E A Lenton

University of Malaya, Kuala Lumpor, Kuala Lumpur, Malaysia

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Publications (110)317.04 Total impact


    Annals of the New York Academy of Sciences 12/2006; 541(1):498 - 509. DOI:10.1111/j.1749-6632.1988.tb22286.x · 4.38 Impact Factor
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    ABSTRACT: The distribution of the length of the luteal phase was investigated in 187 women with regular, apparently ovulatory menstrual cycles of whom 95 had unexplained infertility and the other 92 comprised a group of healthy volunteer subjects. If the short luteal phase is associated with infertility it might be expected t o occur more frequently in women with unexplained infertility. A short luteal phase (defined as a luteal phase lasting ≤ 11 days) was found in 9% of the infertile group and in 8% of the normal group showing that these cycles do not occur more frequently in women with infertility.
    BJOG An International Journal of Obstetrics & Gynaecology 08/2005; 91(11):1120 - 1122. DOI:10.1111/j.1471-0528.1984.tb15087.x · 3.45 Impact Factor
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    P Y S Tay · E A Lenton ·
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    ABSTRACT: This is a prospeve randomised study designed to clarify the impact of various luteal support regimes (HCG and progesterone) on progesterone profiles and pregnancy outcomes. This study involved subjects undergone down regulated. stimulated IVF cycles using various types of luteal support, namely: Cyclogest (n=35). Crinone gel (n=36), various doses of Utrogestan (n=55) and HCG (n=35). Various doses of Utrogestan (administered vaginally), Crinone gel (progesterone administered vaginally) and Cyclogest (progesterone administered rectally) supplementation induced similar end plasma progesterone concentrations ranging from 26 to 32 mmnl/l. These progesterone regimes produced no significant differences. Hence, the impact of exogenous proge,terone supplement was relatively trivial and did not 'stabilise' the sub-optimal luteal phase. In contrast, two small HCG injections during the early and mid-luteal phase possessed a much greater ability to 'stabilise' progesterone profiles. Despite this additional advantage, implantation and pregnancy rates with either HCG or progesterone supplements were similar. Although none of these forms of luteal support adequately 'normalised' luteal progesterone profiles, this did not appear to be detrimental to the process of implantation.
    The Medical journal of Malaysia 07/2005; 60(2):151-7.
  • Noor Ahmed-Ebbiary · EA Lenton · H Badawy · ID Cooke ·
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    ABSTRACT: EFFECT OF BASAL FOLLICLE STIMULATION HORMONE (FSH) AND AGE ON FOLLICLE GOWTH AND THE NUMBER OF DOMINANT FOLLICLES DURING SPONTANEOUS OVULATORY MENSTRUAL CYCLES N. Ahmed-Ebbiary1, E. A. Lenton2 and I. D. Cooke2, 1Department of Ob/Gyn, Queens Park Hospital, Blackburn and 2Sheffield Fertility Centre, England, UK Introduction: The age-dependent decline in fecundity, beginning in the late 30’s is well documented but its precise mechanism is less well understood. The decreasing quality and quantity of the pool of primordial follicles has been implicated and there is evidence of deterioration in the functional and genetic integrity of oocytes associated with a progressive rise in follicle stimulating hormone (FSH) concentrations and/or advancing age. Oocyte developmental competence and its capacity to result in a pregnancy, depends on size, maturity and health of the follicle. In IVF cycles, oocyte competence increased with increasing follicle size; oocytes from larger follicles had significantly higher fertilization, cleavage, implantation and pregnancy rates compared to those from smaller follicles. We aimed to study the association of FSH and age with changes in follicle growth during spontaneous menstrual cycles in order to understand if this could be implicated in declining fecundity. Subjects and Methods. 1074 regularly menstruating women aged 20-50 yr. had one complete cycle of plasma hormones and follicle growth monitoring. Basal FSH (FSH) and luteinising hormone (LH) were measured on day 3. LH and ultrasound assessment of follicle size (mean follicle diameter, FD) were measured daily from day 7 to day LH+2 (LH-O was the day of LH surge). Follicles measuring ≥ 12 mm were considered to be dominant or co-dominant. Plasma oestradiol (E2) was measured during the preovulatory period (LH-2 to LH + 1) and ovulation was assessed using saliva progesterone concentrations. Results: Seventy-six cycles were anovulatory and were excluded. The subjects were divided by age (Table 1) or according to FSH concentrations (Table 2). ANOVA and Chi-square were used for