e 61 6e |he total| pregnan|
|00002070| 63 79 20 72 61 74 65 2c | 20 77 68 69 63 68 20 76 |cy rate,| which v|
|00002080| 61 72 69 65 73 20 6f 76 | 65 72 20 74 69 6d 65 20 |aries ov|er time |
|00002090| 61 6e 64 20 77 61 73 0d | 0a 6f 6e 6c 79 20 37 30 |and was.|.only 70|
|000020a0| 25 20 61 66 74 65 72 20 | 39 20 6d 6f 6e 74 68 73 |% after |9 months|
|000020b0| 20 69 6e 20 74 68 69 73 | 20 70 6f 70 75 6c 61 74 | in this| populat|
|000020c0| 69 6f 6e 2e 0d 0a 20 20 | 20 20 20 49 74 20 69 73 |ion... | It is|
|000020d0| 20 69 6d 70 6f 72 74 61 | 6e 74 20 74 6f 20 63 6f | importa|nt to co|
|000020e0| 75 6e 73 65 6c 20 63 6f | 75 70 6c 65 73 20 74 72 |unsel co|uples tr|
|000020f0| 79 69 6e 67 20 74 6f 20 | 63 6f 6e 63 65 69 76 65 |ying to |conceive|
|00002100| 20 74 68 61 74 20 65 76 | 65 6e 20 69 66 20 62 6f | that ev|en if bo|
|00002110| 74 68 20 74 68 65 0d 0a | 6d 61 6c 65 20 61 6e 64 |th the..|male and|
|00002120| 20 66 65 6d 61 6c 65 20 | 6d 65 6d 62 65 72 73 20 | female |members |
|00002130| 68 61 76 65 20 6e 6f 72 | 6d 61 6c 20 66 65 72 74 |have nor|mal fert|
|00002140| 69 6c 69 74 79 20 74 68 | 65 20 63 68 61 6e 63 65 |ility th|e chance|
|00002150| 20 6f 66 20 68 61 76 69 | 6e 67 20 61 20 63 6c 69 | of havi|ng a cli|
|00002160| 6e 69 63 61 6c 6c 79 0d | 0a 72 65 63 6f 67 6e 69 |nically.|.recogni|
|00002170| 7a 65 64 20 70 72 65 67 | 6e 61 6e 63 79 20 69 6e |zed preg|nancy in|
|00002180| 20 61 6e 79 20 63 79 63 | 6c 65 20 69 73 20 61 74 | any cyc|le is at|
|00002190| 20 62 65 73 74 20 32 35 | 25 2c 20 74 61 6b 69 6e | best 25|%, takin|
|000021a0| 67 20 61 62 6f 75 74 20 | 33 20 6d 6f 6e 74 68 73 |g about |3 months|
|000021b0| 20 74 6f 20 68 61 76 65 | 0d 0a 61 20 63 75 6d 75 | to have|..a cumu|
|000021c0| 6c 61 74 69 76 65 20 70 | 72 65 67 6e 61 6e 63 79 |lative p|regnancy|
|000021d0| 20 72 61 74 65 20 6f 66 | 20 61 62 6f 75 74 20 35 | rate of| about 5|
|000021e0| 30 25 2c 20 61 6e 64 20 | 36 20 6d 6f 6e 74 68 73 |0%, and |6 months|
|000021f0| 20 74 6f 20 72 65 61 63 | 68 20 37 35 25 2e 20 20 | to reac|h 75%. |
|00002200| 54 68 75 73 20 69 74 0d | 0a 77 69 6c 6c 20 74 61 |Thus it.|.will ta|
|00002210| 6b 65 20 36 20 6d 6f 6e | 74 68 73 20 74 69 6d 65 |ke 6 mon|ths time|
|00002220| 20 6f 66 20 61 74 74 65 | 6d 70 74 69 6e 67 20 74 | of atte|mpting t|
|00002230| 6f 20 63 6f 6e 63 65 69 | 76 65 20 66 6f 72 20 61 |o concei|ve for a|
|00002240| 20 63 6c 69 6e 69 63 61 | 6c 6c 79 20 72 65 63 6f | clinica|lly reco|
|00002250| 67 6e 69 7a 65 64 0d 0a | 70 72 65 67 6e 61 6e 63 |gnized..|pregnanc|
|00002260| 79 20 74 6f 20 6f 63 63 | 75 72 20 69 6e 20 33 20 |y to occ|ur in 3 |
|00002270| 6f 75 74 20 6f 66 20 34 | 20 6e 6f 72 6d 61 6c 20 |out of 4| normal |
|00002280| 63 6f 75 70 6c 65 73 2e | 0d 0a 20 20 20 20 20 49 |couples.|.. I|
|00002290| 6e 20 74 68 69 73 20 73 | 74 75 64 79 20 61 6e 20 |n this s|tudy an |
|000022a0| 61 64 64 69 74 69 6f 6e | 61 6c 20 6e 75 6d 62 65 |addition|al numbe|
|000022b0| 72 20 6f 66 20 77 6f 6d | 65 6e 20 68 61 64 20 66 |r of wom|en had f|
|000022c0| 65 72 74 69 6c 69 7a 65 | 64 20 65 6d 62 72 79 6f |ertilize|d embryo|
|000022d0| 73 20 77 68 69 63 68 0d | 0a 69 6d 70 6c 61 6e 74 |s which.|.implant|
|000022e0| 65 64 20 61 6e 64 20 73 | 65 63 72 65 74 65 64 20 |ed and s|ecreted |
|000022f0| 68 43 47 20 62 75 74 20 | 61 62 6f 72 74 65 64 20 |hCG but |aborted |
|00002300| 62 65 66 6f 72 65 20 74 | 68 65 20 70 72 65 67 6e |before t|he pregn|
|00002310| 61 6e 63 79 20 77 61 73 | 20 72 65 63 6f 67 6e 69 |ancy was| recogni|
|00002320| 7a 65 64 0d 0a 63 6c 69 | 6e 69 63 61 6c 6c 79 2e |zed..cli|nically.|
|00002330| 20 20 54 68 65 20 6c 65 | 6e 67 74 68 73 20 6f 72 | The le|ngths or|
|00002340| 20 74 68 65 20 63 79 63 | 6c 65 20 69 6e 20 74 68 | the cyc|le in th|
|00002350| 65 73 65 20 65 61 72 6c | 79 20 70 72 65 67 6e 61 |ese earl|y pregna|
|00002360| 6e 63 69 65 73 20 72 61 | 6e 67 65 64 20 66 72 6f |ncies ra|nged fro|
|00002370| 6d 20 33 34 0d 0a 74 6f | 20 34 31 20 64 61 79 73 |m 34..to| 41 days|
|00002380| 2e 20 20 41 62 6f 75 74 | 20 6f 6e 65 20 66 69 66 |. About| one fif|
|00002390| 74 68 20 6f 66 20 61 6c | 6c 20 74 68 65 20 70 72 |th of al|l the pr|
|000023a0| 65 67 6e 61 6e 63 69 65 | 73 20 69 6e 20 74 68 69 |egnancie|s in thi|
|000023b0| 73 20 73 65 72 69 65 73 | 20 74 65 72 6d 69 6e 61 |s series| termina|
|000023c0| 74 65 64 20 69 6e 0d 0a | 65 61 72 6c 79 20 61 62 |ted in..|early ab|
|000023d0| 6f 72 74 69 6f 6e 73 20 | 74 68 61 74 20 77 65 72 |ortions |that wer|
|000023e0| 65 20 75 6e 72 65 63 6f | 67 6e 69 7a 65 64 20 63 |e unreco|gnized c|
|000023f0| 6c 69 6e 69 63 61 6c 6c | 79 2e 20 20 49 6e 20 61 |linicall|y. In a|
|00002400| 6e 20 61 64 64 69 74 69 | 6f 6e 61 6c 20 75 6e 6b |n additi|onal unk|
|00002410| 6e 6f 77 6e 0d 0a 6e 75 | 6d 62 65 72 20 6f 66 20 |nown..nu|mber of |
|00002420| 63 79 63 6c 65 73 20 66 | 65 72 74 69 6c 69 7a 61 |cycles f|ertiliza|
|00002430| 74 69 6f 6e 20 70 72 6f | 62 61 62 6c 79 20 6f 63 |tion pro|bably oc|
|00002440| 63 75 72 72 65 64 20 62 | 75 74 20 69 6d 70 6c 61 |curred b|ut impla|
|00002450| 6e 74 61 74 69 6f 6e 20 | 64 69 64 20 6e 6f 74 20 |ntation |did not |
|00002460| 74 61 6b 65 0d 0a 70 6c | 61 63 65 2e 20 20 49 74 |take..pl|ace. It|
|00002470| 20 69 73 20 72 65 61 73 | 75 72 72 69 6e 67 20 74 | is reas|urring t|
|00002480| 6f 20 6e 6f 74 65 20 74 | 68 61 74 20 74 68 65 73 |o note t|hat thes|
|00002490| 65 20 65 61 72 6c 79 20 | 61 62 6f 72 74 69 6f 6e |e early |abortion|
|000024a0| 73 20 77 65 72 65 20 75 | 73 75 61 6c 6c 79 0d 0a |s were u|sually..|
|000024b0| 66 6f 6c 6c 6f 77 65 64 | 20 62 79 20 63 6f 6e 63 |followed| by conc|
|000024c0| 65 70 74 69 6f 6e 20 72 | 65 73 75 6c 74 69 6e 67 |eption r|esulting|
|000024d0| 20 69 6e 20 61 20 6e 6f | 72 6d 61 6c 20 74 65 72 | in a no|rmal ter|
|000024e0| 6d 20 67 65 73 74 61 74 | 69 6f 6e 2e 2d 2d 44 2e |m gestat|ion.--D.|
|000024f0| 52 2e 20 4d 69 73 68 65 | 6c 6c 2c 20 4a 72 2e 2c |R. Mishe|ll, Jr.,|
|00002500| 0d 0a 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |..M.D...|$Unique_|
|00002510| 49 44 7b 59 52 42 30 38 | 36 30 32 7d 0d 0a 24 54 |ID{YRB08|602}..$T|
|00002520| 69 74 6c 65 7b 50 6f 6c | 79 63 79 73 74 69 63 20 |itle{Pol|ycystic |
|00002530| 4f 76 61 72 69 65 73 3a | 20 20 41 20 43 6f 6d 6d |Ovaries:| A Comm|
|00002540| 6f 6e 20 46 69 6e 64 69 | 6e 67 20 69 6e 20 4e 6f |on Findi|ng in No|
|00002550| 72 6d 61 6c 20 57 6f 6d | 65 6e 7d 0d 0a 24 41 75 |rmal Wom|en}..$Au|
|00002560| 74 68 6f 72 7b 0d 0a 50 | 6f 6c 73 6f 6e 2c 20 44 |thor{..P|olson, D|
|00002570| 57 0d 0a 41 64 61 6d 73 | 2c 20 4a 0d 0a 57 61 64 |W..Adams|, J..Wad|
|00002580| 73 77 6f 72 74 68 2c 20 | 4a 0d 0a 46 72 61 6e 6b |sworth, |J..Frank|
|00002590| 73 2c 20 53 7d 0d 0a 24 | 41 66 66 69 6c 69 61 74 |s, S}..$|Affiliat|
|000025a0| 69 6f 6e 7b 53 74 20 4d | 61 72 79 27 73 20 48 6f |ion{St M|ary's Ho|
|000025b0| 73 70 20 4d 65 64 20 53 | 63 68 6f 6f 6c 2c 20 4d |sp Med S|chool, M|
|000025c0| 69 64 64 6c 65 73 65 78 | 20 48 6f 73 70 2c 20 4c |iddlesex| Hosp, L|
|000025d0| 6f 6e 64 6f 6e 7d 0d 0a | 24 53 75 62 6a 65 63 74 |ondon}..|$Subject|
|000025e0| 7b 50 6f 6c 79 63 79 73 | 74 69 63 20 6f 76 61 72 |{Polycys|tic ovar|
|000025f0| 79 20 73 79 6e 64 72 6f | 6d 65 2c 20 61 73 20 63 |y syndro|me, as c|
|00002600| 6f 6d 6d 6f 6e 20 66 69 | 6e 64 69 6e 67 20 69 6e |ommon fi|nding in|
|00002610| 20 6e 6f 72 6d 61 6c 20 | 77 6f 6d 65 6e 7d 0d 0a | normal |women}..|
|00002620| 24 4a 6f 75 72 6e 61 6c | 7b 4c 61 6e 63 65 74 7d |$Journal|{Lancet}|
|00002630| 0d 0a 24 56 6f 6c 75 6d | 65 7b 31 7d 0d 0a 24 50 |..$Volum|e{1}..$P|
|00002640| 61 67 65 7b 38 37 30 2d | 38 37 32 7d 0d 0a 24 44 |age{870-|872}..$D|
|00002650| 61 74 65 7b 41 70 72 20 | 31 36 2c 20 31 39 38 38 |ate{Apr |16, 1988|
|00002660| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00002670| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 49 6e 66 65 |ear Book| of Infe|
|00002680| 72 74 69 6c 69 74 79 7d | 0d 0a 24 43 68 61 70 74 |rtility}|..$Chapt|
|00002690| 65 72 7b 32 2d 35 7d 0d | 0a 24 59 42 45 64 69 74 |er{2-5}.|.$YBEdit|
|000026a0| 6f 72 7b 44 72 73 2e 20 | 4d 69 73 68 65 6c 6c 2c |or{Drs. |Mishell,|
|000026b0| 20 50 61 75 6c 73 65 6e | 2c 20 61 6e 64 20 4c 6f | Paulsen|, and Lo|
|000026c0| 62 6f 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |bo}..$Ta|ble{}..$|
|000026d0| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 52 2e 41 2e |Commenta|tor{R.A.|
|000026e0| 20 4c 6f 62 6f 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a | Lobo, M|.D.}....|
|000026f0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|00002700| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|00002710| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00002720| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 38 20 59 |, 1989..|..1988 Y|
|00002730| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 49 6e 66 65 |ear Book| of Infe|
|00002740| 72 74 69 6c 69 74 79 20 | 28 52 29 0d 0a 0d 0a 43 |rtility |(R)....C|
|00002750| 68 61 70 74 65 72 20 32 | 2d 2d 45 70 69 64 65 6d |hapter 2|--Epidem|
|00002760| 69 6f 6c 6f 67 79 20 6f | 66 20 49 6e 66 65 72 74 |iology o|f Infert|
|00002770| 69 6c 69 74 79 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |ility...|.-------|
|00002780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 50 6f 6c 79 63 |--------|-..Polyc|
|000027d0| 79 73 74 69 63 20 4f 76 | 61 72 69 65 73 3a 20 20 |ystic Ov|aries: |
|000027e0| 41 20 43 6f 6d 6d 6f 6e | 20 46 69 6e 64 69 6e 67 |A Common| Finding|
|000027f0| 20 69 6e 20 4e 6f 72 6d | 61 6c 20 57 6f 6d 65 6e | in Norm|al Women|
|00002800| 0d 0a 0d 0a 50 6f 6c 73 | 6f 6e 20 44 57 3b 20 41 |....Pols|on DW; A|
|00002810| 64 61 6d 73 20 4a 3b 20 | 57 61 64 73 77 6f 72 74 |dams J; |Wadswort|
|00002820| 68 20 4a 3b 20 46 72 61 | 6e 6b 73 20 53 0d 0a 28 |h J; Fra|nks S..(|
|00002830| 53 74 20 4d 61 72 79 27 | 73 20 48 6f 73 70 20 4d |St Mary'|s Hosp M|
|00002840| 65 64 20 53 63 68 6f 6f | 6c 2c 20 4d 69 64 64 6c |ed Schoo|l, Middl|
|00002850| 65 73 65 78 20 48 6f 73 | 70 2c 20 4c 6f 6e 64 6f |esex Hos|p, Londo|
|00002860| 6e 29 0d 0a 4c 61 6e 63 | 65 74 20 31 3a 38 37 30 |n)..Lanc|et 1:870|
|00002870| 2d 38 37 32 2c 20 41 70 | 72 20 31 36 2c 20 31 39 |-872, Ap|r 16, 19|
|00002880| 38 38 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |88..----|--------|
|00002890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000028d0| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|000028e0| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 6f 63 63 |.... | The occ|
|000028f0| 75 72 72 65 6e 63 65 20 | 6f 66 20 70 6f 6c 79 63 |urrence |of polyc|
|00002900| 79 73 74 69 63 20 6f 76 | 61 72 69 65 73 20 69 6e |ystic ov|aries in|
