menotropins and Amenorrhea

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche or premature depletion of ovarian follicles before the age of 40 years. However, in several instances the distinction between definitive or intermittent POF may be difficult on clinical bases, therefore the more appropriate term Primary Ovarian Insufficiency (POI) has been recently proposed and will be used in this review. POI is a heterogeneous disorder affecting approximately 1% of women <40 years. The most severe forms present with absent pubertal development and primary amenorrhea, whereas forms with post-pubertal onset are characterized by disappearance of menstrual cycles (secondary amenorrhea) associated with a defective folliculogenesis. POI is generally characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Heterogeneity of POI is reflected by the variety of possible causes, including autoimmunity, toxics, drugs, as well as genetic defects. Several data indicate that POI has a strong genetic component. In this manuscript we discuss the X chromosome abnormalities that are associated with POI.

Topics: Age of Onset; Amenorrhea; Autoimmunity; Bone Morphogenetic Protein 15; Chromosomes, Human, X; Estrogens; Female; Fragile X Mental Retardation Protein; Humans; Menotropins; Oophoritis; Ovary; Primary Ovarian Insufficiency; Sex Chromosome Aberrations; Turner Syndrome

A case of Sheehan's syndrome presented with secondary amenorrhea and was put on L-thyroxine, prednisolone and cyclical estrogen and progestin. Ovulation induction with gonadotrophins and intrauterine insemination with husband's semen resulted in a twin pregnancy. Antepartum course was complicated by bronchial asthma, gestational diabetes and pregnancy-induced hypertension. Cesarian section was done at 34 weeks gestation for preterm rupture of membranes and breech presentation. Both babies and their mother were doing well at 6 months of follow-up.

Topics: Adult; Amenorrhea; Asthma; Breech Presentation; Cesarean Section; Diabetes, Gestational; Female; Fertility Agents, Female; Fetal Membranes, Premature Rupture; Humans; Hypertension; Hypopituitarism; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Twins

The most important causes of the functional hypothalamic amenorrhea (FHA), that are psychological stress, physical stress and weight loss, are associated with a decrease of the frequency of the LH secretory pulses and with a state of hypercortisolism. The slowing down of the LH pulse frequency is difficult to demonstrate in clinical practice. The classical symptoms of FHA which are low gonadotropin levels, and hypogonadism are not very specific. The diagnosis of FHA is therefore one of exclusion. Recent physiopathological studies have individualised new symptoms that are hypercortisolism, hypoprolactinaemia and an important increase in the night serum levels of melatonine, all of which could help to confirm the diagnosis. FHA is relatively frequent and its treatment with pulsatile GnRH administration or naltrexone is very successful.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Diagnosis, Differential; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Menotropins; Stress, Psychological; Weight Loss

Topics: Amenorrhea; Anovulation; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Stimulation, Chemical

This review has summarized the evolution of hMG stimulation of ovulation in amenorrheic individuals, its monitoring, and its complications. Based on the principles learned from these individuals, use of hMG has now extended to women with cervical mucus deficiencies or luteal phase defects, as well as in vitro fertilization. Recommendations regarding the use of hMG at the current time when assessment by both serum E2 and ultrasound are available have been made. Briefly, it is suggested that an "E2 window" of at least 1000 pg/ml be achieved over the course of a 9- to 12-day follicular phase. Furthermore, assessment of these monitoring modalities should be made in combination in order that findings from one modality alone not be allowed to initiate premature hCG administration.

Topics: Amenorrhea; Animals; Anovulation; Chorionic Gonadotropin; Drug Administration Schedule; Estradiol; Estrogens; Estrus; Female; Humans; Menotropins; Monitoring, Physiologic; Ovarian Diseases; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Ultrasonography

There are many methods that can be used to induce ovulation when there is a fault in ovulation in patients who have normal prolactin levels. These are: Bringing the weight to a normal level. Giving Clomiphene. Giving Tamoxifen. Giving cyclofenil and bromocriptine, which really have no more effect than giving a placebo. Giving gonadotrophins in a classical way. This is very useful where there is hypogonadic amenorrhoea but much less useful when the failure of ovulation occurs with normal gonadic function. It is accompanied by a risk of multiple pregnancies and of hyperstimulation, which should be monitored by ultrasound very strictly so that it cannot become too serious. The use of purified FSH which theoretically should be more adequate, at least in cases where the gonadic function is normal in spite of failure of ovulation. Pulsatile administration of LHRH, which in cases of hypothalamic amenorrhoea carries less total risk than giving gonadotrophins. Finally, wedge resection of the ovaries which is reversed for polycystic ovaries that are larger than normal in size, and allied methods. The first choice for hypogonadic hypothalamic amenorrhoea would seem to be the LHRH pump; and for failure of ovulation with normal gonadic function Clomiphene or Tamoxifen. When anti-oestrogens fail to correct these latter cases one can choose according to the case between gonadotrophins, choosing if possible pure FSH, and/or wedge resection. In the last resort in these cases the LHRH pump can be used. The frequent failure of these methods show that perhaps it is possible to create a hypogonadotrophic hypogonadism by giving agonists for a long time or antagonists to LHRH in such a way that a second attempt can be made to induce ovulation using gonadotrophins in better conditions of efficacy and safety.

Topics: Amenorrhea; Anovulation; Clomiphene; Cyclofenil; Epimestrol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Hypopituitarism; Hypothalamic Diseases; Menotropins; Obesity; Ovary; Ovulation Induction; Tamoxifen; Thinness

A practical approach to the diagnosis of amenorrhea is presented. By utilizing a flow-chart 410 patients with amenorrhea were categorized in the following groups: (i) polycystic ovarian disease; (ii) hypergonadotrophic amenorrhoea; (iii) hyperprolactinaemic amenorrhoea; (iv) normogonadotrophic amenorrhoea; and (v) hypergonadotrophic amenorrhoea. This approach helps the practising physician to come to a logical aetiological diagnosis in each category and saves time as well as money. This approach depends on clinical as well as appropriate laboratory examinations, most of which can be done by the private practitioner. Only a minority of patients need sophisticated and costly examinations.

Topics: Amenorrhea; Diagnosis, Differential; Female; Humans; Luteinizing Hormone; Menotropins; Progesterone; Sweden

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Time Factors

A simple scheme of investigation and treatment to restore fertility in amenorrhoeic women is described. Fifty-nine patients with amenorrhoea not due to primary ovarian failure were treated variously as appropriate, mainly with clomiphene (25), bromocriptine (15), or human menopausal gonadotrophins (12), and six by diet to increase their weight. All ovulated, and by the end of the study 55 (93%) had conceived, 42 (71%) had delivered at least one surviving child, and five others (8%) were pregnant and awaiting delivery. Conception rates were 49% within two cycles of treatment and 66% within three cycles; using life-table method to standardise the cumulative conception rates by correcting for patients who did not continue as long as others in the study, the expected conception rate was 79% in six cycles, 94% in 12 cycles, and 98% after 16 cycles. The multiple pregnancy rate was 13% and abortion rate 22%. Delivery rate (for a viable baby) were 48% within 11 months of starting treatment and 53% within one year; expected rates were 76% in 18 months and 97% in two years. The results show that a relatively simple scheme of classifying amenorrhoeic disorders endocrinologically followed by treatment directed at inducing ovulation allows amenorrhoeic women without primary ovarian failure to achieve conception and delivery rates equal to those in normal women.

Topics: Adult; Amenorrhea; Body Weight; Bromocriptine; Clomiphene; Female; Fertility; Fertility Agents, Female; Fertilization; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Time Factors

Despite the efforts of a large number of investigators, the role of GnRH in clinical gynecology is uncertain. At present, its greatest utility is in research directed toward the understanding of hypothalamic-pituitary interrelationships. However, a clear understanding of the hypothalamic control of gonadotropin secretion awaits the actual measurement of the secretion of GnRH by the hypothalamus. In addition, a better understanding of the ability of the pituitary to secrete gonadotropins in various disorders of menstruation and maturation will probably be achieved through the determination of the capacity of the pituitary to synthesize as well as release gonadotropins in response to GnRH. Such determinations will probably utilize repeated or continuous infusions of GnRH rather than the currently more popular single injection technique. Finally, GnRH may be useful in the induction of ovulation. A definition of its role in ovulation induction awaits the results of additional clinical studies. Understanding of the nature of hypothalamic control of the pituitary is as yet incomplete. The availability of hypothalamic releasing factors will make it possible to study in greater detail the mechanisms by which the fine regulation of the endocrine system is achieved.

Topics: Adenoma; Amenorrhea; Clomiphene; Cushing Syndrome; Diabetes Mellitus; Disorders of Sex Development; Female; Galactorrhea; Humans; Hypogonadism; Hypothalamo-Hypophyseal System; Menotropins; Menstruation; Myotonic Dystrophy; Ovulation; Pituitary Diseases; Pituitary Neoplasms; Polycystic Ovary Syndrome; Postpartum Period; Pregnancy

The causes of puerperal infertility in lactating women are poorly understood. The controlling centres may be either the hypothalamic-pituitary axis or the ovary (or both). We studied the secretory dynamics of prolactin and gonadotropins in healthy, normal, lactating and non-lactating women after administering either gonadoliberin to assess pituitary responsiveness or human menopausal gonadotropins to assess ovarian responsiveness during the puerperium. A reciprocal relationship was observed between the secretion of gonadotropins and the secretion of prolactin after the nipples of mothers who were breast-feeding had been stimulated for 30 min. The absence of a short-loop negative feedback control by prolactin for gonadotropin secretion was not confirmed because cyclic secretion of gonadotropin was not necessarily impaired by hyperprolactinaemia. Hyperprolactinaemia did, however, appear to impair the function of the corpus luteum in women suffering from non-puerperal galactorrhoea. We postulate a multifactorial mechanism for puerperal infertility based initially on the peripheral concentration of prolactin and gonadotropins and, in some poorly defined way, on the cerebral concentration of catecholamines.

Topics: Amenorrhea; Breast Feeding; Bromocriptine; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Lactation; Luteinizing Hormone; Menotropins; Menstruation; Nipples; Ovary; Postpartum Period; Pregnancy; Prolactin; Sucking Behavior; Time Factors

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Endoscopy; Female; Fertility; Humans; Hysterosalpingography; Lactation Disorders; Menotropins; Ovulation; Pregnancy; Statistics as Topic

Topics: Amenorrhea; Ascites; Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Estrogens; Female; Follicle Stimulating Hormone; Humans; Hypertrophy; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Menstruation; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple; Time Factors

Topics: Amenorrhea; Ascites; Chorionic Gonadotropin; Female; Gonadotropins; Gonadotropins, Equine; Gonadotropins, Pituitary; Humans; Hydrothorax; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation; Pregnancy; Pregnancy, Multiple; Thrombosis

The objective of this study was to compare, in infertile women suffering from severe hypogonadotropic amenorrhea, the therapeutic utility and the incidence of complications arising from fertility treatment by the conventional human menopausal gonadotropin/human chorionic gonadotropin (hMG-hCG) method, the hMG step-down method, the sequential hMG/gonadotropin-releasing hormone (GnRH) method and a new, modified hMG-GnRH method that has been developed by us. In the step-down method, the daily dose of hMG was decreased from 150 IU to 75 IU when the follicle diameter reached 11-13 mm. In the sequential hMG-GnRH, hMG injection was switched to pulsatile GnRH administration (20 microg/120 min SC), when the follicle diameter reached 11-13 mm. In our new modified hMG-GnRH, pulsatile GnRH was injected together with hMG. Daily hMG was stopped and the GnRH dosage was changed from 10 microg to 20 microg when the follicle diameter reached 11-13 mm. Initially, the three established methods were applied randomly to treat 34 cycles in 20 women; and subsequently, five patients who failed to conceive following treatment by sequential hMG-GnRH were then treated by the modified hMG-GnRH method. More than eight growing follicles and multiple pregnancies were observed during treatment by the conventional method. The incidence of ovarian hyperstimulation syndrome (OHSS) was 25.7% with the conventional method, 20.0% with the step-down method and 0% with the sequential hMG-GnRH method; however, the rate of ovulation was only 50% with the sequential hMG-GnRH method. By contrast, with the modified hMG-GnRH method, less than three growing follicles occurred in 81.8% of patients, there was a 100% rate of ovulation, and neither OHSS nor multiple pregnancies were observed. Moreover, the modified hMG-GnRH method induced pregnancy in 3 out of 5 patients. These data indicate that this new method is favorable for the treatment of severe hypogonadotropic amenorrhea.

Topics: Adult; Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Prolactin

A randomized, double-blind, placebo-controlled trial of cotreatment with biosynthetic, human sequence, growth hormone (GH), and human menopausal gonadotropins (hMG) for induction of ovulation was performed in 16 women with amenorrhea and anovulatory infertility. Patients were randomly allocated to treatment with hMG + GH (24 IU on alternate days, total dose 144 IU) or hMG + placebo. Those who received placebo were given GH in a subsequent course of treatment. On cotreatment with GH compared with placebo, there was a significant reduction in the required dose of hMG, duration of treatment, and the daily effective dose of gonadotropins. Serum insulin-like growth factor-I (IGF-I) rose during treatment with GH but not with placebo. We conclude that growth hormone augments the response of the human ovary to stimulation by gonadotropins. These results suggest a role for the use of GH in induction of ovulation.

Topics: Adult; Amenorrhea; Anovulation; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Growth Hormone; Humans; Hypogonadism; Hypophysectomy; Infertility, Female; Insulin-Like Growth Factor I; Insulin-Like Growth Factor II; Menotropins; Ovulation Induction; Pituitary Neoplasms; Random Allocation

The early hormonal changes that lead to follicular maturation and/or hyperstimulation in women requiring ovulation induction with either human menopausal gonadotropin or gonadotropin-releasing hormone have not been elucidated. This study was undertaken to assess the relative contribution of follicle-stimulating hormone and luteinizing hormone to estradiol secretion and follicular maturation in patients receiving human menopausal gonadotropin or gonadotropin-releasing hormone. The study group consisted of 10 women (26 to 38 years of age) with secondary amenorrhea as a result of hypothalamic dysfunction who had failed to ovulate when given clomiphene citrate. The patients were randomly assigned to either human menopausal gonadotropin (n = 5) or gonadotropin-releasing hormone (n = 5) treatment. On day 5 after the onset of induced menses, all women had baseline blood samples obtained at 10-minute intervals for 4 hours. At this time either 150 U of human menopausal gonadotropin or 75 ng/kg of gonadotropin-releasing hormone administered hourly was given, and blood sampling every 10 minutes was continued for an additional 6 hours. Thereafter, patients were evaluated daily until ovulation. A significant and sustained increase in the mean plasma follicle-stimulating hormone level was first measured during the third hour after human menopausal gonadotropin administration (p less than 0.05. The area under the curve of the mean plasma follicle-stimulating hormone value after this initial increase was significantly greater than its baseline (2119 +/- 240 versus 1425 +/- 188 mlU/ml; p less than 0.01). This rise in mean follicle-stimulating hormone level was followed in less than 2 hours by a significant and uniform rise in mean plasma estradiol concentration (p less than 0.05). In contrast, no immediate change in the mean levels of luteinizing hormone, follicle-stimulating hormone, or estradiol occurred after gonadotropin-releasing hormone administration. The mean daily levels of luteinizing hormone were similar in both groups; however, mean daily follicle-stimulating hormone (20.0 +/- 1.1 versus 9.2 +/- 1.4 mlU/ml) and estradiol (1004 +/- 174 versus 495 +/- 83 pg/ml) levels were significantly higher in patients treated with human menopausal gonadotropin than in those treated with gonadotropin-releasing hormone (p less than 0.001 and p less than 0.05, respectively). In addition, only in patients receiving human menopausal gonadotropin was a positive correlation found b

Topics: Adult; Amenorrhea; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Random Allocation

To present the first gonadotropinoma presenting as pseudo-menopause in a teenager.. Human menopausal gonadotropins (hMG) were given to a 37-year-old woman whose hypergonadotropic amenorrhea with estrogen deficiency as a teenager was changed to hypogonadotropic amenorrhea by the growth and prolactin secretion of a macroprolactinoma.. The patient responded multiple times, and every time to stimulation with hMG and each time produced several dominant follicles. She delivered two babies including conception at age 40.. The fact that this woman could respond consistently to hMG 20 years after the diagnosis of premature menopause, it is clear that initially the etiology of the extremely high LH and FSH levels in an estrogen-deficient 18-year-old was the presence of gonadotropinoma secreting inert LH and FSH. Since serum prolactin was measured the first time at age 37, it is not clear whether the endogenous biologically active gonadotropine were suppressed by replacement of the gonadotroph cells with tumor cells or suppression of endogenous gonadotropins by hyperprolactinoma.