statistical analysis and results are presented as mean ± SE. Effect of chronological age: There was a progressive and significant decrease in mean follicle size (FD) with increasing age (Table 1). There was also a significant increase in the proportion of women with >one dominant follicle on day LH-0; the older the age group, the higher the proportion of >one dominant follicle. However, mean E2 levels were generally equivalent. Effect of FSH: There was also a significant, but more distinct, decrease in mean follicle size with increasing FSH levels (Table 2). Elevated FSH was also associated with a more pronounced increase in the proportion of women with >one dominant follicle on LH-0. Again mean E2 levels were not different. Discussion and conclusion: We report a progressive decrease in follicle size but an increase in the number of mature follicles with increasing basal FSH and advancing age. The preovulatory follicle is crucial in determining the quality of the oocyte and follicle size determines its ability to respond to gonadotrophins and to ovulate a functional oocyte. Follicle size has been described as a reliable predictor of oocyte competence and hence outcome in stimulated IVF cycles. Larger follicles are said to contain more meiotically-competent oocytes and morphologically normal oocyte-cumulus-corona complexes than small follicles. Further, large follicles have been shown to correlate with the better cleavage, implantation and pregnancy rates. The finding of smaller follicle size with increasing FSH levels and/or age may reflect on the functional and genetic competence of oocytes from smaller preovulatory follicles. This study confirms our earlier findings of multiple (>one) preovulatory follicle in women with elevated basal FSH (1) which, similar to stimulated cycles, is associated with recruitment of a larger cohort of follicles and, thus, multiple preovulatory follicles. The later explains the finding of ‘norma’ preovulatory E2 profiles which effectively masks signs of compromise in the follicle itself (its size, health and ability to produce a functional oocyte). Further, the presence of multiple preovulatory follicles in older women or those with elevated FSH explains the higher prevalence of multiple pregnancy in these groups of women. In conclusion, high FSH levels and/or age are associated with the production of multiple follicles and progressive decrease in their size. It is postulated that the decrease in follicle size could impact on the functional and genetic competence of oocytes in older women resulting in decreased fecundity. Further, increasing FSH and/or age is associated with a degree of over-recruitment and multiple, but smaller, preovulatory follicles. Table 1. Association of chronological age with follicle size and number Table (2). Effect of B. FSH on follicle size (FD) and number of preovulatory follicle 1. Ahmed Ebbiary, N. A. et al (1994). The significance of elevated basal FSH. Human Reproduction, 9: 245-252.
    5th World Congress of Ovulation Induction, Bologna, Italy; 05/2005
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    P.Y.S. Tay · E A Lenton ·
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    ABSTRACT: A prospective randomised study was done to assess the effect of supplemental oestradiol in addition to progesterone on the luteal steroid profiles and pregnancy outcome in stimulated cycles with and without pituitary down regulation. Women undergoing stimulated cycle IVF with GnRH-a and FSH (Group A, n = 63) or stimulated intrauterine insemination using CC and FSH (Group B, n = 55) were studied. These subjects were randomly allocated to receive either 400 mg daily of vaginally administrated Cyclogest (progesterone) alone or in combination with 2 mg daily of oral Oestradiol Valerate (E2V) during the luteal phase. Significant lower concentrations of plasma progesterone were observed in those subjects supplemented with both E2V and progesterone compared to those in whom progesterone only was given during the luteal phase (P < 0.05). Exogenous E2V had a minimal impact on plasma oestradiol concentrations and did not disguise the characterised mid luteal decline in oestradiol secretion. The suppressive effect of E2V on plasma progesterone was lost if implantation occurred normally because any small change in steroid concentrations was reversed by the rapidly increasing concentrations of HCG. Similar pregnancy rates were observed among subjects supplemented with or without oestradiol. The addition of oestradiol to the luteal supplement suppresses endogenous corpus luteum progesterone secretion irrespective of the type of assisted conception cycle and that its use is unlikely to be beneficial to the process of implantation.
    The Medical journal of Malaysia 06/2003; 58(2):187-95.