|00002910| 20 6e 6f 72 6d 61 6c 20 | 77 6f 6d 65 6e 20 77 61 | normal |women wa|
|00002920| 73 20 73 74 75 64 69 65 | 64 20 69 6e 20 61 0d 0a |s studie|d in a..|
|00002930| 73 65 72 69 65 73 20 6f | 66 20 32 35 37 20 75 6e |series o|f 257 un|
|00002940| 73 65 6c 65 63 74 65 64 | 20 68 65 61 6c 74 68 79 |selected| healthy|
|00002950| 20 77 6f 6d 65 6e 20 61 | 67 65 64 20 31 38 2d 33 | women a|ged 18-3|
|00002960| 36 20 79 65 61 72 73 20 | 77 68 6f 20 75 6e 64 65 |6 years |who unde|
|00002970| 72 77 65 6e 74 20 70 65 | 6c 76 69 63 0d 0a 75 6c |rwent pe|lvic..ul|
|00002980| 74 72 61 73 6f 6e 6f 67 | 72 61 70 68 79 2e 20 20 |trasonog|raphy. |
|00002990| 4e 69 6e 65 74 79 2d 6e | 69 6e 65 20 77 6f 6d 65 |Ninety-n|ine wome|
|000029a0| 6e 20 77 65 72 65 20 74 | 61 6b 69 6e 67 20 6f 72 |n were t|aking or|
|000029b0| 61 6c 20 63 6f 6e 74 72 | 61 63 65 70 74 69 76 65 |al contr|aceptive|
|000029c0| 73 20 61 74 20 74 68 65 | 20 74 69 6d 65 0d 0a 6f |s at the| time..o|
|000029d0| 66 20 73 74 75 64 79 2e | 0d 0a 20 20 20 20 20 4f |f study.|.. O|
|000029e0| 66 20 74 68 65 20 31 35 | 38 20 77 6f 6d 65 6e 20 |f the 15|8 women |
|000029f0| 6e 6f 74 20 75 73 69 6e | 67 20 6f 72 61 6c 20 63 |not usin|g oral c|
|00002a00| 6f 6e 74 72 61 63 65 70 | 74 69 76 65 73 2c 20 31 |ontracep|tives, 1|
|00002a10| 38 25 20 68 61 64 20 69 | 72 72 65 67 75 6c 61 72 |8% had i|rregular|
|00002a20| 20 6d 65 6e 73 74 72 75 | 61 6c 0d 0a 63 79 63 6c | menstru|al..cycl|
|00002a30| 65 73 2e 20 20 50 6f 6c | 79 63 79 73 74 69 63 20 |es. Pol|ycystic |
|00002a40| 6f 76 61 72 69 65 73 20 | 77 65 72 65 20 70 72 65 |ovaries |were pre|
|00002a50| 73 65 6e 74 20 69 6e 20 | 33 36 20 77 6f 6d 65 6e |sent in |36 women|
|00002a60| 2e 20 20 46 69 76 65 20 | 6f 74 68 65 72 73 20 68 |. Five |others h|
|00002a70| 61 64 0d 0a 6d 75 6c 74 | 69 66 6f 6c 6c 69 63 75 |ad..mult|ifollicu|
|00002a80| 6c 61 72 20 6f 76 61 72 | 69 65 73 2c 20 61 6e 64 |lar ovar|ies, and|
|00002a90| 20 31 20 68 61 64 20 73 | 6d 61 6c 6c 20 75 6e 73 | 1 had s|mall uns|
|00002aa0| 74 69 6d 75 6c 61 74 65 | 64 20 6f 76 61 72 69 65 |timulate|d ovarie|
|00002ab0| 73 2e 20 20 4f 6e 6c 79 | 20 31 20 77 6f 6d 61 6e |s. Only| 1 woman|
|00002ac0| 0d 0a 77 69 74 68 20 6e | 6f 72 6d 61 6c 20 6f 76 |..with n|ormal ov|
|00002ad0| 61 72 69 65 73 20 68 61 | 64 20 69 72 72 65 67 75 |aries ha|d irregu|
|00002ae0| 6c 61 72 20 6d 65 6e 73 | 65 73 2e 20 20 54 68 72 |lar mens|es. Thr|
|00002af0| 65 65 20 66 6f 75 72 74 | 68 73 20 6f 66 20 74 68 |ee fourt|hs of th|
|00002b00| 6f 73 65 20 77 6f 6d 65 | 6e 20 77 69 74 68 0d 0a |ose wome|n with..|
|00002b10| 70 6f 6c 79 63 79 73 74 | 69 63 20 6f 76 61 72 69 |polycyst|ic ovari|
|00002b20| 65 73 20 68 61 64 20 69 | 72 72 65 67 75 6c 61 72 |es had i|rregular|
|00002b30| 20 63 79 63 6c 65 73 2e | 20 20 53 69 78 20 6f 66 | cycles.| Six of|
|00002b40| 20 38 20 77 6f 6d 65 6e | 20 77 69 74 68 20 70 6f | 8 women| with po|
|00002b50| 6c 79 63 79 73 74 69 63 | 20 6f 76 61 72 69 65 73 |lycystic| ovaries|
|00002b60| 0d 0a 61 6e 64 20 72 65 | 67 75 6c 61 72 20 63 79 |..and re|gular cy|
|00002b70| 63 6c 65 73 20 77 65 72 | 65 20 68 69 72 73 75 74 |cles wer|e hirsut|
|00002b80| 65 2e 20 20 4d 65 64 69 | 61 6e 20 73 65 72 75 6d |e. Medi|an serum|
|00002b90| 20 6c 75 74 65 69 6e 69 | 7a 69 6e 67 20 68 6f 72 | luteini|zing hor|
|00002ba0| 6d 6f 6e 65 20 76 61 6c | 75 65 73 20 77 65 72 65 |mone val|ues were|
|00002bb0| 0d 0a 73 69 6d 69 6c 61 | 72 20 69 6e 20 77 6f 6d |..simila|r in wom|
|00002bc0| 65 6e 20 77 69 74 68 20 | 61 6e 64 20 74 68 6f 73 |en with |and thos|
|00002bd0| 65 20 77 69 74 68 6f 75 | 74 20 70 6f 6c 79 63 79 |e withou|t polycy|
|00002be0| 73 74 69 63 20 6f 76 61 | 72 69 65 73 2e 20 20 48 |stic ova|ries. H|
|00002bf0| 6f 77 65 76 65 72 2c 20 | 6f 6e 65 20 66 6f 75 72 |owever, |one four|
|00002c00| 74 68 0d 0a 6f 66 20 77 | 6f 6d 65 6e 20 77 69 74 |th..of w|omen wit|
|00002c10| 68 20 70 6f 6c 79 63 79 | 73 74 69 63 20 6f 76 61 |h polycy|stic ova|
|00002c20| 72 69 65 73 20 68 61 64 | 20 6c 75 74 65 69 6e 69 |ries had| luteini|
|00002c30| 7a 69 6e 67 20 68 6f 72 | 6d 6f 6e 65 20 76 61 6c |zing hor|mone val|
|00002c40| 75 65 73 20 61 62 6f 76 | 65 20 74 68 65 20 75 70 |ues abov|e the up|
|00002c50| 70 65 72 0d 0a 6e 6f 72 | 6d 61 6c 20 6c 69 6d 69 |per..nor|mal limi|
|00002c60| 74 2e 20 20 53 6f 6d 65 | 20 64 69 66 66 65 72 65 |t. Some| differe|
|00002c70| 6e 63 65 20 77 61 73 20 | 61 6c 73 6f 20 65 76 69 |nce was |also evi|
|00002c80| 64 65 6e 74 20 69 6e 20 | 77 6f 6d 65 6e 20 74 61 |dent in |women ta|
|00002c90| 6b 69 6e 67 20 6f 72 61 | 6c 0d 0a 63 6f 6e 74 72 |king ora|l..contr|
|00002ca0| 61 63 65 70 74 69 76 65 | 73 20 77 68 6f 20 68 61 |aceptive|s who ha|
|00002cb0| 64 20 6e 6f 72 6d 61 6c | 20 6f 76 61 72 69 65 73 |d normal| ovaries|
|00002cc0| 20 61 6e 64 20 74 68 6f | 73 65 20 77 69 74 68 20 | and tho|se with |
|00002cd0| 70 6f 6c 79 63 79 73 74 | 69 63 20 6f 76 61 72 69 |polycyst|ic ovari|
|00002ce0| 65 73 2e 0d 0a 20 20 20 | 20 20 50 6f 6c 79 63 79 |es... | Polycy|
|00002cf0| 73 74 69 63 20 6f 76 61 | 72 69 65 73 20 77 65 72 |stic ova|ries wer|
|00002d00| 65 20 66 6f 75 6e 64 20 | 69 6e 20 6e 65 61 72 6c |e found |in nearl|
|00002d10| 79 20 6f 6e 65 20 66 6f | 75 72 74 68 20 6f 66 20 |y one fo|urth of |
|00002d20| 6e 6f 72 6d 61 6c 20 77 | 6f 6d 65 6e 20 6e 6f 74 |normal w|omen not|
|00002d30| 0d 0a 75 73 69 6e 67 20 | 6f 72 61 6c 20 63 6f 6e |..using |oral con|
|00002d40| 74 72 61 63 65 70 74 69 | 6f 6e 20 69 6e 20 74 68 |tracepti|on in th|
|00002d50| 69 73 20 73 74 75 64 79 | 2c 20 61 6e 64 20 69 6e |is study|, and in|
|00002d60| 20 6f 6e 65 20 66 69 66 | 74 68 20 6f 66 20 74 68 | one fif|th of th|
|00002d70| 6f 73 65 20 74 61 6b 69 | 6e 67 20 6f 72 61 6c 0d |ose taki|ng oral.|
|00002d80| 0a 63 6f 6e 74 72 61 63 | 65 70 74 69 76 65 73 2e |.contrac|eptives.|
|00002d90| 20 20 49 74 20 61 70 70 | 65 61 72 73 20 74 68 61 | It app|ears tha|
|00002da0| 74 20 70 6f 6c 79 63 79 | 73 74 69 63 20 6f 76 61 |t polycy|stic ova|
|00002db0| 72 69 65 73 20 69 6e 20 | 74 68 65 73 65 20 77 6f |ries in |these wo|
|00002dc0| 6d 65 6e 20 61 72 65 20 | 70 61 72 74 20 6f 66 0d |men are |part of.|
|00002dd0| 0a 74 68 65 20 73 61 6d | 65 20 63 6c 69 6e 69 63 |.the sam|e clinic|
|00002de0| 61 6c 20 73 70 65 63 74 | 72 75 6d 20 61 73 20 63 |al spect|rum as c|
|00002df0| 6c 61 73 73 69 63 20 53 | 74 65 69 6e 2d 4c 65 76 |lassic S|tein-Lev|
|00002e00| 65 6e 74 68 61 6c 20 73 | 79 6e 64 72 6f 6d 65 2e |enthal s|yndrome.|
|00002e10| 20 20 44 65 73 70 69 74 | 65 20 69 74 73 0d 0a 66 | Despit|e its..f|
|00002e20| 72 65 71 75 65 6e 63 79 | 20 69 6e 20 6e 6f 72 6d |requency| in norm|
|00002e30| 61 6c 20 77 6f 6d 65 6e | 2c 20 68 6f 77 65 76 65 |al women|, howeve|
|00002e40| 72 2c 20 70 6f 6c 79 63 | 79 73 74 69 63 20 6f 76 |r, polyc|ystic ov|
|00002e50| 61 72 69 65 73 20 72 65 | 6d 61 69 6e 20 61 20 64 |aries re|main a d|
|00002e60| 69 73 74 69 6e 63 74 0d | 0a 6d 6f 72 70 68 6f 6c |istinct.|.morphol|
|00002e70| 6f 67 69 63 61 6c 20 65 | 6e 74 69 74 79 2e 0d 0a |ogical e|ntity...|
|00002e80| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00002e90| 0d 0a 20 20 20 20 20 44 | 6f 20 32 33 25 20 6f 66 |.. D|o 23% of|
|00002ea0| 20 61 6c 6c 20 77 6f 6d | 65 6e 20 68 61 76 65 20 | all wom|en have |
|00002eb0| 70 6f 6c 79 63 79 73 74 | 69 63 20 6f 76 61 72 69 |polycyst|ic ovari|
|00002ec0| 65 73 20 28 50 43 4f 29 | 3f 20 20 54 68 69 73 20 |es (PCO)|? This |
|00002ed0| 70 61 70 65 72 20 69 73 | 0d 0a 70 72 6f 76 6f 63 |paper is|..provoc|
|00002ee0| 61 74 69 76 65 20 62 65 | 63 61 75 73 65 20 69 74 |ative be|cause it|
|00002ef0| 20 72 65 6d 69 6e 64 73 | 20 75 73 20 77 65 20 73 | reminds| us we s|
|00002f00| 74 69 6c 6c 20 64 6f 20 | 6e 6f 74 20 6b 6e 6f 77 |till do |not know|
|00002f10| 20 77 68 61 74 20 74 72 | 75 6c 79 20 63 6f 6e 73 | what tr|uly cons|
|00002f20| 74 69 74 75 74 65 73 0d | 0a 22 50 43 4f 2e 22 20 |titutes.|."PCO." |
|00002f30| 20 54 77 6f 20 69 6d 70 | 6f 72 74 61 6e 74 20 69 | Two imp|ortant i|
|00002f40| 73 73 75 65 73 20 65 6d | 65 72 67 65 20 66 72 6f |ssues em|erge fro|
|00002f50| 6d 20 74 68 65 73 65 20 | 64 61 74 61 2e 20 20 46 |m these |data. F|
|00002f60| 69 72 73 74 20 69 73 20 | 74 68 61 74 20 63 79 73 |irst is |that cys|
|00002f70| 74 69 63 0d 0a 6f 76 61 | 72 69 65 73 20 61 72 65 |tic..ova|ries are|
|00002f80| 20 63 6f 6d 6d 6f 6e 20 | 61 6e 64 20 61 72 65 20 | common |and are |
|00002f90| 68 69 67 68 6c 79 20 63 | 6f 72 72 65 6c 61 74 65 |highly c|orrelate|
|00002fa0| 64 20 77 69 74 68 20 6d | 65 6e 73 74 72 75 61 6c |d with m|enstrual|
|00002fb0| 20 69 72 72 72 65 67 75 | 6c 61 72 69 74 69 65 73 | irrregu|larities|
|00002fc0| 2e 0d 0a 54 61 6b 65 6e | 20 61 6c 6f 6e 65 2c 20 |...Taken| alone, |
|00002fd0| 49 20 77 6f 75 6c 64 20 | 6e 6f 74 20 63 61 6c 6c |I would |not call|
|00002fe0| 20 74 68 69 73 20 50 43 | 4f 2e 20 20 53 65 63 6f | this PC|O. Seco|
|00002ff0| 6e 64 2c 20 61 6c 74 68 | 6f 75 67 68 20 69 74 20 |nd, alth|ough it |
|00003000| 69 73 20 66 61 73 68 69 | 6f 6e 61 62 6c 65 20 74 |is fashi|onable t|
|00003010| 6f 0d 0a 64 69 61 67 6e | 6f 73 65 20 50 43 4f 20 |o..diagn|ose PCO |
|00003020| 62 79 20 75 6c 74 72 61 | 73 6f 75 6e 64 20 28 61 |by ultra|sound (a|
|00003030| 6e 64 20 49 20 62 65 6c | 69 65 76 65 20 74 68 69 |nd I bel|ieve thi|
|00003040| 73 20 61 70 70 72 6f 61 | 63 68 20 69 73 20 69 6e |s approa|ch is in|
|00003050| 63 6f 72 72 65 63 74 29 | 2c 20 69 74 20 69 73 0d |correct)|, it is.|
|00003060| 0a 62 65 63 6f 6d 69 6e | 67 20 72 65 61 6c 69 7a |.becomin|g realiz|
|00003070| 65 64 20 74 68 61 74 2c | 20 62 72 6f 61 64 6c 79 |ed that,| broadly|
|00003080| 20 73 70 65 61 6b 69 6e | 67 2c 20 74 68 65 20 73 | speakin|g, the s|
|00003090| 79 6e 64 72 6f 6d 65 20 | 69 73 20 71 75 69 74 65 |yndrome |is quite|
|000030a0| 20 63 6f 6d 6d 6f 6e 3a | 0d 0a 70 72 6f 62 61 62 | common:|..probab|
|000030b0| 6c 79 20 74 68 65 20 6d | 6f 73 74 20 63 6f 6d 6d |ly the m|ost comm|
|000030c0| 6f 6e 20 65 6e 64 6f 63 | 72 69 6e 6f 70 61 74 68 |on endoc|rinopath|
|000030d0| 79 20 69 6e 20 77 6f 6d | 65 6e 2e 20 20 54 68 65 |y in wom|en. The|
|000030e0| 20 75 6c 74 72 61 73 6f | 75 6e 64 20 70 69 63 74 | ultraso|und pict|
|000030f0| 75 72 65 20 69 73 0d 0a | 68 65 6c 70 66 75 6c 20 |ure is..|helpful |
|00003100| 70 61 72 74 69 63 75 6c | 61 72 6c 79 20 66 6f 72 |particul|arly for|
|00003110| 20 74 68 6f 73 65 20 77 | 6f 6d 65 6e 20 68 61 76 | those w|omen hav|
|00003120| 69 6e 67 20 69 6e 64 75 | 63 74 69 6f 6e 20 6f 66 |ing indu|ction of|
|00003130| 20 6f 76 75 6c 61 74 69 | 6f 6e 2e 20 20 49 74 20 | ovulati|on. It |
|00003140| 61 6c 6c 6f 77 73 0d 0a | 75 73 20 74 6f 20 61 70 |allows..|us to ap|
