17-ketosteroids and Anovulation

Topics: 17-Ketosteroids; Animals; Anovulation; Chorionic Gonadotropin; Clomiphene; Estradiol Congeners; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypothalamus; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Neurotransmitter Agents; Ovary; Ovulation; Pregnancy; Progestins; Psychology; Psychotherapy; Rabbits; Testosterone; Thyroid Hormones

Eighty-four treatment units were given to 11 women with clomiphene citrate-resistant polycystic ovarian disease (PCOD). PCOD was defined as oligomenorrhea elevated luteinizing hormone (LH), normal follicle-stimulating hormone (FSH), and preference-elevated androgens. Luteinizing-releasing hormone (LRH) was administered intravenously via a portable infusion pump. Doses varied between 5 and 40 micrograms/pulse given at 60-, 90-, or 120-minute intervals. In 11 women, 85 treatment units (TUs) were completed, of which 74 were ovulatory, showing no specific advantage of any particular pulse dose or pulse interval. Five pregnancies occurred in three women. Two women did not ovulate during 52 and 284 consecutive days of therapy, respectively. Oligomenorrheic patients with PCOD can be made more regular by means of LRH, not necessarily leading to a regular menstrual cycle. In general, LRH is sufficient for luteal support. No signs of hyperstimulation were observed, although two patients incidently developed unilocular cysts with a maximum diameter of 8 cm. Ovulation induction with LRH in PCOD is possible, although the disease itself does not change during therapy. This may be further evidence that altered hypothalamic LRH secretion is more the result, rather than the cause, of the phenomenon of PCOD.

Topics: 17-Ketosteroids; Adult; Androstenedione; Anovulation; Clomiphene; Drug Resistance; Estradiol; Estrogens; Evaluation Studies as Topic; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteal Phase; Luteinizing Hormone; Ovulation Induction; Polycystic Ovary Syndrome; Pregnanediol; Testosterone

Thirteen anovulatory oligomenorrheic, hyperandrogenic, and normoprolactinemic women were treated with spironolactone (aldactone) throughout six consecutive menstrual cycles in a dosage of 100 to 150 mg/day. During this treatment a significant decrease in serum luteinizing hormone (LH), testosterone, prolactin, and 17-ketosteroid values were observed that were accompanied by ovulation in 11 women (85%), according to basal body temperature (BBT) and progesterone values. In addition, improvement of hirsutism was observed in 9 (70%) and restoration of regular cycles in 11 (85%) of the patients. The side effects observed were mild and did not lead to interruption of the treatment. Our data suggest that the antiandrogenic properties of spironolactone render it a suitable agent in the treatment of anovulatory, oligomenorrheic, and hyperandrogenic women.

Topics: 17-Ketosteroids; Androgens; Anovulation; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Menstruation Disturbances; Oligomenorrhea; Progesterone; Spironolactone; Testosterone

In the course of an investigation of 60 patients with clomiphene-resistant anovulation, 35 cases of androgenic hyperacitvity were detected. Fractionation of urinary 17-ketosteroids (17-KS) by a rapid method of chromatography proved to be both practical and reliable for the detection and classification of androgenic disorders of adrenal, ovarian, or mixed origin. In contrast to the total 17-KS values, the fractionated 17-KS values were elevated in all but one of these cases. Following dexamethasone suppression, individual 17-KS showed significant decreases in both adrenal and mixed adrenal-ovarian cases, in contrast to ovarian cases in which no significant change was detected. Human chorionic gonadotropin (HCG) stimulation combined with dexamethasone suppression did not cause any significant change in individual 17-KS values in the adrenal group, whereas both the mixed adrenal-ovarian and ovarian cases showed significant increases. Of 34 treated patients, 22 conceived, 21 had normal deliveries, and 1 aborted. Twelve became ovulatory. Eleven patients were treated with dexamethasone, nineteen with combined dexamethasone and clomiphene, two with dexamethasone and HCG, and two with HCG only.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenal Glands; Adult; Androsterone; Anovulation; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Etiocholanolone; Female; Fertility; Humans; Ovary; Ovulation; Pregnancy

The polycystic ovary has the capacity to produce excessive androgens (delta4-androstenedione, dehydroepiandrosterone, and testosterone). Whether this disorder is caused by constant pituitary priming of the ovaries due to hypothalamic-pituitary derangement or an ovarian enzyme defect, the end result is the same, i.e., abnormal androgen production. In an effort to explain the syndrome, we offer the hypothesis of an inherently sensitized adrenal secreting excessive androgen which leads to an imbalance in the hypothalamic-pituitary axia. The result is a tonic stimulation of the ovaries eventuating in "the androgenic polycystic ovary."

