menotropins and Anovulation

Anovulation is a common cause of female infertility. Treatment for women with anovulation is aimed at induction of ovulation. Ovulation induction with follicle-stimulating hormone (FSH) is indicated in women with WHO type II anovulation in whom treatment with clomifene citrate (clomifene) has failed. The majority of these women have polycystic ovary syndrome. The major disadvantages of ovulation induction with FSH are the risk of ovarian hyperstimulation syndrome and the risk of higher order multiple pregnancies. To reduce the rate of complications due to multiple follicular development, FSH should be administered using a chronic low-dose protocol with small dose increments. In women with WHO type I anovulation, an exogenous supply of luteinizing hormone (LH) is required to achieve an adequate follicular response to FSH treatment. Thus, ovulation induction with FSH is not the treatment of choice in these women. FSH is a hormone that stimulates follicle growth and oocyte maturation. Endogenous FSH is produced by the pituitary gland and exists as a family of isohormones exhibiting distinct oligosaccharide structures. FSH for exogenous administration is derived from urine or is produced as recombinant FSH. The commercially available FSH products all contain different mixtures of FSH isoforms. To determine the effectiveness of urofollitropin (urinary-derived FSH), a comparison with the other available gonadotropins was made (i.e. recombinant FSH and human menopausal gonadotropin). Urofollitropin and recombinant FSH appear to be equally effective and well tolerated for ovulation induction. Human menopausal gonadotropin is comparably effective to urofollitropin in terms of pregnancy outcomes. It remains unclear whether human menopausal gonadotropins have a higher risk of overstimulation and ovarian hyperstimulation syndrome compared to urofollitropin in women with polycystic ovary syndrome. In practice, recombinant products are more convenient to use but are also more expensive. Therefore, if availability is not an issue but costs are, there is still a place for the use of urofollitropins for ovulation induction.

Topics: Anovulation; Drug Costs; Female; Follicle Stimulating Hormone; Humans; Menotropins; Ovulation Induction; Recombinant Proteins

Ovulation induction is one of the greatest success stories in reproductive endocrinology. With appropriate therapy in properly f1p4cted patients, the conception and live birth-rates in treated patients are almost indistinguishable from normal. In the estrogenized woman there are many different techniques to reverse the condition of chronic anovulation. With clomiphene citrate, up to 80% of patients will ovulate, and approximately half will conceive. In women who fail clomiphene therapy, injectable gonadotropins are usually successful in inducing ovulation. New protocols for administering these powerful agents have minimized the risk of ovarian hyperstimulation and multiple pregnancy. When medical therapy fails to result in successful ovulatory cycles, surgical treatments can be considered. Laparoscopic ovarian ablation has been shown to be effective treatment. Whether this less invasive surgery results in fewer adhesions than conventional ovarian wedge resection remains to be proven. By carefully considering each patient and individualizing treatment based on a full knowledge of alternatives, ovulation induction remains one of the most challenging and rewarding treatments in reproductive endocrinology.

Topics: Anovulation; Clomiphene; Estrogens; Female; Humans; Menotropins; Ovary; Ovulation Induction; Polycystic Ovary Syndrome

Sterility related to ovarian dystrophy is currently treated by means of standard inductors of ovulation such as Clomid and HMG. In case of failure, patients are recommended in vitro fertilization. In our study of 30 cases of ovarian dystrophy, 9 pregnancies occurred after in vitro fertilization. Slow injections of purified FSH appear to produce similar results but the method is still under evaluation. Our results suggest that after say, two years of failure with classical methods in patients with a long history of sterility, in vitro fertilization may be expected to give good results.

Topics: Adult; Anovulation; Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome

The patient who has gonadotrophin-resistant ovaries and who requires ovulation induction or superovulation for IVF presents a serious problem. The diagnosis is usually made in the first treatment cycle which is either abandoned due to a failure of response, requires inordinately high doses of gonadotrophins to induce a response or fails to induce satisfactory oestradiol levels and/or follicular development. This situation is often associated with advanced maternal age and high day 3 concentrations of FSH. The possible treatment strategies that we have described seem to offer only a partial solution to specific subgroups of poor responders. These include protocols of clomiphene/hMG, mini-dose GnRH agonist regimens, and cotreatment with GH, each of which may be found to be effective in individual cases. Taking into account today's increasing demand for pregnancy in older aged women, more research is needed to evolve more efficient solutions for this difficult problem.

Topics: Anovulation; Clinical Protocols; Drug Resistance; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Gonadotropins; Growth Hormone; Humans; Menotropins; Ovulation; Ovulation Induction; Superovulation

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

Topics: Anovulation; Female; Follicle Stimulating Hormone; Gonadotropins; Growth Hormone; Humans; Menotropins; Ovulation Induction

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

With the use of pelvic ultrasound imaging we have found that more than half of the women presenting to our clinic with ovulatory disturbances have polycystic ovaries. As a group hirsutism is common, the serum LH, the LH:FSH ratio and serum androgen levels are higher than in other groups of patients with anovulation, but many of the women we studied were non-hirsute and had normal levels of these hormones. The aetiology of PCOS remains obscure and there is probably more than one cause. Disturbance of hypothalamic/pituitary, ovarian or adrenal function could all result in the development of polycystic ovaries. Our own data, based on pelvic ultrasound and measurement of serum androgen levels, suggest that an ovarian abnormality, other than the obvious morphological one, may be identified in most women although this does not prove (except perhaps in those women with unilateral PCOS) that the ovary is the primary site of the disturbance. Management of ovulatory disturbances includes symptomatic treatment of dysfunctional uterine bleeding and induction of ovulation. Although the ovulation rate following clomiphene is quoted as about 75%, this is probably an overestimate; less than half the 'ovulators' become pregnant and in those who do there is a high risk of early pregnancy loss. Induction of ovulation in clomiphene non-responders remains a difficult problem. The results of ovarian wedge resection are variable and any beneficial effect is short-lived with the risk of long-term infertility due to pelvic adhesions. Laparoscopic electrocautery may be a useful alternative, but it is too early to assess this form of treatment. Of the medical methods of ovulation induction in clomiphene non-responders, two methods have emerged as being highly promising: the first is administration of HMG following suppression of the pituitary by an LH-RH analogue; so far only a very small number of patients have been treated. The second is low-dose FSH. Initial studies, including our own, have shown a high incidence of ovulation and a pregnancy rate of 50%.

Topics: Androgens; Anovulation; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Diagnosis, Differential; Estrogens; Female; Follicle Stimulating Hormone; Glucocorticoids; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Hirsutism; Humans; Hyperprolactinemia; Infertility, Female; Menotropins; Menstruation Disturbances; Obesity; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; 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

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

Topics: Anovulation; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Progestins

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

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Cresols; Cyclofenil; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation

Recent methods for induction of ovulation in the woman are described. The only indication for use of these medications is induction of ovulation and pregnancy. In properly selected patients, the success rate is quite high, but treatment has undesirable side effects which occasionally may be severe.

Topics: Affective Symptoms; Animals; Anovulation; Blood Coagulation Disorders; Body Temperature; Castration; Chorionic Gonadotropin; Clomiphene; Depression, Chemical; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Pregnancy, Multiple; Thrombosis

Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5-14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R

Topics: Adult; Anovulation; Anti-Mullerian Hormone; Dose-Response Relationship, Drug; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate

To evaluate, retrospectively, the roles of endogenous and exogenous luteinising hormone (LH) activity on live birth rate in ovulation induction cycles.. Associations between LH activity at baseline, end of stimulation and live birth rate were analysed in relation to patient characteristics, baseline and end of stimulation variables in WHO group II anovulatory women (n = 155) stimulated with recombinant follicle-stimulating hormone (rFSH) or highly purified human menopausal gonadotrophin (HP-hMG). HP-hMG provides FSH and exogenous LH activity mainly in the form of human chorionic gonadotrophin (hCG).. Serum LH concentrations at baseline or end of stimulation were not predictive of live birth rate in the rFSH group (n = 79) or HP-hMG group (n = 76). Serum hCG concentration at end of stimulation was a significant positive predictor in HP-hMG-treated women. Other variables were not independently predictive of live birth in either of the groups, except for a negative association between serum FSH concentrations at the start of stimulation and live birth in the rFSH-treated group.. Endogenous LH concentrations are not predictive of live birth in anovulatory WHO group II patients undergoing ovulation induction with rFSH or HP-hMG. On the other hand, exogenous hCG activity during HP-hMG stimulation is positively associated with treatment outcome.

Topics: Adult; Anovulation; Birth Rate; Chorionic Gonadotropin; Cohort Studies; Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Live Birth; Luteinizing Hormone; Menotropins; Ovulation Induction; Recombinant Proteins; Reproductive Control Agents; Retrospective Studies

The contribution of the LH activity in menotrophin preparations for ovulation induction has been investigated in small trials conducted versus FSH preparations. The objective of this study was to demonstrate non-inferiority of highly purified urinary menotrophin (HP-HMG) versus recombinant FSH (rFSH) with respect to the primary outcome measure, ovulation rate.. This was a randomized, open-label, assessor-blind, multinational study. Women with anovulatory infertility WHO Group II and resistant to clomiphene citrate were randomized (computer-generated list) to stimulation with HP-HMG (n=91) or rFSH (n=93) using a low-dose step-up protocol.. The ovulation rate was 85.7% with HP-HMG and 85.5% with rFSH (per-protocol population), and non-inferiority was demonstrated. Significantly fewer intermediate-sized follicles were observed in the HP-HMG group (P<0.05). The singleton live birth rate was comparable between the two groups. The frequency of ovarian hyperstimulation syndrome and/or cancellation due to excessive response was 2.2% with HP-HMG and 9.8% with rFSH (P=0.058).. Stimulation with HP-HMG is associated with ovulation rates at least as good as a rFSH in anovulatory WHO Group II women. LH activity modifies follicular development so that fewer intermediate-sized follicles develop. This could have a positive impact on the safety of ovulation induction protocols.