|00003150| 70 72 65 63 69 61 74 65 | 20 77 68 61 74 20 74 79 |preciate| what ty|
|00003160| 70 65 20 6f 66 20 6f 76 | 61 72 69 61 6e 20 72 65 |pe of ov|arian re|
|00003170| 73 70 6f 6e 73 65 20 6d | 61 79 20 62 65 20 61 6e |sponse m|ay be an|
|00003180| 74 69 63 69 70 61 74 65 | 64 20 69 6e 20 74 68 61 |ticipate|d in tha|
|00003190| 74 20 63 79 73 74 69 63 | 0d 0a 6f 76 61 72 69 65 |t cystic|..ovarie|
|000031a0| 73 20 28 6c 69 6b 65 20 | 74 68 6f 73 65 20 6f 66 |s (like |those of|
|000031b0| 20 63 6c 61 73 73 69 63 | 20 50 43 4f 29 20 61 72 | classic| PCO) ar|
|000031c0| 65 20 68 69 67 68 6c 79 | 20 73 65 6e 73 69 74 69 |e highly| sensiti|
|000031d0| 76 65 20 74 6f 20 67 6f | 6e 61 64 6f 74 72 6f 70 |ve to go|nadotrop|
|000031e0| 69 6e 73 2c 0d 0a 77 68 | 65 74 68 65 72 20 6f 72 |ins,..wh|ether or|
|000031f0| 20 6e 6f 74 20 74 68 65 | 20 64 69 61 67 6e 6f 73 | not the| diagnos|
|00003200| 69 73 20 69 73 20 74 72 | 75 6c 79 20 50 43 4f 2e |is is tr|uly PCO.|
|00003210| 2d 2d 52 2e 41 2e 20 4c | 6f 62 6f 2c 20 4d 2e 44 |--R.A. L|obo, M.D|
|00003220| 2e 0d 0a 24 55 6e 69 71 | 75 65 5f 49 44 7b 59 52 |...$Uniq|ue_ID{YR|
|00003230| 42 30 38 36 30 33 7d 0d | 0a 24 54 69 74 6c 65 7b |B08603}.|.$Title{|
|00003240| 54 68 65 20 52 65 6c 61 | 74 69 6f 6e 73 68 69 70 |The Rela|tionship|
|00003250| 20 6f 66 20 47 6f 6e 61 | 64 61 6c 20 41 63 74 69 | of Gona|dal Acti|
|00003260| 76 69 74 79 20 61 6e 64 | 20 43 68 65 6d 6f 74 68 |vity and| Chemoth|
|00003270| 65 72 61 70 79 2d 49 6e | 64 75 63 65 64 20 47 6f |erapy-In|duced Go|
|00003280| 6e 61 64 61 6c 20 44 61 | 6d 61 67 65 7d 0d 0a 24 |nadal Da|mage}..$|
|00003290| 41 75 74 68 6f 72 7b 0d | 0a 52 69 76 6b 65 65 73 |Author{.|.Rivkees|
|000032a0| 2c 20 53 41 0d 0a 43 72 | 61 77 66 6f 72 64 2c 20 |, SA..Cr|awford, |
|000032b0| 4a 44 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |JD}..$Af|filiatio|
|000032c0| 6e 7b 4d 61 73 73 61 63 | 68 75 73 65 74 74 73 20 |n{Massac|husetts |
|000032d0| 47 65 6e 20 48 6f 73 70 | 2c 20 42 6f 73 74 6f 6e |Gen Hosp|, Boston|
|000032e0| 3b 20 48 61 72 76 61 72 | 64 20 4d 65 64 20 53 63 |; Harvar|d Med Sc|
|000032f0| 68 6f 6f 6c 7d 0d 0a 24 | 53 75 62 6a 65 63 74 7b |hool}..$|Subject{|
|00003300| 43 68 65 6d 6f 74 68 65 | 72 61 70 79 2c 20 67 6f |Chemothe|rapy, go|
|00003310| 6e 61 64 61 6c 20 64 61 | 6d 61 67 65 20 64 75 65 |nadal da|mage due|
|00003320| 20 74 6f 2c 20 61 6e 64 | 20 67 6f 6e 61 64 61 6c | to, and| gonadal|
|00003330| 20 61 63 74 69 76 69 74 | 79 0d 0a 47 6f 6e 61 64 | activit|y..Gonad|
|00003340| 2c 20 64 61 6d 61 67 65 | 20 64 75 65 20 74 6f 20 |, damage| due to |
|00003350| 63 68 65 6d 6f 74 68 65 | 72 61 70 79 20 61 6e 64 |chemothe|rapy and|
|00003360| 20 67 6f 6e 61 64 61 6c | 20 61 63 74 69 76 69 74 | gonadal| activit|
|00003370| 79 7d 0d 0a 24 4a 6f 75 | 72 6e 61 6c 7b 4a 41 4d |y}..$Jou|rnal{JAM|
|00003380| 41 7d 0d 0a 24 56 6f 6c | 75 6d 65 7b 32 35 39 7d |A}..$Vol|ume{259}|
|00003390| 0d 0a 24 50 61 67 65 7b | 32 31 32 33 2d 32 31 32 |..$Page{|2123-212|
|000033a0| 35 7d 0d 0a 24 44 61 74 | 65 7b 41 70 72 20 38 2c |5}..$Dat|e{Apr 8,|
|000033b0| 20 31 39 38 38 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 | 1988}..|$YBVol{1|
|000033c0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|000033d0| 20 49 6e 66 65 72 74 69 | 6c 69 74 79 7d 0d 0a 24 | Inferti|lity}..$|
|000033e0| 43 68 61 70 74 65 72 7b | 35 2d 32 7d 0d 0a 24 59 |Chapter{|5-2}..$Y|
|000033f0| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 4d 69 73 |BEditor{|Drs. Mis|
|00003400| 68 65 6c 6c 2c 20 50 61 | 75 6c 73 65 6e 2c 20 61 |hell, Pa|ulsen, a|
|00003410| 6e 64 20 4c 6f 62 6f 7d | 0d 0a 24 54 61 62 6c 65 |nd Lobo}|..$Table|
|00003420| 7b 54 61 62 6c 65 20 4f | 6d 69 74 74 65 64 7d 0d |{Table O|mitted}.|
|00003430| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 43 2e |.$Commen|tator{C.|
|00003440| 41 2e 20 50 61 75 6c 73 | 65 6e 2c 20 4d 2e 44 2e |A. Pauls|en, M.D.|
|00003450| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00003460| 63 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |c) Year |Book Med|
|00003470| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00003480| 20 49 6e 63 2e 2c 20 31 | 39 38 39 0d 0a 0d 0a 31 | Inc., 1|989....1|
|00003490| 39 38 38 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |988 Year| Book of|
|000034a0| 20 49 6e 66 65 72 74 69 | 6c 69 74 79 20 28 52 29 | Inferti|lity (R)|
|000034b0| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 35 2d 2d 50 |....Chap|ter 5--P|
|000034c0| 61 74 68 6f 70 73 79 63 | 68 6f 6c 6f 67 79 20 6f |athopsyc|hology o|
|000034d0| 66 20 4d 61 6c 65 20 49 | 6e 66 65 72 74 69 6c 69 |f Male I|nfertili|
|000034e0| 74 79 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ty....--|--------|
|000034f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003520| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003530| 2d 2d 2d 2d 2d 2d 0d 0a | 54 68 65 20 52 65 6c 61 |------..|The Rela|
|00003540| 74 69 6f 6e 73 68 69 70 | 20 6f 66 20 47 6f 6e 61 |tionship| of Gona|
|00003550| 64 61 6c 20 41 63 74 69 | 76 69 74 79 20 61 6e 64 |dal Acti|vity and|
|00003560| 20 43 68 65 6d 6f 74 68 | 65 72 61 70 79 2d 49 6e | Chemoth|erapy-In|
|00003570| 64 75 63 65 64 20 47 6f | 6e 61 64 61 6c 20 44 61 |duced Go|nadal Da|
|00003580| 6d 61 67 65 0d 0a 0d 0a | 52 69 76 6b 65 65 73 20 |mage....|Rivkees |
|00003590| 53 41 3b 20 43 72 61 77 | 66 6f 72 64 20 4a 44 0d |SA; Craw|ford JD.|
|000035a0| 0a 28 4d 61 73 73 61 63 | 68 75 73 65 74 74 73 20 |.(Massac|husetts |
|000035b0| 47 65 6e 20 48 6f 73 70 | 2c 20 42 6f 73 74 6f 6e |Gen Hosp|, Boston|
|000035c0| 3b 20 48 61 72 76 61 72 | 64 20 4d 65 64 20 53 63 |; Harvar|d Med Sc|
|000035d0| 68 6f 6f 6c 29 0d 0a 4a | 41 4d 41 20 32 35 39 3a |hool)..J|AMA 259:|
|000035e0| 32 31 32 33 2d 32 31 32 | 35 2c 20 41 70 72 20 38 |2123-212|5, Apr 8|
|000035f0| 2c 20 31 39 38 38 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1988..|--------|
|00003600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003640| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|00003650| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 54 68 65 |ract....| The|
|00003660| 20 67 6f 6e 61 64 73 20 | 61 72 65 20 70 61 72 74 | gonads |are part|
|00003670| 69 63 75 6c 61 72 6c 79 | 20 76 75 6c 6e 65 72 61 |icularly| vulnera|
|00003680| 62 6c 65 20 74 6f 20 74 | 68 65 20 65 66 66 65 63 |ble to t|he effec|
|00003690| 74 73 20 6f 66 20 63 68 | 65 6d 6f 74 68 65 72 61 |ts of ch|emothera|
|000036a0| 70 65 75 74 69 63 0d 0a | 61 67 65 6e 74 73 20 75 |peutic..|agents u|
|000036b0| 73 65 64 20 69 6e 20 74 | 68 65 20 74 72 65 61 74 |sed in t|he treat|
|000036c0| 6d 65 6e 74 20 6f 66 20 | 6d 61 6c 69 67 6e 61 6e |ment of |malignan|
|000036d0| 74 20 61 6e 64 20 69 6d | 6d 75 6e 6f 6c 6f 67 69 |t and im|munologi|
|000036e0| 63 20 64 69 73 6f 72 64 | 65 72 73 2e 20 20 54 68 |c disord|ers. Th|
|000036f0| 69 73 0d 0a 63 6f 6d 70 | 6c 69 63 61 74 69 6f 6e |is..comp|lication|
|00003700| 20 69 73 20 65 73 70 65 | 63 69 61 6c 6c 79 20 64 | is espe|cially d|
|00003710| 69 73 74 75 72 62 69 6e | 67 20 66 6f 72 20 79 6f |isturbin|g for yo|
|00003720| 75 6e 67 20 61 64 75 6c | 74 73 20 77 68 6f 20 61 |ung adul|ts who a|
|00003730| 72 65 20 63 75 72 65 64 | 20 6f 66 20 74 68 65 69 |re cured| of thei|
|00003740| 72 0d 0a 6d 61 6c 69 67 | 6e 61 6e 63 79 20 62 75 |r..malig|nancy bu|
|00003750| 74 20 61 72 65 20 72 65 | 6e 64 65 72 65 64 20 68 |t are re|ndered h|
|00003760| 79 70 6f 67 6f 6e 61 64 | 61 6c 2e 20 20 49 74 20 |ypogonad|al. It |
|00003770| 68 61 73 20 62 65 65 6e | 20 73 75 67 67 65 73 74 |has been| suggest|
|00003780| 65 64 20 74 68 61 74 0d | 0a 63 68 65 6d 6f 74 68 |ed that.|.chemoth|
|00003790| 65 72 61 70 79 2d 69 6e | 64 75 63 65 64 20 67 6f |erapy-in|duced go|
|000037a0| 6e 61 64 61 6c 20 64 61 | 6d 61 67 65 20 69 73 20 |nadal da|mage is |
|000037b0| 70 72 6f 70 6f 72 74 69 | 6f 6e 61 6c 20 74 6f 20 |proporti|onal to |
|000037c0| 74 68 65 20 64 65 67 72 | 65 65 20 6f 66 20 67 6f |the degr|ee of go|
|000037d0| 6e 61 64 61 6c 0d 0a 61 | 63 74 69 76 69 74 79 20 |nadal..a|ctivity |
|000037e0| 64 75 72 69 6e 67 20 74 | 72 65 61 74 6d 65 6e 74 |during t|reatment|
|000037f0| 2e 20 20 49 66 20 74 68 | 69 73 20 77 65 72 65 20 |. If th|is were |
|00003800| 74 72 75 65 2c 20 70 72 | 65 70 75 62 65 72 74 61 |true, pr|epuberta|
|00003810| 6c 20 63 68 69 6c 64 72 | 65 6e 20 77 69 74 68 0d |l childr|en with.|
|00003820| 0a 69 6e 61 63 74 69 76 | 65 20 67 61 6d 65 74 6f |.inactiv|e gameto|
|00003830| 67 65 6e 65 73 69 73 20 | 77 6f 75 6c 64 20 68 61 |genesis |would ha|
|00003840| 76 65 20 61 20 6c 6f 77 | 65 72 20 69 6e 63 69 64 |ve a low|er incid|
|00003850| 65 6e 63 65 20 6f 66 20 | 63 68 65 6d 6f 74 68 65 |ence of |chemothe|
|00003860| 72 61 70 79 2d 69 6e 64 | 75 63 65 64 0d 0a 64 61 |rapy-ind|uced..da|
|00003870| 6d 61 67 65 20 74 68 61 | 6e 20 77 6f 75 6c 64 20 |mage tha|n would |
|00003880| 73 69 6d 69 6c 61 72 6c | 79 20 74 72 65 61 74 65 |similarl|y treate|
|00003890| 64 20 61 64 75 6c 74 73 | 20 61 6e 64 20 61 64 6f |d adults| and ado|
|000038a0| 6c 65 73 63 65 6e 74 73 | 2e 0d 0a 20 20 20 20 20 |lescents|... |
|000038b0| 54 6f 20 66 75 72 74 68 | 65 72 20 69 6e 76 65 73 |To furth|er inves|
|000038c0| 74 69 67 61 74 65 20 74 | 68 69 73 20 68 79 70 6f |tigate t|his hypo|
|000038d0| 74 68 65 73 69 73 2c 20 | 33 30 20 73 74 75 64 69 |thesis, |30 studi|
|000038e0| 65 73 20 74 68 61 74 20 | 65 76 61 6c 75 61 74 65 |es that |evaluate|
|000038f0| 64 20 67 6f 6e 61 64 61 | 6c 0d 0a 66 75 6e 63 74 |d gonada|l..funct|
|00003900| 69 6f 6e 20 61 66 74 65 | 72 20 63 79 63 6c 6f 70 |ion afte|r cyclop|
|00003910| 68 6f 73 70 68 61 6d 69 | 64 65 20 74 68 65 72 61 |hosphami|de thera|
|00003920| 70 79 20 66 6f 72 20 72 | 65 6e 61 6c 20 64 69 73 |py for r|enal dis|
|00003930| 65 61 73 65 20 6f 72 20 | 61 66 74 65 72 20 63 6f |ease or |after co|
|00003940| 6d 62 69 6e 61 74 69 6f | 6e 0d 0a 63 68 65 6d 6f |mbinatio|n..chemo|
|00003950| 74 68 65 72 61 70 79 20 | 66 6f 72 20 48 6f 64 67 |therapy |for Hodg|
|00003960| 6b 69 6e 27 73 20 64 69 | 73 65 61 73 65 20 6f 72 |kin's di|sease or|
|00003970| 20 61 63 75 74 65 20 6c | 79 6d 70 68 6f 63 79 74 | acute l|ymphocyt|
|00003980| 69 63 20 6c 65 75 6b 65 | 6d 69 61 20 77 65 72 65 |ic leuke|mia were|
|00003990| 20 61 6e 61 6c 79 7a 65 | 64 2e 0d 0a 54 68 65 20 | analyze|d...The |
|000039a0| 64 61 74 61 20 63 6f 76 | 65 72 65 64 20 34 35 36 |data cov|ered 456|
|000039b0| 20 69 6e 64 69 76 69 64 | 75 61 6c 73 20 77 68 6f | individ|uals who|
|000039c0| 20 68 61 64 20 63 6f 6d | 70 6c 65 74 65 64 20 63 | had com|pleted c|