Topics: 17-Ketosteroids; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Androgens; Anovulation; Chorionic Gonadotropin; Corpus Luteum; Female; Follicle Stimulating Hormone; Humans; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Ovary; Polycystic Ovary Syndrome; Veins

Ninety-three infertile women were treated with clomiphene citrate alone or in combination with human chorionic gonadotropin (hCG) for absent or infrequent ovulation. The patients were divided into eight categories according to the diagnosis obtained: ovarian androgenic hyperplasia, adrenal androgenic hyperplasia, mixed ovarian and adrenal androgenic hyperplasia, hypothalamic anovulation, postpill anovulation, follicular phase defect, luteal phase defect, and amenorrhea-galactorrhea syndrome. Each group was analyzed individually to compare the ovulation and conception rates and the complications involved. A survey of the data presented in this study shows that the best response was noted in patients with ovarian androgenic hyperplasia. Patients with a functional pathologic adrenal component responded favorably when dexamethasone was used as an adjuvant to clomiphene therapy. Those with hypothalamic anovulation responded better when hCG was added to clomiphene therapy. Women with postpill anovulation as well as those with follicular phase defect were found to be good candidates for clomiphene therapy. In properly selected patients with poor luteal phase defect, hCG secured excellent results both in ovulation and conception. Patients with lactation amenorrhea failed to ovulate when treated with clomiphene alone.

Topics: 17-Ketosteroids; Adrenal Gland Diseases; Amenorrhea; Androgens; Anovulation; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Endometrium; Female; Galactorrhea; Humans; Hyperplasia; Hypothalamus; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Ovarian Diseases; Ovulation; Pregnancy

Topics: 17-Ketosteroids; Amenorrhea; Anovulation; Clomiphene; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Pregnanediol

Four women with anorexia nervosa were treated with synthetic LH-releasing hormone (LRH) in an attempt to induce ovulation. All the women had very low pretreatment levels of gonadotropins and estrogens. Administration of LRH resulted in significant gonadotropin increases. The FSH response to LRH in relation to the LH response was higher than in regularly menstruating women. LRH (500 mug) was administered parenterally three times daily over about 4 weeks. During this period there were no significant effects on mood, eating behavior, weight, or libido. All the women responded with follicular maturation and ovulation to the prolonged LRH treatment.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Amenorrhea; Anorexia Nervosa; Anovulation; Body Temperature; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Ovarian Follicle; Ovulation; Pregnancy; Progesterone; Testosterone

Gonadotropin levels and secretory patterns were studied in 28 oligomenorrheic patients with various types of polycystic ovary disease (PCO). On the basis of ovarian morphology and histology, the patients PCOuld be separated into two distinct categories arbitarily designated "typical" (type I) and "atypical" (type II) PCO. Although no differences were noted in symptomatology or 17-ketosteroid, testosterone, or follicle-stimulating hormone levels, the 12 type I patients demonstrated widely fluctuating, but markedly elevated, luteinizing hormone (LH) levels, while the 16 type II patients demonstrated lower and less fluctuating LH levels which were comparable to those found during the normal follicular phase. It is likely that type I PCO is a distinct entity similar to that described by Stein and Leventhal, while type II co represents a heterogenous spectrum of disorders, many of which remain obscure.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adult; Anovulation; Dexamethasone; Feedback; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Hyperplasia; Luteal Cells; Luteinizing Hormone; Oligomenorrhea; Ovarian Cysts; Ovarian Diseases; Ovary; Testosterone

Topics: 17-Ketosteroids; Adrenal Cortex Hormones; Adrenal Hyperplasia, Congenital; Adrenogenital Syndrome; Anovulation; Female; Humans; Infertility; Infertility, Female