Topics: Adolescent; Adult; Anovulation; Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation; Recombinant Proteins

To compare the safety and efficacy of recombinant FSH (follitropin beta, Puregon; NV Organon, Oss, the Netherlands) and urinary FSH (urofollitropin, Metrodin; Ares-Serono, Geneva, Switzerland).. A prospective, multicenter, assessor-blind, randomized, clinical trial.. Twelve European infertility clinics.. One hundred seventy-two women (recombinant FSH: n = 105; urinary FSH: n = 67) with clomiphene citrate-resistant normogonadotropic chronic anovulation (World Health Organization group II).. Eligible subjects were randomized (ratio of recombinant to urinary FSH, 3:2) and treated for a maximum of three cycles. A low-dose step-up regimen was used, with 75 IU of FSH given IM daily for a maximum of 14 days and, if needed, weekly increments of half an ampule given thereafter until the threshold dose for follicular development was achieved.. Cumulative ovulation rate after three cycles, total FSH dose, and treatment period needed to achieve ovulation.. The cumulative ovulation rates after three treatment cycles were 95% and 96% for the recombinant and urinary FSH groups, respectively. Overall, ovulation was seen in 155 of 223 treatment cycles (69.5%) in the recombinant FSH group, compared with 92 of 138 treatment cycles (66.7%) in the urinary FSH group. In the first cycle, a statistically significantly lower total dose (750 versus 1,035 IU) and a shorter treatment period (10 versus 13 days) were needed in the recombinant FSH group to reach ovulation. Only one case of ovarian hyperstimulation syndrome led to hospitalization. Two sets of twins (one in each treatment group) and one set of triplets (in the recombinant FSH group) were born.. Recombinant FSH (Puregon) is more efficient than urinary FSH (Metrodin) in inducing follicular development.

Topics: Adult; Anovulation; Chronic Disease; Clomiphene; Drug Resistance; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Menotropins; Ovulation; Prospective Studies; Recombinant Proteins; Reference Values; Time Factors

A randomised clinical trial was performed to evaluate the effect of a 3-month gonadotrophin-releasing-hormone analogue (GnRH-a) in one cycle of ovulation induction with low-dose pure follicle-stimulating hormone (pFSH) in patients with polycystic ovarian syndrome (PCOS) anovulation. Twenty patients with chronic anovulation due to PCOS were randomised to ovulation induction with pFSH administered in a low-dose schedule with (10 patients) and without (10 patients) a 3-month pretreatment with GnRH-a. Ultrasound scan only monitoring of follicular growth, evaluation of plasmatic oestradiol at the day of triggering of ovulation with human chorionic gonadotrophin 5,000 IU and evaluation of plasmatic progesterone 8 days after were the main outcome measures. Ovulation occurred in 9 patients treated with pFSH and in 2 patients treated with GnRH-a plus pFSH. Five pregnancies in the pFSH group and no pregnancy in the GnRH-a group were obtained. Five cycles were stopped due to multifollicular growth in the GnRH-a group and 1 in the pFSH group. Pretreatment with a 3-month administration of a GnRH-a did not improve the ovulation rate and pregnancy rate in PCOS patient ovulation induction with low-dose pFSH.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Triptorelin Pamoate

The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy.. The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded.. There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups.. The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.

Topics: Abortion, Spontaneous; Adrenal Cortex; Adult; Androgens; Anovulation; Chemotherapy, Adjuvant; Chorionic Gonadotropin; Dexamethasone; Drug Therapy, Combination; Estradiol; Female; Fertility Agents, Female; Gonadotropins, Pituitary; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Prolactin; Treatment Failure

The choice of treatment for clomiphene-resistant anovulation associated with polycystic ovary syndrome (PCOS) is presently arbitrary and selection criteria are not available. A total of 144 women with anovulatory infertility associated with PCOS who failed to conceive on clomiphene were treated with either pure follicle stimulating hormone (FSH) (n = 29), or human menopausal gonadotrophin (HMG) (n = 60), or gonadotrophin-releasing hormone analogue (GnRHa) and HMG (n = 55). Analysis of 306 treatment cycles and 53 pregnancies revealed a cumulative conception rate at 4 months of 23% with FSH, 47% with HMG and 69% with GnRHa + HMG. The miscarriage rate was highest in the HMG group (44%) and consequently the cumulative live birth rate was superior when GnRHa was used in combination with HMG. There were no significant differences in the basal clinical and endocrinological features of those who conceived compared with those who did not, either in the whole group, or in the individual treatment groups. Thus, the choice of treatment for clomiphene-resistant women with PCOS cannot be guided by the basal clinical or endocrinological features of this heterogeneous syndrome with the present state or knowledge.

Topics: Adult; Anovulation; Clomiphene; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Retrospective Studies; Treatment Failure; Triptorelin Pamoate

We have explored the use of growth hormone (GH) for ovulation induction and ovarian stimulation for in vitro fertilization and embryo transfer (IVF-ET). We first compared the effects of co-treatment with GH and placebo on the dose of gonadotrophins required to induce ovulation. The patients were gonadotrophin deficient and, for the main part, hypopituitary. We found a significant reduction in the dose of gonadotrophins and the duration of treatment needed to induce ovulation. The dose of GH used in these studies was substantial, and we await the results of a multi-centre trial attempting to establish a dose-response relationship. We then explored the role of GH in patients undergoing IVF-ET. The end-point measured was an increase in the number of follicles developing during standard treatment with gonadotrophins. In the first randomized controlled clinical trial we found a suggestion only of an enhanced ovarian response to co-treatment with GH. Specifically selected patients with ultrasound-diagnosed polycystic ovaries were then treated. All were receiving treatment with luteinizing hormone-releasing hormone analogue as part of their ovarian stimulation protocol. The results showed clearly that in this group of patients, co-treatment with GH augmented the ovarian response to treatment with gonadotrophins. We also found an increase in serum and follicular-fluid insulin-like growth factor I (IGF-I) concentrations, but since the serum concentrations always exceeded those in follicular fluid, the results were consistent with the notion that follicular-fluid growth factor was predominantly derived from serum IGF-I rather than being synthesized locally.

Topics: Adult; Anovulation; Double-Blind Method; Embryo Transfer; Female; Fertilization in Vitro; Growth Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prospective Studies

In a prospective study, 140 patients with infertility because of ovulatory factors (group A) were followed up for 6 months after failure to achieve pregnancy using human menopausal gonadotropin (hMG) therapy. They included cases of oligomenorrhea, polycystic ovarian disease (PCOD), and hypogonadotropic amenorrhea. They were treated with hMG alone or in combination with clomiphene citrate or gonadotropin-releasing hormone agonist analog. The control group (B) included 83 infertile patients because of similar ovulatory factors. They were followed up for 6 months not preceded by ovulation induction. The overall pregnancy rate (PR) in group A (20.7%) was significantly higher than group B (7.2%). The PR was significantly higher in oligomenorrhea and PCOD patients when compared with the control group. There was no significant difference in the hypogonadotropic group.

Topics: Anovulation; Female; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Polycystic Ovary Syndrome; Pregnancy; Prospective Studies

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 use of exogenous gonadotropins for treatment of clomiphene-resistant chronic anovulation in women with the polycystic ovary syndrome (PCO) is hazardous and often ineffective, possibly because of the abnormal endogenous gonadotropin secretion characteristic of PCO. We evaluated the effect of leuprolide acetate, a long-acting GnRH agonist, on serum gonadotropin and sex steroid concentrations before and during human menopausal gonadotropin (hMG) induction of ovulation in women with PCO. In this controlled prospective randomized study, leuprolide was administered daily for 4 weeks, followed by concomitant hMG administration. Gonadotropin and steroid hormone concentrations were compared with those during ovulation induction cycles in women with PCO receiving hMG only. Daily administration of leuprolide for 4 weeks resulted in significantly decreased serum LH, estradiol, and testosterone concentrations, but no change in serum progesterone, FSH, and dehydroepiandrosterone sulfate. Compared to ovulation induction using hMG alone, leuprolide administration before and during hMG treatment prevented preovulatory rises in serum LH and P concentrations, while having no effect on serum FSH, testosterone, estradiol, and dehydroepiandrosterone sulfate. We conclude that leuprolide administered to women with PCO decreases gonadal steroid production and is capable of preventing premature luteinization during hMG induction of ovulation.

Topics: Adult; Anovulation; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone; Testosterone

The long-acting agonist analogue of LHRH, Buserelin (Hoechst) has been used to suppress endogenous gonadotrophins prior to induction of ovulation with low dose human menopausal gonadotrophin (HMG) in women with clomiphene-resistant polycystic ovary syndrome (PCOS). The results have been compared with those in a similar group of patients treated with HMG alone. Buserelin (900-1,500 micrograms/day) was given intranasally to 11 women who thereafter received a total of 33 cycles of treatment with low-dose HMG. The control group comprised 16 women who received 40 cycles of HMG without Buserelin pretreatment. The ovulation rate was similar in the two groups: Buserelin + HMG 70%, HMG alone 68% and both groups showed a high rate of single follicle ovulation (52 and 63%, respectively). The threshold dose of gonadotrophin required to induce a single follicle was similar in the two groups. Premature elevation of LH in the late follicular phase was common in women who received HMG alone, but did not occur in any cycle in the patients receiving Buserelin pretreatment. In summary, these data show that pretreatment with an LHRH analogue prevents a premature LH surge but it remains to be determined whether this will have a significant bearing on the rate of successful pregnancy in women with PCOS.

Topics: Anovulation; Buserelin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation; Polycystic Ovary Syndrome; Pregnancy

The therapeutic use of synthetic luteinizing hormone-releasing hormone (LH-RH) to induce ovulation has been explored. Three dosage schemes have been compared: a single dose of LH-RH, multiple doses of LH-RH, and LH-RH used in combination with human menopausal gonadotrophins (HMG). The results of these three schemes are presented and compared; the last regimen has proved most successful, with a high pregnancy rate, a low incidence of multiple pregnancy and no evidence of ovarian hyperstimulation.