Topics: Adult; Amenorrhea; Diagnosis, Differential; Estrogen Replacement Therapy; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Neoplasms; Pregnancy; Primary Ovarian Insufficiency; Progesterone; Prolactin; Prolactinoma

We describe successful ovulation induction with low-dose hCG administration in addition to hMG in a patient with refractory hypothalamic amenorrhea. A 24-year-old woman with weight loss-related amenorrhea underwent ovulation induction and intracytoplasmic sperm injection (ICSI). Administration of exogenous gonadotropins was ineffective in ovulation induction. Supplementation with low-dose hCG in order to increase luteinizing hormone (LH) activity in the late follicular phase produced late folliculogenesis and steroidogenesis, and ovulation was then successfully induced. This report reacknowledges the critical role that LH plays cooperatively with follicle-stimulating hormone in both folliculogenesis and steroidogenesis.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Drug Combinations; Female; Humans; Hypothalamic Diseases; Infertility, Female; Menotropins; Pregnancy; Treatment Outcome; Weight Loss; Young Adult

When clomiphene citrate is ineffective in the treatment of anovulation, hMG administration is typically selected. However, high-dose hMG therapy is associated with a variety of adverse events. We describe the use of a modified clomiphene citrate regimen that was successful in increasing the effectiveness of ovulation induction.. A patient who did not initially respond to clomiphene citrate therapy required a total dose of 2400 IU hMG to prodeuce mature follicles. However, because of the physical and emotional burdens on the patient, and the possibility of multiple pregnancy and ovarian hyperstimulation syndrome, re-treatment with clomiphene citrate was then selected. Two courses of clomiphene citrate administered at a fixed interval during the same cycle safely induced ovulation. After initial induction of ovulation, her ovulatory failure improved and natural ovulation occurred.. Repeated intracycle clomiphene cirate therapy may be more effective than hMG therapy in inducing ovulation in some patients.

Topics: Adult; Amenorrhea; Anovulation; Clomiphene; Drug Administration Schedule; Female; Fertility Agents, Female; Humans; Menotropins; Ovulation Induction

In a clinical retrospective study, a follow-up of hypothalamo-amenorrheic patients treated firstly with gonadotropin-releasing hormone (GnRH) pump stimulation and secondly with human menopausal gonadotropin (hMG) was performed. Thirty-two hypothalamo-amenorrheic patients, 24-38 years old, were submitted to 103 GnRH stimulation cycles. Seven, with polycystic ovaries (PCO) on ultrasound, were stimulated with hMG after one or several unsuccessful pump cycles. Ovulation was confirmed by a luteinizing hormone (LH) surge or triggered by human chorionic gonadotropin in 80 out of 103 cycles (77.7%/cycle) leading to 62 timed sexual intercourses and 17 intrauterine inseminations (IUI). Twenty-one pregnancies (26.3%/cycle) terminated in eight abortions (38.1%/pregnancy) and 13 deliveries (40.6%/patient). hMG stimulation, in the seven PCO patients (six IVF, one IUI), led to four additional deliveries in three patients. Five patients became pregnant spontaneously after pump failure (n = 2) or unsuccessful IVF (n = 3). Combining all cycles, 17 deliveries were obtained in 16 patients. No case of ovarian hyperstimulation syndrome (OHSS) was observed. GnRH is an efficient and safe treatment of hypothalamo-amenorrheic-induced anovulation. Following GnRH or hMG ovarian stimulation, spontaneous ovulation and conception may be restored in certain hypothalamo-amenorrheic patients.

Topics: Adult; Amenorrhea; Anovulation; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Male; Menotropins; Periodicity; Pregnancy; Retrospective Studies

A simple approach for ovulation induction in women with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH-S) during in-vitro fertilization (IVF)/freezing/surrogacy cycles was evaluated. Weekly progesterone plasma concentrations were measured in order to accurately establish the luteal phase in MRKH-S women. When a rising titre was detected, a gonadotrophin-releasing hormone analogue (GnRHa) was administered as part of a long protocol. Two weeks later human menopausal gonadotrophin (HMG) therapy was started. Ten treatment cycles in four women with MRKH-S were carried out. In all cases, three or less progesterone estimations were needed. Three of the four women are now, through surrogacy, genetic mothers; one of them has two children. We concluded that weekly determination of progesterone plasma concentration is a convenient, efficient and inexpensive simple approach to identify the luteal phase, and therefore suitable to the start of a GnRHa/HMG protocol in MRKH-S women enrolled in an assisted reproduction technology programme.

Topics: Amenorrhea; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Syndrome

To investigate the role of FSH in the depletion of follicular reserve in a human being.. Prospective evaluation of a very rare case.. Academic research environment.. A 43-year-old woman with primary hypogonadotropic hypoestrogenic amenorrhea, with very low levels of plasma FSH throughout her life.. Pulsatile GnRH was administered IV at the dose of 4 micrograms every 90 minutes for 20 days. Blood samples were collected every 3 to 4 days.. Plasma levels of E2, FSH, and LH.. During the 20 days of treatment there was no increase in E2 plasma levels. On the contrary, FSH and LH levels began to rise after 3 days and reached postmenopausal levels within 20 days.. Depletion of follicular reserve may occur also when the levels of FSH are very low throughout a woman's life. Thus FSH seems only able to rescue follicles from atresia without interfering with the onset of menopause.

Topics: Adult; Amenorrhea; Estradiol; Estrogen Replacement Therapy; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction

Changes in serum immunoreactive (IR)-inhibin were measured by RIA in two studies, in order to elucidate, firstly whether the pattern of IR-inhibin secretion is similar to that of estradiol (E2), and secondly, whether inhibin suppresses endogenous FSH release. Study 1: Purified urinary FSH (pFSH) or human menopausal gonadotropin (hMG) were daily injected intramuscularly into women with hypogonadotropic amenorrhea at 12 to 14 week intervals. PFSH and hMG stimulated IR-inhibin release in a similar fashion in the ovulatory cycles, but the increase in estradiol (E2) during pFSH administration was delayed and lower than that during the hMG cycles. This suggests that E2 and IR-inhibin are secreted independently from the granulosa cells. Study 2: Ovulation induction was performed in 18 cycles of 9 women with polycystic ovarian disease (PCOD) by the step-down administration of pFSH. The serum FSH concentration in cycles with premature LH release increased even after the dose of pFSH was reduced, and were significantly higher than those of cycles without premature LH release. It was also found that the serum IR-inhibin concentration in cycles with the premature LH release was 2 to 4 times as high as in cycles without premature LH release. This suggests that IR-inhibin does not suppress endogenous FSH release associated with premature LH release.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Inhibins; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

An analysis was performed on the cumulative conception rates, cumulative live birth rates and adverse effects of ovulation induction in patients with anovulatory infertility attending a single unit over an 11-year period. A total of 200 patients were included, 103 with clomiphene-resistant polycystic ovary syndrome (PCOS), 77 with hypogonadotrophic hypogonadism (HH) and 20 with weight-related amenorrhoea (WRA). Ovulation induction was performed using a number of protocols in which pulsatile luteinizing hormone-releasing hormone was administered s.c. or i.v. and gonadotrophins (human menopausal gonadotrophins or follicle-stimulating hormone) were administered i.m. The cumulative conception and live birth rates in the first course of therapy and after 12 cycles of treatment were, respectively, 73.2 and 62.4% in PCOS patients, 82.1 and 65.4% in the HH group and 95.0 and 85.3% in the WRA group. The miscarriage rates for all courses of treatment were 15.5% in PCOS patients, 22.9% in HH patients and 32.3% in WRA patients which resulted in cumulative live birth rates that were not significantly different. The median number of cycles and ovulations to achieve a pregnancy was 2 in all groups. The multiple pregnancy rate was significantly greater in women with PCOS (17.9%) than in women with HH (3.6%, P = 0.0052, 95% CI 5.12-23.36%) but not WRA (3.2%, P = 0.07, 95% CI 4.35-24.92%). The rate of multiple pregnancy fell after the introduction of monitoring by transvaginal ultrasound. Correction of anovulatory infertility by appropriately selected ovulation induction regimens results in cumulative conception and live birth rates indistinguishable from normal.

Topics: Amenorrhea; Anovulation; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

The course of 60 pregnancies induced by ovulation stimulation with pergonal (in 46 cases) and lutrelef, an LHRF agonist (in 10 cases) was followed up. The authors emphasize the importance of the first therapeutic course as a preparative one, because pregnancies occurred in only 15 and 20% of patients treated with the two drugs, respectively, after it, and 25% of them failed to develop. The major pregnancy complications were due to multiple fetuses (23.4 and 20%, respectively). Stimulated pregnancy should be regarded as a high risk one in respect of spontaneous abortions; indications for abdominal delivery should be extended in such cases.

Topics: Abortion, Threatened; Adult; Amenorrhea; Female; Gonadotropin-Releasing Hormone; Humans; Infant, Newborn; Male; Menotropins; Obstetric Labor, Premature; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

Clinico-hormonal parameters of cycles stimulated with human menopausal gonadotropins in patients with hypogonadotropic amenorrhea and of spontaneous cycles in healthy women of reproductive age are compared. Estradiol hypersecretion in both phases of induced cycle was revealed: hydrocortisone in phase 1 and progesterone and testosterone in phase 2. Dexamethasone in daily dose 0.25 mg was administered for correction. This resulted in a noticeable reduction of estradiol hyperproduction in the first phase of stimulated cycles and in hyperandrogenism elimination. Folliculogenesis, ovulation, and early embryogenesis conditions in schemes of induction with human menopausal gonadotropins and dexamethasone therapy were close to physiologic ones, this resulting in increased share of fertile cycles.

Topics: Adult; Amenorrhea; Female; Genitalia, Female; Gonadotropins; Humans; Menotropins; Ovulation Induction

Forty-three ovulation cycles stimulated with human menopausal gonadotropin were examined in 31 patients with hypogonadotropic amenorrhea. Peripheral blood estradiol and luteinizing hormone were radioimmunoassayed. The findings indicate the possibility of recovery of adenohypophyseal gonadotropin autosecretion in the presence of human menopausal gonadotropin administration.

Topics: Adult; Amenorrhea; Chronic Disease; Estradiol; Female; Gonadotropins, Pituitary; Humans; Hypopituitarism; Luteinizing Hormone; Menotropins; Ovulation Induction; Stimulation, Chemical

In view of the association of hyperinsulinemia with elevated luteinizing hormone (LH) levels and hyperandrogenism in polycystic ovary syndrome (PCOS), the effect of octreotide was investigated in women with PCOS. Twelve amenorrheic women were treated with 100 micrograms octreotide twice a day for 7 days; 13 infertile women unresponsive to clomiphene citrate were treated either with octreotide (100 micrograms twice a day from day 1 of the menstrual cycle until corpus luteum formation) in addition to human menopausal gonadotropins (HMG) or with HMG alone. Octreotide significantly reduced the 4-hour integrated LH concentrations. LH pulse amplitude and nadir concentrations, and LH, testosterone, androstenedione, and estradiol responses to a gonadotropin-releasing hormone (GnRH) analogue in amenorrheic PCOS women. Octreotide treatment also resulted in a more "appropriate" hormonal milieu at the time of human chorionic gonadotropin (HCG) injection in the infertile women, with LH and testosterone levels being reduced while follicle-stimulating hormone (FSH) levels increased. Orderly follicular growth occurred, with one or two mature follicles being present at the time of HCG injection in cycles in which octreotide was given together with HMG. There were no cases of hyperstimulation, even in women who had previously hyperstimulated after HMG alone. Octreotide thus inhibits LH and androgen secretion and may improve ovulatory performance in infertile women with PCOS.

Topics: Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Follicular Phase; Gonadal Steroid Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Luteinizing Hormone; Menotropins; Octreotide; Polycystic Ovary Syndrome

The efficacy of a technique of gonadotropin suppression and human menopausal gonadotropins (hMG) to induce ovulation in women with hypergonadotropic amenorrhea was evaluated in 100 consecutive women. Ovulation was achieved in 19% of cycles (68/361), the pregnancy rate per cycle was 5.2% (19/361), and the viable pregnancy rate was 2.2% (8/361). In the majority of the successful cases, estrogen was used to decrease the elevated luteinizing hormone and follicle-stimulating hormone levels, especially where the ethinyl estradiol therapy alone induced a rise in endogenous 17 beta-estradiol levels with hMG used to boost the follicle to maturation. Although the success rate is low, this technique can result in some successes in otherwise almost hopeless cases.

Topics: Adult; Amenorrhea; Estrogens; Ethinyl Estradiol; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Hormones; Humans; Infertility; Leuprolide; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Outcome; Time Factors

Thirty-one women with hypothalamic primary or protracted secondary amenorrhoea were treated with human menopausal gonadotrophin (HMG) in 89 cycles, but adequate follicular growth failed to occur. They were then treated with a gonadotrophin releasing hormone analogue (GnRHa) and HMG in 91 cycles. An adequate ovarian response occurred in 68 cycles (74.7%) and pregnancy occurred in 26 cycles (28.6%). GnRHa and HMG produced an adequate ovarian response in hypothalamic amenorrhoeic patients who failed to respond to HMG alone. The strong initial agonistic effect of GnRHa produced sudden high levels of FSH that might possibly have initiated folliculogenesis which was continued by HMG.