|000039d0| 68 65 6d 6f 74 68 65 72 | 61 70 79 20 62 75 74 20 |hemother|apy but |
|000039e0| 68 61 64 20 6e 6f 74 0d | 0a 75 6e 64 65 72 67 6f |had not.|.undergo|
|000039f0| 6e 65 20 61 62 64 6f 6d | 69 6e 61 6c 20 6f 72 20 |ne abdom|inal or |
|00003a00| 67 6f 6e 61 64 61 6c 20 | 69 72 72 61 64 69 61 74 |gonadal |irradiat|
|00003a10| 69 6f 6e 2e 0d 0a 20 20 | 20 20 20 54 68 65 20 69 |ion... | The i|
|00003a20| 6e 63 69 64 65 6e 63 65 | 20 6f 66 20 67 6f 6e 61 |ncidence| of gona|
|00003a30| 64 61 6c 20 64 79 73 66 | 75 6e 63 74 69 6f 6e 20 |dal dysf|unction |
|00003a40| 76 61 72 69 65 64 20 61 | 63 63 6f 72 64 69 6e 67 |varied a|ccording|
|00003a50| 20 74 6f 20 70 75 62 65 | 72 74 61 6c 20 73 74 61 | to pube|rtal sta|
|00003a60| 74 75 73 20 61 74 0d 0a | 74 68 65 20 74 69 6d 65 |tus at..|the time|
|00003a70| 20 6f 66 20 74 68 65 72 | 61 70 79 2c 20 73 65 78 | of ther|apy, sex|
|00003a80| 2c 20 74 79 70 65 20 6f | 66 20 69 6c 6c 6e 65 73 |, type o|f illnes|
|00003a90| 73 2c 20 61 6e 64 20 63 | 68 65 6d 6f 74 68 65 72 |s, and c|hemother|
|00003aa0| 61 70 65 75 74 69 63 20 | 72 65 67 69 6d 65 6e 2e |apeutic |regimen.|
|00003ab0| 0d 0a 50 61 74 69 65 6e | 74 73 20 77 68 6f 20 75 |..Patien|ts who u|
|00003ac0| 6e 64 65 72 77 65 6e 74 | 20 63 68 65 6d 6f 74 68 |nderwent| chemoth|
|00003ad0| 65 72 61 70 79 20 64 75 | 72 69 6e 67 20 70 75 62 |erapy du|ring pub|
|00003ae0| 65 72 74 61 6c 20 64 65 | 76 65 6c 6f 70 6d 65 6e |ertal de|velopmen|
|00003af0| 74 20 77 65 72 65 20 6c | 65 73 73 0d 0a 61 66 66 |t were l|ess..aff|
|00003b00| 65 63 74 65 64 20 74 68 | 61 6e 20 61 64 75 6c 74 |ected th|an adult|
|00003b10| 73 20 62 75 74 20 77 65 | 72 65 20 6d 6f 72 65 20 |s but we|re more |
|00003b20| 61 66 66 65 63 74 65 64 | 20 74 68 61 6e 20 70 72 |affected| than pr|
|00003b30| 65 70 75 62 65 72 74 61 | 6c 20 70 61 74 69 65 6e |epuberta|l patien|
|00003b40| 74 73 20 74 72 65 61 74 | 65 64 0d 0a 73 69 6d 69 |ts treat|ed..simi|
|00003b50| 6c 61 72 6c 79 20 28 46 | 69 67 20 35 2d 33 29 2e |larly (F|ig 5-3).|
|00003b60| 20 20 4d 61 6c 65 20 70 | 61 74 69 65 6e 74 73 20 | Male p|atients |
|00003b70| 77 65 72 65 20 6d 6f 72 | 65 20 6c 69 6b 65 6c 79 |were mor|e likely|
|00003b80| 20 74 6f 20 69 6e 63 75 | 72 20 67 6f 6e 61 64 61 | to incu|r gonada|
|00003b90| 6c 20 64 61 6d 61 67 65 | 0d 0a 74 68 61 6e 20 66 |l damage|..than f|
|00003ba0| 65 6d 61 6c 65 20 70 61 | 74 69 65 6e 74 73 20 77 |emale pa|tients w|
|00003bb0| 68 65 6e 20 74 72 65 61 | 74 65 64 20 66 6f 72 20 |hen trea|ted for |
|00003bc0| 72 65 6e 61 6c 20 64 69 | 73 65 61 73 65 20 6f 72 |renal di|sease or|
|00003bd0| 20 48 6f 64 67 6b 69 6e | 27 73 20 64 69 73 65 61 | Hodgkin|'s disea|
|00003be0| 73 65 2c 20 62 75 74 0d | 0a 6e 6f 74 20 77 68 65 |se, but.|.not whe|
|00003bf0| 6e 20 74 68 65 79 20 77 | 65 72 65 20 74 72 65 61 |n they w|ere trea|
|00003c00| 74 65 64 20 66 6f 72 20 | 6c 65 75 6b 65 6d 69 61 |ted for |leukemia|
|00003c10| 2e 20 20 43 68 65 6d 6f | 74 68 65 72 61 70 79 2d |. Chemo|therapy-|
|00003c20| 69 6e 64 75 63 65 64 20 | 67 6f 6e 61 64 61 6c 20 |induced |gonadal |
|00003c30| 64 61 6d 61 67 65 0d 0a | 77 61 73 20 61 6c 73 6f |damage..|was also|
|00003c40| 20 72 65 6c 61 74 65 64 | 20 74 6f 20 74 68 65 20 | related| to the |
|00003c50| 61 6d 6f 75 6e 74 20 61 | 6e 64 20 74 79 70 65 20 |amount a|nd type |
|00003c60| 6f 66 20 63 79 74 6f 74 | 6f 78 69 63 20 61 67 65 |of cytot|oxic age|
|00003c70| 6e 74 20 61 64 6d 69 6e | 69 73 74 65 72 65 64 2e |nt admin|istered.|
|00003c80| 0d 0a 20 20 20 20 20 49 | 74 20 61 70 70 65 61 72 |.. I|t appear|
|00003c90| 73 20 74 68 61 74 20 63 | 68 65 6d 6f 74 68 65 72 |s that c|hemother|
|00003ca0| 61 70 79 2d 69 6e 64 75 | 63 65 64 20 64 61 6d 61 |apy-indu|ced dama|
|00003cb0| 67 65 20 69 73 20 69 6e | 64 65 65 64 20 70 72 6f |ge is in|deed pro|
|00003cc0| 70 6f 72 74 69 6f 6e 61 | 6c 20 74 6f 0d 0a 67 6f |portiona|l to..go|
|00003cd0| 6e 61 64 61 6c 20 61 63 | 74 69 76 69 74 79 2e 20 |nadal ac|tivity. |
|00003ce0| 20 46 75 72 74 68 65 72 | 20 73 74 75 64 69 65 73 | Further| studies|
|00003cf0| 20 73 68 6f 75 6c 64 20 | 62 65 20 75 6e 64 65 72 | should |be under|
|00003d00| 74 61 6b 65 6e 20 74 6f | 20 64 65 74 65 72 6d 69 |taken to| determi|
|00003d10| 6e 65 20 77 68 65 74 68 | 65 72 0d 0a 69 6e 64 75 |ne wheth|er..indu|
|00003d20| 63 65 64 20 67 6f 6e 61 | 64 61 6c 20 71 75 69 65 |ced gona|dal quie|
|00003d30| 73 63 65 6e 63 65 20 64 | 75 72 69 6e 67 20 63 68 |scence d|uring ch|
|00003d40| 65 6d 6f 74 68 65 72 61 | 70 79 20 77 6f 75 6c 64 |emothera|py would|
|00003d50| 20 72 65 64 75 63 65 20 | 74 68 65 20 68 69 67 68 | reduce |the high|
|00003d60| 20 69 6e 63 69 64 65 6e | 63 65 0d 0a 6f 66 20 67 | inciden|ce..of g|
|00003d70| 6f 6e 61 64 61 6c 20 66 | 61 69 6c 75 72 65 20 61 |onadal f|ailure a|
|00003d80| 66 74 65 72 20 63 68 65 | 6d 6f 74 68 65 72 61 70 |fter che|motherap|
|00003d90| 79 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |y.....Po|st-Comme|
|00003da0| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 54 68 69 73 20 |nt.... | This |
|00003db0| 61 72 74 69 63 6c 65 20 | 66 6f 63 75 73 65 73 20 |article |focuses |
|00003dc0| 6f 6e 20 61 6e 20 69 6d | 70 6f 72 74 61 6e 74 20 |on an im|portant |
|00003dd0| 62 75 74 20 6e 65 77 20 | 69 73 73 75 65 3b 20 74 |but new |issue; t|
|00003de0| 68 61 74 20 69 73 2c 20 | 77 68 65 6e 20 74 68 65 |hat is, |when the|
|00003df0| 0d 0a 74 65 73 74 65 73 | 20 61 72 65 20 65 78 70 |..testes| are exp|
|00003e00| 6f 73 65 64 20 74 6f 20 | 61 20 6e 6f 78 69 6f 75 |osed to |a noxiou|
|00003e10| 73 20 61 67 65 6e 74 2c | 20 69 73 20 74 68 65 20 |s agent,| is the |
|00003e20| 6c 6f 6e 67 2d 74 65 72 | 6d 20 64 61 6d 61 67 65 |long-ter|m damage|
|00003e30| 20 72 65 6c 61 74 65 64 | 20 74 6f 20 74 68 65 0d | related| to the.|
|00003e40| 0a 64 65 67 72 65 65 20 | 6f 66 20 67 6f 6e 61 64 |.degree |of gonad|
|00003e50| 61 6c 20 66 75 6e 63 74 | 69 6f 6e 20 61 74 20 74 |al funct|ion at t|
|00003e60| 68 65 20 74 69 6d 65 20 | 6f 66 20 65 78 70 6f 73 |he time |of expos|
|00003e70| 75 72 65 3f 20 20 49 6e | 20 74 68 69 73 20 69 6e |ure? In| this in|
|00003e80| 73 74 61 6e 63 65 2c 20 | 74 68 65 0d 0a 65 66 66 |stance, |the..eff|
|00003e90| 65 63 74 73 20 6f 66 20 | 63 68 65 6d 6f 74 68 65 |ects of |chemothe|
|00003ea0| 72 61 70 79 20 77 65 72 | 65 20 65 78 61 6d 69 6e |rapy wer|e examin|
|00003eb0| 65 64 20 61 6e 64 2c 20 | 61 73 20 65 78 70 65 63 |ed and, |as expec|
|00003ec0| 74 65 64 2c 20 74 68 65 | 72 65 20 77 61 73 20 6c |ted, the|re was l|
|00003ed0| 65 73 73 20 67 6f 6e 61 | 64 61 6c 0d 0a 64 79 73 |ess gona|dal..dys|
|00003ee0| 66 75 6e 63 74 69 6f 6e | 20 69 66 20 74 68 65 20 |function| if the |
|00003ef0| 70 61 74 69 65 6e 74 73 | 20 77 65 72 65 20 70 72 |patients| were pr|
|00003f00| 65 70 75 62 65 72 74 61 | 6c 20 61 74 20 74 68 65 |epuberta|l at the|
|00003f10| 20 74 69 6d 65 20 6f 66 | 20 63 68 65 6d 6f 74 68 | time of| chemoth|
|00003f20| 65 72 61 70 79 2e 0d 0a | 53 65 76 65 72 61 6c 20 |erapy...|Several |
|00003f30| 63 65 6e 74 65 72 73 20 | 68 61 76 65 20 63 6f 6e |centers |have con|
|00003f40| 73 69 64 65 72 65 64 20 | 74 68 65 20 6e 65 78 74 |sidered |the next|
|00003f50| 20 73 74 65 70 2c 20 74 | 68 61 74 20 69 73 2c 20 | step, t|hat is, |
|00003f60| 77 68 65 74 68 65 72 20 | 6f 6e 65 20 63 61 6e 20 |whether |one can |
|00003f70| 73 75 70 70 72 65 73 73 | 0d 0a 74 65 73 74 69 63 |suppress|..testic|
|00003f80| 75 6c 61 72 20 66 75 6e | 63 74 69 6f 6e 20 77 69 |ular fun|ction wi|
|00003f90| 74 68 20 74 65 73 74 6f | 73 74 65 72 6f 6e 65 20 |th testo|sterone |
|00003fa0| 6f 72 20 6c 75 74 65 69 | 6e 69 7a 69 6e 67 20 68 |or lutei|nizing h|
|00003fb0| 6f 72 6d 6f 6e 65 2d 72 | 65 6c 65 61 73 69 6e 67 |ormone-r|eleasing|
|00003fc0| 20 68 6f 72 6d 6f 6e 65 | 0d 0a 61 67 6f 6e 69 73 | hormone|..agonis|
|00003fd0| 74 73 20 6f 72 20 61 6e | 74 61 67 6f 6e 69 73 74 |ts or an|tagonist|
|00003fe0| 73 20 62 65 66 6f 72 65 | 20 63 68 65 6d 6f 74 68 |s before| chemoth|
|00003ff0| 65 72 61 70 79 2e 20 20 | 54 68 65 20 61 6e 73 77 |erapy. |The answ|
|00004000| 65 72 20 69 73 20 6e 6f | 74 20 69 6e 20 61 73 20 |er is no|t in as |
|00004010| 79 65 74 2c 20 62 75 74 | 0d 0a 74 68 65 20 6d 61 |yet, but|..the ma|
|00004020| 69 6e 20 70 72 6f 62 6c | 65 6d 20 69 6e 20 74 68 |in probl|em in th|
|00004030| 69 73 20 6d 61 74 74 65 | 72 20 63 65 6e 74 65 72 |is matte|r center|
|00004040| 73 20 61 72 6f 75 6e 64 | 20 74 68 65 20 71 75 65 |s around| the que|
|00004050| 73 74 69 6f 6e 3a 20 20 | 68 6f 77 20 6c 6f 6e 67 |stion: |how long|
|00004060| 20 63 61 6e 0d 0a 63 68 | 65 6d 6f 74 68 65 72 61 | can..ch|emothera|
|00004070| 70 79 20 62 65 20 70 6f | 73 74 70 6f 6e 65 64 20 |py be po|stponed |
|00004080| 65 74 68 69 63 61 6c 6c | 79 20 77 68 69 6c 65 20 |ethicall|y while |
|00004090| 73 75 70 70 72 65 73 73 | 69 6f 6e 20 6f 66 20 74 |suppress|ion of t|
|000040a0| 65 73 74 69 63 75 6c 61 | 72 20 66 75 6e 63 74 69 |esticula|r functi|
|000040b0| 6f 6e 20 69 73 0d 0a 61 | 74 74 65 6d 70 74 65 64 |on is..a|ttempted|
|000040c0| 3f 20 28 53 65 65 20 41 | 62 73 74 72 61 63 74 20 |? (See A|bstract |
|000040d0| 35 2d 33 29 2e 2d 2d 43 | 2e 41 2e 20 50 61 75 6c |5-3).--C|.A. Paul|
|000040e0| 73 65 6e 2c 20 4d 2e 44 | 2e 0d 0a 24 55 6e 69 71 |sen, M.D|...$Uniq|
|000040f0| 75 65 5f 49 44 7b 59 52 | 42 30 38 36 30 34 7d 0d |ue_ID{YR|B08604}.|
|00004100| 0a 24 54 69 74 6c 65 7b | 43 68 61 72 61 63 74 65 |.$Title{|Characte|
|00004110| 72 69 7a 61 74 69 6f 6e | 20 6f 66 20 52 65 63 6f |rization| of Reco|
|00004120| 6d 62 69 6e 61 6e 74 20 | 44 4e 41 20 44 65 72 69 |mbinant |DNA Deri|
|00004130| 76 65 64 2d 48 75 6d 61 | 6e 20 4c 75 74 65 69 6e |ved-Huma|n Lutein|
|00004140| 69 7a 69 6e 67 20 48 6f | 72 6d 6f 6e 65 20 49 6e |izing Ho|rmone In|
|00004150| 20 56 69 74 72 6f 20 61 | 6e 64 20 49 6e 20 56 69 | Vitro a|nd In Vi|
|00004160| 76 6f 3a 20 20 45 66 66 | 69 63 61 63 79 20 69 6e |vo: Eff|icacy in|
|00004170| 20 4f 76 75 6c 61 74 69 | 6f 6e 20 49 6e 64 75 63 | Ovulati|on Induc|
|00004180| 74 69 6f 6e 20 61 6e 64 | 20 43 6f 72 70 75 73 20 |tion and| Corpus |
|00004190| 4c 75 74 65 75 6d 20 53 | 75 70 70 6f 72 74 7d 0d |Luteum S|upport}.|
|000041a0| 0a 24 41 75 74 68 6f 72 | 7b 0d 0a 53 69 6d 6f 6e |.$Author|{..Simon|
|000041b0| 2c 20 4a 41 0d 0a 44 61 | 6e 66 6f 72 74 68 2c 20 |, JA..Da|nforth, |
|000041c0| 44 52 0d 0a 48 75 74 63 | 68 69 73 6f 6e 2c 20 4a |DR..Hutc|hison, J|
|000041d0| 53 0d 0a 48 6f 64 67 65 | 6e 2c 20 47 44 7d 0d 0a |S..Hodge|n, GD}..|
|000041e0| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 45 61 73 |$Affilia|tion{Eas|
|000041f0| 74 65 72 6e 20 56 69 72 | 67 69 6e 69 61 20 4d 65 |tern Vir|ginia Me|
|00004200| 64 20 53 63 68 6f 6f 6c | 20 4e 6f 72 66 6f 6c 6b |d School| Norfolk|