Topics: Anovulation; Drug Administration Schedule; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Pregnancy

The aim of this study was to evaluate an individualised gonadotrophin starting dose regimen for women with anovulatory infertility.. We included 71 normogonadotrophic anovulatory infertile women in a prospective, observational study. All underwent one ovulation induction cycle in a flexible, low-dose step-up protocol. The gonadotrophin starting dose (75-150IU/day) was individualised according to a nomogram incorporating menstrual cycle pattern (oligo- or amenorrhoea), BMI, and mean ovarian volume. The number of women who fulfilled the criteria for human chorionic gonadotrophin (hCG) administration (one follicle ≥17mm or 2-3 follicles ≥15mm) was assessed.. Of the 50 women (70.4%) who fulfilled the hCG criteria and underwent intrauterine insemination, 34 (47.9%) achieved monofollicular growth and 16 (22.5%) developed 2-3 mature follicles. Seventeen (23.9%) cycles were converted to in vitro fertilisation (IVF) due to the development of >3 mature follicles, and one (1.4%) cycle was cancelled due to risk of ovarian hyperstimulation syndrome. Baseline total antral follicle count was found to be significantly associated with fulfillment of the hCG criteria (OR 0.96, 95% CI: 0.92-0.99, P=0.01).. The nomogram-based dose regimen was not considered suitable for ovulation induction due to a tendency to overestimate the gonadotrophin starting dose. However, the model may serve as a mild IVF regimen, especially in women prone to excessive follicle growth.

Topics: Adult; Anovulation; Female; Fertility Agents, Female; Humans; Menotropins; Nomograms; Ovarian Follicle; Ovulation Induction; Precision Medicine; Pregnancy; Pregnancy Rate; Prospective Studies

Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives.. A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children.. The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967).. This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

Topics: Adult; Anovulation; Clomiphene; Cost-Benefit Analysis; Female; Fertility Agents, Female; Humans; Infertility, Female; Laparoscopy; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Retrospective Studies; Treatment Failure; Young Adult

Topics: Anovulation; Body Mass Index; Exercise; Feeding and Eating Disorders; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hypogonadism; Hypopituitarism; Hypothalamic Diseases; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; World Health Organization

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

Hormonal indices, phase pattern of estrous cycles, and histological structure of the ovaries were studied in female rats with polycystic ovaries caused by subcutaneous implantation of Silastic capsules with testosterone after consecutive treatment with non-steroid antiandrogen, flutamide (flutafarm), urinary FSH (menopur) and HCG (choragon). It was shown that while the plasma testosterone level was increased, administration of the drugs in subtherapeutical doses interrupted persistent diestrus, renewed estrous cycle, gonadal and uterine weights, induced appearance of postovulatory luteal bodies and restored fertility. Therefore, antiandrogen potentiation of pharmnnaco-dynamic effect of the gonadotropins with regard to their ability to ovulation induction was found out.

Topics: Androgen Antagonists; Androgen Receptor Antagonists; Animals; Anovulation; Chorionic Gonadotropin; Disease Models, Animal; Estrus; Female; Fertility Agents, Female; Flutamide; Menotropins; Ovulation; Polycystic Ovary Syndrome; Rats; Rats, Wistar; Receptors, Gonadotropin; Testosterone

To assess whether ovarian volume of World Health Organization II anovulatory patients in the early follicular phase predicts the response to ovulation induction with gonadotropins.. Retrospective data analysis of two prospective, randomized, multicenter studies.. Clinical development unit of biotechnology company.. Four hundred sixty-five World Health Organization II anovulatory patients undergoing ovulation induction.. Ovarian response to stimulation, ovulation (mid-luteal serum progesterone > 30 nmol/L), cancellation rate, pregnancy rate, and incidence of the ovarian hyperstimulation syndrome (OHSS) according to baseline ovarian volume (day 2-5) before stimulation.. Mean ovarian volume was 11.55 +/- 6.0 cm(3) (range, 0.8-49.3 cm(3)). Small ovarian volume was associated with lower rates of cycle cancellation owing to risk for OHSS (3 vs. 29 patients [2.8% vs. 9%]). Patients with small ovarian volume (<7.25 cm(3)) required fewer ampules of FSH (1373 IU vs. 1629 IU) and shorter duration of stimulation (16 vs. 18.1 days) and had higher ovulation rate than did patients with mid-range and larger ovarian volume (84.3% vs. 69.1% and 68.8%, respectively). The clinical pregnancy rate per cycle of hCG administration was similar in the three groups (25.8%, 28.1%, and 27.5%).. World Health Organization II anovulatory women with medium-sized or large ovaries who are undergoing low-dose gonadotropin stimulation for ovulation induction may have higher risk for OHSS than do women with small ovaries. Women with small ovaries who meet criteria for administration of hCG respond better to ovulation induction and have a similar likelihood of conceiving compared with women with larger ovaries.

Topics: Adult; Anovulation; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Follicular Phase; Humans; Menotropins; Ovarian Hyperstimulation Syndrome; Ovary; Ovulation Induction; Predictive Value of Tests; Prospective Studies; Randomized Controlled Trials as Topic; Recombinant Proteins; Treatment Outcome

To examine the stage-specific follicular response to recombinant human FSH (rhFSH), urinary FSH (uFSH), and hMG preparations.. In vitro follicle culture.. Small preantral and tertiary follicles isolated from adult normal BDF-1 mice and androgen-sterilized mice were cultured with rhFSH, uFSH, and hMG for 4 days.. Follicular diameter. Immunoreactive inhibin, E2, and progesterone concentrations in cultured medium.. The minimal effective dose of rhFSH, uFSH, and hMG for the follicular growth of small preantral follicles from normal mice was 10 mIU/mL, 1 mIU/mL, and 0.1 mIU/mL, respectively. For tertiary follicles from normal mice, the minimal effective dose of rhFSH, uFSH, and hMG was 10 mIU/mL, 10 mIU/mL, and 1 mIU/mL, respectively. The minimal effective dose of hMG for the follicular growth of small preantral follicles from androgen-sterilized mice was 0.01 mIU/mL, and that of rhFSH and uFSH on tertiary follicles from androgen-sterilized mice was 1 mIU/mL and 10 mIU/mL, respectively. No significant increase was found in the follicular diameter of the tertiary follicles from androgen-sterilized mice as a result of stimulation by hMG, but an hMG dose of >10 mIU/mL produced a significant increase in progesterone secretion.. Human menopausal gonadotropin preparation acts detrimentally on follicles from androgen-sterilized mice by increasing the sensitivity of small preantral follicles to FSH and by inducing the luteinization of tertiary follicles.

Topics: Age Factors; Androgens; Animals; Anovulation; Cells, Cultured; Estradiol; Female; Follicle Stimulating Hormone; Humans; Inhibins; Menotropins; Mice; Mice, Inbred Strains; Ovarian Follicle; Polycystic Ovary Syndrome; Progesterone; Recombinant Proteins

Insulin-like growth factors (IGFs) in the intraovarian autocrine control mechanism may serve as a central signal, and the granulosa cell is their site of production, reception, and action. In addition, various IGF-binding proteins (IGFBPs) are thought to modulate and regulate the actions of IGFs and in turn influence the growth and maturation of ovarian follicles.. To further investigate the follicular growth and maturation regulated by IGFs and IGFBPs in the ovary of low responders, 14 cases of low responders cotreated with growth hormone (GH) were studied. Another 14 normal responders without GH treatment were also recruited as controls.. Serum levels of estradiol on day 6 and day 9 of the cycle and on the day of HCG administration, and the numbers of oocytes retrieved and follicles on the day of oocyte retrieval were significantly lower in low responders before growth hormone (GH) treatment than those in low responders after GH treatment as well as those in normal responders. Expression of both IGF-II and IGFBP-1 mRNA was elevated (by 23% and 35%, respectively) in granulosa cells from low responders after GH treatment as compared to that in low responders before GH treatment. In contrast, there was a substantial decrease (16%) in expression of IGFBP-3 mRNA in granulosa cells from low responders after GH treatment. Clinically, the pregnancy rate was lower in low responders after GH treatment as compared to controls (7% vs. 29%).. Cotreatment with growth hormone in low responders might not increase the pregnancy rate.

Topics: Anovulation; Drug Therapy, Combination; Female; Fertility Agents, Female; Granulosa Cells; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor Binding Proteins; Leuprolide; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; RNA, Messenger; Somatomedins; Treatment Outcome

To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI.. Retrospective analysis.. The Center for Reproductive Medicine at the Brigham and Women's Hospital, a tertiary care academic medical center.. Two hundred seventy-four women who underwent controlled ovarian hyperstimulation with gonadotropins and IUI.. Infertility treatment with gonadotropins and IUI.. Pregnancy rates according to patient age, infertility diagnosis, and number of treatment cycles.. Pregnancy rates decreased with increasing patient age. The cumulative pregnancy rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.. There is a clear age-related decline in fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. Patients <40 years of age and those with male factor infertility or tubal factor infertility have a particularly poor prognosis.

Topics: Adult; Aging; Anovulation; Endometriosis; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Retrospective Studies

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

To avoid a high cancellation rate and/or a high multiple pregnancy rate due to multifollicular development in gonadotrophin stimulated cycles, such cycles were converted in the same cycle to in vitro fertilization/embryo transfer (IVF/ET). The results from a four year period using this strategy are summarized.. Seventy-three anovulatory women (seven WHO group I, 66 WHO group II) were studied during this period. In a majority of the cycles a GnRH-analogue was used for down-regulation according to a long protocol, followed by stimulation with FSH and/or hMG.. Out of 154 WHO group II gonadotrophin stimulation cycles intended for ovulation induction, 25 cycles were converted to IVF. The pregnancy and delivery rates in the IVF-converted cycles were 50% and 41%, respectively, and 31% and 22% when gonadotrophin stimulation was followed by intercourse. The cancellation rate, including both ovulation induction and IVF cycles, was 15% and the multiple pregnancy rate was 30%, mainly twins. Lean women achieved better outcome than obese women. In WHO group I only 12 cycles were performed. One cycle was converted to IVF resulting in delivery and one cycle was cancelled. The pregnancy- and delivery rates were both 50% when gonadotrophin stimulation was followed by intercourse.. It is concluded that the option to convert a gonadotrophin stimulation cycle to IVF in the same cycle, in cases of multifollicular development, seemed to be a good alternative. The conversion results in a low cancellation rate and a low incidence of high order multiple pregnancies. Patients should be informed of this opportunity before entering ovulation stimulation.