Topics: Adult; Amenorrhea; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypothalamus; Infertility, Female; Menotropins; Pregnancy

Human gonadotropins are widely used for induction of ovulation in the treatment of anovulatory infertility and for induction of multiple follicular development (MFD) in in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and artificial insemination with husband's semen (AIH) programs. Reported is a patient with normal menstrual cycles, who had two episodes of gonadal unresponsiveness to human gonadotropin therapy, followed by transient hypergonadotropic amenorrhea ("resistant ovary" syndrome), during induction of MFD in conjunction with AIH as treatment for unexplained infertility. The first episode occurred during the sixth cycle of a first series of MFD induction with daily intramuscular injections of exogenous gonadotropins. The second episode occurred during the second cycle of a second series of MFD induction with intravenous pulsatile administration of FSH. On both occasions, normalization of endogenous gonadotropin levels and reappearance of ovulatory cycles occurred spontaneously, after two and three months, respectively. A similar mechanism could occur in the failures of MFD induction observed in IVF programs.

Topics: Adult; Amenorrhea; Clomiphene; Female; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Insemination, Artificial, Homologous; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction

We report the case of a 35-year-old woman with premature ovarian failure that was documented at 29 years of age, who wanted to conceive. Although she failed to respond to high doses of menotropin therapy, she ovulated and conceived after she took an oral contraceptive. The oral contraceptive was used to reduce the elevated level of gonadotropins in an effort to restore receptors to the luteinizing hormone and follicle-stimulating hormone, which theoretically may have been down-regulated.

Topics: Adult; Amenorrhea; Contraceptives, Oral; Estradiol; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Menopause; Menopause, Premature; Menotropins; Norethindrone; Pregnancy

The pulsatile subcutaneous administration of human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was used for induction of ovulation in 26 patients with hypothalamic/pituitary amenorrhea or polycystic ovary syndrome (PCO). Ovulation was observed in 116 (90.6%) of 128 treatment cycles, and 15 (16 treatment cycles) of 26 patients became pregnant. All 14 fetuses, excluding two pregnancies interrupted spontaneously at weeks 6 and 9, were singleton conceptions. Ovarian hyperstimulation was observed in 15.6% of treatment cycles. Five patients with PCO who failed to conceive on the hMG regimen also received pulsatile FSH administration. Although ovulation rates in PCO patients did not differ significantly between the hMG (88.1%) and FSH (88.2%) regimens, a significant reduction in the average dose of FSH (P less than 0.05) was observed with pulsatile FSH administration. Furthermore, the number of patients who conceived during the FSH regimen was significantly greater than that found with hMG treatment. The present data demonstrate that pulsatile subcutaneous administration of hMG or FSH is effective in induction of successful ovulation and establishment of singleton pregnancy in patients with various types of anovulatory infertility.

Topics: Adult; Amenorrhea; Drug Administration Schedule; Female; Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Radioimmunoassay

A hypogonadotropic patient with primary pituitary insufficiency who has been previously treated for four cycles with hMG/hCG for ovulation induction is described. The hMG consumption was 76 to 96 ampules/cycle. Addition of GH (16 to 24 units/cycle) to hMG treatment was associated with a significant diminution in hMG consumption (35 to 36 ampules/cycle). The patient conceived on the second cycle of combined hMG/GH/hCG treatment. The possible role of GH as an adjunct to gonadotropin treatment is discussed, as well as the possible mechanisms of GH effects on the ovary.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Drug Synergism; Female; Fertilization; Growth Hormone; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovarian Follicle; Stimulation, Chemical

A comparative assessment of variations in sex hormone levels and echographic parameters of fertile and infertile cycles was carried out in patients with gonadotrophic deficiency during pergonal induction of the ovulation. It was demonstrated that 83% of the infertile cycles were the first stimulation cycles. Basic differences were identified in the variation of sex hormone levels and echographic parameters of target organs between the fertile and infertile cycles. It is concluded that the first ovulation-induction course should be regarded as a preventive or preparatory one, where an optimum drug dosage is adjusted while the gonads and target organs are getting ready for the ovulation.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Fertility; Fertility Agents, Female; Humans; Menotropins; Menstrual Cycle; Ovulation; Ovulation Induction

Clinical examinations including morphometry, mammography, x-ray examination of the cranium, ultrasonic examination of the small pelvic organs help detect the patients with hypogonadotropic amenorrhea and predict the efficacy of ovulation induction with menopausal gonadotropin. Women with a positive reaction to administration of progesterone and LH releasing factor make up the group most promising in respect of ovulation induction with menopausal gonadotropin.

Topics: Adult; Amenorrhea; Anovulation; Female; Humans; Menotropins; Menstrual Cycle; Ovulation; Ovulation Induction

The effect of prolonged inhibition of gonadotrophin secretion was studied in 12 women with premature ovarian failure. All the patients had plasma concentrations of follicle-stimulating hormone (FSH) greater than 20 i.u./l, and in six, primordial follicles had been seen on ovarian biopsy. Goserelin (Zoladex, ICI), a depot synthetic analogue of luteinizing hormone-releasing hormone (LHRH) was administered by three consecutive 4-weekly injections. Plasma concentrations of luteinizing hormone (LH) fell from 34 (SD 11) i.u./l to 2.4 (SD 1.9) i.u./l, and plasma concentrations of FSH fell from 106 (SD 29) i.u./l to 4.5 (SD 2.6) i.u./l 4 weeks after the first injection. Plasma concentrations of gonadotrophins returned to pretreatment values in every patient within 9 weeks of the final injection of goserelin. Regular ultrasonography during the period following the final injection failed to demonstrate the development of ovarian follicles in any patient, and plasma concentrations of oestradiol remained below 100 pmol/l. This study has failed to show that suppression of gonadotrophin secretion reverses premature ovarian failure.

Topics: Adult; Amenorrhea; Buserelin; Female; Follicle Stimulating Hormone; Goserelin; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary

Endocrine studies were made on 23 female patients aged 13 to 29 years, with delayed puberty or primary amenorrhoea and beta thalassaemia major, and 12 healthy controls, of whom six were prepubertal and six were in Tanner's stage 3-4. Each patient and control received a single intravenous dose of 100 micrograms gonadotrophin releasing hormone (GnRH), and one week later, 10 U/kg body weight of human menopausal gonadotrophin (hMG) to stimulate ovarian function. The patients had decreased gonadotrophin reserves when compared with those of normal controls, only one of 23 patients had an intact luteinising hormone and follicle stimulating hormone response. Most of the thalassaemic patients with delayed puberty showed normal gonad response to human menopausal gonadotrophin (hMG), but three had very low responses, when compared with that of controls. The gonadal failure was even more severe in four of six patients with primary amenorrhoea. It is important to assess hypothalamic-pituitary-gonadal function in young women with beta thalassaemia major, so that those with glandular dysfunction may be started on replacement therapy.

Topics: Adolescent; Adult; Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Pituitary Hormone-Releasing Hormones; Puberty, Delayed; Stimulation, Chemical; Thalassemia

A case of Rothmund-Thomson syndrome of a 24-year old woman with primary amenorrhoea is presented. This autosomal recessive disorder is characterised by atrophy, hyperpigmentation and teleangiectasiae of the skin, furthermore by juvenile cataracts and congenital bone defects as saddle nose. Endocrinologic and morphologic parameters suggest a resistant ovary syndrome as cause of this hypergonadotropic hypogonadism.

Topics: Adult; Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Syndrome

Eight thalassemic patients, aged 24-35 years, who developed amenorrhea 2-15 years after menarche, were studied. Mean basal serum LH and FSH levels and the peak levels after gonadotropin-releasing hormone were significantly less than corresponding values in normal controls. All patients showed low basal serum levels of estradiol and six had a poor or absent response to human menopausal gonadotropin. One subject had intact pituitary-gonadal function and one patient had an impaired LH and FSH response to gonadotropin-releasing hormone in the presence of a significant increase of estradiol after human menopausal gonadotropin stimulation. The findings regarding pituitary hormones other than gonadotropins suggest that iron overload damages tropic cells unequally and inconsistently. We conclude that both pituitary and gonadal damage may be responsible for the secondary amenorrhea in thalassemic patients.

Topics: Adult; Amenorrhea; Female; Humans; Hypothalamo-Hypophyseal System; Iron; Menotropins; Ovary; Pituitary Function Tests; Pituitary Hormone-Releasing Hormones; Thalassemia; Thyroid Function Tests; Ultrasonography; Uterus

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estradiol; Feedback; Female; Gonadotropin-Releasing Hormone; Humans; Hypothalamus; Luteinizing Hormone; Menotropins; Ovary

This study evaluated the activity of central opiate receptors modulating luteinizing hormone (LH) secretion before and during treatment with human menopausal gonadotropin (n = 8) or purified human urinary follicle-stimulating hormone (n = 6) in 14 patients with hypogonadotropic hypogonadism (n = 6) or secondary amenorrhea (n = 8). LH response to saline infusion and naloxone administration (4 mg intravenously) was assessed. As control, 6 normal ovulating women were studied. Before therapy, all amenorrheic patients showed no LH increase after naloxone injection. Gonadotropin treatment restored the naloxone-induced LH response at preovulatory and midluteal phases in ovulating patients with secondary amenorrhea. The same response was present in spontaneously ovulating women but was absent in the hypogonadotropic hypogonad patients, despite the gonadotropin therapy's efficiency. In conclusion, when the alteration of gonadotropin-releasing hormone synthesis and/or release is reversible, the opioid system actively participates in the regulation of the hypothalamus-pituitary-gonadal axis.

Topics: Adult; Amenorrhea; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Naloxone; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Receptors, Opioid; Sodium Chloride; Stimulation, Chemical

Serum concentrations of various hormones in seven normal women were measured daily for 5 days before and after ovulation. Steroid levels were also measured in severe amenorrheic patients during the induction of ovulation with HMG-HCG. Blood samples from the patients of II grade amenorrhea were collected on the day when the cervical mucus increased more than 200 mm3 in HMG therapy. HCG was given after the blood samples were obtained. Ovulation was successfully induced in six patients and they were classified as group I. In 8 patients induction of ovulation did not succeed and these patients were classified as group II. Hormone levels including LH, FSH, estradiol (E2), progesterone (P4), 17 alpha OH-P4 (17P4), delta 4 androstenedione (delta 4 A), testosterone (Tes.), pregnenolone (P5), 17 alpha OH-P5 (17P5), DHA, delta 5 androstenediol (delta 5 AD), and 20 alpha OH-P4 (20P4) were measured by specific RIA. The following results were obtained. Steroid levels during normal ovulatory cycle: Levels of E2 (380 +/- 16 pg/ml), P5 (6.9 +/- 4.1 ng/ml), and Tes. (3.3 +/- 1.2 ng/ml) showed a peak on the day before LH surge. A significant increase in P4, 17P5 and 20P4 levels was observed after ovulation. Hormone levels in group I: FSH in group I was significantly higher while LH was lower than that in normal women measured during -1 to -3 days from LH surge. On the other hand, among the steroids measured, significantly low Tes. and high 17P5, and E2 levels were noticed in group I. Comparison of hormone levels between group I and II: FSH and LH levels showed no significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amenorrhea; Androstenes; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnenes

The frequency of complications during gonadotropin therapy was reduced after the introduction of rapid estrogen assays. However, pregnancy rates remained low especially in normoestrogenic women. One hundred forty-three infertile normoestrogenic women were treated with human menopausal gonadotropin-human chorionic gonadotropin for 661 cycles. Almost all cycles were ovulatory. Whereas 53.7% of the patients conceived when drug administration was monitored by cervical score and serum estradiol levels only, 72.1% became pregnant when treatment was monitored by these modalities and real-time ultrasonography of the ovaries (p less than 0.05). Mean serum estradiol levels were significantly higher when ultrasonography was used to monitor response, but complications such as multiple births and ovarian enlargement did not occur more often. The data suggest that "true" ovulation occurs more often when ovarian imaging is used to determine drug dosage. Because of the higher pregnancy rate achieved by combined clinical (cervical score), biochemical (serum estradiol), and sonographic methods of monitoring, this approach should replace less extensive techniques.

Topics: Adult; Amenorrhea; Cervix Uteri; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Menstruation Disturbances; Oligomenorrhea; Ovary; Ovulation; Pregnancy; Ultrasonography

Three women with hypothalamic amenorrhea (HA) were treated with pulsatile gonadotropin-releasing hormone (GnRH). They responded with high luteinizing hormone (LH) values, minimal increments in follicle-stimulating hormone (FSH) values, and failure of follicular development. In subsequent GnRH-stimulated cycles, 1 ampule of human menopausal gonadotropin (hMG) was given intramuscularly for 3 consecutive days once the dominant follicle had attained a diameter of 7 to 8 mm. In all women, subsequent administration of human chorionic gonadotropin (hCG) produced presumptive evidence of ovulation. Five cycles were induced in three women using this regimen. A conception occurred in all three. One woman has conceived a second time. It was concluded that some women with HA respond to GnRH with an inappropriate LH and suppressed FSH response that may be overcome successfully using small doses of hMG.

Topics: Amenorrhea; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ultrasonics

The goal of this study was to evaluate the effects of menstrual cyclicity on plasma beta-endorphin (beta-EP) levels. For this purpose, beta-EP and cortisol plasma concentrations were measured during the menstrual cycle in healthy control subjects (n = 12), in patients affected by anovulatory syndrome (n = 6), and in amenorrheic patients (n = 8). In the same patients, beta-EP and cortisol were also measured under treatment for the induction of ovulation with pulsatile luteinizing hormone-releasing hormone or human menopausal gonadotropin plus human chorionic gonadotropin administration. In spontaneous and pharmacologically induced ovulatory cycles, a significant preovulatory rise of plasma beta-EP levels was always evident. Constant levels were found in the other periods of ovulatory cycles and in the patients affected by anovulatory syndrome and primary amenorrhea. Cortisol levels did not show any significant change throughout the cycle, either in controls or in patients before or after treatment. This result suggests that when ovulation occurs, plasma beta-EP levels show a relevant rise, the physiologic significance of which remains to be elucidated.

Topics: Adult; Amenorrhea; Anovulation; beta-Endorphin; Endorphins; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hydrocortisone; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Prolactin

To evaluate the endocrine profiles during induction of ovulation with pulsatile and continuous administration of hMG (Pergonal), 3 patients with polycystic ovarian disease (PCO) and 4 patients with hypothalamic amenorrhea were selected as the subjects. The total dose of hMG per day was 150 IU in each patient. hMG pulse was administered intravenously via a portable infusion pump every 90 min in 4 patients including 3 PCO cases (9.375 IU/pulse) and every 18 min in one patient (1.875 IU/pulse). The remaining 2 patients received continuous subcutaneous infusion of hMG (150 IU/day). Following hMG treatment, 8,000 to 10,000 IU of hCG was used to induce ovulation. All 7 patients ovulated and 4 of them conceived. Pregnancy resulted in 2 patients following pulsatile (every 90 min) administration and in 2 patients after continuous infusion. The duration of hMG treatment needed to induce ovulation was similar among the three modes of administration and within the range of 7 to 10 days. A sustained elevation of circulating FSH levels was observed in all patients and serum estradiol increased more than 3,000 pg/ml in 6 of 7 patients during the course of treatment. Mean (+/- SE) midluteal progesterone level was 107.1 +/- 20.9 ng/ml. Moderate to severe ovarian hyperstimulation occurred in all patients. These results indicate that both pulsatile and continuous administration of hMG are similarly effective in inducing ovulation. They also appear to indicate that the hMG-induced follicular development is profoundly affected by the maintenance of high levels of FSH in the circulation rather than by the mode of administering hMG, whether pulsatile or continuous.