|00004210| 3b 20 53 65 72 6f 6e 6f | 20 4c 61 62 73 20 49 6e |; Serono| Labs In|
|00004220| 63 2c 20 52 61 6e 64 6f | 6c 70 68 2c 20 4d 61 73 |c, Rando|lph, Mas|
|00004230| 73 7d 0d 0a 24 53 75 62 | 6a 65 63 74 7b 44 4e 41 |s}..$Sub|ject{DNA|
|00004240| 2c 20 64 65 72 69 76 65 | 64 2d 4c 48 2c 20 72 65 |, derive|d-LH, re|
|00004250| 63 6f 6d 62 69 6e 61 6e | 74 2c 20 63 68 61 72 61 |combinan|t, chara|
|00004260| 63 74 65 72 69 7a 61 74 | 69 6f 6e 20 6f 66 2c 20 |cterizat|ion of, |
|00004270| 4c 48 2c 20 72 65 63 6f | 6d 62 69 6e 61 6e 74 20 |LH, reco|mbinant |
|00004280| 44 4e 41 0d 0a 64 65 72 | 69 76 65 64 2d 4c 48 2c |DNA..der|ived-LH,|
|00004290| 20 63 68 61 72 61 63 74 | 65 72 69 7a 61 74 69 6f | charact|erizatio|
|000042a0| 6e 20 6f 66 2c 20 4f 76 | 75 6c 61 74 69 6f 6e 2c |n of, Ov|ulation,|
|000042b0| 20 4c 48 20 69 6e 2c 20 | 72 65 63 6f 6d 62 69 6e | LH in, |recombin|
|000042c0| 61 6e 74 20 44 4e 41 20 | 64 65 72 69 76 65 64 2d |ant DNA |derived-|
|000042d0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 4a 41 4d 41 |}..$Jour|nal{JAMA|
|000042e0| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 32 35 39 7d 0d |}..$Volu|me{259}.|
|000042f0| 0a 24 50 61 67 65 7b 33 | 32 39 30 2d 33 32 39 35 |.$Page{3|290-3295|
|00004300| 7d 0d 0a 24 44 61 74 65 | 7b 4a 75 6e 65 20 31 30 |}..$Date|{June 10|
|00004310| 2c 20 31 39 38 38 7d 0d | 0a 24 59 42 56 6f 6c 7b |, 1988}.|.$YBVol{|
|00004320| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00004330| 66 20 49 6e 66 65 72 74 | 69 6c 69 74 79 7d 0d 0a |f Infert|ility}..|
|00004340| 24 43 68 61 70 74 65 72 | 7b 39 2d 33 7d 0d 0a 24 |$Chapter|{9-3}..$|
|00004350| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 4d 69 |YBEditor|{Drs. Mi|
|00004360| 73 68 65 6c 6c 2c 20 50 | 61 75 6c 73 65 6e 2c 20 |shell, P|aulsen, |
|00004370| 61 6e 64 20 4c 6f 62 6f | 7d 0d 0a 24 54 61 62 6c |and Lobo|}..$Tabl|
|00004380| 65 7b 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |e{}..$Co|mmentato|
|00004390| 72 7b 44 2e 52 2e 20 4d | 69 73 68 65 6c 6c 2c 20 |r{D.R. M|ishell, |
|000043a0| 4a 72 2e 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |Jr., M.D|.}....Co|
|000043b0| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|000043c0| 20 42 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 | Book Me|dical Pu|
|000043d0| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 2c 20 |blishers|, Inc., |
|000043e0| 31 39 38 39 0d 0a 0d 0a | 31 39 38 38 20 59 65 61 |1989....|1988 Yea|
|000043f0| 72 20 42 6f 6f 6b 20 6f | 66 20 49 6e 66 65 72 74 |r Book o|f Infert|
|00004400| 69 6c 69 74 79 20 28 52 | 29 0d 0a 0d 0a 43 68 61 |ility (R|)....Cha|
|00004410| 70 74 65 72 20 39 2d 2d | 4f 76 75 6c 61 74 69 6f |pter 9--|Ovulatio|
|00004420| 6e 20 49 6e 64 75 63 74 | 69 6f 6e 0d 0a 0d 0a 2d |n Induct|ion....-|
|00004430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004450| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004460| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004470| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00004480| 0a 43 68 61 72 61 63 74 | 65 72 69 7a 61 74 69 6f |.Charact|erizatio|
|00004490| 6e 20 6f 66 20 52 65 63 | 6f 6d 62 69 6e 61 6e 74 |n of Rec|ombinant|
|000044a0| 20 44 4e 41 20 44 65 72 | 69 76 65 64 2d 48 75 6d | DNA Der|ived-Hum|
|000044b0| 61 6e 20 4c 75 74 65 69 | 6e 69 7a 69 6e 67 20 48 |an Lutei|nizing H|
|000044c0| 6f 72 6d 6f 6e 65 20 49 | 6e 20 56 69 74 72 6f 0d |ormone I|n Vitro.|
|000044d0| 0a 61 6e 64 20 49 6e 20 | 56 69 76 6f 3a 20 20 45 |.and In |Vivo: E|
|000044e0| 66 66 69 63 61 63 79 20 | 69 6e 20 4f 76 75 6c 61 |fficacy |in Ovula|
|000044f0| 74 69 6f 6e 20 49 6e 64 | 75 63 74 69 6f 6e 20 61 |tion Ind|uction a|
|00004500| 6e 64 20 43 6f 72 70 75 | 73 20 4c 75 74 65 75 6d |nd Corpu|s Luteum|
|00004510| 20 53 75 70 70 6f 72 74 | 0d 0a 0d 0a 53 69 6d 6f | Support|....Simo|
|00004520| 6e 20 4a 41 3b 20 44 61 | 6e 66 6f 72 74 68 20 44 |n JA; Da|nforth D|
|00004530| 52 3b 20 48 75 74 63 68 | 69 73 6f 6e 20 4a 53 3b |R; Hutch|ison JS;|
|00004540| 20 48 6f 64 67 65 6e 20 | 47 44 0d 0a 28 45 61 73 | Hodgen |GD..(Eas|
|00004550| 74 65 72 6e 20 56 69 72 | 67 69 6e 69 61 20 4d 65 |tern Vir|ginia Me|
|00004560| 64 20 53 63 68 6f 6f 6c | 20 4e 6f 72 66 6f 6c 6b |d School| Norfolk|
|00004570| 3b 20 53 65 72 6f 6e 6f | 20 4c 61 62 73 20 49 6e |; Serono| Labs In|
|00004580| 63 2c 20 52 61 6e 64 6f | 6c 70 68 2c 20 4d 61 73 |c, Rando|lph, Mas|
|00004590| 73 29 0d 0a 4a 41 4d 41 | 20 32 35 39 3a 33 32 39 |s)..JAMA| 259:329|
|000045a0| 30 2d 33 32 39 35 2c 20 | 4a 75 6e 65 20 31 30 2c |0-3295, |June 10,|
|000045b0| 20 31 39 38 38 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1988..-|--------|
|000045c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004600| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00004610| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 47 6f 6e 61 |act.... | Gona|
|00004620| 64 6f 74 72 6f 70 69 63 | 20 6d 65 64 69 63 61 74 |dotropic| medicat|
|00004630| 69 6f 6e 73 20 61 72 65 | 20 75 73 65 64 20 66 6f |ions are| used fo|
|00004640| 72 20 67 6f 6e 61 64 61 | 6c 20 73 74 69 6d 75 6c |r gonada|l stimul|
|00004650| 61 74 69 6f 6e 20 69 6e | 20 6d 65 6e 20 61 6e 64 |ation in| men and|
|00004660| 20 77 6f 6d 65 6e 0d 0a | 77 68 6f 20 72 65 71 75 | women..|who requ|
|00004670| 69 72 65 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |ire trea|tment of|
|00004680| 20 68 6f 72 6d 6f 6e 61 | 6c 20 61 62 6e 6f 72 6d | hormona|l abnorm|
|00004690| 61 6c 69 74 69 65 73 20 | 74 68 61 74 20 63 61 75 |alities |that cau|
|000046a0| 73 65 20 69 6e 66 65 72 | 74 69 6c 69 74 79 2e 0d |se infer|tility..|
|000046b0| 0a 48 6f 77 65 76 65 72 | 2c 20 74 68 65 20 6c 61 |.However|, the la|
|000046c0| 63 6b 20 6f 66 20 70 75 | 72 65 20 70 72 65 70 61 |ck of pu|re prepa|
|000046d0| 72 61 74 69 6f 6e 73 20 | 61 6e 64 20 61 6c 74 65 |rations |and alte|
|000046e0| 72 6e 61 74 69 76 65 20 | 72 61 74 69 6f 73 20 6f |rnative |ratios o|
|000046f0| 66 0d 0a 66 6f 6c 6c 69 | 63 6c 65 2d 73 74 69 6d |f..folli|cle-stim|
|00004700| 75 6c 61 74 69 6e 67 20 | 68 6f 72 6d 6f 6e 65 20 |ulating |hormone |
|00004710| 61 6e 64 20 6c 75 74 65 | 69 6e 69 7a 69 6e 67 20 |and lute|inizing |
|00004720| 68 6f 72 6d 6f 6e 65 20 | 68 61 76 65 20 68 61 6d |hormone |have ham|
|00004730| 70 65 72 65 64 20 74 68 | 65 0d 0a 72 65 6c 69 61 |pered th|e..relia|
|00004740| 62 69 6c 69 74 79 20 61 | 6e 64 20 66 6c 65 78 69 |bility a|nd flexi|
|00004750| 62 69 6c 69 74 79 20 6f | 66 20 73 6f 6d 65 20 74 |bility o|f some t|
|00004760| 72 65 61 74 6d 65 6e 74 | 20 72 65 67 69 6d 65 6e |reatment| regimen|
|00004770| 73 2e 20 20 54 68 65 20 | 66 65 61 73 69 62 69 6c |s. The |feasibil|
|00004780| 69 74 79 20 6f 66 0d 0a | 70 72 6f 64 75 63 69 6e |ity of..|producin|
|00004790| 67 20 61 20 63 6f 6d 6d | 65 72 63 69 61 6c 6c 79 |g a comm|ercially|
|000047a0| 20 61 76 61 69 6c 61 62 | 6c 65 20 6d 65 64 69 63 | availab|le medic|
|000047b0| 61 74 69 6f 6e 20 6f 66 | 20 70 75 72 65 20 68 75 |ation of| pure hu|
|000047c0| 6d 61 6e 20 6c 75 74 65 | 69 6e 69 7a 69 6e 67 20 |man lute|inizing |
|000047d0| 68 6f 72 6d 6f 6e 65 0d | 0a 66 72 6f 6d 20 72 65 |hormone.|.from re|
|000047e0| 63 6f 6d 62 69 6e 61 6e | 74 20 44 4e 41 20 74 65 |combinan|t DNA te|
|000047f0| 63 68 6e 6f 6c 6f 67 79 | 20 28 72 65 63 68 4c 48 |chnology| (rechLH|
|00004800| 29 20 74 6f 20 62 65 20 | 75 73 65 64 20 66 6f 72 |) to be |used for|
|00004810| 20 6f 76 61 72 69 61 6e | 20 6f 72 20 74 65 73 74 | ovarian| or test|
|00004820| 69 63 75 6c 61 72 0d 0a | 73 74 69 6d 75 6c 61 74 |icular..|stimulat|
|00004830| 69 6f 6e 20 77 61 73 20 | 65 78 61 6d 69 6e 65 64 |ion was |examined|
|00004840| 2e 20 20 54 68 65 20 72 | 65 63 68 4c 48 20 70 72 |. The r|echLH pr|
|00004850| 65 70 61 72 61 74 69 6f | 6e 20 69 73 20 64 65 72 |eparatio|n is der|
|00004860| 69 76 65 64 20 69 6e 20 | 6d 61 6d 6d 61 6c 69 61 |ived in |mammalia|
|00004870| 6e 20 63 65 6c 6c 73 0d | 0a 74 72 61 6e 73 66 65 |n cells.|.transfe|
|00004880| 63 74 65 64 20 77 69 74 | 68 20 70 6c 61 73 6d 69 |cted wit|h plasmi|
|00004890| 64 73 20 63 6f 6e 74 61 | 69 6e 69 6e 67 20 63 6f |ds conta|ining co|
|000048a0| 6d 70 6c 65 6d 65 6e 74 | 61 72 79 20 44 4e 41 20 |mplement|ary DNA |
|000048b0| 66 6f 72 20 62 6f 74 68 | 20 68 75 6d 61 6e 0d 0a |for both| human..|
|000048c0| 6c 75 74 65 69 6e 69 7a | 69 6e 67 20 68 6f 72 6d |luteiniz|ing horm|
|000048d0| 6f 6e 65 20 73 75 62 75 | 6e 69 74 73 2e 0d 0a 20 |one subu|nits... |
|000048e0| 20 20 20 20 49 6e 20 74 | 68 65 73 65 20 73 74 75 | In t|hese stu|
|000048f0| 64 69 65 73 2c 20 61 20 | 70 75 72 69 66 69 65 64 |dies, a |purified|
|00004900| 20 70 72 65 70 61 72 61 | 74 69 6f 6e 20 6f 66 20 | prepara|tion of |
|00004910| 68 75 6d 61 6e 20 70 69 | 74 75 69 74 61 72 79 20 |human pi|tuitary |
|00004920| 6c 75 74 65 69 6e 69 7a | 69 6e 67 0d 0a 68 6f 72 |luteiniz|ing..hor|
|00004930| 6d 6f 6e 65 20 73 74 61 | 6e 64 61 72 64 69 7a 65 |mone sta|ndardize|
|00004940| 64 20 61 67 61 69 6e 73 | 74 20 61 6e 20 69 6e 74 |d agains|t an int|
|00004950| 65 72 6e 61 74 69 6f 6e | 61 6c 20 72 65 66 65 72 |ernation|al refer|
|00004960| 65 6e 63 65 20 70 72 65 | 70 61 72 61 74 69 6f 6e |ence pre|paration|
|00004970| 20 77 61 73 20 75 73 65 | 64 20 66 6f 72 0d 0a 63 | was use|d for..c|
|00004980| 6f 6d 70 61 72 69 73 6f | 6e 2e 20 20 43 6f 6d 6d |ompariso|n. Comm|
|00004990| 65 72 63 69 61 6c 20 72 | 61 64 69 6f 69 6d 6d 75 |ercial r|adioimmu|
|000049a0| 6e 6f 61 73 73 61 79 20 | 6b 69 74 73 20 77 65 72 |noassay |kits wer|
|000049b0| 65 20 75 73 65 64 20 74 | 6f 20 64 65 74 65 72 6d |e used t|o determ|
|000049c0| 69 6e 65 20 6c 75 74 65 | 69 6e 69 7a 69 6e 67 0d |ine lute|inizing.|
|000049d0| 0a 68 6f 72 6d 6f 6e 65 | 20 63 6f 6e 63 65 6e 74 |.hormone| concent|
|000049e0| 72 61 74 69 6f 6e 73 2e | 20 20 41 20 76 61 72 69 |rations.| A vari|
|000049f0| 65 74 79 20 6f 66 20 65 | 78 70 65 72 69 6d 65 6e |ety of e|xperimen|
|00004a00| 74 73 20 77 61 73 20 63 | 6f 6e 64 75 63 74 65 64 |ts was c|onducted|
|00004a10| 20 69 6e 20 72 6f 64 65 | 6e 74 73 20 61 6e 64 0d | in rode|nts and.|
|00004a20| 0a 6e 6f 6e 68 75 6d 61 | 6e 20 70 72 69 6d 61 74 |.nonhuma|n primat|
|00004a30| 65 73 20 74 6f 20 61 73 | 73 65 73 73 20 74 68 65 |es to as|sess the|
|00004a40| 20 63 68 61 72 61 63 74 | 65 72 69 73 74 69 63 73 | charact|eristics|
|00004a50| 20 6f 66 20 74 68 65 20 | 6e 65 77 20 72 65 63 68 | of the |new rech|
|00004a60| 4c 48 20 70 72 65 70 61 | 72 61 74 69 6f 6e 2e 0d |LH prepa|ration..|
|00004a70| 0a 20 20 20 20 20 54 68 | 65 20 72 65 73 75 6c 74 |. Th|e result|
|00004a80| 73 20 6f 66 20 74 68 65 | 20 76 61 72 69 6f 75 73 |s of the| various|