Topics: Adult; Anovulation; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple

To determine the efficiency and comparison of two different protocols, human menopausal gonadotropin (hMG) plus gonadotropin-releasing hormone analog (GnRH-a) and low-dose hMG to reduce multifollicular development in clomiphene-resistant polycystic ovary syndrome (PCOS) patients.. Prospective comparative and pilot study in 20 patients for 31 cycles. The first group (n = 10) was treated with buserelin acetate, 600 micrograms/d, for six weeks before ovulation induction with hMG in conventional doses for 14 cycles. The other group (n = 10) was treated only with low-dose hMG for 17 cycles. All cycles were compared in terms of the number of follicles per cycle, cycles human chorionic gonadotropin withheld, estradiol level on ovulation day, treatment duration and number of ampules used per cycle. In addition, the outcome of cycles and complications of multifollicular development, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy were determined.. As compared with the GnRH-a + hMG protocol, the low-dose hMG protocol yielded less multifollicular (57.1% vs. 17.6%) and more monofollicular (35.7% vs. 70.6%) development. Consequently, less OHSS (21.4% vs. 0%) and multiple pregnancy (10% vs. 0%) occurred in the low-dose group.. Low-dose hMG therapy has distinct advantages in eliminating multifollicular development and related complications in clomiphene citrate-resistant PCOS patients. The addition of GnRH-a to gonadotropins does not change the incidence of multifollicular development.

Topics: Adult; Anovulation; Clomiphene; Dose-Response Relationship, Drug; Drug Resistance; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovarian Follicle; Ovulation Induction; Pilot Projects; Polycystic Ovary Syndrome; Prospective Studies

The patterns of plasma melatonin, gonadotropins, sex steroids and prolactin were studied in anovulatory infertile females undergoing ovulation induction with hMG/hCG. Melatonin levels were found to fluctuate during the menstrual cycle of these subjects with a nadir at mid-cycle and peak occurring at the early follicular/late luteal phases of the cycle (p < 0.05). Melatonin correlated negatively with estradiol during the follicular phase (r=-0.5180, p < 0.05) and positively with LH (5 + 0.6321, p < 0.05) in the luteal phase, respectively. Correlational analyses by partial and multiple correlations suggest that the effects of estradiol and LH on melatonin in the follicular phase are interdependent whereas the effect of LH on melatonin in the luteal phase is independent of the effects of other hormones. The results suggest that hormonal interactions and phases of the cycle are important variables contributing to the fluctuations in melatonin levels during the menstrual cycle.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Melatonin; Menotropins; Menstrual Cycle; Ovulation Induction; Progesterone; Prolactin

Concerns have been raised recently about the possible association between superovulation and ovarian cancer. In order to contribute to the limited literature on this important issue, two cases of ovarian tumours in women who had undergone multiple ovulation inductions are presented. In the first case, the patient had secondary anovulatory infertility. She was treated with human menopausal gonadotrophin (HMG) alone and in combination with clomiphene citrate or buserelin for six cycles. She then underwent ovarian stimulation with buserelin/HMG in the long protocol for in-vitro fertilization (IVF) and embryo transfer. In preparation for a new IVF/embryo transfer attempt, 8 months later, the screening ultrasound revealed a cystic formation of the left ovary and an enlargement of the right. During laparotomy, both ovaries were found to bear large tumours (approximately 6 x 5 x 4 cm) which were removed. Histological examination showed that they were epithelial tumours (serous-papillary cystadenomas) of borderline malignancy. The patient conceived spontaneously 1.5 years after the operation. In the second case, the patient presented with secondary anovulatory infertility. She underwent ovulation induction with clomiphene/HMG and with buserelin/HMG in the long protocol, and intra-uterine insemination with husband's spermatozoa and conceived (singleton pregnancy). She was delivered by Caesarean section, during which a cystic tumour of the left ovary was removed. Histological examination revealed a benign mucous cystadenoma of the ovary.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Anovulation; Buserelin; Clomiphene; Cystadenoma, Mucinous; Cystadenoma, Papillary; Cystadenoma, Serous; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Neoplasms; Ovulation Induction

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

To analyze cumulative conception rates and the prognostic factors influencing them during exogenous human menopausal gonadotropin (hMG) therapy for World Health Organization (WHO) group I or II ovulatory disorders.. A retrospective review was conducted of 468 treatment cycles in 146 women with ovulatory disorders refractory to conventional therapy. Cumulative conception rates were calculated, and the effects of diagnostic group, age, gravidity, and duration of infertility were examined using the Cox proportional hazards model.. The cumulative proportion pregnant following six hMG cycles in WHO group I (0.89) was significantly greater than in the hyperandrogenic subgroup of WHO group II (0.30) (95% confidence interval [CI] 0.2-0.7, P = .006) or the luteal phase defect subgroup (0.35) (95% CI 0.07-0.6, P = .02). Conception rates in WHO group I did not differ significantly from those in the normoandrogenic oligo-ovulatory subgroup of WHO group II (0.63) (95% CI 0.3-1.3, P = .6). Conception rates were not influenced by duration of infertility or primary versus secondary infertility. Women 35 years or older had significantly lower conception rates than those aged 27 years or less (P = .04, hazard ratio 0.3, 95% CI 0.1-0.8).. Cumulative conception rates following exogenous gonadotropin therapy for women with refractory ovulatory disorders were both diagnosis- and age-dependent. Treatment with hMG approximated or surpassed normal fertility rates in women with WHO group I and normoandrogenic WHO group II oligo-ovulation, but was significantly less successful at correcting the underlying defect in women with hyperandrogenic anovulation and luteal phase defects.

Topics: Adult; Age Factors; Anovulation; Female; Fertilization; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Ovulation Induction; Prognosis; Proportional Hazards Models; Retrospective Studies; World Health Organization

To establish the predictive role of preovulatory ovarian ultrasonography in the occurrence of multiple pregnancy after hMG and hCG treatment for anovulatory infertility.. Prospective.. Outpatient Infertility Clinic.. Ninety-five anovulatory women who conceived after gonadotropin therapy.. Induction of ovulation by hMG and hCG monitored by plasma E2 measurements and ovarian ultrasonography.. All follicles visualized on the day of hCG administration were recorded and divided into the following four groups: group I, 10 to 12 mm; group II, 13 to 15 mm; group III, 16 to 18 mm; and group IV, 19 mm and larger. The sonographic findings were statistically evaluated to 80 singletons and 45 multiple pregnancies.. No statistical correlation was found to exist between the number of follicles from the different groups and the number of fetuses.. The number and sizes of follicles visualized on the day of hCG administration have no predictive value regarding the occurrence of a multiple pregnancy.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Humans; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies; Ultrasonography

While ovulation induction with human menopausal gonadotropins (hMG) is commonly used to treat refractory ovulatory disorders, little is known about the characteristics of multiple consecutive treatment cycles. Since such cycles may be required to achieve pregnancy, it is important to ensure that the ovarian response is not compromised during consecutive cycles. We examined the ovarian response and cycle characteristics of 25 women with World Health Organization (WHO) group II ovulatory disorders who underwent three consecutive ovulatory hMG cycles. The total hMG dose and duration of treatment increased significantly between the first and third consecutive hMG cycles, although the final estradiol levels remained similar. While the mean numbers of follicles > or = 14 mm in diameter were comparable, the size of the largest follicle was significantly greater during the third cycle as compared to the first. These results suggest that while the ovary required more vigorous stimulation during subsequent cycles, the ultimate hormonal and follicular response did not appear to be compromised during this series of three consecutive cycles.

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

To assess the clinical relevance of daily hormonal changes for achieving a successful pregnancy in anovulatory infertile women.. A comparative study of hormonal dynamics in pregnant and nonpregnant cycles during the pulsatile subcutaneous administration of hMG. Subjects received subcutaneous injection of either 9.375 IU or 14.0625 IU of hMG diluted in 50-microL physiological saline (total daily dose, 150 or 225 IU) at 90-minute intervals by means of a portable peristaltic pump.. Kyorin University Hospital and Ichikawa General Hospital.. We analyzed 18 pregnant and 42 nonpregnant cycles in 17 patients with secondary hypothalamic/pituitary amenorrhea who conceived after receiving pulsatile hMG treatment. Another 14 women with normal spontaneous ovulation, including 14 pregnant and 15 nonpregnant cycles, served as controls.. Serum concentrations of LH, FSH, E2, and P were measured, and the P:E2 ratio was determined.. Serum concentrations of LH and FSH did not differ significantly between the pregnant and nonpregnant cycles. Serum levels of P and E2 were significantly higher during the hMG treatments than those of the spontaneous ovulatory cycles throughout the follicular and luteal phases. Up to the midluteal phase, the P and E2 values in the nonpregnant cycles during the hMG treatments did not differ significantly from those in the pregnant cycles. The P:E2 ratios were comparable between the pulsatile stimulatory cycles and the normal spontaneous ovulatory cycles. However, the P:E2 ratio in the early and midluteal phases was significantly greater in the pregnant cycles than in the nonpregnant cycles.. The P:E2 ratio in the early and midluteal phases is a more important indicator of hormonal function for implantation than the absolute levels of either P or E2.

Topics: Adult; Anovulation; Female; Gonadal Steroid Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Menotropins; Pregnancy; Pulsatile Flow

Ten patients with polycystic ovary disease (PCOD) had ovulation induction after pituitary suppression by gonadotropin releasing hormone agonist (GnRHa) with GnRHa plus pure follicle-stimulating hormone (FSH) or plus human menopausal gonadotropin (hMG). Duration of the stimulation period and gonadotropin doses were superimposable. A multifollicular response was observed in both treatments. Bioassay and radioimmunoassay of luteinizing hormone, androstanedione and testosterone plasma levels were higher in hMG cycles compared to FSH-treated cycles. No differences was found in FSH and estradiol (E2) plasma concentrations, whereas in hMG-treated cycles the E2/number of follicles and E2/ovarian volume ratios were greater than in the FSH-treated cycles. Clinical results in terms of percentages of ovulation and pregnancies were the same in the two protocols. We conclude that the presence of luteinizing hormone in induction of ovulation in patients with PCOD does not seem to influence follicular recruitment and development, but it may have a role in the enhancement of steroid production.

Topics: Adult; Analysis of Variance; Androstenedione; Anovulation; Biological Assay; Buserelin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovary; Ovulation Induction; Pituitary Gland; Polycystic Ovary Syndrome; Radioimmunoassay; Testosterone

Theoretically, clomiphene citrate or human menopausal gonadotropins might have a higher chance of inducing pregnancy per cycle were it not for the concomitant rise in androgens induced by these follicle-maturing drugs. In the present study, mid-cycle androgen levels were evaluated in anovulatory women with normal baseline early follicular levels who were treated with either clomiphene citrate or human menopausal gonadotropins. The only mid-cycle androgen to rise above the normal range was androstenedione. However, no negative effects of elevated androstenedione levels on pregnancy rates were apparent. Thus, at least in women with normal baseline androgen levels, the use of follicle-maturing drugs does not appear to cause a rise in androgen levels except for androstenedione, and the rise in androstenedione at mid-cycle appears to have no adverse effect on conception.