  • P Y S Tay · E A Lenton ·
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    ABSTRACT: (1) To describe the progesterone profiles following pituitary down regulation in stimulated IVF cycles with the use of GnRH-a (2) To assess the impact of progesterone supplement and pregnancy on the subsequent luteal phase. A prospective observational study performed in a specialist infertility clinic based at a tertiary centre in the north of England. Subjects were divided into cohorts depending on their treatment (natural or stimulated IVF cycles), the type of luteal support (nil or Progesterone) and eventual outcome (successful pregnancy or failure to conceive). Saliva Progesterone concentrations were the only measuring outcome. Natural versus stimulated cycle (SIVF); As expected saliva progesterone concentrations were significantly higher in subjects undergoing SIVF than in the natural cycle from day 1 to day 6 of the cycle (P<0.001) but thereafter stimulated cycle concentrations declined prematurely to fall below those of the natural cycle group by day 7, becoming significantly lower than natural cycle concentrations by days 9 and 10 (P<0.01). With and without progesterone supplementation; Saliva progesterone concentrations in subjects undergoing NIVF and receiving progesterone supplement were 2.5-3 times greater than those concentrations seen in the unsupplementated natural cycle (P<0.001). Similarly in the SIVF-Progesterone supplemented group, saliva concentrations remained significantly higher (P<0.001) than in the unsupplemented cycle throughout luteal phase. Despite this, luteal supplementation did not prevent nor reverse the acute mid luteal (day 7) decline in progesterone seen in all stimulated cycles. Luteal phase following pituitary down regulation is grossly abnormal. The timing and degree of luteal support routinely provided following stimulated IVF is not effective in 'correcting' the progesterone profile.
    The Medical journal of Malaysia 06/2002; 57(2):178-87.
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    S D Keay · E A Lenton · I D Cooke · M.G.R. Hull · J M Jenkins ·
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    ABSTRACT: Cancellation of assisted conception cycles because of poor ovarian response to gonadotrophins is a significant problem in assisted reproduction. Various adjuvant treatments have been suggested to improve responsiveness. This study reports on the potential benefits of low dose dexamethasone. Patients <40 years of age were invited to participate in a twin centre prospective double blind randomized placebo controlled study. A total of 290 patients were recruited and computer randomized using sealed envelopes to receive either 1 mg dexamethasone (n = 145) or placebo tablets (n = 145) in addition to a standard long protocol gonadotrophin-releasing hormone analogue with gonadotrophin stimulation regime. A significantly lower cancellation rate for poor ovarian response was observed in the dexamethasone group compared with controls (2.8 versus 12.4% respectively, P < 0.002). Further comparisons between the dexamethasone group and controls were made of median fertilization rates (60 versus 61% respectively, NS), implantation rates (16.3 versus 11.6% respectively, NS) and pregnancy rate per cycle started (26.9 versus 17.2%, NS). The benefit was apparent in patients both with polycystic and normal ovaries. Low dose dexamethasone co-treatment reduces the incidence of poor ovarian response. It may increase clinical pregnancy rates and should be considered for inclusion in stimulation regimes to optimize ovarian response.
    Human Reproduction 10/2001; 16(9):1861-5. · 4.57 Impact Factor
  • P Y Tay · EA Lenton ·
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    ABSTRACT: To assess a range of exogenous HCG regimes designed to simulate the endocrine environment occurring in biochemical, single and multiple pregnancies and to study the response of the corpus luteum to those regimes. Prospective clinical study. Twenty-five normally cycling women aged 24-35 years were given one of four regimes of HCG injections designed to mimic the HCG concentrations found following spontaneous implantation. Regimes A, B, C and D were designed with starting HCG doses of 60, 140, 250 and 1000 iu, respectively. The daily HCG injections were then increased to give a doubling concentration every 30 h for regime A, every 27 h for regime B, every 24 h for regimes C and D. HCG administration was started on either days 7 or 8 after the LH peak. Plasma HCG and progesterone concentrations. Subjects given regime A failed to demonstrate any rescue of the corpus luteum despite low-detectable amounts of HCG in the circulation equivalent to those seen in some biochemical pregnancies. In contrast, subjects given regimes B and C demonstrated prompt increases in progesterone secretion immediately after the first HCG injection achieving HCG and progesterone concentrations in plasma similar to those seen in normal singleton pregnancies. Subjects given regime D also showed rapid rescue of the corpus luteum but this time achieved plasma HCG concentrations in the range normally seen in multiple pregnancies. All subjects in regimes B, C and D secreted significantly higher amounts of progesterone than those in regime A (P<0.001). However, despite the greater amounts of HCG used in regime D, the amount of progesterone produced was not significantly different from regimes B or C. The exogenous HCG regimes used in this study successfully mimicked the hormonal environment found in biochemical, single and multiple pregnancies and elicited appropriate corpus luteum responses.