|00004a90| 20 65 78 70 65 72 69 6d | 65 6e 74 73 20 73 68 6f | experim|ents sho|
|00004aa0| 77 20 74 68 61 74 20 74 | 68 65 20 72 65 63 68 4c |w that t|he rechL|
|00004ab0| 48 20 70 72 65 70 61 72 | 61 74 69 6f 6e 0d 0a 70 |H prepar|ation..p|
|00004ac0| 6f 73 73 65 73 73 65 73 | 20 63 68 61 72 61 63 74 |ossesses| charact|
|00004ad0| 65 72 69 73 74 69 63 73 | 20 6f 66 20 62 69 6f 6c |eristics| of biol|
|00004ae0| 6f 67 69 63 20 61 63 74 | 69 76 69 74 79 20 74 68 |ogic act|ivity th|
|00004af0| 61 74 20 61 72 65 20 72 | 65 6d 61 72 6b 61 62 6c |at are r|emarkabl|
|00004b00| 79 20 73 69 6d 69 6c 61 | 72 20 74 6f 0d 0a 74 68 |y simila|r to..th|
|00004b10| 6f 73 65 20 6f 66 20 6b | 6e 6f 77 6e 20 6c 75 74 |ose of k|nown lut|
|00004b20| 65 69 6e 69 7a 69 6e 67 | 20 68 6f 72 6d 6f 6e 65 |einizing| hormone|
|00004b30| 20 70 72 65 70 61 72 61 | 74 69 6f 6e 73 20 64 65 | prepara|tions de|
|00004b40| 72 69 76 65 64 20 66 72 | 6f 6d 20 65 69 74 68 65 |rived fr|om eithe|
|00004b50| 72 20 70 69 74 75 69 74 | 61 72 79 0d 0a 74 69 73 |r pituit|ary..tis|
|00004b60| 73 75 65 20 6f 72 20 74 | 68 65 20 75 72 69 6e 65 |sue or t|he urine|
|00004b70| 20 6f 66 20 70 6f 73 74 | 6d 65 6e 6f 70 61 75 73 | of post|menopaus|
|00004b80| 61 6c 20 77 6f 6d 65 6e | 2e 20 20 49 74 20 61 63 |al women|. It ac|
|00004b90| 68 69 65 76 65 64 20 6f | 76 75 6c 61 74 69 6f 6e |hieved o|vulation|
|00004ba0| 20 69 6e 64 75 63 74 69 | 6f 6e 0d 0a 61 6e 64 20 | inducti|on..and |
|00004bb0| 63 6f 72 70 75 73 20 6c | 75 74 65 75 6d 20 73 75 |corpus l|uteum su|
|00004bc0| 70 70 6f 72 74 20 69 6e | 20 74 68 65 20 70 72 69 |pport in| the pri|
|00004bd0| 6d 61 74 65 20 6d 65 6e | 73 74 72 75 61 6c 20 63 |mate men|strual c|
|00004be0| 79 63 6c 65 2e 0d 0a 20 | 20 20 20 20 54 68 65 20 |ycle... | The |
|00004bf0| 61 76 61 69 6c 61 62 69 | 6c 69 74 79 20 6f 66 20 |availabi|lity of |
|00004c00| 72 65 63 68 4c 48 20 70 | 72 6f 76 69 64 65 73 20 |rechLH p|rovides |
|00004c10| 61 6e 20 6f 70 70 6f 72 | 74 75 6e 69 74 79 20 66 |an oppor|tunity f|
|00004c20| 6f 72 20 73 69 67 6e 69 | 66 69 63 61 6e 74 0d 0a |or signi|ficant..|
|00004c30| 69 6d 70 72 6f 76 65 6d | 65 6e 74 20 69 6e 20 74 |improvem|ent in t|
|00004c40| 72 65 61 74 69 6e 67 20 | 69 6e 66 65 72 74 69 6c |reating |infertil|
|00004c50| 65 20 77 6f 6d 65 6e 20 | 61 6e 64 20 6d 65 6e 20 |e women |and men |
|00004c60| 77 68 6f 20 72 65 71 75 | 69 72 65 20 67 6f 6e 61 |who requ|ire gona|
|00004c70| 64 61 6c 20 73 74 69 6d | 75 6c 61 74 69 6f 6e 2e |dal stim|ulation.|
|00004c80| 0d 0a 54 68 65 72 65 20 | 61 72 65 20 73 65 76 65 |..There |are seve|
|00004c90| 72 61 6c 20 74 68 65 72 | 61 70 65 75 74 69 63 20 |ral ther|apeutic |
|00004ca0| 61 64 76 61 6e 74 61 67 | 65 73 20 6f 66 20 72 65 |advantag|es of re|
|00004cb0| 63 68 4c 48 20 6f 76 65 | 72 20 74 68 65 20 63 75 |chLH ove|r the cu|
|00004cc0| 72 72 65 6e 74 6c 79 20 | 61 76 61 69 6c 61 62 6c |rrently |availabl|
|00004cd0| 65 0d 0a 6c 75 74 65 69 | 6e 69 7a 69 6e 67 20 68 |e..lutei|nizing h|
|00004ce0| 6f 72 6d 6f 6e 65 20 70 | 72 65 70 61 72 61 74 69 |ormone p|reparati|
|00004cf0| 6f 6e 73 2c 20 69 6e 63 | 6c 75 64 69 6e 67 20 62 |ons, inc|luding b|
|00004d00| 65 74 74 65 72 20 72 65 | 6c 69 61 62 69 6c 69 74 |etter re|liabilit|
|00004d10| 79 20 6f 66 20 74 68 65 | 20 61 76 61 69 6c 61 62 |y of the| availab|
|00004d20| 6c 65 0d 0a 73 75 70 70 | 6c 79 20 61 6e 64 20 69 |le..supp|ly and i|
|00004d30| 6d 70 72 6f 76 65 64 20 | 74 72 65 61 74 6d 65 6e |mproved |treatmen|
|00004d40| 74 20 66 6c 65 78 69 62 | 69 6c 69 74 79 20 69 6e |t flexib|ility in|
|00004d50| 20 64 65 74 65 72 6d 69 | 6e 69 6e 67 20 74 68 65 | determi|ning the|
|00004d60| 20 6f 70 74 69 6d 61 6c | 20 64 6f 73 65 20 72 61 | optimal| dose ra|
|00004d70| 74 69 6f 0d 0a 6f 66 20 | 66 6f 6c 6c 69 63 6c 65 |tio..of |follicle|
|00004d80| 2d 73 74 69 6d 75 6c 61 | 74 69 6e 67 20 68 6f 72 |-stimula|ting hor|
|00004d90| 6d 6f 6e 65 2d 6c 75 74 | 65 69 6e 69 7a 69 6e 67 |mone-lut|einizing|
|00004da0| 20 68 6f 72 6d 6f 6e 65 | 20 66 6f 72 20 69 6e 64 | hormone| for ind|
|00004db0| 69 76 69 64 75 61 6c 20 | 70 61 74 69 65 6e 74 73 |ividual |patients|
|00004dc0| 2e 0d 0a 0d 0a 50 6f 73 | 74 2d 43 6f 6d 6d 65 6e |.....Pos|t-Commen|
|00004dd0| 74 0d 0a 0d 0a 20 20 20 | 20 20 54 68 69 73 20 69 |t.... | This i|
|00004de0| 73 20 74 68 65 20 66 69 | 72 73 74 20 72 65 70 6f |s the fi|rst repo|
|00004df0| 72 74 20 74 6f 20 64 65 | 6d 6f 6e 73 74 72 61 74 |rt to de|monstrat|
|00004e00| 65 20 74 68 65 20 66 65 | 61 73 69 62 69 6c 69 74 |e the fe|asibilit|
|00004e10| 79 20 6f 66 20 70 72 6f | 64 75 63 74 69 6f 6e 20 |y of pro|duction |
|00004e20| 6f 66 20 61 0d 0a 63 6f | 6d 6d 65 72 63 69 61 6c |of a..co|mmercial|
|00004e30| 6c 79 20 61 76 61 69 6c | 61 62 6c 65 20 70 75 72 |ly avail|able pur|
|00004e40| 65 20 6c 75 74 65 69 6e | 69 7a 69 6e 67 20 68 6f |e lutein|izing ho|
|00004e50| 72 6d 6f 6e 65 20 66 72 | 6f 6d 20 72 65 63 6f 6d |rmone fr|om recom|
|00004e60| 62 69 6e 61 6e 74 20 44 | 4e 41 20 74 65 63 68 6e |binant D|NA techn|
|00004e70| 6f 6c 6f 67 79 2e 0d 0a | 43 6f 6d 70 61 72 65 64 |ology...|Compared|
|00004e80| 20 77 69 74 68 20 63 75 | 72 72 65 6e 74 20 70 72 | with cu|rrent pr|
|00004e90| 65 70 61 72 61 74 69 6f | 6e 73 20 6f 66 20 68 4d |eparatio|ns of hM|
|00004ea0| 47 20 61 6e 64 20 68 43 | 47 20 64 65 72 69 76 65 |G and hC|G derive|
|00004eb0| 64 20 66 72 6f 6d 20 75 | 72 69 6e 65 20 74 68 61 |d from u|rine tha|
|00004ec0| 74 20 76 61 72 79 0d 0a | 69 6e 20 70 6f 74 65 6e |t vary..|in poten|
|00004ed0| 63 79 20 74 68 65 20 72 | 65 63 68 4c 48 20 73 68 |cy the r|echLH sh|
|00004ee0| 6f 75 6c 64 20 70 72 6f | 76 69 64 65 20 61 20 73 |ould pro|vide a s|
|00004ef0| 6f 75 72 63 65 20 6f 66 | 20 61 20 63 6f 6e 73 74 |ource of| a const|
|00004f00| 61 6e 74 20 64 6f 73 65 | 20 6f 66 20 68 6f 72 6d |ant dose| of horm|
|00004f10| 6f 6e 65 20 61 6e 64 0d | 0a 74 68 75 73 20 70 65 |one and.|.thus pe|
|00004f20| 72 6d 69 74 20 69 6e 76 | 65 73 74 69 67 61 74 6f |rmit inv|estigato|
|00004f30| 72 73 20 74 6f 20 64 65 | 74 65 72 6d 69 6e 65 20 |rs to de|termine |
|00004f40| 74 68 65 20 6f 70 74 69 | 6d 61 6c 20 72 61 74 69 |the opti|mal rati|
|00004f50| 6f 20 6f 66 20 66 6f 6c | 6c 69 63 6c 65 2d 73 74 |o of fol|licle-st|
|00004f60| 69 6d 75 6c 61 74 69 6e | 67 0d 0a 68 6f 72 6d 6f |imulatin|g..hormo|
|00004f70| 6e 65 20 74 6f 20 6c 75 | 74 65 69 6e 69 7a 69 6e |ne to lu|teinizin|
|00004f80| 67 20 68 6f 72 6d 6f 6e | 65 20 6e 65 65 64 65 64 |g hormon|e needed|
|00004f90| 20 66 6f 72 20 74 72 65 | 61 74 6d 65 6e 74 2e 20 | for tre|atment. |
|00004fa0| 20 42 65 63 61 75 73 65 | 20 68 75 6d 61 6e 20 6c | Because| human l|
|00004fb0| 75 74 65 69 6e 69 7a 69 | 6e 67 0d 0a 68 6f 72 6d |uteinizi|ng..horm|
|00004fc0| 6f 6e 65 20 68 61 73 20 | 61 20 73 68 6f 72 74 65 |one has |a shorte|
|00004fd0| 72 20 68 61 6c 66 20 6c | 69 66 65 20 74 68 61 6e |r half l|ife than|
|00004fe0| 20 68 43 47 2c 20 75 73 | 65 20 6f 66 20 68 75 6d | hCG, us|e of hum|
|00004ff0| 61 6e 20 6c 75 74 65 69 | 6e 69 7a 69 6e 67 20 68 |an lutei|nizing h|
|00005000| 6f 72 6d 6f 6e 65 20 6d | 61 79 0d 0a 72 65 64 75 |ormone m|ay..redu|
|00005010| 63 65 20 74 68 65 20 69 | 6e 63 69 64 65 6e 63 65 |ce the i|ncidence|
|00005020| 20 6f 66 20 6d 75 6c 74 | 69 70 6c 65 20 6f 76 75 | of mult|iple ovu|
|00005030| 6c 61 74 69 6f 6e 20 77 | 68 65 6e 20 75 73 65 64 |lation w|hen used|
|00005040| 20 66 6f 72 20 6f 76 75 | 6c 61 74 69 6f 6e 20 69 | for ovu|lation i|
|00005050| 6e 64 75 63 74 69 6f 6e | 20 61 6e 64 0d 0a 70 65 |nduction| and..pe|
|00005060| 72 68 61 70 73 20 61 76 | 6f 69 64 20 74 68 65 20 |rhaps av|oid the |
|00005070| 70 72 6f 62 6c 65 6d 20 | 6f 66 20 68 79 70 65 72 |problem |of hyper|
|00005080| 73 74 69 6d 75 6c 61 74 | 69 6f 6e 2e 20 20 46 75 |stimulat|ion. Fu|
|00005090| 72 74 68 65 72 20 63 6c | 69 6e 69 63 61 6c 20 74 |rther cl|inical t|
|000050a0| 72 69 61 6c 73 20 77 69 | 74 68 0d 0a 74 68 69 73 |rials wi|th..this|
|000050b0| 20 61 67 65 6e 74 20 61 | 72 65 20 61 77 61 69 74 | agent a|re await|
|000050c0| 65 64 20 77 69 74 68 20 | 65 78 74 72 65 6d 65 20 |ed with |extreme |
|000050d0| 69 6e 74 65 72 65 73 74 | 2e 2d 2d 44 2e 52 2e 20 |interest|.--D.R. |
|000050e0| 4d 69 73 68 65 6c 6c 2c | 20 4a 72 2e 2c 20 4d 2e |Mishell,| Jr., M.|
|000050f0| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00005100| 52 42 30 38 36 30 35 7d | 0d 0a 24 54 69 74 6c 65 |RB08605}|..$Title|
|00005110| 7b 41 64 6d 69 6e 69 73 | 74 72 61 74 69 6f 6e 20 |{Adminis|tration |
|00005120| 6f 66 20 4e 61 73 61 6c | 20 4e 61 66 61 72 65 6c |of Nasal| Nafarel|
|00005130| 69 6e 20 61 73 20 43 6f | 6d 70 61 72 65 64 20 57 |in as Co|mpared W|
|00005140| 69 74 68 20 4f 72 61 6c | 20 44 61 6e 61 7a 6f 6c |ith Oral| Danazol|
|00005150| 20 66 6f 72 20 45 6e 64 | 6f 6d 65 74 72 69 6f 73 | for End|ometrios|
|00005160| 69 73 3a 20 20 41 20 4d | 75 6c 74 69 63 65 6e 74 |is: A M|ulticent|
|00005170| 65 72 20 44 6f 75 62 6c | 65 2d 42 6c 69 6e 64 20 |er Doubl|e-Blind |
|00005180| 43 6f 6d 70 61 72 61 74 | 69 76 65 20 43 6c 69 6e |Comparat|ive Clin|
|00005190| 69 63 61 6c 20 54 72 69 | 61 6c 7d 0d 0a 24 41 75 |ical Tri|al}..$Au|
|000051a0| 74 68 6f 72 7b 0d 0a 48 | 65 6e 7a 6c 2c 20 4d 52 |thor{..H|enzl, MR|
|000051b0| 0d 0a 43 6f 72 73 6f 6e | 2c 20 53 4c 0d 0a 4d 6f |..Corson|, SL..Mo|
|000051c0| 67 68 69 73 73 69 2c 20 | 4b 0d 0a 42 75 74 74 72 |ghissi, |K..Buttr|
|000051d0| 61 6d 2c 20 56 43 0d 0a | 42 65 72 71 76 69 73 74 |am, VC..|Berqvist|
|000051e0| 2c 20 43 0d 0a 4a 61 63 | 6f 62 73 6f 6e 2c 20 4a |, C..Jac|obson, J|
|000051f0| 0d 0a 6f 74 68 65 72 20 | 6d 65 6d 62 65 72 73 20 |..other |members |
|00005200| 6f 66 20 74 68 65 20 4e | 61 66 61 72 65 6c 69 6e |of the N|afarelin|
|00005210| 20 53 74 75 64 79 20 47 | 72 6f 75 70 7d 0d 0a 24 | Study G|roup}..$|
|00005220| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 7d 0d 0a 24 |Affiliat|ion{}..$|
|00005230| 53 75 62 6a 65 63 74 7b | 45 6e 64 6f 6d 65 74 72 |Subject{|Endometr|
|00005240| 69 6f 73 69 73 2c 20 64 | 61 6e 61 7a 6f 6c 20 69 |iosis, d|anazol i|
|00005250| 6e 2c 20 76 73 2e 20 6e | 61 66 61 72 65 6c 69 6e |n, vs. n|afarelin|
|00005260| 0d 0a 45 6e 64 6f 6d 65 | 74 72 69 6f 73 69 73 2c |..Endome|triosis,|
|00005270| 20 6e 61 66 61 72 65 6c | 69 6e 20 76 73 2e 20 64 | nafarel|in vs. d|
|00005280| 61 6e 61 7a 6f 6c 20 69 | 6e 0d 0a 4e 61 66 61 72 |anazol i|n..Nafar|
|00005290| 65 6c 69 6e 20 69 6e 20 | 65 6e 64 6f 6d 65 74 72 |elin in |endometr|
|000052a0| 69 6f 73 69 73 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c |iosis}..|$Journal|
|000052b0| 7b 4e 20 45 6e 67 6c 20 | 4a 20 4d 65 64 7d 0d 0a |{N Engl |J Med}..|