Topics: Androgens; Androstenedione; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Pregnancy

Dopamine agonist Bromocriptin tablet has been used in 102 cases, partly for the inhibition of puerperal lactation, partly for the treatment of infertility accompanied by hyperprolactinaemia. On the basis of the clinical results and the changes of PRL level the drug was found to be very effective in both indications. Side-effects necessitating the discontinuance of treatment were not observed.

Topics: Adult; Anovulation; Bromocriptine; Clomiphene; Drug Therapy, Combination; Female; Humans; Hyperprolactinemia; Infant, Newborn; Infertility, Female; Lactation; Menotropins; Postpartum Period; Pregnancy

Induction of ovulation was performed in 148 cycles using human menopausal gonadotropins (HMG) in 52 patients, seven with hypothalamic-pituitary failure and 45 suffering dysfunction at this level. Several induction schemes were used beginning on the second day of the cycle, until one or more follicles larger than 14 mm were found, to administrate 10,000 UI of human chorionic gonadotropin (HCG). Clinical valuation of cervical mucus and ultrasound of the ovaries to assess follicular development were done, from day eight of the cycle. Twenty five pregnancies resulted in 23 patients (44%), three in patients with failure and 22 in the dysfunction group. A total of 19 healthy babies were taken home, however three neonatal deaths, four miscarriages and one ectopic pregnancy occurred. Multiple gestation was present in three patients (12%), one was quadruplet, one triplet and one twin. The ovarian hyperstimulation syndrome (OHS) was detected in seven patients (13.4%), three were mild, two moderate and two severe; two cases of OHS had multiple pregnancies. Although induction of ovulation with HMG in patients with anovulation is a complex procedure requiring strict clinical vigilance and advanced technological resources, in this clinical study it was possible to obtain similar results to other series, using high resolution ultrasound only, without daily measurements of hormones.

Topics: Adult; Anovulation; Cervix Mucus; Female; Follicular Phase; Humans; Menotropins; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Ultrasonography

In this study structural alterations were tested on anovulatory infertile women who had undergone treatment of HMG + HCG to induce ovulation and subsequently to achieve pregnancy. For this purpose, a single premenstrual endometrial fundal biopsy was performed and evaluated using light and electron microscopy. The aim of the study was to evaluate the biopsies with respect to 'in-phase' or 'out-of-phase' at light microscopic level, in which a series of strict criteria were chosen, and then to detect the additional structural abnormalities at electron microscopic level, if present. Only one of the women in our study who had an in-phase endometrium became pregnant after proper treatment protocol individually adjusted and consequently terminated by an early abortion. Histologic features of the biopsies revealed that about half were normal while the rest had various types of structural abnormalities in the transformation of the secretory endometrium detected by light and/or electron microscopy. At the electron microscopic level, multiple alterations were seen in cellular and intercellular components even in those diagnosed as normal by light microscopy. As a result of the above data it was concluded that the cause of inconceivability might arise from some fine structural alterations which may affect the endometrial receptivity of an implanting embryo.

Topics: Adult; Anovulation; Arterioles; Biopsy; Capillaries; Chorionic Gonadotropin; Decidua; Endometrium; Female; Humans; Menotropins; Microscopy, Electron; Ovulation Induction

Luteal phase abnormalities are known to complicate ovulation induction with gonadotropins. This study was performed to test the effect of a modified human chorionic gonadotropin (hCG) regimen on the luteal phase during gonadotropin treatment.. Fifteen women from a private practice setting volunteered to be studied during each of two nonconception, gonadotropin-stimulated cycles. After ovarian stimulation with human menopausal gonadotropins (hMG), hCG was administered either as a single dose of 10,000 IU (single dose) or in two divided doses of 5,000 IU given 1 week apart (split dose).. Early, midluteal, and late luteal estradiol (E2) and progesterone (P) levels and luteal phase lengths were measured, and their median values and intraquartile ranges (IQR) compared using nonparametric analysis.. Early and midluteal E2 and P levels were similar regardless of which hCG regimen was administered. The median late luteal E2 level was 1,146.0 pg/mL (the IQR ranged from 633 to 1,650, IQR = 1,017) with the split-dose regimen and 240.0 pg/mL (the IQR ranged from 150 to 460, IQR = 310) with the single-dose regimen. The median late luteal P level was 108.0 ng/mL (the IQR ranged from 58.5 to 129, IQR = 70.5) with the split-dose regimen and 4.2 ng/mL (the IQR ranged from 1.9 to 11.7, IQR = 9.8) with the single-dose regimen. Median luteal phase lengths were 16 days (the IQR ranged from 15 to 17, IQR = 2) for the split-dose regimen and 11 days (the IQR ranged from 10 to 12, IQR = 2) for the single-dose regimen.. In hMG-stimulated cycles, a second dose of hCG given during the midluteal phase significantly increases late luteal E2 and P levels and consistently lengthens the luteal phase.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteal Phase; Luteinizing Hormone; Menotropins; Progesterone; Radioimmunoassay

To document the persistence of a sensitizing effect of human growth hormone on the ovarian responsiveness to human menopausal gonadotrophin in anovulatory patients resistant to standard gonadotrophin doses.. We performed an open study of three patients given 4, 12 or 24 IU recombinant growth hormone on alternate days for 5-7 doses, concomitantly with gonadotrophin, and assessed gonadotrophin dose requirements before, during and after the cycle of growth hormone therapy.. We studied two with isolated gonadotrophin deficiency and primary amenorrhoea and one with a pituitary tumour and hyperprolactinaemia which normalized with bromocriptine but in whom there was persisting secondary amenorrhoea.. We measured body mass index, FSH, LH, prolactin, growth hormone, insulin-like growth factor I (IGF-I), oestradiol and inhibin at baseline and growth hormone, IGF-I, oestradiol and inhibin during treatment. In addition we noted the numbers of ampoules (75 IU) and the last pre-hCG dose of gonadotrophin used before, during and after growth hormone therapy.. Baseline growth hormone levels were low but IGF-I levels were normal. IGF-I increased by 20% in the subject given 4 IU growth hormone, and by 50-100% in the other two. Pretreatment daily gonadotrophin dosage of 8-11 ampoules pre-hCG was reduced to 3-6 ampoules during growth hormone and 3-4 post growth hormone. This effect persisted for 4 cycles over 7 months in one subject.. Growth hormone causes persisting ovarian sensitization to gonadotrophin and may produce a substantial lowering of gonadotrophin requirement for ovulation induction in patients with large dosage needs.

Topics: Adult; Anovulation; Female; Growth Hormone; Humans; Hypogonadism; Insulin-Like Growth Factor I; Menotropins; Menstruation; Ovary; Ovulation Induction; Time Factors

To attempt the monitoring of ovulation induction solely with ultrasound (US).. Using serial US measurements to monitor ovulation induction using human menopausal gonadotropin and human chorionic gonadotropin (hCG), in comparison with estradiol (E2) concentrations that became available at the end of each cycle.. Specialist Reproductive Endocrine Unit.. Twenty hypogonadotropic and 29 ultrasonically diagnosed polycystic ovary patients.. Follicular growth, uterine measurements, endometrial thickness, and serum E2 concentrations.. Follicular growth, uterine measurements, and endometrial thickness correlated strongly with E2 concentrations (P less than 0.0001). The endometrium on the day of hCG administration was significantly thicker (P less than 0.01) in the conception (n = 27) compared with the nonconception cycles (n = 87), whereas no significant difference were observed in serum E2 concentrations. No pregnancy was observed when hCG had been administered when the endometrial thickness was less than or equal to 7 mm. Midluteal endometrial thickness of greater than or equal to 11 mm was found to be a good prognostic factor for detecting early pregnancy (P less than 0.008).. Serial US examinations used alone have proven to be safe and highly efficient. It also has a unique ability to detect pregnancy in the midluteal phase.

Topics: Adult; Anovulation; Endometrium; Estradiol; Female; Humans; Hypogonadism; Luteal Phase; Menotropins; Monitoring, Physiologic; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Ultrasonography; Uterus

The results of ovulation induction in patients with ovulatory dysfunction were reviewed for a one year period. Eighty-six women were assigned to four groups: secondary amenorrhea, anovulation, oligo-ovulation, and luteal phase defect/short luteal phase (LPD). All patients were monitored with basal body temperature (BBT) graph, postcoital testing, and ultrasonic scanning of ovarian follicles. All patients received therapy with clomiphene citrate (CC) for a minimum of four cycles and 13 patients conceived. Fifty patients were offered additional therapy with human menopausal gonadotropins (HMG-HCG). Seventeen completed a minimum of four cycles, and 13 conceived. The number of CC-treated patients with poor mucus quality in the face of adequate follicular development was 24, or 48%. The overwhelming problem with ovulation induction when CC failed was the large number of patients who dropped out of therapy, 48%. In summary, close monitoring during ovulation induction to confirm ovulation, and assess mucus quality and luteal function allow detection and correction of inadequate response. Induction of ovulation can be highly successful if patients can follow through and complete protocols of therapy.

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

Late follicular phase levels of 17 beta-oestradiol (E2) and progesterone (P) in serum were studied during the induction of follicular maturation with human menopausal gonadotrophin (HMG) (n = 23) and HMG-clomiphene citrate (CC) (n = 18). For each patient one hormonal profile was studied between 6 days to 2 h before administration of human chorionic gonadotrophin (HCG). Ultrasonographic follicular measurement at the time of evaluation demonstrated preovoulatory ovarian follicles of various number and size in all patients studied. Sixteen endometrial biopsies were performed at the time of evaluation (eight for each subgroup), before HCG administration. Mean late follicular phase levels of E2 did not differ significantly between the two groups (436 +/- 348 and 475 +/- 267 pg/ml for the HMG and HMG-CC groups respectively). The mean progesterone levels in the HMG-CC group (1.233 +/- 0.67 ng/ml) was significantly higher than that for the HMG group of (0.86 +/- 0.55 ng/ml, P less than or equal to 0.04). The mean time interval between ovulation and HCG administration for the two groups was 2.5 and 2.4 days for the HMG and HMG-CC groups, respectively. In all eight biopsies taken from the HMG group, various stages of endometrial proliferation were demonstrated. Premature glandular secretory transformation and oedematous stroma were observed in three out of eight biopsy specimens obtained from the HMG-CC group. Taken together, these results demonstrate that subtle or full premature luteinization in the late follicular phase occurs more frequently with the use of HMG-CC for induction of follicular maturation.