Topics: Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone

A woman with secondary amenorrhea following head trauma showing isolated gonadotropin deficiency of hypothalamic origin did not respond to massive doses of hMG therapy (11 250 IU daily dose). Ovarian biopsy showed the absence of follicles, despite persistently low FSH levels. In this case the occurrence of premature ovarian failure was only suspected from the lack of response to hMG and diagnosed by ovarian histology.

Topics: Adult; Amenorrhea; Craniocerebral Trauma; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovary

Pulsatile administration of human menopausal gonadotropin (hMG) via the subcutaneous route was evaluated in 15 patients with various ovulatory disorders. Administration of hMG was started at a dose of 4.6875 IU (75 IU/day) or 9.375 IU (150 IU/day) per pulse every 90 minutes. Ovulation was observed in 26 (92.9%) of 28 treatment cycles, and two singleton pregnancies were confirmed. Ovarian hyperstimulation was observed in 1 to 26 ovulatory cycles; however, no other side effects were observed during treatment. A regimen of 75 IU/day resulted in a significant increase (P less than 0.0001) of the total dose and prolongation of the treatment period for induction of ovulation, as compared with that of 150 IU/day. Shortened luteal phases occurred in ovulatory cycles induced by pulsatile subcutaneous treatment. Human chorionic gonadotropin administration given every other day until the midluteal phase significantly prolonged the duration of the luteal phase (P less than 0.05). This treatment in patients with the polycystic ovary syndrome was followed by a normalization of luteinizing hormone/follicle-stimulating hormone ratio and resulted in a successful induction of ovulation in 8 to 10 cycles. The present data demonstrated that pulsatile subcutaneous administration of hMG was effective in inducing follicular maturation and ovulation in patients with various types of anovulatory infertility.

Topics: Adult; Amenorrhea; Anovulation; Drug Administration Schedule; Female; Gonadal Steroid Hormones; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamic Diseases; Infertility, Female; Injections, Subcutaneous; Luteal Phase; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

The endocrine effects of induction of ovulation with menotropins were studied in 43 patients: 11 with hypothalamic amenorrhea and 32 with the polycystic ovary syndrome. Patients with polycystic ovary syndrome had higher base-line values of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17 beta-estradiol, dehydroepiandrosterone sulfate, testosterone, and a higher testosterone-free index than those with hypothalamic amenorrhea. During treatment with menotropins, patients with polycystic ovary syndrome had higher values of serum LH, prolactin, dehydroepiandrosterone sulfate, testosterone, percent free testosterone, testosterone-free index, and body weight than those with hypothalamic amenorrhea; serum FSH, dose of menotropins per kilogram body weight, and total follicular volume were higher in patients with hypothalamic amenorrhea than in those with polycystic ovary syndrome. Multiple linear regression after log transformation demonstrated that the testosterone-free index was predicted statistically by total ovarian volume and dehydroepiandrosterone sulfate and that serum 17 beta-estradiol was predicted statistically by total ovarian volume and testosterone-free index. Adding dexamethasone to menotropins in six patients with polycystic ovary syndrome produced significant decreases in 17 beta-estradiol, dehydroepiandrosterone sulfate, testosterone, and testosterone-free index. Higher concentrations of endogenous serum LH and dehydroepiandrosterone sulfate in patients with polycystic ovary syndrome in comparison with those with hypothalamic amenorrhea were associated with higher concentrations of serum testosterone, a lower total follicular volume, and an effective response to menotropins at a lower serum FSH and a lower dose of menotropins per kilogram body weight. These data suggest that serum dehydroepiandrosterone sulfate may be a precursor for ovarian steroidogenesis.

Topics: Adrenal Glands; Amenorrhea; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Prolactin; Testosterone

Twenty-four hour urinary oestrogen results obtained in 20 amenorrhoeic patients undergoing human menopausal gonadotrophin (hMG) therapy have been analysed in detail in an attempt to improve their value in predicting multiple conception. Of 96 treatment cycles 88 were acceptably stimulated including 76 presumed ovulatory (midluteal serum progesterone concentration greater than or equal to 30 nmol/l). Conception occurred in 27 (26% of all, 33% of ovulatory cycles), of which 10 were multiple (37%). The chance of conception or multiple conception could not be related to luteal progesterone or preovulatory peak urinary oestrogen levels (at least within the clinically imposed limits of the oestrogen values). Discriminant analysis applied to all oestrogen results in individual cycles failed to predict conception, but in the conception cycles was 86% successful in predicting a single or multiple conception. Multiple conceptions were associated with an earlier but slower rise in oestrogen excretion during the last 5 days of hMG therapy, although the starting and final oestrogen levels were approximately the same. Unfortunately, the differences were small and as conception cycles were in the minority and could not be distinguished from non-conception cycles the oestrogen results could not be used reliably in practice to predict multiple pregnancy.

Topics: Amenorrhea; Circadian Rhythm; Estrogens; Female; Follow-Up Studies; Hormones; Humans; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Progesterone; Prognosis; Time Factors; Triplets; Twins

The effects of HMG (Humegon)-HCG therapy in 6096 cycles in 2166 Japanese women with anovulatory infertility were examined. The rates of ovulation, pregnancy, the ovarian hyperstimulation syndrome, multiple pregnancy, abortion, and malformations in the newborn were recorded, and the possible factors of multiple pregnancies were analyzed. Ovulation occurred in 73.2% of the cases and 64.5% of the treatment cycles. Pregnancy occurred in 23.0% of the cases and 8.6% of the cycles. Ovarian hyperstimulation syndrome with grade I of WHO definition or more was observed in 10.3% of the cases and 5.3% of the cycles. The incidence of the ovarian hyperstimulation syndrome was high in amenorrheic patients, who respond to progestin with bleeding. The multiple pregnancy rate was 20.5%, of which 13.0% was twins and 7.5% triplets or more. The abortion rate was 22.0%, and the abortion rate in multiple pregnancy was significantly higher (P less than 0.05) than that in singleton pregnancy. The external malformation rate was 1.68% in the 594 newborn who could be examined. No significant differences were found in maternal factors, the treatment schedule, or the ovarian response to treatment in singleton and multiple pregnancy groups. This survey revealed that the efficacy and the incidence of adverse effects of Humegon-HCG therapy in a large number of Japanese women were not different from those in Caucasians except for a lower rate of multiple pregnancy, and no special causative factors for multiple pregnancy were found.

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Adult; Amenorrhea; Anovulation; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple

The cumulative pregnancy rate after gonadotropin treatment was evaluated in 63 hyperprolactinemic and 242 normoprolactinemic women. All pregnancies in the hyperprolactinemic patients were achieved within four treatment cycles; the cumulative pregnancy was 62% as compared with 29% in normoprolactinemics. The same results were obtained when patients were divided according to endogenous estrogenic activity. These results imply that in bromocriptine failures there is no need to lower prolactin levels to achieve pregnancy with gonadotropins.

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovulation; Pregnancy; Prolactin

Estrogen levels are a useful indicator to use in predicting of ovarian hyperstimulation syndrome (OHSS) which is one of the side effects of HMG-HCG therapy. However, the quantitative assay of estrogens entails cumbersome time-consuming procedures. The present study represents our attempt to establish criteria for predicting the occurrence of OHSS by the use of ultrasonography (USG), a diagnostic procedure that can be performed quickly and conveniently. The subjects were 40 anovulatory women (79 cycles) receiving HMG-HCG therapy. Each patient had USG performed at the time of switching to HCG in a regimen of sequentially administered gonadotropins and was measured for maximum follicular diameter (FD) and total of vertical follicular area (FA) to correlate measurements of these parameters with simultaneously determined serum estradiol (E2) levels. A study was also made of relationships of FD and FA with ovulation and OHSS. The results are summarized as follows: No distinct correlation was observed between FD and E2 (r = 0.3794). It should be noted, however, that the therapy was successful in inducing ovulation in those cases in which the patient was switched to HCG from HMG when FD was 18mm or above. There was a significant correlation between FA and E2 (r = 0.8113, p less than 0.001). FA was thus proven to well reflect E2 levels and hence to be a parameter of the predictive value for OHSS. All but one (with moderate OHSS) of 26 cases showing evidence of OHSS had FA values of more than 6.0cm2, while those developing severe OHSS invariably.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovarian Follicle; Ovulation Induction; Ultrasonography

A high incidence of premature labor, incompetent cervix and fetal wastage occurs in multiple gestations which follow treatment with human menopausal gonadotropins (HMG). In order to determine the effect of treatment with HMG on hormone secretion in human pregnancy, progesterone (PROG), 17 beta-estradiol (E2), estriol (E3) and human chorionic gonadotropin (hCG) were determined by radioimmunoassay in 341 serum specimens from 229 normal singleton pregnancies and in 79 serum specimens from 20 pregnancies following induction of ovulation with HMG in women with either hypothalamic amenorrhea (HA) or the polycystic ovary syndrome (PCO). Fitting equations were found for the log transformed normal values and the residuals were obtained by subtraction of the predicted normal values from the log transformed values observed in the HMG pregnancies. In pregnancies which followed treatment with HMG, PROG and E2 were initially elevated above normal. As pregnancy progressed, the deviation from normal became proportionately less. PROG (P less than 0.025) was lower and E2 (P less than 0.025) and E3 (P less than 0.05) were higher in PCO pregnancies than in HA pregnancies. Multiple gestation produced increases in PROG (P less than 0.005), E2 (P less than 0.005) and E3 (P less than 0.001) in comparison to singleton pregnancies.

Topics: Amenorrhea; Chorionic Gonadotropin; Estradiol; Estriol; Female; Humans; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Progesterone; Statistics as Topic; Time Factors

Induction of ovulation with subcutaneous pulsatile (every 90 min.) administration of HMG (Pergonal) 75 or 150 IU/day using a portable pump (Nipro SP-3I) was performed in 3 PCO patients (6 cycles), 4 first grade amenorrhea (Am-I) patients (7 cycles) and 4 Am-II patients (4 cycles). All patients ovulated except one cycle of Am-I patients and one PCO woman conceived. In regard to the duration of administration and the total dose of HMG until ovulation, the administration of 150 IU/day (M +/- SD=15.2 +/- 5.0 days, 2280 +/- 774 IU) is superior to 75 IU/day (39.5 +/- 11.4 days, 3900 +/- 1357 IU), and there was no significant difference between this method and the daily intramuscular injection of HMG. The group treated with HCG in the luteal phase revealed a longer luteal phase (14.0 +/- 2.3 days) than the nontreated group (12.6 +/- 1.5 days). Ovarian hyperstimulation was observed in one case and subsided spontaneously after admission. There were no other side effects. In conclusion, this method has the following advantages: A high ovulation rate, comparable with daily intramuscular administration. It is a less painful procedure than daily intramuscular injection. It is possible for the patient to lead normal life, insertion and removal being easily done by herself.

Topics: Adult; Amenorrhea; Drug Administration Schedule; Female; Humans; Menotropins; Ovulation; Ovulation Induction; Pregnancy

In five hypothalamic amenorrhea patients who underwent chronic intermittent gonadotropin-releasing hormone (GnRH) therapy for induction of ovulation, small doses (2 to 4 ampules/day) of human menopausal gonadotropin (hMG) were administered 9 to 32 days after the start of GnRH treatment. In seven treatment cycles, the addition of hMG initiated a sudden rise of 17 beta-estradiol concentrations, followed by a luteinizing hormone and follicle-stimulating hormone surge and ultrasonographic evidences of ovulation. Four of five patients conceived (singleton pregnancies) after the first or second treatment course. There were no clinical signs of ovarian hyperstimulation. Combined therapy of GnRH and hMG may be useful, therefore, for the treatment of hypothalamic amenorrhea patients who demonstrate prolonged follicular phases or luteinized unruptured follicle syndrome under chronic treatment with pulsatile GnRH alone.

Topics: Adult; Amenorrhea; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Injections, Intramuscular; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Progesterone; Prolactin

The use of HMG is only justified to obtain a pregnancy, and cannot be used until after an investigation which excludes other causes of sterility, and necessitates careful surveillance. The contraindications should be respected. The author discusses the present indications for the administrations of HMG.

Topics: Amenorrhea; Anovulation; Female; Fertilization in Vitro; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins

Topics: Amenorrhea; Female; Gonadotropins, Pituitary; Humans; Luteinizing Hormone; Menotropins; Prolactin

Topics: Adult; Amenorrhea; Estrogens; Estrogens, Conjugated (USP); Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction

In 20 anovulatory patients who were normoprolactinaemic, 12 developed transient hyperprolactinaemia when they were treated with human menopausal gonadotropin (hMG) for induction of ovulation. The hyperprolactinaemia was probably due to the increased oestrogen production effect on some susceptible patients. The pregnancy rate was found to be lower in those who developed this condition. The dosage of hMG required was found to be significantly higher in this group. The importance of recognizing this transient hyperprolactinaemia and the probably role of Bromocriptine are discussed. Further study is suggested.

Topics: Adult; Amenorrhea; Estradiol; Female; Humans; Menotropins; Menstruation Disturbances; Oligomenorrhea; Ovulation Induction; Prolactin; Time Factors

Topics: Adult; Amenorrhea; Drug Evaluation; Female; Gonadotropins; Humans; Hypothalamic Diseases; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Diseases; Pregnancy

Topics: Adult; Amenorrhea; Body Weight; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Progesterone

Plasma hormonal changes were analysed in patients with hyperprolactinemia who conceived following Bromocriptine therapy. Following the administration of HMG-HCG and Bromocriptine, serial plasma samples were collected from the cases. Plasma levels of FSH, LH, prolactin (PRL), estrone (E1), estradiol (E2), 17-hydroxyprogesterone (17-P), 20 alpha-dihydroprogesterone (20 alpha-P), progesterone (P) were determined simultaneously using specific radioimmunoassays. Pretreatment PRL levels, 180--420 ng/ml, were normalized by 7.5--12.5 mg/day of Bromocriptine treatment causing a rapid decrease in plasma PRL, reaching a plateau within several days. The first LH surge at midcycle after the start of the Bromocriptine treatment was established at 10--50 days. In the patients the first mid-cycle LH surge was observed, but the luteal phase was definitely short, as demonstrated by plasma progestins levels. The results from the present longitudinal studies on hyperprolactinemia revealed characteristic changes accompanied by the restoration of the hypothalamic-pituitary-ovarian function during the treatment period.