    Clinical Endocrinology 09/2000; 53(3):345-50. DOI:10.1046/j.1365-2265.2000.01075.x · 3.46 Impact Factor
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    P.Y.S. Tay · E A Lenton ·
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    ABSTRACT: Our purpose was to study the optimum time to administer exogenous human chorionic gonadotropin (hCG) to rescue the human corpus luteum during the luteal phase of normal menstrual cycles. Groups of normally cycling women were given 4-day regimes of exogenous hCG by daily injection beginning 4 (Group A), 8 (Group B), and 12 (Group C) days after the midcycle luteinizing hormone surge. The hCG regime used was designed to mimic hCG levels following a spontaneous implantation. All subjects acted as their own controls in a preceding normal menstrual cycle. Group A subjects exhibited patterns and levels of salivary progesterone concentration similar to those seen in the control cycles throughout the normal luteal phase. In contrast, subjects in both Group B and Group C demonstrated a rapid and sustained increase in progesterone production following the hCG injections. Furthermore, subjects in Group B achieved the highest mean peak progesterone concentrations and the total amount of salivary progesterone secreted was significantly higher than in the control cycles (P < 0.05). Although the mean luteal-phase length was greatest in Group C, the response of the corpus luteum was suboptimal, with a delayed rise in salivary progesterone. These data show that the qualitative and quantitative response of corpus luteum to an early pregnancy-type hCG signal is maximal around the midluteal phase, coincident with the time of implantation.
    Journal of Assisted Reproduction and Genetics 11/1999; 16(9):495-9. DOI:10.1023/A:1020507217897 · 1.72 Impact Factor
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    F Zayed · EA Lenton · I D Cooke ·
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    ABSTRACT: A prospective trial was undertaken to evaluate the efficacy of stimulated in-vitro fertilization (SIVF) and stimulated intrauterine insemination (SIUI) in couples with unexplained and mild male factor infertility. In all, 80 couples were allocated to treatment with SIVF or SIUI, both treatments following the same protocol [clomiphene citrate and follicle stimulating hormone (FSH) injection], except that higher doses of FSH were used in the SIVF treatment cycles. Initially, 41 couples were allocated to and started treatment with SIVF but eight cases were eventually converted to SIUI because of under-response. Similarly, although 39 couples were initially allocated to SIUI treatment, five of these converted to SIVF because of over-response. The treatment cycles that were converted either to SIUI or to SIVF were not considered as treatment failures but as treatment changes and so were included in the analyses. Of the final 38 SIVF cycles, four were cancelled (dysfunctional response), failed fertilization occurred in five cycles and 29 subjects reached embryo transfer. There were two biochemical pregnancies [positive human chorionic gonadotrophin (HCG) only], two clinical abortions and seven live births. Of the final 42 SIUI cycles, only two were cancelled, insemination being performed in the remaining 40 cases. The result was one clinical abortion, three ectopics and eight live births. The proportion of cycles with positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for SIUI) and the livebirth rates were also not different (18.4% per cycle treated for SIVF and 19.0% for SIUI). The cost per maternity of SIUI was approximately half that of SIVF (Pounds Sterling 1923 versus Pounds Sterling 4611) and so we conclude that, as SIUI had an efficacy that was not significantly different from SIVF (using similar protocols) but was more cost-effective, it must be considered the more appropriate form of management for the treatment of unexplained and mild male factor infertility. Indeed, it is hard to justify the routine use of IVF, as a first approach, in unexplained infertility.
    Human Reproduction 12/1997; 12(11):2408-13. DOI:10.1093/humrep/12.11.2408 · 4.57 Impact Factor
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    F Zayed · E.A. Lenton · I.D. Cooke ·
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    ABSTRACT: This study evaluated outcome in 117 couples with unexplained infertility who underwent 162 attempts at natural cycle in-vitro fertilization (NIVF) between 1991 and 1993. An egg was obtained in 138 cycles and a single embryo was transferred in 89 cycles. There were 16 implantations (four biochemical pregnancies, three clinical abortions and nine live births). The implantation rate per embryo was 16/89 (18.0%), which translated into a live birth rate per egg collection of 9/138 (6.5%). The impact factors that were assessed included oocyte quality, sperm quality, embryo quality and woman's age. The outcome measures used were fertilization/inseminated egg and implantation/replaced embryo. All embryo transfers were of single embryos. We conclude that, in couples with unexplained infertility, outcome following NIVF is affected by both egg and sperm quality and by the age of the woman. Embryo quality was independent of the above factors but was also critical for successful implantation.