Topics: Adult; Anovulation; Biopsy; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Drug Therapy, Combination; Endometrium; Estradiol; Female; Follicular Phase; Humans; Menotropins; Ovarian Follicle; Ovulation Induction; Progesterone; Ultrasonography

Twenty-eight hyperandrogenemic women suffering from infertility owing to chronic anovulation were treated with hMG. Only 7 patients exhibited the typical polycystic ovarian appearance of multiple subcortical cysts, however, a wide range (6-15 cm3) of ovarian volume was observed. The LH/FSH ratio was consistently lower than 2.5 and circulating androgens of both ovarian and adrenal origin were elevated. The 4 days dexamethasone suppression test showed more than 80% suppression of dehydroepiandrosterone-sulphate and a variable (40-60%) reduction of testosterone and androstenedione levels. Two different patterns of follicular development were observed in response to hMG. Sixteen patients exhibited polycystic ovarian reaction, whereas 12 women had a follicular growth pattern similar to that seen in hMG-stimulated normo-ovulatory subjects. Patients with polycystic ovarian reaction showed a significantly increased androstenedione response to hMG when compared with the other group. Moreover, the non-stimulated ovarian volume was found to be markedly greater than in subjects without polycystic reaction. Thus, ovarian stimulation of patients with mixed hyperandrogenemia may elucidate the presence of borderline polycystic ovaries; furthermore the increased accumulation of androstenedione may suggest an inherent ovarian failure.

Topics: Adult; Androgens; Androstenedione; Anovulation; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Polycystic Ovary Syndrome; Testosterone

Topics: Anovulation; Chorionic Gonadotropin; Female; Humans; Luteal Phase; Menotropins; Pregnancy

Continuous exposure to GnRH eliminates the pituitary as a source of gonadotropins and may have direct suppressive effects on the ovary. A woman with PCO syndrome received leuprolide acetate (1 mg/d SC) for 4 weeks before and simultaneously with hMG stimulation. Human chorionic gonadotropin (5,000 IU) was administered IM on the 8th day of hMG therapy. There were 10 follicles greater than 15 mm and a polycystic appearance to the ovaries with 25 follicles measuring less than 10 mm. The serum E2 concentration was 2,280 pg/mL. She developed severe ovarian hyperstimulation and required hospitalization for 12 days for fluid management. A viable intrauterine pregnancy was present. Four weeks of pretreatment with leuprolide did not prevent hyperstimulation in the presence of an intrauterine pregnancy.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Menotropins; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Stimulation, Chemical

We investigated the endocrine response to an experimental protocol in which human menopausal gonadotropin was delivered in pulses every 90-120 minutes by an automated pump. Thirty clomiphene citrate- and gonadotropin-releasing hormone-unresponsive anovulatory women were studied over 107 treatment cycles. In response to episodic intravenous (IV) delivery, pulses of FSH and LH were demonstrable in the circulation. In four World Health Organization (WHO) group I anovulatory women, ovulation occurred in all cycles (N = 8); the pregnancy rate per cycle was 63% and the cumulative pregnancy rate 100%. In 26 WHO group II patients, 42.4% of treatment cycles were in 12 women previously refractory to the intramuscular route of administration; the rate for ovulation was 86% (total of 99 cycles), the pregnancy rate per ovulatory cycle was 14%, and the cumulative pregnancy rate 56%. A mild phlebitis occurred at the site of the IV catheter in 24% of treatment cycles. Intravenous delivery of gonadotropins in small pulses had a dose-sparing effect and was an effective method of treating anovulatory infertile patients refractory to other conventional methods of ovulation induction.

Topics: Adult; Anovulation; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infusion Pumps, Implantable; Infusions, Intravenous; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Ovulation Induction

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

We have found a significant improvement of pregnancy rates after pretreatment with an agonist of gonadotrophin releasing hormone (GnRH-a). The pregnancy rate in patients treated with HMG/HCG was 17% per patient and 5.5% per cycle, in patients treated with buserelin, 25% per patient and 15% per cycle and in the triptorelin group 25% per patient and 22% per cycle. From 740 HMG/HCG cycles without GnRH-a only 66% were sufficient according to the analytical data. In 16% we found a premature LH discharge and in 18% an irregular LH fluctuation during stimulation. It is clear that gonadotrophin stimulation during pituitary suppression provokes a more intense ovarian reaction with respect to the number of follicles, as well as the endocrine activity. There are also some important practical advantages: ovarian stimulation can be started without any respect to a definite time of menstruation or of the cycle. Of further importance is the much greater flexibility in the timing of HCG administration. Finally, it will be favourable for all patients who need ovulation induction, especially for oocyte retrieval for IVF or GIFT, because no cycle has to be cancelled.

Topics: Anovulation; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteal Phase; Luteinizing Hormone; Luteolytic Agents; Menotropins; Ovulation Induction; Progesterone; Testosterone; Triptorelin Pamoate

Four women with unexplained infertility and two anovulatory oligomenorrheic women who experienced repeated premature luteinization when treated with human menopausal gonadotropin (hMG) or gonadotropin-releasing hormone (GnRH) were given the gonadotropin-releasing hormone agonist (GnRHa), luprolide acetate, in order to effect medical hypophysectomy. This was followed by hMG for induction of ovulation. Four of the six patients had hMG-only cycles, which were compared with the luprolide acetate/hMG cycles. The luprolide acetate/hMG cycles resulted in normal folliculogenesis with presumptive ovulation. In luprolide/hMG cycles, significantly more hMG was needed for induction of ovulation than in hMG-only cycles. Premature luteinization was abolished with luprolide acetate treatment.

Topics: Adult; Anovulation; Drug Administration Schedule; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Luteal Phase; Luteinizing Hormone; Menotropins; Oligomenorrhea; Ovulation Induction; Prospective Studies

Ovulatory dysfunction is a leading cause of female infertility in the United States. Fortunately, ovulatory dysfunction is often amenable to treatment. Thorough testing is necessary to identify the exact cause of anovulation before conventional ovulation-inducing therapy is started. Careful patient monitoring is essential to avoid risks such as the ovarian hyperstimulation syndrome. Several newer ovulation-inducing agents are available for use in special situations.

Topics: Anovulation; Bromocriptine; Clomiphene; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pituitary Hormone-Releasing Hormones

To correlate ovarian growth and follicular size with 17 beta-estradiol (E2) and androstenedione (A) peripheral levels, 20 induced cycles, 6 spontaneous ovulatory cycles and 6 spontaneous anovulatory cycles from 32 women during follicular phase were examined in order to obtain a better insight in the events involved in multiple folliculogenesis. In spontaneous ovulatory cycles, a significant correlation was obtained between E2 plasma levels and volume of the dominant follicle (p less than 0.05) as well as total follicular volume (p less than 0.01). Plasma A was significantly related with sonographic features likely related to ovarian stroma as well as preantral and antral subordinated follicles, which usually fail to ovulate. Significant correlation between E2/A peripheral ratio and volume of the dominant follicle(s) was also found (p less than 0.01). In anovulatory cycles, inverse significant correlation between E2 and sonographic aspects of degenerating antral follicles (p less than 0.001) was found, whereas a positive significant correlation between E2 and ovarian stroma was obtained (p less than 0.001). No correlation between peripheral A and any ovarian sonographic compartment was evident. However in the anovulatory cycles group a significant correlation between A v E2 peripheral levels was found, too. During HMG regimen, all the ovarian compartments seemed to be responsible for E2 peripheral levels. Ovarian stroma as well as preantral and multiple antral follicles were related to A levels. E2/A peripheral ratio did not result to be a good indicator of the large follicles. During "pure" FSH therapy, exclusive correlations between estrogen and large follicles as well as total follicular volume were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Androstenedione; Anovulation; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Ultrasonics

One hundred ten women with anovulatory infertility (World Health Organization [WHO] group I n = 50, WHO group II n = 60) were given 341 treatment courses with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Additional hCG was given as single or repeated injections during the luteal phase in 205 ovulatory cycles. In WHO group I, the incidence of luteal phase defects was lower and the pregnancy rate higher in cycles with extra hCG administration during the luteal phase than in cycles with no extra hCG. In WHO group II, there was no such difference after supplemental hCG. The abortion rate was the same after cycles with or without extra hCG administration. It is suggested that during ovulation induction with hMG/hCG in anovulatory women with no evidence of endogenous estrogen activity, the luteal phase should be supplemented with additional hCG.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Corpus Luteum; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Ten women of polycystic ovarian-type (PCO-type) anovulation, having a decreased ratio of FSH to LH and androgen excess, resistant to the previous clomiphene, bromocriptine and/or daily im injections of human menopausal gonadotropine (hMG), were treated with continuous sc infusion of 150 IU/day hMG. The treatment was initiated on cycle day 2-5 and continued until the dominant follicle reached 20 mm or more in diameter, when an im bolus of 10,000 IU human chorionic gonadotropin was given. The treatment elevated the geometric mean of pretreatment serum FSH (8.6 mIU/ml) to 15.9 mIU/ml (p less than 0.001), while serum LH decreased from 29.4 mIU/ml to 20.7 mIU/ml (p less than 0.01). This resulted in a highly significant increase in the FSH/LH ratio from 0.29 to 0.77 (p less than 0.0001). Follicle enlargement was demonstrated in 13 of the 14 treatment cycles, 12 of which were ovulatory. Pregnancy ensued in 4 cases, 1 of which was a quadruplet pregnancy. Continuous infusion of hMG was indicated as an effective way of inducing ovulation in PCO-type anovulation resistant to conventional methods of ovulation induction.