Topics: Adult; Amenorrhea; Bromocriptine; Chorionic Gonadotropin; Female; Gonadal Steroid Hormones; Gonadotropins, Pituitary; Humans; Menotropins; Ovary; Ovulation; Prolactin

Statistical evaluation of 133 cycles of induction of ovulation using generalized linear models demonstrated that the occurrence and severity of ovarian hyperstimulation was influenced by the serum 17 beta-estradiol (E2) concentration (P less than 0.001), conception (P less than 0.001), and the endocrinologic diagnosis, polycystic ovary syndrome (PCO) or hypothalamic amenorrhea (HA) (P less than 0.01). When menotropins were administered between 5:00 P.M. and 8:00 P.M. and blood was drawn at 8:00 A.M., an upper limit for serum E2 in patients with HA of 2417 pg/ml or an upper limit for patients with PCO of 3778 pg/ml gave an approximate 5% risk of severe ovarian hyperstimulation in conception cycles and a 1.3% risk of severe hyperstimulation in nonconception cycles. Comparison of our E2 radioimmunoassay involving extraction and chromatography to the Pantex immunodirect Estradiol 125I kit (Pantex, Santa Monica, CA) demonstrated no detectable systematic error, allowing the use of these limits with either assay. The ovulating injection of human chorionic gonadotropin was given at 5:00 P.M. to 8:00 P.M. on the evening of blood drawing as soon as the first follicle reached an average diameter of 14 mm or greater. The ultrasound parameters allow the chance of pregnancy to be optimized and the chance of multiple gestation to be minimized. Serum E2 monitoring indicates when the risk of ovarian hyperstimulation is too great for human chorionic gonadotropin to be given.

Topics: Amenorrhea; Chorionic Gonadotropin; Chromatography; Estradiol; Female; Humans; Hypothalamic Diseases; Infertility, Female; Iodine Radioisotopes; Menotropins; Models, Biological; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Radioimmunoassay; Time Factors

A comparison of peripheral patterns of androstenedione (A), 17 beta-estradiol (E2) and progesterone (P) is reported in ten infertile women during HMG-HCG induction of ovulation, in order to assess the site of ovarian secretion of plasma A and the possible influence on conception. Evidence for both the follicular and luteal secretion of plasma A is suggested, in addition to the stromal and adrenal contributions, since a highly significant (p less than 0.001) correlation between A and E2 plasma levels was shown during the treatment. In three cycles of conception, plasma A showed a periovulatory peak and drop, followed by a luteal increase, all of which are characteristic of E2.

Topics: Adult; Amenorrhea; Androstenedione; Animals; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone; Rabbits

Eighty cycles induced by human menopausal gonadotropins in 45 women were studied with serial ultrasound examinations. The incidence of ovarian hyperstimulation (OHS) was 44%, considerably higher than in other series using similar induction protocols. This was probably due to the superior ability of ultrasound to detect ovarian enlargement and the withholding of human chorionic gonadotropin until at least one follicle had reached a minimum size of 15 mm. No difference was found between the mean urinary estrogen levels of those in whom mild or moderate OHS developed and those in whom it did not. It is concluded that the development of OHS is a frequent but acceptable result of ovulation induction.

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovary; Ovulation; Ovulation Induction; Ultrasonography

Topics: Adolescent; Amenorrhea; Female; Humans; Menotropins; Menstruation; Ovulation Detection; Ultrasonography

Two primary amenorrheic sisters were diagnosed as 46,XX pure gonadal dysgenesis. Their brother, a normal phenotypic and genotypic male, was azoospermic due to primary germinative failure. Parental consanguinity was observed, suggesting an autosomal recessive inheritance. This is the first reported family in which both an otherwise healthy male and two females were affected by gonadal germinative failure. Endocrine studies showed impaired gonadal function in the three affected siblings. The two females with gonadal dysgenesis and the azoospermic male shared one human leukocyte antigen haplotype; the second haplotype, however, was different. The common haplotype was also found in the oligomenorrheic sister whose gonadotropin-releasing hormone test was compatible with normal ovarian function, in the mother, and in one of her offspring who had a normal spermiogram. Hence, linkage between human leukocyte antigens and gonadal failure in this family had been excluded. The possible etiology of familial, chromosomally competent, gonadal failure is discussed.

Topics: Amenorrhea; Consanguinity; Estradiol; Female; Gonadal Dysgenesis; Gonadal Dysgenesis, 46,XY; HLA Antigens; Humans; Hydrocortisone; Luteinizing Hormone; Male; Menotropins; Menstruation Disturbances; Oligomenorrhea; Oligospermia; Pedigree; Prolactin; Testosterone; Thyroxine

Topics: Amenorrhea; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Medicine, Chinese Traditional; Menotropins; Ovulation Induction; Prolactin

Twenty-six daughters born to amenorrheic women after gonadotropin-induced ovulation were studied at 10 to 16 years of age. The aim of the study was to assess whether the mothers' condition, namely, amenorrhea and infertility followed by the pharmacologic induction of ovulation, had any effect on their female offspring in terms of endocrine disorders at puberty. The daughters were found to have normal onset of puberty as well as normal physical and mental development. The mean age at menarche, body weight, and height were similar to those of the general female population in Israel. A functioning hypothalamic-pituitary-ovarian axis was evidenced by the appearance of menarche followed by regular cycles. These data form a reassuring sample for the clinicians, the treated mothers, and their offspring.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Amenorrhea; Child; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menarche; Menotropins; Ovulation Induction; Pregnancy; Prenatal Exposure Delayed Effects; Puberty

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Corpus Luteum; Drug Evaluation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Progesterone; Time Factors

We schemed out a new method of ovulation induction with HMG-HCG using E2 rapid radio-immunoassay (RIA). On measurement of E2 values, the method of E2-(125)I kit (Daiichi Radioisotope Labs., LTD) was simplified, that is, an omission of defatting, shortened incubation time and a standard curve constructed by three points. There was a good correlation between the E2-(125)I kit method and the E2 rapid RIA method in E2 values obtained. The lowest detectable amount was 75 pg/ml. This rapid method seemed to be suitable to monitor the extent of follicular maturation during HMG therapy. Our new method of ovulation induction was as follows. (i) On the basis of E2 values measured every 3 days, HMG dosage was adjusted. (ii) When E2 was over 400 pg/ml for 2 days, HCG was given on the next day. with this method, there was an increase in the percentage of ovulatory cycles from 54.5% to 100% and a decline in the incidence of ovarian enlargement and the ascites. This new method minimized inconvenience and expense of E2 determination without drastically influencing therapy outcome.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation Induction; Radioimmunoassay

Forty-nine patients in whom clomiphene citrate failed to induce ovulation were treated for 177 cycles with a fixed low dosage of menotropin. Among these 49 patients, there were 24 pregnancies. Among these pregnancies were two that were multiple and three spontaneous abortions. In only one treatment cycle was there a hyperstimulation syndrome. These patients were divided into three clinical groups: the secondary amenorrheic patient, the oligo-amenorrheic patient, and the patient with poor corpus luteum function. There was no statistically significant difference in the pregnancy rate per month among all groups during the first three treatment cycles (average value, 0.07). However, there was a statistically significant improvement in the pregnancy rate per month in the group with secondary amenorrhea and the group with poor corpus luteum in the last three treatment cycles, as compared with the first three treatment cycles (P = 0.05; average value, 0.75). The oligo-amenorrheic patients, on the other hand, during the last 3 months of treatment, had no statistically significant increase in the pregnancy rate per month. These data suggest that menotropin therapy may have a priming effect. These data do not fit the currently accepted model of a constant pregnancy rate per month for all patients. The data suggest that caution should be exercised before combining patient groups when evaluating the results of menotropin therapy.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Estradiol Congeners; Female; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Pregnancy; Statistics as Topic; Superovulation

This report is based on 416 infertile female patients who were treated for 1,033 cycles with gonadotropins. 28.6% of the patients conceived after hMG/hCG treatment in 79.8% of these pregnancies, healthy children were born. Spontaneous abortion or premature birth occurred in 20.2% of the cases. The twin rate was 28.6%, the triplet rate 5.5%. Most of the abortions occurred in the first trimester (52.2%). No malformations were seen. The pregnancy rate showed striking differences in the various diagnostic groups: hypogonadotropic amenorrhea 44.4%, normogonadotropic amenorrhea 50%, anovulatory cycles 22%, corpus luteum insufficiency 14.8%. The abortion rates for these four groups were as follows: hypogonadotropic amenorrhea 25%, normogonadotropic amenorrhea 14.7%, anovulatory cycles 4.8%, corpus luteum insufficiency 36.3%. A detailed analysis of the treatment cycles is given for the four groups: the number of ampoules of hMG/hCG increased from 21.4 ampoules in patients with corpus luteum insufficiency to 47.7 ampoules in patients with hypogonadotropic amenorrhea. The inactive phase increased from 5.6 days in patients with corpus luteum insufficiency to 8.5 days in patients with hypogonadotropic amenorrhea. Estrogen values around the time of ovulation and in the corpus luteum phase were much lower in patients with spontaneous uterine bleedings. Hyperstimulation syndrome occurred less frequently in these patients. The percentage of pregnancies decreased in patients with corpus luteum insufficiency from 8.1% in the first treatment cycle to 4.8% in the following treatment cycles, whereas it increased from the first to the following cycles in the other diagnostic groups. Patients with anovulatory cycles and corpus luteum insufficiency respond differently to hMG/hCG treatment than patients with normogonadotropic amenorrhea. The inactive and active phase are important parameters for the evaluation of ovulation induction with hMG/hCG, hMG/hCG treatment is of little value in patients with corpus luteum insufficiency.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Corpus Luteum; Drug Therapy, Combination; Female; Fertility Agents, Female; Fetal Death; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Pregnancy

Twenty-four courses of ovulation induction with HMG-HCG were accompanied by ultrasound sector scanning. The results of cross-sectional studies did not deviate from those reported for normal cycles. Cross-sectional studies indicate smaller peak follicular volumes than repeated measurements of the same follicles. Results may, however, be influenced by frequency and time of measurements, as well as frequency and time of coitus for the patients. Peak-size follicular volumes in patients who became pregnant were relatively large. Peak volumes connected with subsequent pregnancies may therefore have another range of variation than follicles releasing oocytes which will remain unfertilized.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Oligomenorrhea; Ovulation; Ovulation Detection; Pregnancy; Ultrasonography

Sex hormone binding globulin (SHBG) levels were studied for possible effects of oestradiol-17 beta on SHBG. No change in SHBG plasma was recorded during normal menstrual cycles or during treatment with oestradiol-17 beta to menopausal women. However, gonadotrophin treatment to amenorrhoeic women to induce ovulation resulted in high oestradiol concentrations and a pronounced increase in SHBG was found during the luteal phase of these cycles. A marked increase of SHBG was also recorded in a woman with pronounced fluctuations of oestradiol during treatment with levonorgestrel sc implants for contraception. In conclusion, effects on SHBG were only found when extraordinarily high levels of plasma oestradiol were recorded.

Topics: Adult; Amenorrhea; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Estradiol; Female; Humans; Levonorgestrel; Menopause; Menotropins; Menstruation; Norgestrel; Ovulation; Progesterone; Sex Hormone-Binding Globulin

Topics: Amenorrhea; beta-Endorphin; Chorionic Gonadotropin; Endorphins; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Menstruation; Prolactin

Correlation coefficients for dehydroepiandrosterone sulfate (DHEAS) were determined in women on menotropin. DHEAS was significantly correlated with testosterone free index (TFI), 0.78**; percentage free testosterone (%FT), 0.66**; androstenedione (delta 4A), 0.66*; luteinizing hormone (LH), 0.55**; LH/follicle-stimulating hormone (FSH) ratio, 0.55**; 17-OH-progesterone (17-P), 0.55**; testosterone (T), 0.53**; weight (WT), 0.40**, urinary estriol glucuronide (E3G), 0.33*; and free cortisol index (FFI), 0.32*, with 43 df but not with prolactin (PRL), 0.25. Normal male DHEAS (3.5 +/- 1.2, 25) (microgram/ml; mean +/- standard deviation, n) was higher than normal female DHEAS (2.4 +/- 1.1, 27), P less than 0.01 and DHEAS in women on oral contraceptives (1.9 +/- 1.1, 17) was slightly lower than in normal females, P greater than 0.2. In the combined population (male, female, and females on oral contraceptives) DHEAS was correlated with TFI (0.56**), T (0.54**), %FT (0.52**), delta 4A (0.40**), and age (-0.40**) with 66 df and 17-P (0.30*) with 54 df. TFI appears to be one determinant of plasma DHEAS, **P less than 0.01. *P less than 0.05.

Topics: Amenorrhea; Dehydroepiandrosterone; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Polycystic Ovary Syndrome; Testosterone

Serum gonadotrophin values were measured in 410 patients with amenorrhoea. These patients were grouped into five groups in order to determine diagnostic gonadotrophin values, since the latter are most often implicated in the diagnostic investigation of patients with amenorrhoea. Statistically significant differences were noted. To differentiate between hypergonadotrophin amenorrhoea and polycystic ovarian disease, determination of both gonadotrophins, namely follicle-stimulating hormone (FSH) and luteinizing hormone (LH), is necessary. Because of overlapping of values in the polycystic ovarian disease group and the normogonadotrophic group, the LH:FSH ratio is important.

Topics: Amenorrhea; Female; Humans; Luteinizing Hormone; Menotropins

We evaluated gonadal function in 18 female and eight male patients with galactosemia due to transferase deficiency; it was normal in the males, but 12 females had signs of hypergonadotropic hypogonadism. All female patients had a 46,XX karyotype, normal levels of thyroid hormone and prolactin, and no anti-ovarian antibodies. The biologic activity of urinary gonadotropins was normal. Ultrasonography of the pelvis revealed that ovarian tissue was diminished or absent. Total estrogens increased in one of two patients after administration of human menopausal gonadotropin. The frequency of hypergonadotropic hypogonadism was higher in females in whom dietary treatment for galactosemia was delayed. Clinical course and mean erythrocyte galactose-1-phosphate and urinary galactitol levels did not correlate with ovarian function. We conclude that female patients with galactosemia have a high incidence of ovarian failure due to acquired ovarian atrophy. Galactose or its metabolites may be toxic to the ovarian parenchyma, particularly during the immediate neonatal period.

Topics: Adolescent; Adult; Amenorrhea; Atrophy; Child; Estradiol; Female; Follicle Stimulating Hormone; Galactosemias; Gonadotropins, Pituitary; Humans; Hypogonadism; Luteinizing Hormone; Male; Menotropins; Ovarian Diseases; Puberty; Sex Factors

Topics: Amenorrhea; Drug Evaluation; Endocrine System Diseases; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prolactin

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Prolactin

Topics: Adult; Amenorrhea; Drug Resistance; Drug Therapy, Combination; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Progesterone

To investigate the possibility of using urinary estradiol-17 beta-glucuronide (E2-17G) measured by direct radioimmunoassay to monitor ovulation induction with human menopausal gonadotropin (hMG), serum estrogen and urinary E2-17G levels were determined daily by 21 women treated with hMG for a total of 32 treatment cycles. Urinary E2-17G was measured in 24-hour and overnight specimens. A significant correlation was found between serum estrogens (primarily estradiol) measured by radioimmunoassay without preceding chromatography and urinary E2-17G excretion measured at 24 hours and overnight. The correlation was not significantly improved by correcting the 24-hour and overnight urinary E2-17G excretion levels with creatinine measurements. Although there was significant correlation between serum estrogens and urinary E2-17G measured by direct radioimmunoassay, the urinary E2-17G concentrations observed when serum estrogens levels indicated preovulatory follicle maturation (ie, at serum estrogens levels between 500 and 1000 pg/ml) varied so much that a clinical decision to trigger or not to trigger ovulation with human chorionic gonadotropin could not be reached in each case. These data indicate that significant correlation is not the only prerequisite for a new method to replace a proved procedure. Further studies are required to determine the reliability of monitoring hMG therapy with direct E2-17G radioimmunoassays in overnight urine collections.

