Coadministration of lutropin alfa 75 IU and follitropin alfa is safe and effective in inducing follicular development and pregnancy in hypogonadotrophic hypogonadal women with profound gonadotrophin deficiency in a setting consistent with established medical practice.

Objective : To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome. Design : Retrospective longitudinal cohort study. Setting : Tertiary referral centre/university hospital. Patients : Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers. Interventions : Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles ≥ 5 mm was subjectively assessed using a modified grading system (grades 0-4). Main outcome measures : Ovarian PFBF and pregnancy. Results : Treatment cycles were retrospectively divided into two groups: Group 1 (n = 20) had cycles with at least one small (5-10 mm) or medium (11-14 mm) size follicle(s) of high grade (2-4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n = 17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1-3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1-35.7) compared to Group 2. Conclusion : High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.

Summary and conclusionsPlasma concentrations and total amounts of pregnancy associated plasma protein A were determined in 272 patients at 34 weeks' gestation by immunoelectrophoretic assay. The mean plasma concentration and mean total amount of this protein were closely related (r=0 9643) and were significantly raised in patients who subsequently developed pre-eclampsia (28 patients), went into premature labour (12), or suffered from antepartum haemorrhage (10). Mean values in all patients delivering growth-retarded babies were also raised, but when the results for such patients who also had other complications were excluded there were no differences between the sets of means.The assays were easily performed, and they may be a useful technique for screening pregnant women to detect those at risk of developing pre-eclamptic toxaemia, although the full potential of these assays cannot be realised until the protein's function is known.

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Summary The plasma concentration of pregnancy‐associated plasma protein A (PAPP‐A) was measured in 34 women during the last 10 weeks of pregnancy. From 30 to 36 weeks the concentration of this protein increased steadily. Thereafter the concentration of PAPP‐A rose more steeply, the highest amounts being found in early labour. The concentration of PAPP‐A in peripheral venous blood and in the uterine vein was much the same. It was less in the retroplacental blood and a great deal less in the peritoneal fluid. The day‐to‐day variation was small; the coefficient of variation at 38 weeks was only 7.3 per cent. After delivery, the concentration of PAPP‐A fell more slowly than other placental proteins and steroids, the average half‐life being 51 hours. Although there is no doubt that PAPP‐A is a product of the syncytiotrophoblast, our findings suggest that it is not simply secreted by the chorionic villi directly into the intervillous space but makes its way into the maternal circulation by a more circuitous route.