|000052c0| 24 56 6f 6c 75 6d 65 7b | 33 31 38 7d 0d 0a 24 50 |$Volume{|318}..$P|
|000052d0| 61 67 65 7b 34 38 35 2d | 34 38 39 7d 0d 0a 24 44 |age{485-|489}..$D|
|000052e0| 61 74 65 7b 46 65 62 20 | 32 35 2c 20 31 39 38 38 |ate{Feb |25, 1988|
|000052f0| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00005300| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 49 6e 66 65 |ear Book| of Infe|
|00005310| 72 74 69 6c 69 74 79 7d | 0d 0a 24 43 68 61 70 74 |rtility}|..$Chapt|
|00005320| 65 72 7b 31 31 2d 39 7d | 0d 0a 24 59 42 45 64 69 |er{11-9}|..$YBEdi|
|00005330| 74 6f 72 7b 44 72 73 2e | 20 4d 69 73 68 65 6c 6c |tor{Drs.| Mishell|
|00005340| 2c 20 50 61 75 6c 73 65 | 6e 2c 20 61 6e 64 20 4c |, Paulse|n, and L|
|00005350| 6f 62 6f 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |obo}..$T|able{}..|
|00005360| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 44 2e 52 |$Comment|ator{D.R|
|00005370| 2e 20 4d 69 73 68 65 6c | 6c 2c 20 4a 72 2e 2c 20 |. Mishel|l, Jr., |
|00005380| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|00005390| 68 74 20 28 63 29 20 59 | 65 61 72 20 42 6f 6f 6b |ht (c) Y|ear Book|
|000053a0| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|000053b0| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 38 39 0d |ers, Inc|., 1989.|
|000053c0| 0a 0d 0a 31 39 38 38 20 | 59 65 61 72 20 42 6f 6f |...1988 |Year Boo|
|000053d0| 6b 20 6f 66 20 49 6e 66 | 65 72 74 69 6c 69 74 79 |k of Inf|ertility|
|000053e0| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|000053f0| 31 31 2d 2d 45 6e 64 6f | 6d 65 74 72 69 6f 73 69 |11--Endo|metriosi|
|00005400| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|00005410| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005420| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005450| 2d 2d 2d 2d 2d 0d 0a 41 | 64 6d 69 6e 69 73 74 72 |-----..A|dministr|
|00005460| 61 74 69 6f 6e 20 6f 66 | 20 4e 61 73 61 6c 20 4e |ation of| Nasal N|
|00005470| 61 66 61 72 65 6c 69 6e | 20 61 73 20 43 6f 6d 70 |afarelin| as Comp|
|00005480| 61 72 65 64 20 57 69 74 | 68 20 4f 72 61 6c 20 44 |ared Wit|h Oral D|
|00005490| 61 6e 61 7a 6f 6c 20 66 | 6f 72 0d 0a 45 6e 64 6f |anazol f|or..Endo|
|000054a0| 6d 65 74 72 69 6f 73 69 | 73 3a 20 20 41 20 4d 75 |metriosi|s: A Mu|
|000054b0| 6c 74 69 63 65 6e 74 65 | 72 20 44 6f 75 62 6c 65 |lticente|r Double|
|000054c0| 2d 42 6c 69 6e 64 20 43 | 6f 6d 70 61 72 61 74 69 |-Blind C|omparati|
|000054d0| 76 65 20 43 6c 69 6e 69 | 63 61 6c 20 54 72 69 61 |ve Clini|cal Tria|
|000054e0| 6c 0d 0a 0d 0a 48 65 6e | 7a 6c 20 4d 52 3b 20 43 |l....Hen|zl MR; C|
|000054f0| 6f 72 73 6f 6e 20 53 4c | 3b 20 4d 6f 67 68 69 73 |orson SL|; Moghis|
|00005500| 73 69 20 4b 3b 20 42 75 | 74 74 72 61 6d 20 56 43 |si K; Bu|ttram VC|
|00005510| 3b 20 42 65 72 71 76 69 | 73 74 20 43 3b 20 4a 61 |; Berqvi|st C; Ja|
|00005520| 63 6f 62 73 6f 6e 20 4a | 3b 20 61 6e 64 20 6f 74 |cobson J|; and ot|
|00005530| 68 65 72 0d 0a 6d 65 6d | 62 65 72 73 20 6f 66 20 |her..mem|bers of |
|00005540| 74 68 65 20 4e 61 66 61 | 72 65 6c 69 6e 20 53 74 |the Nafa|relin St|
|00005550| 75 64 79 20 47 72 6f 75 | 70 0d 0a 4e 20 45 6e 67 |udy Grou|p..N Eng|
|00005560| 6c 20 4a 20 4d 65 64 20 | 33 31 38 3a 34 38 35 2d |l J Med |318:485-|
|00005570| 34 38 39 2c 20 46 65 62 | 20 32 35 2c 20 31 39 38 |489, Feb| 25, 198|
|00005580| 38 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8..-----|--------|
|00005590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055d0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|000055e0| 0a 0d 0a 20 20 20 20 20 | 4d 65 64 69 63 61 6c 20 |... |Medical |
|000055f0| 74 72 65 61 74 6d 65 6e | 74 20 6f 66 20 65 6e 64 |treatmen|t of end|
|00005600| 6f 6d 65 74 72 69 6f 73 | 69 73 20 68 61 73 20 62 |ometrios|is has b|
|00005610| 65 65 6e 20 64 6f 6d 69 | 6e 61 74 65 64 20 62 79 |een domi|nated by|
|00005620| 20 64 61 6e 61 7a 6f 6c | 20 61 6e 64 0d 0a 63 6f | danazol| and..co|
|00005630| 6e 74 72 61 63 65 70 74 | 69 76 65 20 73 74 65 72 |ntracept|ive ster|
|00005640| 6f 69 64 73 2e 20 20 48 | 6f 77 65 76 65 72 2c 20 |oids. H|owever, |
|00005650| 74 68 65 73 65 20 73 74 | 65 72 6f 69 64 73 20 68 |these st|eroids h|
|00005660| 61 76 65 20 6e 6f 74 20 | 62 65 65 6e 20 74 65 73 |ave not |been tes|
|00005670| 74 65 64 20 69 6e 0d 0a | 63 6f 6e 74 72 6f 6c 6c |ted in..|controll|
|00005680| 65 64 20 70 72 6f 73 70 | 65 63 74 69 76 65 20 74 |ed prosp|ective t|
|00005690| 72 69 61 6c 73 2e 0d 0a | 20 20 20 20 20 49 6e 20 |rials...| In |
|000056a0| 74 68 65 20 70 72 65 73 | 65 6e 74 20 74 72 69 61 |the pres|ent tria|
|000056b0| 6c 20 6e 61 73 61 6c 20 | 6e 61 66 61 72 65 6c 69 |l nasal |nafareli|
|000056c0| 6e 2c 20 61 20 67 6f 6e | 61 64 6f 74 72 6f 70 69 |n, a gon|adotropi|
|000056d0| 6e 2d 72 65 6c 65 61 73 | 69 6e 67 20 68 6f 72 6d |n-releas|ing horm|
|000056e0| 6f 6e 65 0d 0a 61 67 6f | 6e 69 73 74 2c 20 77 61 |one..ago|nist, wa|
|000056f0| 73 20 63 6f 6d 70 61 72 | 65 64 20 77 69 74 68 20 |s compar|ed with |
|00005700| 6f 72 61 6c 20 64 61 6e | 61 7a 6f 6c 20 69 6e 20 |oral dan|azol in |
|00005710| 74 68 65 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |the trea|tment of|
|00005720| 20 65 6e 64 6f 6d 65 74 | 72 69 6f 73 69 73 20 69 | endomet|riosis i|
|00005730| 6e 20 32 31 33 0d 0a 70 | 61 74 69 65 6e 74 73 20 |n 213..p|atients |
|00005740| 77 68 6f 20 77 65 72 65 | 20 72 61 6e 64 6f 6d 69 |who were| randomi|
|00005750| 7a 65 64 20 74 6f 20 72 | 65 63 65 69 76 65 20 65 |zed to r|eceive e|
|00005760| 69 74 68 65 72 20 69 6e | 74 72 61 6e 61 73 61 6c |ither in|tranasal|
|00005770| 20 6e 61 66 61 72 65 6c | 69 6e 20 28 32 30 30 20 | nafarel|in (200 |
|00005780| 6f 72 20 34 30 30 0d 0a | 6d 75 5f 67 20 74 77 69 |or 400..|mu_g twi|
|00005790| 63 65 20 64 61 69 6c 79 | 29 20 61 6e 64 20 70 6c |ce daily|) and pl|
|000057a0| 61 63 65 62 6f 20 74 61 | 62 6c 65 74 73 20 6f 72 |acebo ta|blets or|
|000057b0| 20 64 61 6e 61 7a 6f 6c | 20 74 61 62 6c 65 74 73 | danazol| tablets|
|000057c0| 20 28 34 30 30 20 6d 67 | 20 74 77 69 63 65 20 64 | (400 mg| twice d|
|000057d0| 61 69 6c 79 29 0d 0a 77 | 69 74 68 20 70 6c 61 63 |aily)..w|ith plac|
|000057e0| 65 62 6f 20 6e 61 73 61 | 6c 20 73 70 72 61 79 2e |ebo nasa|l spray.|
|000057f0| 20 20 52 65 73 75 6c 74 | 73 20 6f 66 20 70 72 65 | Result|s of pre|
|00005800| 74 72 65 61 74 6d 65 6e | 74 20 61 6e 64 20 70 6f |treatmen|t and po|
|00005810| 73 74 74 72 65 61 74 6d | 65 6e 74 0d 0a 6c 61 70 |sttreatm|ent..lap|
|00005820| 61 72 6f 73 63 6f 70 69 | 65 73 20 77 65 72 65 20 |aroscopi|es were |
|00005830| 63 6f 6d 70 61 72 65 64 | 2e 0d 0a 20 20 20 20 20 |compared|... |
|00005840| 54 68 65 20 65 78 74 65 | 6e 74 20 6f 66 20 64 69 |The exte|nt of di|
|00005850| 73 65 61 73 65 20 77 61 | 73 20 72 65 64 75 63 65 |sease wa|s reduce|
|00005860| 64 20 69 6e 20 6d 6f 72 | 65 20 74 68 61 6e 20 38 |d in mor|e than 8|
|00005870| 30 25 20 6f 66 20 70 61 | 74 69 65 6e 74 73 20 69 |0% of pa|tients i|
|00005880| 6e 20 65 61 63 68 0d 0a | 67 72 6f 75 70 2e 20 20 |n each..|group. |
|00005890| 49 6e 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |In patie|nts with|
|000058a0| 20 61 64 76 61 6e 63 65 | 64 20 64 69 73 65 61 73 | advance|d diseas|
|000058b0| 65 20 74 68 65 72 61 70 | 79 20 63 6f 6e 73 69 64 |e therap|y consid|
|000058c0| 65 72 61 62 6c 79 20 64 | 65 63 72 65 61 73 65 64 |erably d|ecreased|
|000058d0| 20 74 6f 74 61 6c 0d 0a | 6d 65 61 6e 20 6c 61 70 | total..|mean lap|
|000058e0| 61 72 6f 73 63 6f 70 69 | 63 20 73 63 6f 72 65 73 |aroscopi|c scores|
|000058f0| 2e 20 20 54 68 65 20 70 | 65 72 63 65 6e 74 61 67 |. The p|ercentag|
|00005900| 65 20 6f 66 20 77 6f 6d | 65 6e 20 77 69 74 68 20 |e of wom|en with |
|00005910| 73 65 76 65 72 65 6c 79 | 20 70 61 69 6e 66 75 6c |severely| painful|
|00005920| 0d 0a 73 79 6d 70 74 6f | 6d 73 20 64 65 63 6c 69 |..sympto|ms decli|
|00005930| 6e 65 64 20 66 72 6f 6d | 20 34 30 25 20 74 6f 20 |ned from| 40% to |
|00005940| 6c 65 73 73 20 74 68 61 | 6e 20 31 30 25 2e 20 20 |less tha|n 10%. |
|00005950| 41 66 74 65 72 20 74 72 | 65 61 74 6d 65 6e 74 20 |After tr|eatment |
|00005960| 37 30 25 20 6f 66 20 70 | 61 74 69 65 6e 74 73 0d |70% of p|atients.|
|00005970| 0a 68 61 64 20 6c 69 74 | 74 6c 65 20 64 69 73 63 |.had lit|tle disc|
|00005980| 6f 6d 66 6f 72 74 2e 20 | 20 54 68 69 72 74 79 2d |omfort. | Thirty-|
|00005990| 6e 69 6e 65 20 70 65 72 | 63 65 6e 74 20 6f 66 20 |nine per|cent of |
|000059a0| 70 61 74 69 65 6e 74 73 | 20 77 68 6f 20 74 72 69 |patients| who tri|
|000059b0| 65 64 20 74 6f 20 62 65 | 63 6f 6d 65 0d 0a 70 72 |ed to be|come..pr|
|000059c0| 65 67 6e 61 6e 74 20 61 | 66 74 65 72 20 74 72 65 |egnant a|fter tre|
|000059d0| 61 74 6d 65 6e 74 20 77 | 65 72 65 20 73 75 63 63 |atment w|ere succ|
|000059e0| 65 73 73 66 75 6c 3b 20 | 72 61 74 65 73 20 77 65 |essful; |rates we|
|000059f0| 72 65 20 73 69 6d 69 6c | 61 72 20 69 6e 20 61 6c |re simil|ar in al|
|00005a00| 6c 20 67 72 6f 75 70 73 | 2e 0d 0a 20 20 20 20 20 |l groups|... |
|00005a10| 4e 61 66 61 72 65 6c 69 | 6e 20 69 73 20 65 66 66 |Nafareli|n is eff|
|00005a20| 65 63 74 69 76 65 20 61 | 73 20 74 68 65 72 61 70 |ective a|s therap|
|00005a30| 79 20 66 6f 72 20 65 6e | 64 6f 6d 65 74 72 69 6f |y for en|dometrio|
|00005a40| 73 69 73 2c 20 77 69 74 | 68 20 68 79 70 6f 65 73 |sis, wit|h hypoes|
|00005a50| 74 72 6f 67 65 6e 69 73 | 6d 0d 0a 62 65 69 6e 67 |trogenis|m..being|
|00005a60| 20 31 20 6f 66 20 74 68 | 65 20 66 65 77 20 73 69 | 1 of th|e few si|
|00005a70| 64 65 20 65 66 66 65 63 | 74 73 2e 0d 0a 0d 0a 50 |de effec|ts.....P|
|00005a80| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00005a90| 20 20 20 20 54 68 69 73 | 20 77 65 6c 6c 2d 64 6f | This| well-do|
|00005aa0| 6e 65 20 72 61 6e 64 6f | 6d 69 7a 65 64 20 74 72 |ne rando|mized tr|
|00005ab0| 69 61 6c 20 69 6e 64 69 | 63 61 74 65 73 20 74 68 |ial indi|cates th|
|00005ac0| 61 74 20 75 73 65 20 6f | 66 20 61 0d 0a 67 6f 6e |at use o|f a..gon|
|00005ad0| 61 64 6f 74 72 6f 70 69 | 6e 2d 72 65 6c 65 61 73 |adotropi|n-releas|
|00005ae0| 69 6e 67 20 68 6f 72 6d | 6f 6e 65 20 61 67 6f 6e |ing horm|one agon|
|00005af0| 69 73 74 20 77 61 73 20 | 61 73 20 65 66 66 65 63 |ist was |as effec|
|00005b00| 74 69 76 65 20 61 73 20 | 61 20 68 69 67 68 20 64 |tive as |a high d|
|00005b10| 6f 73 65 20 6f 66 0d 0a | 64 61 6e 61 7a 6f 6c 20 |ose of..|danazol |
|00005b20| 66 6f 72 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |for trea|tment of|
|00005b30| 20 6d 6f 64 65 72 61 74 | 65 20 61 6e 64 20 73 65 | moderat|e and se|
|00005b40| 76 65 72 65 20 65 6e 64 | 6f 6d 65 74 72 69 6f 73 |vere end|ometrios|
|00005b50| 69 73 2e 20 20 53 69 64 | 65 20 65 66 66 65 63 74 |is. Sid|e effect|