Topics: Adult; Amenorrhea; Estradiol; Estrogens; Female; Follicular Phase; Humans; Menotropins; Ovulation Induction; Radioimmunoassay; Time Factors

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Corpus Luteum; Estradiol; Estrogen Antagonists; Female; Follicle Stimulating Hormone; Humans; Hypothalamus; Luteinizing Hormone; Menotropins; Menstruation; Oligomenorrhea; Ovarian Diseases; Ovulation; Pituitary Hormone-Releasing Hormones

The fertility in previously sterile women who conceived at least once following hMG/hCG-induced ovulation is investigated. The study comprises 141 women. The cumulative spontaneous pregnancy rate (CSPR) was calculated using life table analysis and was found to be 30.4% after 5 years. The CSPR for subsequent pregnancies reached 91.3% after 5 years. This figure is similar to that of normal parous women, although the study group (previously infertile women) requires a larger exposure period to attain the figure. The spontaneous abortion rate in the hMG/hCG-induced pregnancies was 29%; whereas in subsequent spontaneous pregnancies this rate was 8.8%. This difference in rate was found to be statistically significant, and the possible reasons are discussed.

Topics: Abortion, Spontaneous; Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Galactorrhea; Humans; Infertility, Female; Menotropins; Menstruation; Oligomenorrhea; Ovulation Induction; Postpartum Period; Pregnancy

Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.

Topics: Administration, Intranasal; Adult; Amenorrhea; Body Temperature; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Progesterone

The methods and results of treatment with human menopausal gonadotropins (hMG) and chorionic gonadotropin (hCG) in 26 patients (mean age 24 years, range 22-35 years) with hypogonadotropic primary amenorrhea and without chromosomal abnormalities are reported. The usual dose of hMG was 225 IU daily until the karyopycnotic index rose to 40% or more and the other clinical parameters revealed sufficient follicular maturation. A dose of hCG was then administered at the rate of 10,000 IU daily for 4 days. In 60 courses of treatment, we obtained 17 pregnancies (28.3%) in 13 patients (i.e., including some second pregnancies), 35 ovulations without pregnancy (58.3%), and seven patients did not respond (11.6%). Three patients who did not respond and who continued the treatment ovulated and became pregnant. Clinical hyperstimulation occurred in three patients on the first course of treatment. Two of them again presented this complication on repetition of treatment despite the precautions taken. Urinary estrogen and pregnanediol measurements on the 7th-11th day after hCG administration revealed considerable hormonal hypersecretion in 19 of 27 courses of treatment. In eight patients the high output of pregnanediol continued during the first 1-2 months of pregnancy and decreased thereafter. The rate of pregnancies seemed to be higher in patients with hypersecretion whereas clinical hyperstimulation did not correlate with the degree of the hormonal output. Pregnancies were all single and uneventful except for one abortion in a patient who was found to have mycoplasma infection. All patients gave birth to normal children and lactated normally. The increased dosage of hCG used in this series is considered to be a decisive factor in the induction of ovulation and the maintenance of pregnancies through the abundant steroid production it induced.

Topics: Adult; Amenorrhea; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnanediol

In an attempt to determine whether prolactin influences estrogen biosynthesis in the ovary, the estrogenic responses of women with amenorrhea under treatment with human menopausal gonadotropin (hMG), with and without the simultaneous administration of the prolactin inhibitor bromocriptine, were investigated in a total of 20 treatment cycles. In five of the six women studied, the addition of bromocriptine produced a urinary excretion of estrogenic compounds 79% higher than that produced by treatment with hMG alone. In one woman with a slightly increased serum prolactin level, the addition of bromocriptine necessitated halving the total hMG dosage. One woman with low endogenous levels of follicle-stimulating hormone (FSH) and a limited response to gonadotropin-releasing hormone showed no increased estrogen excretion after bromocriptine administration over that produced by hMG alone. These results suggest that (1) both elevated and normal serum prolactin levels can have a direct inhibitory effect on the ovary and (2) FSH may be necessary for the formation of prolactin receptors in the ovary.

Topics: Adult; Amenorrhea; Bromocriptine; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menopause; Menotropins; Pituitary Hormone-Releasing Hormones; Prolactin; Time Factors

Topics: Adult; Amenorrhea; Cervix Mucus; Chronic Disease; Drug Evaluation; Estrogens; Female; Humans; Infertility, Female; Menotropins

We report herein 11 pregnancies in patients with primary amenorrhea and normally developed secondary sex characteristics. All patients were fully investigated, and their ovaries as visualized by laparotomy or laparoscopy were found to be small. Ovarian biopsy revealed numerous unstimulated primordial follicles. The hormonal profiles showed hypoestrogenism with atrophic endometrium. Human gonadotropins were used in large amounts in order to achieve pregnancy. Two patients responded in all treatment cycles with menses. The remainder failed to respond to all treatment cycles. All patients became pregnant and carried their pregnancies normally to term. There were four sets of twins and seven single births. Of fifteen newborns, one died of congenital heart disease.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Female; Humans; Menotropins; Pregnancy; Pregnancy Complications; Sex Characteristics

A patient with growth hormone deficiency and primary amenorrhoea became pregnant with the help of human menopausal gonadotrophin. Pregnancy was complicated only by abdominal discomfort due to her very small stature and by moderate oedema. She was delivered of healthy female twins by lower segment Caesarean section at the 37th week.

Topics: Adult; Amenorrhea; Female; Growth Disorders; Growth Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Complications; Pregnancy, Multiple

A method for the large scale preparation of partially desialylated human chorionic gonadotrophin suitable for human use is reported. To obtain the desired grade of desialylation and to avoid the presence of the enzyme in the modified hormone, neuraminidase coupled to Sepharose 4B was used. The preparation showed to be active in vitro (OAAD and SVW tests) and its half-life was found to be 13 min in the rat and 75 min in human beings. This desialo hCG proved to be effective in inducing ovulation in amenorrhoeic women. Among 39 induced cycles 31 ovulations and 5 pregnancies occurred.

Topics: Adult; Amenorrhea; Animals; Asialoglycoproteins; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Neuraminidase; Ovary; Ovulation; Pregnancy; Progesterone; Rats; Sepharose; Sialic Acids; Ultrafiltration

Gonadotropin therapy for anovulation is highly successful: 58.6% of treated patients conceive. Better results are achieved in patients with galactorrhea-amenorrhea (77.1%) and hypogonadotropic hypogonadism (63.3%) than in patients with normal gonadotropin levels (45.4%). The spontaneous abortion rate (27.5%) is somewhat higher than that in spontaneous pregnancies. The multiple pregnancy rate is 31% and was slightly lower in cycles with preovulatory estrogen levels in the physiologic range. In patients treated with human menopausal and chorionic gonadotropins for 7 to 9 days per cycle, the multiple pregnancy rate is considerably less (12.9%) than in patients with longer treatment. The efficacy of treatment does not diminish with repeat-treatment cycles.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estrogens; Female; Galactorrhea; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Time Factors

Correlation between 17 beta-estradiol blood content and the excretion of estrogens was studied during 19 cycles in 10 women with amenorrhea treated with pergonal-500. A high degree of correlation between two lines of values has been observed (r = 0.89 +/- 0.03). It is concluded that both methods are equally informative in the evaluation of pergonal therapeutic effect.

Topics: Adult; Amenorrhea; Drug Combinations; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Time Factors

Topics: Amenorrhea; Clomiphene; Female; Humans; Menotropins; Progesterone Congeners

Forty-one amenorrheic patients were grouped on the basis of presence or absence of withdrawal uterine bleeding following the intramuscular administration of progesterone. Ovarian volume, ovarian morphology with particular reference to presence or absence of follicles and state of follicular development, and steroidogenic function were investigated in each group. Most of amenorrheic patients with progesterone-induced uterine bleeding had relatively large ovaries with follicles of high developmental stage (tertiary-Graafian follicle) and responded to exogenously administered HMG and HCG with a rise in the 24-hour urinary excretion of total estrogens. In contrast, most of amenorrheic patients without progesterone-induced uterine bleeding had relatively small ovaries without follicles or with follicles of low developmental stage (primordial-secondary follicle) and did not respond to exogenous HMG and HCG. The results of the present study suggest that presence or absence of progesterone-induced uterine bleeding is closely correlated with the volume, morphology and steroidogenic function of the ovary in amenornorrheic patients. Thus, pathologic amenorrhea could be divided into two groups by utilizing the progesterone challenge test and this clinical categorization might be useful for the diagnosis and treatment of amenorrheic patients.

Topics: 3-Hydroxysteroid Dehydrogenases; Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Glucosephosphate Dehydrogenase; Histocytochemistry; Humans; Menotropins; Menstruation-Inducing Agents; Ovarian Follicle; Ovary; Progesterone

Among 1099 patients seen over an 8-year period for amenorrhea or oligomenorrhea, 115 (10.5%) had developed amenorrhea after ceasing oral contraception. These patients were the subject of a special study. Those who were treated received either clomiphene alone, hMG/hCG therapy, or both. There was no correlation between the incidence of either spontaneous or treatment-induced ovulation and menstruation and the duration of use of oral contraception, previous parity, or the nature of prior menstrual cycles. The incidence of treatment-induced resumption of menses was essentially the same as that for spontaneous resumption. An average duration of 30 months of oral contraceptive use did not significantly affect urinary excretion levels of estrogens and gonadotropins.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Contraceptives, Oral, Synthetic; Drug Therapy, Combination; Estrogens; Female; Humans; Menotropins; Menstruation; Ovulation Induction; Parity; Pregnancy; Syndrome

Topics: Adult; Amenorrhea; Chronic Disease; Drug Evaluation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovarian Follicle; Pregnancy; Time Factors

Seventy-six patients with primary or secondary amenorrhea who wished to conceive were treated with clomiphene citrate, 2-Br-alpha-ergocryptine, and/or human menopausal gonadotropins (hMG). Of these 71 patients who received clomiphene citrate, 39 (55%) ovulated. Of these 71 patients, 52 had withdrawal uterine bleeding following IM progesterone, and 38 (73%) ovulated; only 1 of the 19 who did not bleed ovulated (P less than 0.001). Ovulation occurred in the former group of patients whether or not they had galactorrhea. Of the 32 patients who failed to ovulate despite treatment with the maximal dose of clomiphene, 250 mg/day for 5 days, 26 received hMG-hCG. All 26 ovulated and 15 conceived. All 8 patients with amenorrhea-galactorrhea who were treated either primarily or secondarily with bromergocryptine ovulated, and 4 conceived. Therefore, the drug of choice for ovulation induction in amenorrheic patients depends on 1) the presence of withdrawal bleeding after progesterone and 2) the presence of galactorrhea. In all patients with progesterone withdrawal bleeding with or without galactorrhea, the initial treatment of choice is clomiphene citrate. In the absence of withdrawal bleeding, hMG should be administered if galactorrhea is absent, and bromergocryptine should be administered if galactorrhea is present.

Topics: Amenorrhea; Bromocriptine; Clomiphene; Female; Galactorrhea; Humans; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Substance Withdrawal Syndrome; Uterine Hemorrhage

Topics: Adult; Amenorrhea; Antibodies; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition, intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.

Topics: Administration, Intranasal; Adult; Amenorrhea; Anovulation; Body Temperature; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Pregnancy

Correlation between ovarian follicular apparatus and hormonal parameters such as serum gonadotropin and urinary estrogen levels was investigated in patients with primary and secondary amenorrhea. Serum gonadotropin levels were elevated in amenorrheic patients without ovarian follicles or with follicles of low developmental stage and pituitary responsiveness to LH-RH in these patients were marked compared with patients with follicles of high developmental stage or normal ovulating women in the follicular phase of the menstrual cycle. The 24-hour urinary excretion of total estrogens was low in patients without follicles or with follicles of low developmental stage and ovarian responsiveness to exogenous gonadotropins was quite low in comparison with patients with highly developed follicles or normal control subjects. Thus, serum gonadotropin and urinary estrogen measurements and LH-RH and gonadotropin loading tests are diagnostic of the presence or absence and the state of development of ovarian follicles in the diagnosis and treatment of primary and secondary amenorrhea.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovary; Pituitary Gland, Anterior; Turner Syndrome

Topics: Adolescent; Adult; Amenorrhea; Female; Growth Hormone-Releasing Hormone; Humans; Menotropins; Ovarian Diseases; Ovary; Stimulation, Chemical; Syndrome

1. Only FSH was increased after intravenous administration of 0.025 mg of GnRH in 2 female patients suffering from olfacto-genital syndrome. LH-serum-concentrations increased significantly, only when 0.1 mg GnRH was applicated intravenously twice with an interval of one hour.2. The response of hPRL-secretion to 0.2 mg TRH was found normal in both patients. However, when 25 mg chlorpromacine were administered intramuscularly, only one patient responded with an adequate rise of serum-hPRL. 3. One patient became pregnant during treatment with HMG/HCG. The clinical course of pregnancy was quite normal. HPL- and HCG-levels were in the normal, hPRL in the low normal range during pregnancy.

Topics: Adult; Amenorrhea; Chlorpromazine; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Olfaction Disorders; Pituitary Hormone-Releasing Hormones; Pregnancy; Prolactin; Syndrome; Thyrotropin-Releasing Hormone

To study the effects of graded amounts of estrogens on prolactin (PRL) secretion, PRL response to chlorpromazine (CPZ) during administration of human menopausal gonadotropin (hMG) was determined. A control CPZ test was done prior to initiation of hMG therapy and the test was repeated when endogenous estrogen secretion reached the physiologic range (350 to 400 pg. per milliliter) which stimulates luteinizing hormone surge in the normal ovulatory menstrual cycle. Six euprolactinemic women with secondary amenorrhea were studied. Studies showed that there was no significant change in the mean serum prolactin concentrations during control and repeat CPZ testing procedure (5.8 +/- 2 and 10.8 +/- 2 ng. per milliliter, p less than 0.1). The maximal response of PRL to CPZ was significantly higher during hMG-induced high estrogenic state than during control testing (69.9 and 32.3 ng. per milliliter, p less than 0.01). This findings suggests that endogenous estrogen may play a role in the regulation of serum prolactin concentration during the menstrual cycle.

Topics: Amenorrhea; Chlorpromazine; Estradiol; Estrogens; Female; Menotropins; Menstruation; Prolactin

Topics: Adult; Amenorrhea; Cervix Mucus; Chorionic Gonadotropin; Drug Combinations; Estrogens; Female; Gonadotropins; Humans; Menotropins; Ovulation

This report describes in detail the hormonal and ultrastructural findings in a 21 year old woman with secondary amenorrhoea, who fulfilled all the criteria necessary to establish the diagnosis of resistant ovary syndrome. Ovarian biopsies revealed numerous primordial and primary follicles, which both by light and electron microscopy showed a normal morphology. Nevertheless, the follicles could not be stimulated neither by large doses of human gonadotrophins alone nor by simultaneous administration of cortisone acetate and large doses of human gonadotrophins. The association of a decreased target cell response with increased levels of serum FSH and LH might be explained in different ways. The presence of an inhibitor preventing the normal action of gonadotrophins could not be substantiated, because we did not detect any circulating gonadotrophin antibodies. Furthermore the serum prolactin level was normal.

