A randomized, double-blind, group-comparative study was performed over a 6 month period to compare ovarian suppression and vaginal bleeding during the use of three oral contraceptives containing doses of 30, 50 or 75 micrograms desogestrel. A total of 44 female volunteers with regular cycles and established ovulation by ultrasonography were recruited from an out-patient clinic in a university hospital and asked to participate in the study. Ultrasonography and serum oestradiol and progesterone measurements were performed during two assessment periods. The 75 microgram dose showed complete suppression of ovulation and a more acceptable bleeding pattern than the lower doses. The 75 microgram dose of desogestrel is the most promising dose for the development of a new progestogen-only oral contraceptive agent.

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Keywords Large ovarian cyst . Laparoscopic management and ovarian cyst Case reportWe present a case of laparoscopic drainage and excision of a large ovarian cyst. A 22-year-old, nulliparous woman presented to a general practitioner with occasional rightsided upper abdominal pain. An abdominal ultrasound was arranged to assess the biliary system. However, the scan identified a huge ovarian cyst filling the entire abdominal cavity from the epigastrium to the pouch of Douglas. An urgent review was arranged at the gynaecology clinic. There was generalized distension of the abdomen, but the margins of the cyst were not palpable. A repeat pelvic ultrasound scan was arranged in the gynaecological ultrasound department to examine the cyst in detail. It appeared simple in nature, with a unilocular fluid-filled cavity. The approximate size was 50×30×13 cm. No solid elements, ascites or renal system dilatation was noted on ultrasound. CA-125(15 iu/ml), CEA (2 ng/ml) and HCG (<5 iu/l) were all normal. After detailed discussion with the patient about the management options, a decision was made to perform laparoscopic drainage and excision of the cyst. The patient was aware of the possibility of oophrectomy and laparotomy if complications arose during the procedure or if it proved impossible to excise the cyst laparoscpically.The procedure was performed under general anaesthetic in the lithotomy position. A Veres needle was inserted through the umbilicus into the cyst as for routine laparoscopy and 5,800 ml of straw-coloured fluid was drained through the suction apparatus till the fluid stopped draining. The Veres needle was than removed and reinserted at the same point and CO2 in-sufflation was performed as per routine. A 10-mm trocar was then inserted with ease into the peritoneal cavity. The cyst had completely collapsed and the detailed inspection revealed origin from the right adnexa possibly ovarian in nature, but the right ovary appeared healthy and well preserved. The left ovary also appeared normal. The cyst had expanded in the mesosalpinx and broad ligament and had involved the right tube. Ureters were identified separately on both sides. Two further 5-mm ports were inserted in the suprapubic area on either side of the midline. Right partial salpingectomy and excision of the base of the cyst were performed with bipolar diathermy and laparoscpic scissors. Hemostasis was secured using bipolar diathermy. The cyst was then grasped with lockable laparoscpic forceps inserted through a suprapubic port on the left. The portal entry incision was enlarged by a further 1 cm as the port, forceps and cyst were being removed under direct vision. The cyst was removed piecemeal and both ovaries were preserved. The patient made an uneventful post-operative recovery with minimal use of oral analgesics only and was discharged the next day.The histology showed a unilocilar thin-walled cyst. The cyst wall was composed of fibrous tissue and was lined by tubal-type cuboidal epithelium. No background ovarian tissue was seen. Attached to the...

A 32 year old lady attended the subfertility clinic with a 12 month history of primary infertility. Medical history and examination were unremarkable. She had regular cycles, 6/31. Routine hormone investigations were normal as was her husband's seminal analysis. Temperatures showed no evidence of ovulation and luteal phase serum progesterone assays confirmed anovulation (day 21, 0.7; day 24, 0.9; day 28, I .3 nmol/l). The patient was prescribed clomiphene citrate 50mg on days 2 4 of her cycles, which shortened to 28 days. Serum progesterone concentrations remained low (day 18, 0.7; day 24, 0.9 nmol/l). Clomiphene was increased to 100 mg doses and in the next two cycles serum progesterones were:day 19,6.9; day 22, 32.7; day 26, 21.0 nmol/l; followed by day 18, 0.3; day 22, 24.8; day 24, 12.9nmol/l. assayed using Coat-a-Count (Diagnostic Products).Our policy would be to regard these values as inadequate but conception was achieved In this final cycle. No progesterone supplements were given and no further progesterone assays performed. The patient has since given birth to non-identical twins. DiscussionPituitary and gonadal hormones in women during spontaneous and induced ovulatory cycles. Recent Progress in Hormone Research 26, 1 4 2 . Soules M. R., Clifton D. K., Steiner R. A,, Cohen N. L. J Obstet Gynaecol Downloaded from informahealthcare.com by Monash University on 02/03/15 For personal use only.

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