Topics: Adult; Androgens; Anovulation; Female; Follicle Stimulating Hormone; Humans; Infusions, Parenteral; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

The value of multiple parameters in the prediction of fertile cycles was prospectively evaluated in 52 menotropin-induced cycles. The periovulatory pattern of estradiol (E2) was found to correlate with conceptional cycles. E2 levels greater than 500 pg/ml on the day of human chorionic gonadotropin administration (day 0) with a further increase on day +1 (high ascending pattern--A1) were found to have a 51% predictive value for fertile cycles. Twelve of the 17 fertile cycles had an A1, type of response (71%), whereas the overall incidence of an A1 pattern was 42% (22 of 52). No pregnancies have occurred with preovulatory follicles less than or equal to 14 mm in diameter. The number of preovulatory follicles, E2 level on day 0, and midluteal progesterone had no predictive value for fertile cycles.

Topics: Anovulation; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Prospective Studies

Eight human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced cycles in four anovulatory women unresponsive to clomiphene citrate plus hCG were studied. Blood samples were obtained for baseline determinations and daily thereafter, 24 hours after the injection of hMG. Serum estradiol (E2), progesterone, follicle-stimulating hormone, and luteinizing hormone (LH) were measured by radioimmunoassay. Bioassayable LH (LH-b) was determined by the immature mice interstitial cell in vitro bioassay for testosterone with LER-907 as the reference standard. Appropriate follicular growth, assessed by pelvic ultrasonography, occurred in all cycles. During induction days mean immunoassayable LH (LH-i) and LH-b levels were suppressed until the E2 concentrations rose to a mean of 1420.5 +/- 149 pg/ml (standard error of the mean), at which time a concurrent rise in LH-b and LH-i levels was observed (130% and 34%, respectively). LH-b/LH-i ratio increased by 63% on the day E2 peaked, indicating enhanced LH bioactivity before hCG administration. Our data suggest that during hMG/hCG-induced cycles, in a high E2 milieu, endogenous or exogenous LH may show a heterogeneity in its molecular content, resulting in enhanced bioactivity relative to immunoactivity.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Time Factors

The purpose of this study is to investigate the ovulatory effect of the following three methods on 40 patients with normoprolactinemic amenorrhea patients who failed to respond to clomiphene citrate (Cl) alone. Method I is the combined therapy with bromocriptine and Cl (Brc/Cl). Method II is the combined therapy with Brc/Cl and an additional small amount of HMG (less than or equal to 300 IU). Method III is the combined therapy with Brc/Cl and an increased amount of HMG (less than or equal to 1,200 IU) and HCG. The ovulation rate of method I was 57.5% (23/40) in 40 cases, and 55.6% (99/178) in 178 cycles. The pregnancy rate for this method was 23.8% (5/21). Out of the 12 nonrespondent method I cases, 5 additional cases were ovulated by method II and 3 cases were ovulated by method III. The total pregnancy rate was 42.9% (9/21) with these three methods. Seven cases were normal pregnancies, one case was a twin pregnancy and 1 case was an abortion. No other side effects were found in this study. From these results, the combined therapy with Brc/Cl or Brc/Cl + HMG had almost the same ovulatory rate as the HMG-HCG therapy, and fewer side effects.

Topics: Adolescent; Adult; Anovulation; Bromocriptine; Clomiphene; Drug Administration Schedule; Drug Resistance; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Prolactin

The stimulation regimens and the results of ovulation induction in anovulatory patients and in patients suffering from a Luteinized Unruptured Follicle (LUF) syndrome are discussed as well as the findings concerning superovulation in IVF cycles. The percentage of multiple pregnancies (less than or equal to 20 p. cent) is acceptable, due to the accurate daily performance of hormonal determinations. The pregnancy rate is lower in a LUF population, than in anovulatory patients. This is likely due to the unknown pathophysiology of the LUF syndrome. Compared to natural cycles, the maximum serum LH concentration is reduced in stimulated cycles although multiple oocytes have to mature in superovulated patients. A possible explanation for these reduced LH surges could be an increase in inhibin -like substances. There is still a need for more research to find out the real interaction between the follicle and the hypothalamic-hypophysial axis.

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Female; Fertilization in Vitro; Humans; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy

A preparation of HMG purified to contain only FSH (FSH 75 IU/LH less than 1 IU) was used in 26 patients who had anovulatory sterility because of sclero-polycystic ovaries. It was a selected population in that all the patients had proved to be resistant to Clomiphene Citrate and at risk with HMG therapy. Purified urinary FSH was used and monitored as classical HMG treatment. 44 treatment cycles resulted in 33 ovulatory cycles (75%) and 6 pregnancies (13.6% per cycle). The number of cases of hyperstimulation (13.6%) was low when it is compared to situations at risk when HCG was administered in 2/3 of the treatment cycles. The results obtained in a population with a bad prognosis can be considered to be very encouraging and gives purified urinary FSH a specific place in our therapeutic armamentarium.

Topics: Adult; Anovulation; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Polycystic Ovary Syndrome

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

Ultrasound has been employed in diagnosing the luteinized unruptured follicle syndrome (LUF). Eighty-nine of 333 infertility patients were found to have LUF. The patients were divided into three groups. Group 1 was on no fertility medication. Twenty-five of 39 of this group released with HCG alone. Ten of the nonreleasers to HCG did release with HMG mixed with HCG. Group 2 patients had been treated with clomiphene and found to have LUF. Thirteen of 16 patients released with HCG and one of the failures released with HMG-HCG. Group 3 patients had been treated with HMG and had failed to release the ova despite HCG. Thirty-one of 33 did release with HMG-HCG. Twenty-six of 89 patients achieved a pregnancy within six months of therapy and 20 of 36 patients with all fertility factors corrected achieved a pregnancy.

Topics: Anovulation; Chorionic Gonadotropin; Corpus Luteum; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovarian Follicle; Pregnancy; Syndrome; Ultrasonography

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

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Gonadal Steroid Hormones; Humans; Hydrocortisone; Menotropins; Ovulation Induction

Topics: Anovulation; Costs and Cost Analysis; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovulation Induction

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Follicular Phase; Humans; Luteal Phase; Menotropins; Ovulation Induction; Ultrasonography

We have developed a simplified quick semiquantitative determination for urinary estrogen in non-pregnant female by utilizing Amberlite XAD-2 and E3 LAIR-KIT. The whole procedure required only 20 minutes. Interassay variance of this method was 10% and intraassay variance was 7%. The recovery was 85%. There was a highly significant correlation between the data obtained by this method and those by RIA (r = 0.944). We applied this method to the monitoring of follicular maturation in the HMG-HCG therapy. Urinary estrogens obtained from 28 anovulatory women (60 cycles) were determined by this method in order to decide the appropriate timing for the HCG injection following the HMG. Our data indicate that it is possible to induce ovulation without the risk of ovarian hyperstimulation syndrome if the HCG was injected on the day when the urinary estrogen level rose to between 70 and 100 ng/ml for 2 consecutive days. This method could well be applied to prospective monitoring in ovulation induction with HMG-HCG therapy.

Topics: Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Monitoring, Physiologic; Ovulation Induction

Thirty-eight patients underwent 38 cycles of induction of ovulation using stepwise human menopausal gonadotropin and human chorionic gonadotropin (hCG) administration. Ultrasonography was performed on the day of hCG injection. The mean age +/- standard error of the mean (SEM) of the patients was 32.9 +/- 0.8 years, and the duration of infertility ranged from 1 to 14 years (median, 2.8). Ultrasonographic measurements were obtained of the largest diameter and the volume of the dominant follicles as well as all other follicles in both ovaries. Data were analyzed by Student's t-test, regression analysis, and analysis of variance. The mean +/- SEM diameter of dominant follicles was 1.8 +/- 0.1 cm, and the volume of dominant follicles was 3.5 +/- 0.8 cm. The mean +/- SEM serum estradiol (E2) level before hCG administration was 659 +/- 62 pg/ml. Significant correlations were found between preovulatory serum E2 levels and the total follicular volume of both ovaries (r = 0.41, P less than 0.05) and follicular volume of the ovary containing the dominant follicle (r = 0.42, P less than 0.01). No significant correlation was observed between the diameter of the dominant follicle and serum E2 levels. These results suggest that ultrasound findings reflect growth, whereas serum E2 levels primarily detect functional activity of follicles.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Drug Administration Schedule; Estradiol; Female; Humans; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Ultrasonography

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 effectiveness of ovulation induction with clomiphene citrate or human menopausal gonadotropins was evaluated in 52 infertile women with stage I or stage II endometriosis and ovulatory dysfunction: anovulation or luteinized unruptured follicle (LUF) syndrome before (group I) and after (group II) danazol treatment. The incidence of anovulation and LUF in the endometriosis population was 9% and 34%, respectively. In group I, 10 of 36 patients (27.8%) conceived, with an average of 17.6 induction cycles per pregnancy. In group II, 21 of 30 patients (70%) conceived, with an average of 4.5 cycles per pregnancy (difference significant at P less than 0.001). There was no difference in the average number of ovulation induction cycles per patient between groups I and II (4.9 and 3.1, respectively). Of 14 patients who did not conceive in group I and crossed over to group II, 9 (64.3%) conceived (not different from group II). Spontaneous abortion rates were 20% in group I and 14% in group II. These results indicate that mild endometriosis may interfere with conception through mechanisms other than ovulatory dysfunction and that treatment with danazol appears to more than double the fertility rate.

Topics: Adult; Anovulation; Clomiphene; Danazol; Endometriosis; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Pregnadienes

Real-time ultrasound scanning of follicular development was performed during 45 cycles of 15 patients receiving gonadotropin therapy for treatment of anovulatory infertility. The amount of gonadotropins administered was based exclusively on the results of the ultrasound examinations. Fourteen pregnancies were obtained, with 10 singletons, 2 sets of twins, and 1 set of triplets, resulting in a cumulative pregnancy rate of greater than 93%. Mild hyperstimulation occurred in two cases. Ultrasound alone can be used effectively to control gonadotropin therapy in the majority of cases.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ultrasonography

This study was designed to compare the efficiency of daily intramuscular human menopausal gonadotropin (hMG) therapy to an intermittent subcutaneous regimen in women with ovulatory dysfunction. Ovarian follicular development was assessed with the use of serial ultrasound scans and serum 17 beta-estradiol (E2) levels. Ovulation was based on pregnancy and/or elevated luteal progesterone values. There were no significant differences between the two treatment regimens, based on E2 levels, follicular size, and/or number of follicles greater than 1.0 cm. Pregnancy and ovulation occurred more frequently after intramuscular hMG therapy. These results indicate that daily hMG is preferred over intermittent subcutaneous administration because of convenience.