    Human Reproduction 12/1997; 12(11):2402-7. DOI:10.1093/humrep/12.11.2402 · 4.57 Impact Factor
  • Noor Ahmed-Ebbiary · EA Lenton · ID Cooke ·

    10th Congress on IVF and Assisted Conception Techniques, Vancouver, Vancouver, British Columbia, Canada; 05/1997
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    A Kumar · P Benny · E A Lenton · I D Cooke ·
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    ABSTRACT: Two modes of embryo transfer, uterine and tubal, were compared following natural cycle in-vitro fertilization (IVF). Only patients with patent Fallopian tubes were included in the study. Tubal embryo transfer was performed by retrograde tubal cannulation without analgesia on an outpatient basis. Tubal transfer conferred no benefit compared with uterine transfer in male factor infertility with positive fertilization (pregnancy rates of 15.8% in both groups). Although tubal embryo transfer in the patients with unexplained infertility improved the pregnancy rates from 7.8% in uterine transfer (5/64) to 17.6% in the tubal transfer group (13/74), this improvement was not statistically significant.
    Human Reproduction 04/1997; 12(3):484-6. DOI:10.1093/humrep/12.3.484 · 4.57 Impact Factor
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    ABSTRACT: Young women with unexplained infertility who exhibit elevated basal serum follicle stimulating hormone (FSH) concentrations (>10 IU/l) have poor outcomes in in-vitro fertilization. A subgroup of these women has regular menses, representing 'subclinical' ovarian failure, which may have an autoimmune basis and could potentially be treated by immunosuppression. To investigate this further, a range of immunological markers was used to assess autoimmune activity in 14 women aged <40 years with elevated FSH compared with 15 infertile women with normal FSH and 10 pre-menopausal, healthy controls. All samples were taken during natural menstrual cycles. Organ-specific antibodies against ovary, endometrium and thyroid, and non-organ-specific antibodies against histones and cardiolipin, were not significantly increased in elevated FSH patients compared with other control groups. Soluble CD23 and soluble intercellular adhesion molecule concentrations were not elevated in the sera of the women tested, and circulating T cell subsets remained unaltered. Significantly, increased concentrations of the complement breakdown product C3a and terminal complement complexes were detected in the elevated FSH group compared with the normal FSH group, although the latter also had significant complement activation compared with laboratory controls. Autoimmunity appears as an infrequent cause of 'subclinical' ovarian failure, but there is evidence of activation of complement in the sera of infertile women.
    Human Reproduction 03/1997; 12(2):244-9. DOI:10.1093/humrep/12.2.244 · 4.57 Impact Factor
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    K Turner · EA Lenton ·
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    ABSTRACT: Co-culture of human embryos with cell layers has generally shown that blastocyst formation rates are improved compared to routine culture in medium alone. In order to assess this further, we have additionally classified resulting blastocysts according to their morphology and secretion of human chorionic gonadotrophin (HCG). A total of 70 supernumerary human embryos from 15 patients were divided equally and randomly between two culture conditions: (i) co-culture with Vero cells; and (ii) culture in our routine medium. Embryo development and morphology were recorded for up to 14 days in culture. The results showed that embryos on Vero cells had a significantly higher blastocyst formation rate (P < 0.02) by or on day 6 of development than those in routine culture medium alone (77 and 46% respectively). For HCG analysis, the culture medium was changed in both culture systems on days 5, 7, 9, 12 and 14 of embryo development and analysed. Most embryos began to produce HCG between days 7 and 9, with HCG secretion being significantly higher from embryos on Vero cells between days 9 and 12 than from embryos in routine culture (P < 0.03). The morphology of the blastocysts obtained was related to their ability to hatch and produce HCG but was not significantly better for one type of culture system than for the other.
    Human Reproduction 09/1996; 11(9):1966-74. · 4.57 Impact Factor
  • K. Turner · E.A. Lenton ·

    Human Reproduction 09/1996; 11(9):1966-1974. DOI:10.1093/oxfordjournals.humrep.a019526 · 4.57 Impact Factor
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    A Dhar · P Dockery · W S O · K Turner · EA Lenton · I D Cooke ·
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    ABSTRACT: The human ovarian granulosa cell is perhaps the most widely studied endocrine cell, but little quantitative structural information exists for this cell. In the present study new and traditional stereological probes have been employed to provide quantitative structural information on these functionally important cells. Granulosa cells were obtained from follicular aspirations from 10 women during in vitro fertilisation procedures. Initially 2 methods were used to estimate the mean nuclear volume of these cells: the mean number weighted nuclear volume was estimated by the Selector and the mean volume weighted nuclear volume by the point sampled intercept method. It was found that the difference between the 2 volume estimates was only 8.5%. The volume weighted mean nuclear volume was used as an estimate of nuclear volume. This was subsequently corrected (taking the percentage difference as the empirical bias) and combined with fractional cell volumes (Vv) to produce estimates of cell, mitochondrial, lipid and nucleolar volume. The proportion of the cell occupied by the nucleus had a remarkably low interindividual variation (CV = 7.6%). The proportion of the nucleus occupied by euchromatin also had a striking low variation (CV < 6%). All other cellular parameters had CVs of less than 35%. The lipid composition of these cells showed the greatest interindividual variability, with a CV of 42% for relative and 54% for absolute volume. The present study outlines a simple protocol for the quantitation of granulosa cell structure using new unbiased stereological probes and providing baseline structural information.
    Journal of Anatomy 06/1996; 188 ( Pt 3)(3):671-6. · 2.10 Impact Factor
  • Ahmed N. A. Ebbiary · E A Lenton · I D Cooke ·

    Menopause 01/1996; 3(4):252. DOI:10.1097/00042192-199603040-00102 · 3.36 Impact Factor
  • Ahmed N. A. Ebbiary · I D Cooke · E A Lenton ·

    Menopause 01/1996; 3(4):251-252. DOI:10.1097/00042192-199603040-00101 · 3.36 Impact Factor
  • N A Ahmed Ebbiary · E A Lenton · R Welsby · A Mowforth · I D Cooke ·
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    ABSTRACT: During development of the dominant follicle, the avascular granulosa cells and oocyte are exposed to the follicular fluid endocrine microenvironment. An alteration in the endocrine characteristics of follicular fluid affects follicular steroidogenesis, oocyte maturation, ovulation and subsequent corpus luteum function. In-vitro studies on pooled follicular fluid from ovarian specimens lacked temporal precision between menstrual and follicular endocrine events. We have established a new technique, termed folliculocentesis (FC), to sample follicular fluid from the dominant ovarian follicle without compromising its growth or function during the mid- to late follicular phase. A total of 38 subjects with regular ovulatory cycles each underwent two identical cycles of hormone and follicle growth monitoring: one cycle served as the control, and FC was performed during the second cycle. During all cycles, plasma luteinizing hormone (LH), oestradiol and ultrasound monitoring of follicle growth were commenced on day 7 and continued until after ovulation. During FC cycles, 200 microliters of follicular fluid were aspirated from the dominant follicle using transvaginal ultrasound guidance when the follicle diameter reached > or = 10 mm. Six subjects were excluded from the study because of incomplete or invalid endocrine data. In all, 32 subjects completed both the FC and control cycles. The follicle growth pattern, maximum follicle diameter, plasma oestradiol, oestradiol peak, plasma LH, LH surge and follicular phase length were similar during FC and control cycles. A total of 50 valid follicular fluid samples were obtained when the dominant follicle was sampled once, twice or three times during the same cycle and from the same follicle in 15, 16 and one subjects respectively. The follicular fluid samples contained steroid concentrations consistent with those of the mid- to late follicular phase. We conclude that the FC procedure is safe, easy to perform and does not affect follicle growth or hormone dynamics. Analysis of the follicular fluid samples is expected to provide us with valuable in-vivo information about ovarian endocrinology.
    Human Reproduction 09/1995; 10(9):2325-33. · 4.57 Impact Factor

Publication Stats

2k Citations
317.04 Total Impact Points


  • 2002
    • University of Malaya
      • Department of Obstetrics and Gynaecology
      Kuala Lumpor, Kuala Lumpur, Malaysia
  • 1977-2001
    • The University of Sheffield
      • Department of Biomedical Science
      Sheffield, England, United Kingdom