Letter to editor
2
PROSTAGLANDINS LETTER TO EDITOR Sirs: The work of Korda et al (Prbstaglandins, 9:443) implied that PGF?~ injected in microdoses into the corpus luteum, might be luteoI~tic in the human (i). This experimental approach was apparently aiming at an answer for the concept whether PGF_ delivered to the corpus luteum in sufficient concentration~ has any luteolytic effect in the human. If this proves true, then local ovarian production of PGF?_ may be the physiological mechanism regulating luteal regressib~. Moreover, it would encourage further expenditure of effort and money in search for a clinically acceptable approach to utilize PGs as luteolytic agents. The following comprise attempts at speculation as how to arrive to such aim: i) A prolonged application of a PG compound (natural or synthe- tic analogues) in low doses via a slow release system e.g. sialastic vaginal or intra-uterlne rings. 2) Systemic testing of new analogues in the hope of spotting a compound with a marked prolongation of action and an en- hanced luteal specificity relative to other tissues. Fascinated by the same theoretical assumption, a similar study (2), though slightly differing in design, was carried out in our department and the data were presented in a meeting "Prostaglandins in Human Reproduction" held in June 1974. In three patients, 500 ~g PGF2_ (0.5 ml) were injected into the corpus luteum during laparo~omies that involved minimal mani- pulations of the adnexa. Two other patients served as con- trols where the injection (0.3-0.5 ml) contained normal saline only. All the cases (whether PGF9_ or saline) got menstrual like bleeding within 1-2 days and'~heir peripheral venous plasma demonstrated a rapid and significant drop in proges- terone levels (table I). The major differences between our study and that of Korda et al was the method and volume of injection (laparoscopy and 0.i ml in their study versus 0.3-0.5 ml by laparotomy in ours). Korda et al drew more samples at specific dates in the cycle and performed tubal diathermy in their cases. However, they did not include a control group in the study. 9-29 -75 OCTOBER 1975 +COL. 10 NO. 4 725
Transcript of Letter to editor
PROSTAGLANDINS
LETTER TO EDITOR
Sirs:
The work of Korda et al (Prbstaglandins, 9:443) implied that PGF?~ injected in microdoses into the corpus luteum, might be luteoI~tic in the human (i). This experimental approach was apparently aiming at an answer for the concept whether PGF_ delivered to the corpus luteum in sufficient concentration~ has any luteolytic effect in the human. If this proves true, then local ovarian production of PGF?_ may be the physiological mechanism regulating luteal regressib~. Moreover, it would encourage further expenditure of effort and money in search for a clinically acceptable approach to utilize PGs as luteolytic agents. The following comprise attempts at speculation as how to arrive to such aim:
i) A prolonged application of a PG compound (natural or synthe- tic analogues) in low doses via a slow release system e.g. sialastic vaginal or intra-uterlne rings.
2) Systemic testing of new analogues in the hope of spotting a compound with a marked prolongation of action and an en- hanced luteal specificity relative to other tissues.
Fascinated by the same theoretical assumption, a similar study (2), though slightly differing in design, was carried out in our department and the data were presented in a meeting "Prostaglandins in Human Reproduction" held in June 1974. In three patients, 500 ~g PGF2_ (0.5 ml) were injected into the corpus luteum during laparo~omies that involved minimal mani- pulations of the adnexa. Two other patients served as con- trols where the injection (0.3-0.5 ml) contained normal saline only. All the cases (whether PGF9_ or saline) got menstrual like bleeding within 1-2 days and'~heir peripheral venous plasma demonstrated a rapid and significant drop in proges- terone levels (table I).
The major differences between our study and that of Korda et al was the method and volume of injection (laparoscopy and 0.i ml in their study versus 0.3-0.5 ml by laparotomy in ours). Korda et al drew more samples at specific dates in the cycle and performed tubal diathermy in their cases. However, they did not include a control group in the study.
9-29 -75
OCTOBER 1975 +COL. 10 NO. 4 725
PROSTAGLANDINS
Table I. Clinical data of cases given operative intra-luteal injection of PG or normal saline (controls).
Average Opera- Onset of Shorter Change in Patients duration tion Compound bleeding duration duration of
of menst, day in after op. of cycle bleeding cycle(days) cycle (days) (days) (days)
A.M.A. 27 17 PGF~ 2 - 8 + I F.M. 21 12 PGF~ i - 8 - i
(+ i)* (+ 2)* S.M. 28 18 PGF2~ 2 - 8 0
C.F. 26 20 Saline 1 - 5 0 B.M. 28 24 Saline 1 - 3 - 2
* Another phase of uterine bleeding occurred one day after the expected time of menses and continued for two days more than the average for this patient.
It therefore appeared to us that the menstrual like bleed- ing and the drop in plasma progesterone levels following intra- luteal injection (PGF2~ or saline) were probably secondary to the traumatic manipulations of the injection procedure or the in- duced luteal distension, acting as non-pharmacologlcal factors interfering with luteal function. However, this Still does not exclude that PGF2~ may possess a luteolytlc property when de- livered to the lu~eal tissue in sufficient concentrations or chronically in lower doses provided that some other design (non- traumatic) would be utilized.
REFERENCES
(I) Korda, A.R., D.A. Shutt, I.D. Smith, R.P. Shearman and R.C. Lyneham. Assessment of possible luteolytlc effect of intra-ovarlan injection of prostaglandln F2= in the human, Prostaglandlns 9:443, 1975.
(2) Toppozada, M., M.A. Rizk and W. Ei-Agouz. Corpus luteum demise by prostaglandln Fg~. In: Prostaglandins in human reproduction (ed.: M. Top~zada), Alexandria Uniyersity Press, Alexandria, 1974.
Mokhtar Toppozada, M.D. Associate Professor Department of Obstetrics & Gynecology The University of Alexandria, Egypt
726 OCTOBER 1975 VOL. 10 NO. 4
