PROSTAGLANDINS

LETTER

TO E D I T O R

Sirs: The w o r k of K o r d a et al ( P r b s t a g l a n d i n s , 9:443) i m p l i e d PGF?~ i n j e c t e d in m i c r o d o s e s into the corpus luteum, might be l u t e o I ~ t i c in the h u m a n (i). This e x p e r i m e n t a l a p p r o a c h was a p p a r e n t l y aiming at an answer for the concept w h e t h e r PGF_ d e l i v e r e d to the corpus luteum in s u f f i c i e n t c o n c e n t r a t i o n ~ has any l u t e o l y t i c effect in the human. If this proves true, then local o v a r i a n p r o d u c t i o n of PGF?_ may be the p h y s i o l o g i c a l m e c h a n i s m r e g u l a t i n g luteal regressib~. Moreover, it w o u l d e n c o u r a g e further e x p e n d i t u r e of effort and money in search for a c l i n i c a l l y a c c e p t a b l e a p p r o a c h to u t i l i z e PGs as l u t e o l y t i c agents. The f o l l o w i n g c o m p r i s e attempts at s p e c u l a t i o n as how to arrive to such aim: that

i) A p r o l o n g e d a p p l i c a t i o n of a PG c o m p o u n d (natural or synthetic analogues) in low doses via a slow release s y s t e m e.g. s i a l a s t i c v a g i n a l or i n t r a - u t e r l n e rings. 2) Systemic testing of new a n a l o g u e s in the hope of spotting c o m p o u n d w i t h a m a r k e d p r o l o n g a t i o n of action and an enh a n c e d luteal s p e c i f i c i t y r e l a t i v e to other tissues.

a

F a s c i n a t e d by the same t h e o r e t i c a l a s s u m p t i o n , a similar study (2), though s l i g h t l y d i f f e r i n g in design, was carried out in our d e p a r t m e n t and the data were p r e s e n t e d in a meeting " P r o s t a g l a n d i n s in H u m a n R e p r o d u c t i o n " held in June 1974. In three patients, 500 ~g PGF2_ (0.5 ml) were i n j e c t e d into the corpus luteum during l a p a r o ~ o m i e s that i n v o l v e d m i n i m a l manip u l a t i o n s of the adnexa. Two other patients served as controls w h e r e the i n j e c t i o n (0.3-0.5 ml) c o n t a i n e d n o r m a l saline only. All the cases (whether PGF9_ or saline) got m e n s t r u a l like b l e e d i n g w i t h i n 1-2 days a n d ' ~ h e i r p e r i p h e r a l venous p l a s m a d e m o n s t r a t e d a rapid and s i g n i f i c a n t drop in p r o g e s terone levels (table I). The m a j o r d i f f e r e n c e s b e t w e e n our study and that of K o r d a et al was the m e t h o d and volume of i n j e c t i o n ( l a p a r o s c o p y and 0.i ml in their study versus 0.3-0.5 ml by l a p a r o t o m y in ours). K o r d a et al drew more samples at s p e c i f i c dates in the cycle and p e r f o r m e d tubal d i a t h e r m y in their cases. However, they did not include a control group in the study.

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OCTOBER 1975

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PROSTAGLANDINS

Table I.

Patients

Clinical data of cases given operative intra-luteal injection of PG or normal saline (controls). Average duration of menst, cycle(days)

Operation day in cycle

Compound

Onset of bleeding after op. (days)

Shorter duration of cycle (days) - 8 - 8

Change in duration of bleeding (days)

A.M.A. F.M.

27 21

17 12

PGF~ PGF~

2 i

S.M.

28

18

PGF2~

2

- 8

0

C.F. B.M.

26 28

20 24

Saline Saline

1 1

- 5 - 3

0 - 2

(+ i)*

+ I - i

(+ 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 t h e r e f o r e a p p e a r e d to us t h a t the m e n s t r u a l like b l e e d ing and the drop in p l a s m a p r o g e s t e r o n e levels f o l l o w i n g intral u t e a l i n j e c t i o n (PGF2~ or saline) w e r e p r o b a b l y s e c o n d a r y to the t r a u m a t i c m a n i p u l a t i o n s of the i n j e c t i o n p r o c e d u r e or the induced luteal distension, acting as n o n - p h a r m a c o l o g l c a l f a c t o r s i n t e r f e r i n g with luteal function. However, this Still does not e x c l u d e that PGF2~ may p o s s e s s a l u t e o l y t l c p r o p e r t y w h e n del i v e r e d to the l u ~ e a l tissue in s u f f i c i e n t c o n c e n t r a t i o n s or c h r o n i c a l l y in l o w e r doses p r o v i d e d that some other d e s i g n (nontraumatic) w o u l d be utilized. REFERENCES (I) Korda, A.R., D.A. Shutt, I.D. Smith, R.P. S h e a r m a n and R.C. Lyneham. A s s e s s m e n t of p o s s i b l e l u t e o l y t l c effect of i n t r a - o v a r l a n i n j e c t i o n of p r o s t a g l a n d l n F2= in the human, P r o s t a g l a n d l n s 9:443, 1975. (2) T o p p o z a d a , M., M.A. R i z k and W. Ei-Agouz. Corpus l u t e u m d e m i s e by p r o s t a g l a n d l n Fg~. In: P r o s t a g l a n d i n s in h u m a n r e p r o d u c t i o n (ed.: M. T o p ~ z a d a ) , Alexandria Uniyersity Press, A l e x a n d r i a , 1974.

M o k h t a r T o p p o z a d a , M.D. Associate Professor D e p a r t m e n t of O b s t e t r i c s & G y n e c o l o g y The U n i v e r s i t y of A l e x a n d r i a , Egypt

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O C T O B E R 1975

VOL. 10 NO. 4

Letter: Luteolytic effect of intraluteally administered PGF2 alpha.

PROSTAGLANDINS LETTER TO E D I T O R Sirs: The w o r k of K o r d a et al ( P r b s t a g l a n d i n s , 9:443) i m p l i e d PGF?~ i n j e c t e...
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