Topics: Adult; Amenorrhea; Cortisone; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Microscopy, Electron; Oocytes; Ovarian Follicle; Ovary; Syndrome

Topics: Amenorrhea; Estrogens; Female; Humans; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

Topics: Amenorrhea; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

Amenorrhea is a symptom having many possible causes. Since amenorrhea can result from disturbed function anywhere in the hypothalamic-pituitary-ovarian-uterine axis, a specific etiologic diagnosis must be made if treatment is to be effective. For this purpose, a diagnostic scheme for the differential diagnosis of the etiology of primary and secondary amenorrhea is proposed. This scheme includes a progestin test, a cyclic estrogen and progestin test, a luteinizing hormone-releasing hormone (LH-RH) loading test, and a gonadotropin (human menopausal gonadotropin and human chorionic gonadotropin) loading test. A specific pattern of responses to LH-RH and gonadotropins exists in patients with hypothalamic, pituitary, and ovarian amenorrheas, respectively, and the character of the response may facilitate the etiologic diagnosis of amenorrhea. The clinical usefulness and/or value of the scheme in the diagnosis and treatment of amenorrheas is discussed.

Topics: Adult; Amenorrhea; Chlormadinone Acetate; Chorionic Gonadotropin; Diagnosis, Differential; Endocrine System Diseases; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Mestranol; Progesterone

Twenty-six patients seeking advice for sterility were given courses of treatment with HMG-HCG. Ovarian maturation was followed by daily evaluation of plasma 17beta-oestradiol concentrations. HCG was administered as soon as 17beta-oestradiol levels reached 250 pg/ml. In a first group of 7 amenorrheic patients with lack of oestrogen activity, a pregnancy rate of 71.4% and an ovulation rate of 91.7% were achieved. In a second group of 5 amenorrheic patients showing evidence of oestrogen activity, a pregnancy rate of 80.0% and an ovulation rate of 100% were obtained. In a third group of 14 oligomenorrheic patients, the pregnancy rate attained 71.4% and the ovulation rate 96.9%. The overall pregnancy rate was 73.0%. With this procedure of monitoring HMG-HCG treatment by means of plasma 17beta-oestradiol levels, the multiple pregnancy rate reached only 11.7% and only one case of mild ovarian hyperstimulation was observed. Pre-ovulatory and pre-conceptional 17beta-oestradiol concentration were identical with those observed in spontaneous ovulatory cycles with or without conception.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Female; Menotropins; Oligomenorrhea; Ovulation; Pregnancy; Progesterone

In order to determine the pituitary or ovarian site of the anti-gonadotrophic action of prolactin (PRL), ten women with hyperprolactinaemia were studied in the following way: 1) Repeated estimations of PRL, gonadotrophins (LH and FSH), plasma estradiol and progesterone during six weeks of treatment with bromocriptine. 2) Verification of the effects of estradiol benzoate on LH and FSH levels before and after normalisation of prolactin. 3) Exploration of the ovarian response to the administration of human menopausal gonadotrophin. Without it being possible to exclude any direct effect of prolactin on the ovary, it may be affirmed that the hormone decreases the sensitivity of the gonadotrophic cells to the positive feedback mechanism exerted by plasma estradiol.. To determine the pituitary or ovarian site of the antigonadotropic action of prolactin (PRL), 10 women with hyperprolactinemia were studied; 1) Repeated estimations of PRL, luteinizing hormone (LH), follicle stimluating hormone (FSH), plasma estradiol, and progesterone during 10 weeks of treatment with bromocriptine. 2) Verification of the effects of estradiol benzoate on LH and FSH levels before and after normalization of prolactin. 3) Exploration of the ovarian response to the administration of human menopausal gonadotropin. Although it is impossible to exclude any direct effect of PRL on the ovary, it may be affirmed that the hormone decreases the sensitivity of the gonadotropic cells to the positive feedback mechanism exerted by plasma estradiol.

Topics: Adult; Amenorrhea; Bromocriptine; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Lactation Disorders; Luteinizing Hormone; Male; Menotropins; Ovary; Pregnancy; Progesterone; Prolactin

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Humans; Menotropins; Pessaries

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Drug Evaluation; Female; Humans; Menotropins; Pregnancy

There are specific indications for the use of clomiphene. When used with the simple precautions that have been outlined, it is a safe, relatively inexpensive and convenient method of ovulation induction. Clomiphene certainly deserves its prominent place in the treatment of the infertile woman.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Menotropins; Ovulation

Topics: Adult; Age Factors; Amenorrhea; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Menotropins; Pregnancy

Topics: Adult; Amenorrhea; Female; Humans; Menotropins; Ovulation; Pregnancy; Pregnancy, Ectopic

In 9 hypogonadotrophic, normoprolactinemic women with primary or secondary amenorrhea, who were infertile, 16 treatment cycles with menopausal gonadotropin and chorionic gonadotropin (HMG-HCG) were carried out. Nine treatment cycles were monitored indirectly with the cervical factor and hormonal cytology. The concomitant serum estradiol and progesterone values were later determined by radioimmunoassays. The other 7 treatment cycles were monitored by daily serum estradiol determinations. There were 4 pregnancies. Successful induction of ovulation with subsequent pregnancies was only obtained in the treatment cycles monitored by serum estradiol determinations (pregnancy rate 60%). Classical signs of overstimulation with ascites and hydrothorax occurred twice in treatment cycles which were monitored by clinical means only. Neither the maturation index nor the cervical factor reflected a quantitative overstimulation of the ovaries. The daily radioimmunological determination of estradiol prevented overstimulation of the ovaries, and permitted optimal timing of the induction of ovulation with HCG. In our experience, the maturation index determined from vaginal cytology and the clinical determination of the cervical factor are inappropriate parameters to monitor individually a successful induction of ovulation with HMG-HCG.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation; Pregnancy; Radioimmunoassay

Topics: Adolescent; Adult; Amenorrhea; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Recurrence

Topics: Adult; Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Pregnancy

Topics: 17-Ketosteroids; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamus; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Prolactin

Topics: Adult; Amenorrhea; Anovulation; Clomiphene; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Ovarian Follicle; Ovary; Ovulation; Pregnancy; Progesterone

To determine if elevated serum prolactin hPRL inhibits ovarian steroidogenesis and contributes to the amenorrhea associated with galactorrhea syndromes, the following study was performed. Four women with amenorrhea, galactorrhea, and elevated serum hPRL levels were treated with menopausal gonadotropins (Pergonal) for the associated infertility. Urinary estrogen response was comparable to that in normal ovulatory women in each patient. Ovulation occurred in 3 of the 4 women with resultant conception and normal pregnancies. There was no evidence to support the contention that elevated hPRL interferes with ovarian function.

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Galactorrhea; Humans; Infertility, Female; Menotropins; Ovary; Pregnancy; Prolactin

Prolactin levels during a gonadotropin-induced pregnancy have not been previously reported. A patient with Forbes-Albright syndrome is described. She received radiation therapy, with cessation of her galactorrhea, but she remained amenorrheic. Three years after irradiation, a pregnancy was successful induced with human menopausal gonadotropins and human chorionic gonadotropin. Prolactin levels determined prior to gonadotropin therapy, during an insulin hypoglycemia stimulation test, serially during pregnancy, and postpartum during lactation are presented. These levels are compared with the previously reported levels for basal prolactin, response to insulin hypoglycemia, pregnancy, and lactation. Possible etiologies for the abnormal values and responses obtained from investigation of this patient are discussed.

Topics: Adult; Amenorrhea; Female; Galactorrhea; Humans; Insulin; Lactation; Menotropins; Ovulation; Pituitary Neoplasms; Pregnancy; Prolactin

Topics: Adolescent; Adult; Amenorrhea; Estrogens; Female; Humans; Menotropins

Oral combined contraceptives did not seem to alter histamine metabolism in females. During treatment with gonadotrophic hormones in four amenorrhoeic patients there was a tendency towards increasing excretion of methylhistamine (MeHi) followed by a sudden decrease corresponding to changes in the urinary estrogen. The excretion of methylimidazoleacetic acid (MeImAA) seemed to parallel that of MeHi. The findings support the hypothesis that an endogenous surge of estrogen may influence histamine turnover in women. Women of post-menopausal age have about the same histamine metabolism as younger menstruating women. Estrogen medication relieved symptoms of hot flushes or sweats but did not seem to affect the histamine turnover.

Topics: Adult; Aged; Amenorrhea; Chorionic Gonadotropin; Climacteric; Contraceptives, Oral; Contraceptives, Oral, Combined; Estrogens; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Histamine; Humans; Luteinizing Hormone; Menopause; Menotropins; Methylhistamines; Middle Aged; Progesterone

In ten patients with amenorrhea-galactorrhea who had hyperprolactinemia, ovulation could not be induced clomiphene citrate or exogenous gonadotropins. Treatment with bromocryptine in eight of these patients resulted in suppression of PRL in all, cessation of galactorrhea and ovulation in seven and conception in five.

Topics: Amenorrhea; Bromocriptine; Ergolines; Female; Fertility; Galactorrhea; Gonadotropins, Pituitary; Humans; Lactation Disorders; Menotropins; Ovary; Ovulation; Pregnancy; Prolactin; Thyrotropin

Topics: 17-Ketosteroids; Adult; Amenorrhea; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Menotropins; Ovary; Pregnanediol

The authors report a case of amenorrhoea with galatorrheoa due to a prolactin adenoma secondary to an inducer of ovulation (HMG and HCG) and in which pregnancy occurred. There was sudden progression of the adenoma with formation of a haematoma and the necessity for emergency surgery. In the light of this case, the risks and indications of inducers of ovulation in the sterile woman complaining of amenorrhoea with galactorrhoea are discussed.

Topics: Adenoma; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Fertility Agents, Female; Galactorrhea; Humans; Hypophysectomy; Infertility, Female; Menotropins; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin; Radiography; Sella Turcica

Ovulation has been induced by clomiphene citrate and human gonadotropins in infertile women. Clomiphene should be the first choice in anovulatory women with active ovaries as indicated by basic levels of estrogens in blood or urine, in women with post-pill amenorrhea even if their ovaries are quiescent and in women with functional abnormalities of the hypothalamus or pituitary. Human gonadotrophins should be used as a second alternative when clomiphene fails. It should also be used as a first choice in women with primary amenorrhea and quiescent ovaries and in women with gross anatomical changes in the pituitary or hypothalamus. If no result is obtained after two courses of gonadotropic therapy, further treatment should be reconsidered and the infertile couple reinvestigated.

Topics: Adult; Amenorrhea; Anovulation; Clomiphene; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Polycystic Ovary Syndrome; Pregnancy

Topics: Amenorrhea; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Diseases; Pituitary Diseases; Pregnanetriol; Progesterone; Uterine Diseases

Ten patients with hypothalamic anovulation weretreated with a "retard" preparation of synthetic luteinizing hormone releasing hormone (LHRH) after an HMG stimulation in order to induce ovulation and pregnancy. Four of the patient ovulated after intramuscular administration of the LHRH preparation. This study suggests that is is possible to induce ovulation with LHRH in patients pretreated with HMG, and that LHRH has advantages over HCG since it does not induce hyperstimulation even in the presence of exagerated follicular growth. Nevertheless, the optimal conditions for the use and monitoring of LHRH treatment have yet to be clarified.

Topics: Adult; Amenorrhea; Anovulation; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Pregnancy; Progesterone; Radioimmunoassay

The direct effect of steroids on rat pituitaries, as reflected by their response to the hypothalamic gonadotropin-releasing hormone (GnRH), was studied in rats. Also, the modulating effect of steroids was investigated in women with primary amenorrhea due to hypothalamic failure. In the human cases, the pituitary was considered as not being regulated by endogenous gonadotropin-releasing hormones and any steroidal effects could be ascribed as being exerted directly on the pituitary gland without being mediated via the hypothalamus. The ovaries of these patients were capable of steroid secretion when stimulated by exogenous gonadotropins. The response to GnRH was evaluated prior to and at different phases of the cycles of ovarian stimulation. Techniques used in the in vitro rat studies are described. Estradiol had a dual effect depending on the dose. Progeste rone had no effect on the base level secretion of either luteinizing hormone (LH) or follicle stimulating hormone (FSH) or on the stimulatory effect of GnRH. However, the addition of progesterone to estradiol counteracted the sensitizing effect of estradiol. In the human cases, dynamic stimulating tests were done to localize the origin of the hormon al insufficiency and to exclude pituitary and ovarian unresponsiveness t o appropriate stimuli. None responded to clomiphene citrate but all had a pituitary response to GnRH and an ovarian response to human menopausal gonadodtropins. In Phase 1 in the absence of ovarian steroids, GnRH evoked an increase in both LH and FSH. In Phase 2, when the endogenous level of estradiol was high, GnRH did not induce FSH release. Elevation of LH secretion was prolonged and reached higher values at the time of increase in the plasma progesterone. In Phase 3, the luteal phase, GnRH failed to elicit either LH or FSH release. It seemed that estrogen sensitized the pituitary to respond to GnRH with a selective augmentatio n of LH secretion. Therefore, it is thought that steroids can modulate pituitary responsiveness to hypothalamic stimuli.

Topics: Amenorrhea; Animals; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamus; Luteinizing Hormone; Male; Menotropins; Ovary; Pituitary Gland; Progesterone; Rats

In order to assess the action of prolactin on the puerperal pituitary-ovarian resistance to physiologic stimulation, a study was conducted in 27 women divided into three groups. Group I: 9 postpartum women who did not wish to breastfeed their infants and received 2.5 mg bromocriptin (CB 154) twice daily for 14 days starting immediately after delivery; Group II: 9 normally lactating mothers; and Group III: 9 women with hyperprolactinemia associated with amenorrhea. The three groups underwent stimulation with LHRH and Pergonal 500. Results indicate lack of prolactin dependence in the pituitary-ovarian resistance of the puerperium. The possible mechanisms involved in the anovulatory period of lactation are discussed.

Topics: Adult; Amenorrhea; Breast Feeding; Bromocriptine; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Humans; Lactation Disorders; Menotropins; Ovary; Pituitary Gland; Postpartum Period; Pregnancy; Prolactin

Eighteen normal puerperal women received a combined administration of human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) and the ovarian response to these human gonadotropins was evaluated by the daily estimation of the 24 hour urinary excretion of total estrogens. Fourteen of the 18 subjects studied were responsive to the exogenously administered gonadotropins with a rise in the urinary estrogen excretion. Moreover, plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels during the postpartum period were low compared to normal cycle gonadotropin levels. Thus, it might be concluded that puerperal anovulation and amenorrhea during lactation might be due to hypophyseal gonadotropic dysfunction rather than to ovarian refractoriness.