|00005b60| 73 20 6f 66 0d 0a 68 79 | 70 6f 65 73 74 72 6f 67 |s of..hy|poestrog|
|00005b70| 65 6e 69 73 6d 2c 20 73 | 75 63 68 20 61 73 20 68 |enism, s|uch as h|
|00005b80| 6f 74 20 66 6c 75 73 68 | 65 73 20 61 6e 64 20 76 |ot flush|es and v|
|00005b90| 61 67 69 6e 61 6c 20 64 | 72 79 6e 65 73 73 2c 20 |aginal d|ryness, |
|00005ba0| 6f 63 63 75 72 72 65 64 | 20 77 69 74 68 20 62 6f |occurred| with bo|
|00005bb0| 74 68 0d 0a 61 67 65 6e | 74 73 20 62 75 74 20 77 |th..agen|ts but w|
|00005bc0| 65 72 65 20 6d 6f 72 65 | 20 63 6f 6d 6d 6f 6e 20 |ere more| common |
|00005bd0| 77 69 74 68 20 6e 61 66 | 61 72 65 6c 69 6e 2e 20 |with naf|arelin. |
|00005be0| 20 48 6f 77 65 76 65 72 | 2c 20 61 6e 64 72 6f 67 | However|, androg|
|00005bf0| 65 6e 69 63 20 65 66 66 | 65 63 74 73 20 73 75 63 |enic eff|ects suc|
|00005c00| 68 20 61 73 0d 0a 77 65 | 69 67 68 74 20 67 61 69 |h as..we|ight gai|
|00005c10| 6e 20 61 6e 64 20 61 63 | 6e 65 20 6f 63 63 75 72 |n and ac|ne occur|
|00005c20| 72 65 64 20 6f 6e 6c 79 | 20 77 69 74 68 20 64 61 |red only| with da|
|00005c30| 6e 61 7a 6f 6c 2e 20 20 | 44 61 6e 61 7a 6f 6c 2c |nazol. |Danazol,|
|00005c40| 20 62 75 74 20 6e 6f 74 | 20 6e 61 66 61 72 65 6c | but not| nafarel|
|00005c50| 69 6e 2c 0d 0a 61 64 76 | 65 72 73 65 6c 79 20 61 |in,..adv|ersely a|
|00005c60| 66 66 65 63 74 73 20 74 | 68 65 20 6c 69 70 69 64 |ffects t|he lipid|
|00005c70| 20 70 72 6f 66 69 6c 65 | 2c 20 77 68 65 72 65 61 | profile|, wherea|
|00005c80| 73 20 6e 61 66 61 72 65 | 6c 69 6e 20 63 61 75 73 |s nafare|lin caus|
|00005c90| 65 73 20 61 20 72 65 64 | 75 63 74 69 6f 6e 20 69 |es a red|uction i|
|00005ca0| 6e 0d 0a 62 6f 6e 65 20 | 64 65 6e 73 69 74 79 2e |n..bone |density.|
|00005cb0| 20 20 4e 61 66 61 72 65 | 6c 69 6e 20 61 6c 73 6f | Nafare|lin also|
|00005cc0| 20 68 61 73 20 74 6f 20 | 62 65 20 67 69 76 65 6e | has to |be given|
|00005cd0| 20 62 79 20 6e 61 73 61 | 6c 20 73 70 72 61 79 2c | by nasa|l spray,|
|00005ce0| 20 61 6e 64 20 64 61 6e | 61 7a 6f 6c 20 63 61 6e | and dan|azol can|
|00005cf0| 20 62 65 0d 0a 74 61 6b | 65 6e 20 6f 72 61 6c 6c | be..tak|en orall|
|00005d00| 79 2e 20 20 4e 61 66 61 | 72 65 6c 69 6e 20 69 73 |y. Nafa|relin is|
|00005d10| 20 6e 6f 74 20 79 65 74 | 20 6d 61 72 6b 65 74 65 | not yet| markete|
|00005d20| 64 20 66 6f 72 20 75 73 | 65 20 61 73 20 74 72 65 |d for us|e as tre|
|00005d30| 61 74 6d 65 6e 74 20 6f | 66 0d 0a 65 6e 64 6f 6d |atment o|f..endom|
|00005d40| 65 74 72 69 6f 73 69 73 | 2c 20 62 75 74 20 77 68 |etriosis|, but wh|
|00005d50| 65 6e 20 69 74 20 69 73 | 2c 20 74 68 65 20 63 6f |en it is|, the co|
|00005d60| 73 74 20 6f 66 20 74 68 | 65 20 32 20 61 67 65 6e |st of th|e 2 agen|
|00005d70| 74 73 20 61 73 20 77 65 | 6c 6c 20 61 73 20 74 68 |ts as we|ll as th|
|00005d80| 65 20 64 69 66 66 65 72 | 65 6e 74 0d 0a 73 69 64 |e differ|ent..sid|
|00005d90| 65 20 65 66 66 65 63 74 | 73 20 6d 75 73 74 20 62 |e effect|s must b|
|00005da0| 65 20 63 6f 6e 73 69 64 | 65 72 65 64 20 77 68 65 |e consid|ered whe|
|00005db0| 6e 20 64 65 63 69 64 69 | 6e 67 20 77 68 69 63 68 |n decidi|ng which|
|00005dc0| 20 6f 6e 65 20 74 6f 20 | 75 73 65 20 66 6f 72 20 | one to |use for |
|00005dd0| 61 6e 20 69 6e 64 69 76 | 69 64 75 61 6c 0d 0a 70 |an indiv|idual..p|
|00005de0| 61 74 69 65 6e 74 2e 2d | 2d 44 2e 52 2e 20 4d 69 |atient.-|-D.R. Mi|
|00005df0| 73 68 65 6c 6c 2c 20 4a | 72 2e 2c 20 4d 2e 44 2e |shell, J|r., M.D.|
|00005e00| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|00005e10| 30 38 36 30 36 7d 0d 0a | 24 54 69 74 6c 65 7b 4e |08606}..|$Title{N|
|00005e20| 6f 6e 6f 70 65 72 61 74 | 69 76 65 20 45 6d 62 72 |onoperat|ive Embr|
|00005e30| 79 6f 20 54 72 61 6e 73 | 66 65 72 20 74 6f 20 74 |yo Trans|fer to t|
|00005e40| 68 65 20 46 61 6c 6c 6f | 70 69 61 6e 20 54 75 62 |he Fallo|pian Tub|
|00005e50| 65 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 0d 0a 4a 61 |e}..$Aut|hor{..Ja|
|00005e60| 6e 73 65 6e 2c 20 52 50 | 53 0d 0a 41 6e 64 65 72 |nsen, RP|S..Ander|
|00005e70| 73 6f 6e 2c 20 4a 43 0d | 0a 53 75 74 68 65 72 6c |son, JC.|.Sutherl|
|00005e80| 61 6e 64 2c 20 50 44 7d | 0d 0a 24 41 66 66 69 6c |and, PD}|..$Affil|
|00005e90| 69 61 74 69 6f 6e 7b 52 | 6f 79 61 6c 20 50 72 69 |iation{R|oyal Pri|
|00005ea0| 6e 63 65 20 41 6c 66 72 | 65 64 20 48 6f 73 70 2c |nce Alfr|ed Hosp,|
|00005eb0| 20 53 79 64 6e 65 79 2c | 20 41 75 73 74 72 61 6c | Sydney,| Austral|
|00005ec0| 69 61 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 45 6d |ia}..$Su|bject{Em|
|00005ed0| 62 72 79 6f 2c 20 74 72 | 61 6e 73 66 65 72 2c 20 |bryo, tr|ansfer, |
|00005ee0| 74 6f 20 66 61 6c 6c 6f | 70 69 61 6e 20 74 75 62 |to fallo|pian tub|
|00005ef0| 65 2c 20 6e 6f 6e 6f 70 | 65 72 61 74 69 76 65 0d |e, nonop|erative.|
|00005f00| 0a 46 61 6c 6c 6f 70 69 | 61 6e 2c 20 74 75 62 65 |.Fallopi|an, tube|
|00005f10| 2c 20 65 6d 62 72 79 6f | 20 74 72 61 6e 73 66 65 |, embryo| transfe|
|00005f20| 72 20 74 6f 2c 20 6e 6f | 6e 6f 70 65 72 61 74 69 |r to, no|noperati|
|00005f30| 76 65 7d 0d 0a 24 4a 6f | 75 72 6e 61 6c 7b 4e 20 |ve}..$Jo|urnal{N |
|00005f40| 45 6e 67 6c 20 4a 20 4d | 65 64 7d 0d 0a 24 56 6f |Engl J M|ed}..$Vo|
|00005f50| 6c 75 6d 65 7b 33 31 39 | 7d 0d 0a 24 50 61 67 65 |lume{319|}..$Page|
|00005f60| 7b 32 38 38 2d 32 39 31 | 7d 0d 0a 24 44 61 74 65 |{288-291|}..$Date|
|00005f70| 7b 41 75 67 20 34 2c 20 | 31 39 38 38 7d 0d 0a 24 |{Aug 4, |1988}..$|
|00005f80| 59 42 56 6f 6c 7b 31 39 | 38 39 20 59 65 61 72 20 |YBVol{19|89 Year |
|00005f90| 42 6f 6f 6b 20 6f 66 20 | 49 6e 66 65 72 74 69 6c |Book of |Infertil|
|00005fa0| 69 74 79 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 31 |ity}..$C|hapter{1|
|00005fb0| 33 2d 31 37 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |3-17}..$|YBEditor|
|00005fc0| 7b 44 72 73 2e 20 4d 69 | 73 68 65 6c 6c 2c 20 50 |{Drs. Mi|shell, P|
|00005fd0| 61 75 6c 73 65 6e 2c 20 | 61 6e 64 20 4c 6f 62 6f |aulsen, |and Lobo|
|00005fe0| 7d 0d 0a 24 54 61 62 6c | 65 7b 7d 0d 0a 24 43 6f |}..$Tabl|e{}..$Co|
|00005ff0| 6d 6d 65 6e 74 61 74 6f | 72 7b 44 2e 52 2e 20 4d |mmentato|r{D.R. M|
|00006000| 69 73 68 65 6c 6c 2c 20 | 4a 72 2e 2c 20 4d 2e 44 |ishell, |Jr., M.D|
|00006010| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00006020| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00006030| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00006040| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00006050| 31 39 38 38 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1988 Yea|r Book o|
|00006060| 66 20 49 6e 66 65 72 74 | 69 6c 69 74 79 20 28 52 |f Infert|ility (R|
|00006070| 29 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 31 33 2d |)....Cha|pter 13-|
|00006080| 2d 41 73 73 69 73 74 65 | 64 20 52 65 70 72 6f 64 |-Assiste|d Reprod|
|00006090| 75 63 74 69 76 65 20 54 | 65 63 68 6e 6f 6c 6f 67 |uctive T|echnolog|
|000060a0| 69 65 73 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ies....-|--------|
|000060b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060f0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 4e 6f 6e 6f 70 65 72 |-------.|.Nonoper|
|00006100| 61 74 69 76 65 20 45 6d | 62 72 79 6f 20 54 72 61 |ative Em|bryo Tra|
|00006110| 6e 73 66 65 72 20 74 6f | 20 74 68 65 20 46 61 6c |nsfer to| the Fal|
|00006120| 6c 6f 70 69 61 6e 20 54 | 75 62 65 0d 0a 0d 0a 4a |lopian T|ube....J|
|00006130| 61 6e 73 65 6e 20 52 50 | 53 3b 20 41 6e 64 65 72 |ansen RP|S; Ander|
|00006140| 73 6f 6e 20 4a 43 3b 20 | 53 75 74 68 65 72 6c 61 |son JC; |Sutherla|
|00006150| 6e 64 20 50 44 0d 0a 28 | 52 6f 79 61 6c 20 50 72 |nd PD..(|Royal Pr|
|00006160| 69 6e 63 65 20 41 6c 66 | 72 65 64 20 48 6f 73 70 |ince Alf|red Hosp|
|00006170| 2c 20 53 79 64 6e 65 79 | 2c 20 41 75 73 74 72 61 |, Sydney|, Austra|
|00006180| 6c 69 61 29 0d 0a 4e 20 | 45 6e 67 6c 20 4a 20 4d |lia)..N |Engl J M|
|00006190| 65 64 20 33 31 39 3a 32 | 38 38 2d 32 39 31 2c 20 |ed 319:2|88-291, |
|000061a0| 41 75 67 20 34 2c 20 31 | 39 38 38 0d 0a 2d 2d 2d |Aug 4, 1|988..---|
|000061b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00006200| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00006210| 20 20 41 20 6d 65 74 68 | 6f 64 20 6f 66 20 63 61 | A meth|od of ca|
|00006220| 74 68 65 74 65 72 69 7a | 69 6e 67 20 74 68 65 20 |theteriz|ing the |
|00006230| 66 61 6c 6c 6f 70 69 61 | 6e 20 74 75 62 65 73 20 |fallopia|n tubes |
|00006240| 66 72 6f 6d 20 74 68 65 | 20 76 61 67 69 6e 61 20 |from the| vagina |
|00006250| 75 73 69 6e 67 20 61 0d | 0a 73 79 73 74 65 6d 20 |using a.|.system |
|00006260| 6f 66 20 73 6c 69 64 69 | 6e 67 20 63 61 74 68 65 |of slidi|ng cathe|
|00006270| 74 65 72 73 20 77 61 73 | 20 64 65 76 65 6c 6f 70 |ters was| develop|
|00006280| 65 64 2e 20 20 4e 6f 72 | 6d 61 6c 20 70 72 65 67 |ed. Nor|mal preg|
|00006290| 6e 61 6e 63 69 65 73 20 | 68 61 76 65 20 72 65 73 |nancies |have res|
|000062a0| 75 6c 74 65 64 0d 0a 66 | 72 6f 6d 20 74 72 61 6e |ulted..f|rom tran|
|000062b0| 73 66 65 72 72 69 6e 67 | 20 73 70 65 72 6d 20 74 |sferring| sperm t|
|000062c0| 6f 20 74 68 65 20 74 75 | 62 61 6c 20 69 73 74 68 |o the tu|bal isth|
|000062d0| 6d 75 73 20 6a 75 73 74 | 20 62 65 66 6f 72 65 20 |mus just| before |
|000062e0| 6f 76 75 6c 61 74 69 6f | 6e 2e 20 20 54 68 65 0d |ovulatio|n. The.|
|000062f0| 0a 70 72 6f 63 65 64 75 | 72 65 20 63 61 6e 20 62 |.procedu|re can b|
|00006300| 65 20 70 65 72 66 6f 72 | 6d 65 64 20 69 6e 20 74 |e perfor|med in t|
|00006310| 68 65 20 6f 66 66 69 63 | 65 2e 20 20 46 6f 6c 6c |he offic|e. Foll|
|00006320| 69 63 6c 65 73 20 61 72 | 65 20 61 73 70 69 72 61 |icles ar|e aspira|
|00006330| 74 65 64 0d 0a 74 72 61 | 6e 73 76 61 67 69 6e 61 |ted..tra|nsvagina|
|00006340| 6c 6c 79 20 69 6e 20 77 | 6f 6d 65 6e 20 77 69 74 |lly in w|omen wit|
|00006350| 68 20 6e 6f 72 6d 61 6c | 20 74 75 62 65 73 3b 20 |h normal| tubes; |
|00006360| 61 66 74 65 72 20 69 6e | 20 76 69 74 72 6f 20 66 |after in| vitro f|
|00006370| 65 72 74 69 6c 69 7a 61 | 74 69 6f 6e 2c 20 65 61 |ertiliza|tion, ea|
|00006380| 72 6c 79 0d 0a 65 6d 62 | 72 79 6f 73 20 61 72 65 |rly..emb|ryos are|
|00006390| 20 74 72 61 6e 73 66 65 | 72 72 65 64 20 6e 6f 6e | transfe|rred non|
|000063a0| 6f 70 65 72 61 74 69 76 | 65 6c 79 2e 0d 0a 20 20 |operativ|ely... |
|000063b0| 20 20 20 54 68 65 20 63 | 61 74 68 65 74 65 72 20 | The c|atheter |
|000063c0| 73 65 74 20 63 6f 6e 73 | 69 73 74 73 20 6f 66 20 |set cons|ists of |
|000063d0| 69 6e 6e 65 72 20 61 6e | 64 20 6f 75 74 65 72 20 |inner an|d outer |
|000063e0| 63 61 6e 6e 75 6c 61 73 | 20 61 6e 64 20 61 20 6d |cannulas| and a m|
|000063f0| 61 6c 6c 65 61 62 6c 65 | 20 6d 65 74 61 6c 0d 0a |alleable| metal..|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.