Topics: Adult; Anovulation; Estradiol; Evaluation Studies as Topic; Female; Humans; Infertility, Female; Injections, Intramuscular; Injections, Subcutaneous; Menotropins; Ovarian Follicle; Pregnancy; Progesterone; Ultrasonography

Therapy with human menopausal gonadotropin (HMG) conventionally has been monitored by estrogen measurements. Pelvic sonography may offer a more accurate method of monitoring HMG therapy. In this study 67 anovulatory patients were treated with HMG until at least one follicle had a diameter of 17 mm. The serum estradiol level was noted at the time a mature follicle was achieved. There was a correlation between the ultrasound data and the serum estradiol range in 57% of the cases. However, in 24% it was necessary to push the estradiol level above the allowable maximum of 2000 pg/mL. Twenty percent of the patients attained a 17-mm follicle before reaching the minimum required estradiol level of 500 pg/mL. Sonographic monitoring should improve the efficacy of HMG therapy.

Topics: Anovulation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Detection; Pregnancy; Pregnancy, Multiple; Progesterone; Ultrasonography

Follicular maturity and atresia have been defined previously, both hormonally and microscopically, in normal ovulatory women. Ovarian hyperstimulation with clomiphene citrate and human menopausal gonadotropins in normal women is carried out for the purpose of aspirating oocytes from several large follicles for in vitro fertilization. Alterations in follicular fluid (FF) hormone levels occur with hyperstimulation regimens, and some of these large follicles (greater than 18 mm) appear morphologically atretic. We have used the term dysmature to describe those large follicles that have an abnormal oocyte morphological appearance and cannot be fertilized in vitro. Mature follicles have been defined by their size, their oocyte morphological appearance, and their ability to be fertilized in vitro. FF from small (2-3 mm) and large (greater than 18 mm) mature and dysmature follicles were obtained from 10 untreated ovulatory women. Mature and dysmature follicles also were obtained from clomiphene and human menopausal gonadotropin-treated normal (n = 11) and anovulatory (n = 5) women. In untreated cycles, the FF steroid content of the small follicles characterized these follicles to be atretic. FF from dysmature follicles from spontaneous untreated cycles had higher concentrations of dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, and 17 beta-estradiol (E2) and lower progesterone (Prog) and Prog to E2 ratios (P less than 0.05). Compared to mature follicles from untreated patients, hyperstimulated mature follicles from ovulatory women had higher FF E2 concentrations and lower Prog to E2 ratios (P less than 0.05). In ovulatory patients, the FF concentrations of testosterone were higher and FF Prog and Prog to E2 ratios were lower (P less than 0.05) in the dysmature than in the mature follicles. Mature follicles from hyperstimulated ovulatory patients and those from hyperstimulated anovulatory patients were similar except for lower FF Prog, higher FF E2, and lower Prog to E2 ratios in the anovulatory group. Dysmature follicles from hyperstimulated anovulatory patients had lower FF androstenedione and dihydrotestosterone, but were generally similar to mature follicles. The percentages of dysmature follicles occurring among all large (greater than 18 mm) follicles that were aspirated were similar in ovulatory (34%) and anovulatory (45%) patients. FF steroid concentrations did not correlate with serum levels of testosterone and E2 at the time of follicle asp

Topics: Adult; Androstane-3,17-diol; Androstenedione; Anovulation; Body Fluids; Chorionic Gonadotropin; Clomiphene; Dihydrotestosterone; Estradiol; Female; Follicular Atresia; Gonadal Steroid Hormones; Humans; Menotropins; Middle Aged; Oocytes; Ovarian Follicle; Ovulation; Progesterone; Testosterone

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

We studied 15 anovulatory women undergoing ovulation induction with purified human urinary FSH or purified human urinary FSH and LH [human menopausal gonadotropins (hMG)]. All patients had either sporadic or no vaginal bleeding after progesterone therapy and failed to ovulate after receiving clomiphene (250 mg for 5 days) plus hCG. Other causes of infertility were ruled out. Sixteen cycles of FSH and 12 cycles of hMG were administered according to a standard protocol. Estradiol, progesterone, androstenedione, testosterone, LH, and FSH concentrations were quantitated by RIA. Follicular diameter was determined using ultrasound. There was no significant difference in the amount of FSH or hMG used per patient, in the duration of therapy before hCG administration, or in the length of the luteal phase in any patient. There was a difference in the number of follicles greater than 1000 mm3 per cycle in those patients receiving FSH compared to the number in those receiving hMG [2.8 +/- 1.3 (+/- SEM) vs. 4.4 +/- 1.5 follicles; P = 0.026). The maximum follicular phase serum estradiol (18.3 vs. 34.8 ng/ml) and maximum luteal phase progesterone concentrations (1289 vs. 2808 pg/ml; P = 0.026) were also different between the FSH and hMG groups. Linear regression analysis revealed a significant correlation between the peripheral serum estradiol levels and the total follicular volume of follicles in the hMG-treated group which was not apparent in the FSH-treated group. These findings suggest that exogenous LH may not be required to induce folliculogenesis in anovulatory patients.

Topics: Adult; Androstenedione; Anovulation; Clomiphene; Drug Resistance; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Progesterone; Testosterone

A prospective longitudinal and standardized study is presented, dealing with ultrasonographic and hormonal characteristics of the luteinized unruptured follicle (LUF) syndrome. Among 600 cycles monitored in 270 infertility patients, 40 cycles in 27 patients showed no evidence of follicle rupture, in spite of signs of luteinization, as reflected by basal body temperature recordings and progesterone determinations. In this study, 20 LUF cycles in 20 infertile patients were compared with 45 ovulatory cycles in 45 control women. During the follicular phase, no substantial difference in follicle growth was found, but after the luteinizing hormone peak, LUF follicles, instead of rupturing, showed a typical accelerated growth pattern. Both mean luteinizing hormone peak levels and midluteal progesterone levels were significantly lower in LUF cycles than in the control cycles. However, the duration of the luteal phase was not affected. Both central and local factors can be held responsible for the lack of follicle rupture. Ultrasound offers new possibilities as a noninvasive method in diagnosing the LUF syndrome.

Topics: Adult; Anovulation; Body Temperature; Chorionic Gonadotropin; Female; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Progesterone; Prospective Studies; Syndrome; Ultrasonography

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

Various methods used by gynecologists in the past for hormone therapy and ovulation inducement are discussed including the administration of: 1) steroids composed mainly of estrogen, 2) clomiphene or tamoxifen (estrogen), 3) bromocriptine for high prolactin or latent (transitory) prolactin, 4) glucocorticoid for high androgen levels such as polycystic ovary or adrenogenital syndrome, 5) human menopausal gonadotropin (hMG) and human chorionic gonadotropin, and 6) hMG (pulsatile). In previous studies, another method--the administration of luteinizing hormone releasing hormone (LHRH) by drip infusion--was unsuccessful in inducing ovulation. However, experiments have been performed in which monkeys were given a pulsatile administration of LHRH every 60 minutes for 10-14 days. This new method proved successful in inducing ovulation and normalizing the ovulation cycle. Graphs showing the results of both the old method of ovulation inducement and the new method by pulsatile administration of LHRH are included. There is a brief discussion of contraception, examining, in particular, a new noncoital means of birth control involving antiprogesterone steroids which has been in the developmental stages for the past several years.

Topics: Adult; Anovulation; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Estrenes; Female; Gestrinone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Mifepristone; Ovarian Cysts; Ovarian Neoplasms; Ovulation Induction

Ovarian hyperstimulation syndrome occurred after induction of ovulation with menotropins (follicle-stimulating hormone and luteinizing hormone) and implantation of an intrauterine pregnancy. Serial determinations of aldosterone, deoxycorticosterone, 17 beta-estradiol, progesterone, human chorionic gonadotropin, urinary and plasma electrolytes, and fluid balance were obtained. Plasma renin activity, aldosterone, deoxycorticosterone, and antidiuretic hormone rose markedly. Hydration for four days improved urinary output but also accelerated sodium and fluid retention. Subsequent restriction of salt and water stabilized the patient. Spontaneous abortion was followed by prompt diuresis without a change in therapy. Regression analysis of the authors' data, the clinical observations, and other data in the literature suggest that the ovarian hyperstimulation syndrome is produced by excessive secretion of an unknown hormone that regulates peritoneal fluid during the normal menstrual cycle, and that elevations of plasma renin, aldosterone, and antidiuretic hormone are secondary.

Topics: Adult; Aldosterone; Anovulation; Chorionic Gonadotropin; Desoxycorticosterone; Electrolytes; Female; Humans; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progesterone; Ultrasonography; Water-Electrolyte Balance

Topics: Adenoma; Anovulation; Bromocriptine; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovulation Induction; Pituitary Neoplasms; Prolactin

Three groups of women with different types of ovulatory dysfunction who had failed to conceive on conventional therapy were treated with pulsatile gonadotropin-releasing hormone (GnRH). Group A consisted of nine patients with luteal phase defect; group B included four patients with apparently normal menstrual cycles but disordered folliculogenesis seen by serial ultrasound examinations; and group C consisted of eight patients who exhibited anovulation or irregular ovulation. GnRH was administered subcutaneously or intravenously in dosages varying from 5 micrograms to 20 micrograms, with pulse frequency of 2 to 3 hours in 53 cycles. Forty-one cycles were ovulatory. Four pregnancies resulted, one ending in miscarriage at 12 weeks' gestation. Our results indicate that GnRH may be used as an alternative to the prevalent therapeutic methods for ovulatory dysfunction. Only those women who had anovulation and abnormal basal levels of serum luteinizing hormone were resistant to GnRH therapy.

Topics: Adult; Anovulation; Cervix Mucus; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteal Phase; Menotropins; Menstruation Disturbances; Pregnancy; Time Factors

Every woman begins and ends her years of cyclic menstrual function with periods of anovulation, with or without vaginal bleeding. Many women, however, experience anovulation during their reproductive years. It may be an occasional problem or a chronic condition. In some cases, the anovulatory state requires only a little time or minimal pharmacological intervention to correct. Once homeostatis is achieved, the system returns to its cyclic function. