L. Pawelczyk
Division of Infertility and Reproductive, Department of GYN/OB., K. Marcinkowski University of Medical Sciences, Poznah, Poland

Luteal phase defect (LPD) is a very important problem in infertility treatment. It is characterized by the deficient secretory changes in the endometrium due to the quantitative or qualitative defects in corpus luteum function. It results in the lack of endometrial receptivity for the fertilized ovum. It manifests with shortening of the luteal phase and no characteristic changes on ultrasound. It has to be stressed that LPD may be caused by the abnormalities of endometrium, with normal functioning corpus luteum. The occurrence of LPD is variously in different studies. Taubert et al detected LPD in 45% of infertile women based on the single endometrial biopsy. On the other hand other investigators presented considerably smaller numbers: Olive -5%, Insler 4,3%, Bopp 3% of infertile couples. The diagnostic criteria for LPD as well as the methods of treatment are controversial. Body temperature is not a sensitive and specific enough marker and the endometrial seems to be invasive and subjective method. Hence in the Division of Infertility and Reproductive Endocrinology of Karol Marcinkowski University LPD is diagnosed on the basis of clinical factors (temperature, length of luteal phase), serum progesterone concentration and ultrasound examination of the endometrium (thickness and echogenicity). The diagnostic criteria were progesterone index bellow 15ng/ml and luteal phase shorter than 12 days. Using this protocol we diagnosed LPD in 64 out of 711 (9%) infertile women. After implementation of selected treatment protocols we stated that supplementation with human chorionic gonadatropin is more efficient than treatment with progesterone and dydrogesterone in terms of prolongation of the luteal phase, increased thickness of the endometrium as well increase in the progesterone index. Additionally ovulation induction improved luteal phase status regardless which protocol was used., probably due to the increase in the number of corpus luteurn and indirectly trought the number of LH receptors.

Longin Marianowski, Halina Gadomska
I Clinic of Obstetrics and Gynecology, University Medical School, Warsaw, Poland

Estrogen exerts a protective antiatherosclerotic effects directly on the arterial wall and on circulating lipoproteins and by favorable impact on fibrynolysis. Estrogen‑induced lipid changes reduce the risk of cardiovascular disease, especially in women vith abnormal lipids. The most important is reduction in LDL-cholesterol and increase in HDL-cholesterol. The routes of administration of estrogeny may have an impact on these changes.

The changes in serum concentration of total cholesterol, HDL-cholesterol, triglycerides, lipoproteins and fibrinogen have been studied in women receiving HRT transvaginally, transdermally, orally and intramuscularly. In our 85 investigated women we found most favorable changes in group using HRT orally and intramuscularly.

Diet plays an important role during menopausal transition. Over 80% of European women gain about 10 kg of weight between the ages of 20 and 50 years. Menopausal status amplifies this phenomenon.

The most urgent task is preventing osteoporosis, cardiovascular diseases, metabolic disorders and weight gain. It could be archived by tailored diet with vitamins and microelements supplementation, exercises and proper life style.

Szymanski W Grabiec M.
Third Depatment of Obstetrics and Women's Diseases of the Ludwik Rydygier Medical University in Bydgoszcz, Head: Prof W Szymanski

The discovery of a protein hormone leptin by Zhang in 1994, which is an OB gene product has become a crucial step in the research on adipose tissue ant: its connection with reproduction. Leptin is considered to be a factor informing hypothalamic centers about nutrition state and allows normal functions of reproductive system when energetic sources are full enough and blocks it during energetic low levels.

Despite great knowledge of the structure of leptin, there is not much research available concerning the relationship between leptin. and reproductive system. In our study, leptin concentrations during the ovulatory cvclc. pregnancy, puerperium and assistcd reproduction have been presented. Leptin stimulates secretion of gonadotropins, prolactin and gorowth factor, yet it leads to lower concentration; of 17-beta-estradiol, progesterone and cortisol. It is considered that higher leptin levels occur in periovulatory and luteal phase during normal menstrual cycle in comparison with follicular phase.  During pregnancy higher leptin concentration, are observed in 2nd and 3rd term, with the highest levels in 28th week of pregnacy. However just before delivery the values am 2 - 3 times higher than in case of non-pregnant women. it was considered that higher Win concentrations occur in patients with PCOS, notwithstanding their BMI.

In IVF cycles, during the stimulation with gonadotropins, significant increase of leptin level was observed. especially with the use of pure FSH. It seem that leptin may have an advantageous effect not only on oocytes and zygotes development in the early stages, but also on the process of implantation and therefore its evaluation may be useful for the clinical determination of embrion's quality in IVF-ET program.

Woyton J. Pajak J.
Department of reproduction and obstetrics, Medical University, Wroclaw Poland

Effectiveness of estrogens in hormone replacement therapy (HRT.) dependirug, on dose and rout of adminitration was discussed on the basis of the review of important articles. Pills, patches, gels, imlants, vaginal rings and recently nasal sprays are among the options of administration. The transition from  previous high-dose simple und uniform to low-dose, iridividualized and complex HRT during last 20 years was demonstrated. Long term compliance of HRT pivotal in obtaining long-term benefits. Fear of breast cancer and poor bleeding control are main reasons 'for discontinuation of HRT. Individualized, low-dose of estrogens is required to decrease the risk of - cancer and other-side effects. The. Novel intranasal administration form of estradiol offers stable pharmacokinetic profile and effect of intestinal and hepatic first pass as  well as low individual variation in absorption rate. Authors discussed the possibilities of decreasing estrogen doses in different regiments and routs of administration. On the end authors ask rhetoric questions where  are the limits of low dose's of estrogens.