Topics: Amenorrhea; Chorionic Gonadotropin; Circadian Rhythm; Estrogens; Female; Follicle Stimulating Hormone; Humans; Injections, Intramuscular; Lactation; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Pituitary Gland; Postpartum Period; Pregnancy; Puerperal Disorders; Radioimmunoassay; Time Factors

We report the results obtained with a standard system of gonadotrophin therapy. Seventy-seven consecutive patients were given 322 treatment cycles. Thirty-seven patients (48 per cent) conceived, six of them on two occasions, making 43 pregnancies of which 31.6 per cent were multiple. Five per cent of all treatment cycles were complicated by mild, and 0.62 per cent by severe hyperstimulation. The factors involved in achieving a satisfactory pregnancy rate whilst avoiding complications are discussed. Most complications occurred during the first cycle in which the rise in oestrogen excretion suggested follicular development and human chorionic gonadotrophin (HCG) was given (the "first effective" treatment cycle). In such cycles the risk of hyperstimulation rose sharply when the day 6 urinary total estrogen level was above 150 mug. per 24 hours and the multiple pregnancy rate was increased by a large dose of HCG.

Topics: Abortion, Spontaneous; Adult; Amenorrhea; Chorionic Gonadotropin; Congenital Abnormalities; Estrogens; Female; Follicle Stimulating Hormone; Hernia, Umbilical; Humans; Infertility, Female; Luteinizing Hormone; Meningocele; Menotropins; Menstruation Disturbances; Pierre Robin Syndrome; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple

Six theoretically possible syndromes of IGD are shown in Table 1. 1) IBGD is well-substantiated both in males and in females, and appears to be either of pituitary or more frequently of nonpituitary origin. 2) An example of isolated FSH deficiency has been described. The defect appears to reside at the pituitary level and may be localized to the FSH beta subunit. Recently a male patient has been studied with isolated FSH deficiency and a concordant testicular picture viz germinal cell aplasia. However, the syndrome is complicated by an associated chromosomal abnormality (XO/XXY/XY) whose significance is unclear. 3) Several examples of isolated hLH deficiency have been described. Several questions remain about the exact nature of the defect in some of the published reports of this syndrome.

Topics: Amenorrhea; Clomiphene; Estradiol; Eunuchism; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Hypogonadism; Luteinizing Hormone; Male; Menotropins; Sex Characteristics; Syndrome; Testosterone

Eight hMG-hCG therapy cycles in 6 anovulatory infertile patients are presented. Daily plasma estrogen monitoring during the therapy contributed to success in inducing ovulation in all 6, 3 of whom established pregnancies and delivered healthy babies. The duration of hMG therapy required varies among individuals. Duration and dosage can be determined on the basis of daily plasma estrogen levels. Administration hCG is recommended to trigger ovulation when these levels reach 300 to 600 pg/ml. Although success in ovulation induction and pregnancy is achievable, multiple ovulation and multiple pregnancy cannot be predicted or prevented.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estrogens; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Ovulation Detection; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Progesterone

Topics: Adenoma, Chromophobe; Adolescent; Adult; Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Gonadotropins, Equine; Humans; Menotropins; Pituitary Neoplasms; Pregnancy

Nine pregnancies are described in patients with pituitary tumours. All patients had definite radiological evidence of a pituitary tumour and no evidence of acromegaly or Cushing's disease. In seven patients serum prolactin levels were estimated before pregnancy and found to be raised.Seven patients had been treated with pituitary implantation of yttrium-90. The remaining two developed complications of the tumour during pregnancy. One developed a bitemporal visual field defect in the second trimester which was successfully treated by emergency yttrium-90 implantation. The other developed diabetes insipidus in the third trimester which resolved spontaneously after delivery.Six patients were treated with drugs to achieve pregnancy. Four took bromocriptine to suppress raised prolactin levels, one was treated with human menopausal gonadotrophin, and one was treated with clomiphene.

Topics: Adult; Amenorrhea; Bromocriptine; Clomiphene; Diabetes Insipidus; Female; Humans; Labor, Obstetric; Menotropins; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prolactin; Vision Disorders; Visual Fields; Yttrium Radioisotopes

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Dexamethasone; Female; Humans; Levodopa; Menotropins

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Methods; Radioimmunoassay

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estrone; Female; Humans; Menotropins; Menstruation; Ovulation; Pregnancy

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Amenorrhea; Down Syndrome; Drug Evaluation; Female; Follow-Up Studies; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovulation; Pregnancy; Triplets; Twins

Topics: Adult; Age Factors; Amenorrhea; Biopsy; Brain Neoplasms; Chorionic Gonadotropin; Endometrium; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovary; Pregnancy; Stimulation, Chemical

Topics: Amenorrhea; Chorionic Gonadotropin; Estradiol; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation; Periodicity; Pregnanediol; Progesterone; Time Factors

Topics: Adult; Amenorrhea; Androstenedione; Chorionic Gonadotropin; Estradiol; Estrogens; Female; Humans; Menotropins; Menstruation; Ovary; Ovulation; Pregnanediol; Radioimmunoassay; Time Factors; Veins

Topics: Adolescent; Adult; Age Factors; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Cyclofenil; Female; Fertility; Humans; Menotropins; Surveys and Questionnaires; Time Factors

Topics: Adult; Amenorrhea; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Topics: Amenorrhea; Animals; Binding, Competitive; Chorionic Gonadotropin; Corpus Luteum; Estradiol; Female; Humans; Hydroxyprogesterones; Menotropins; Menstruation; Ovary; Pregnancy; Progesterone; Protein Binding; Rabbits; Radioimmunoassay

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Drug Administration Schedule; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Progesterone

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Menotropins; Pregnancy; Progesterone; Radioimmunoassay; Syndrome

Topics: Adult; Amenorrhea; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Injections, Intravenous; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Pregnancy; Progesterone; Stimulation, Chemical

Topics: Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infusions, Parenteral; Injections, Intravenous; Luteinizing Hormone; Menotropins; Ovulation; Progesterone; Radioimmunoassay

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Gland; Polycystic Ovary Syndrome; Pregnancy

Topics: Adult; Amenorrhea; Castration; Chorionic Gonadotropin; Clomiphene; Depression, Chemical; Estrogens; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Immune Sera; Iodine Radioisotopes; Luteinizing Hormone; Menopause; Menotropins; Mestranol; Middle Aged; Ovary; Ovulation; Radioimmunoassay; Stimulation, Chemical

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Radioimmunoassay; Time Factors

Topics: Amenorrhea; Birth Weight; Cesarean Section; Chorionic Gonadotropin; Female; Gestational Age; Humans; Infant Care; Infant, Newborn; Infertility, Female; Male; Menotropins; Organ Size; Placenta; Pregnancy; Pregnancy, Multiple; Prenatal Care

The syndrome of postpill amenorrhea was investigated retrospectively by studying records of diagnosed cases of amenorrhea (1300) treated or confirmed at the Mayo Clinic. Data are taken from records dating to 1960 (low use of contraceptives) and terminate in 1971. 12 cases are reviewed which were diagnosed as prolonged oversuppression syndrome. No particular oral contraceptive formulation was implicated. 4 of 12 patients had had irregular menstrual cycles before oral contraceptive therapy; whereas 8 had had regular cycles. Bioassay of urinary gonadotropins were consistently in the mid-low normal limits (only 1 determination was available for each patient); some patients had been radioimmunoassayed (single assay) for other pituitary hormones: LH (luteinizing hormone) was at normal basal levels and FSH (follicle stimulating hormone) was also in the normal range. Concentrations of total circulating estrogens were in low or subnormal range in each case. 4 cases had associated galactorrhea, which was attributed to exogenous steroid suppression of the prolactin-inhibiting center of the pituitary. Clomiphene citrate was used to restore functions of the hypothalamic-pituitary axis, and of the 8 receiving clomiphene, 5 responded and 2 conceived.

Topics: Adult; Amenorrhea; Clomiphene; Contraceptives, Oral; Corticosterone; Female; Gonadotropins; Humans; Lactation Disorders; Menotropins; Ovary; Pregnancy; Progesterone; Syndrome; Time Factors

Topics: Abortion, Spontaneous; Amenorrhea; Chorionic Gonadotropin; Chromosome Aberrations; Clomiphene; Female; Humans; Menotropins; Ovulation; Pregnancy

Among a group of 249 women examined during 1969-1971 in Swedish hospitals because of amenorrhea after oral contraceptive therapy, 177 patients answered a follow-up questionnaire in April 1972. For purposes of study these latter patients were divided into Groups 1 (6-12 month amenorrhea, spontaneous recovery), 2 (12-39 month amenorrhea, spontaneous recovery), and 3 (ongoing amenorrhea in May 1972). The numbers of patients in Groups 1, 2, and 3 were 38, 67, and 72, respectively. For 122 of the patients, no explanation other than one relating to oral contraceptive therapy could be postulated for the amenorrhea. 63 patients (35.4%) had had menstrual irregularities before using oral contraceptives. However, it is impossible to foretell simply from past menstrual history whether a woman will develop amenorrhea after oral contraceptive therapy. No correlation was seen between therapy duration or age of patient and the duration of the subsequent amenorrheic period. In the women with amenorrhea lasting more than 12 months, low excretions of low polar estrogens and 17-ketogenic steroids were seen. Possible precise causes of amenorrhea relating to oral contraceptive therapy and treatment are discussed.

Topics: Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Dehydroepiandrosterone; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypothalamus; Luteinizing Hormone; Menotropins; Ovary; Pituitary Hormone-Releasing Hormones

Topics: Amenorrhea; Clomiphene; Female; Humans; Lactation Disorders; Menotropins; Ovary; Ovulation; Polycystic Ovary Syndrome; Pregnancy

Topics: Adult; Amenorrhea; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Hydroxyprogesterones; Menotropins; Menstruation; Ovulation; Pregnancy; Progesterone; Time Factors

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Injections, Intravenous; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Function Tests; Pituitary Hormone-Releasing Hormones; Radioimmunoassay; Time Factors

Topics: Adult; Amenorrhea; Cervix Mucus; Clomiphene; Female; Humans; Infertility, Female; Infusions, Parenteral; Injections, Intramuscular; Injections, Subcutaneous; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Hormone-Releasing Hormones; Pregnancy; Time Factors; Vaginal Smears

Topics: Amenorrhea; Ascites; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Triplets; Twins; Vaginal Smears

Topics: Amenorrhea; Cervix Mucus; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Progesterone; Stimulation, Chemical

Topics: Amenorrhea; Chorionic Gonadotropin; Evaluation Studies as Topic; Female; Humans; Injections, Intramuscular; Menotropins; Ovulation; Pregnancy

Topics: Adult; Amenorrhea; Body Temperature; Clomiphene; Contraceptives, Oral; Female; Fertilization; Follicle Stimulating Hormone; Hirsutism; Humans; Hypothalamus; Infertility, Female; Lactation Disorders; Luteinizing Hormone; Menotropins; Ovulation; Polycystic Ovary Syndrome; Pregnancy; Prognosis; Radioimmunoassay

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Estrone; Female; Humans; Menotropins; Ovulation; Pregnanediol; Progesterone; Radioimmunoassay

Topics: 17-Ketosteroids; Adolescent; Adult; Amenorrhea; Biopsy; Blood Proteins; Chorionic Gonadotropin; Climacteric; Endometrium; Estrogens; Female; Gonadotropins; Humans; Iodine; Ketosteroids; Menotropins; Ovarian Follicle; Ovary; Pregnancy; Protein Binding; Sex Chromatin

Out of 210 women seen at the Middlesex Hospital with secondary amenorrhoea the 63 who developed it after stopping oral contraceptives were fully investigated. Five had organic disease sufficient to account for the amenorrhoea (one had severe diabetes, one a pituitary tumour, and three premature ovarian failure); two patients had galactorrhoea (one of whom also had the pituitary tumour); two had anorexia nervosa.Of the 63 women 40 (63%) had suffered from amenorrhoea or prolonged or irregular menstrual cycles before taking the pill, and this suggested that combined oestrogen-progestogen oral contraceptives should be used with caution for women with irregular menstruation.Nineteen patients wished to become pregnant and 12 have so far done so after treatment with clomiphene or gonadotrophins.In another study 204 women recorded when their first menstrual cycle occurred after stopping the pill. Seventy-four had a cycle longer than five weeks but only five exceeded three months, and only one of the five had more than six months' amenorrhoea. These results confirm that the incidence of amenorrhoea after stopping oral contraceptives is low.

Topics: Adult; Affective Symptoms; Amenorrhea; Clomiphene; Contraceptives, Oral; Diabetes Complications; Estrogens; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovarian Diseases; Pituitary Neoplasms; Progestins; Prospective Studies; Time Factors

Topics: Adult; Amenorrhea; Body Temperature; Drug Combinations; Estrogens; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Menotropins; Ovarian Cysts; Pregnancy; Pregnanediol

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovulation; Pregnadienediols; Pregnancy

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections; Menotropins; Methods; Ovulation; Pregnancy; Statistics as Topic

Topics: Adolescent; Adult; Amenorrhea; Capillary Permeability; Chiari-Frommel Syndrome; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Stimulation, Chemical

Topics: Amenorrhea; Amniocentesis; Amniotic Fluid; Chorionic Gonadotropin; Chromosome Aberrations; Chromosomes, Human, 13-15; Chromosomes, Human, 21-22 and Y; Down Syndrome; Female; Genetic Counseling; Humans; Infant, Newborn; Karyotyping; Menotropins; Ovulation; Pregnancy

Topics: Adrenocorticotropic Hormone; Adult; Amenorrhea; Biopsy; Clomiphene; Endocrine System Diseases; Estrogens, Conjugated (USP); Female; Follicle Stimulating Hormone; Glycoproteins; Growth Hormone; Humans; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Menotropins; Ovary; Radioimmunoassay; Thyrotropin

Topics: Adult; Amenorrhea; Cervix Mucus; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Endometrium; Estradiol; Female; Follicle Stimulating Hormone; Gonads; Humans; Hypogonadism; Hypophysectomy; Menotropins; Ovary; Ovulation; Pituitary Function Tests; Pituitary Gland; Pregnanediol; Stimulation, Chemical

Topics: Amenorrhea; Female; Fertilization; Humans; Infertility, Female; Menotropins; Ovulation; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Retrospective Studies

Topics: Amenorrhea; Animals; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; Rats

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; Stimulation, Chemical

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins, Pituitary; Humans; Menotropins; Menstruation; Ovulation; Pregnancy; Progesterone

Topics: Abortion, Spontaneous; Amenorrhea; Child, Preschool; Chorionic Gonadotropin; Female; Follow-Up Studies; Gonadotropins, Pituitary; Humans; Infant; Infant, Newborn; Infertility, Female; Male; Menotropins; Ovarian Diseases; Pregnancy; Pregnancy, Multiple

Topics: Adult; Age Factors; Amenorrhea; Chorionic Gonadotropin; Female; Gonadotropins, Equine; Humans; Iodine Isotopes; Male; Menotropins; Menstruation; Sex Factors; Thyrotropin

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation; Pregnanediol; Time Factors

Topics: Adolescent; Adult; Amenorrhea; Body Temperature; Dose-Response Relationship, Drug; Drug Interactions; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypopituitarism; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation; Polycystic Ovary Syndrome

Topics: Amenorrhea; Chorion; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infant, Newborn; Menotropins; Ovulation; Pregnancy; Pregnancy, Multiple; Pregnancy, Quadruplet; Quadruplets

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility; Infertility, Female; Menotropins; Ovulation

Topics: Amenorrhea; Atrophy; Endometrium; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility; Infertility, Female; Menotropins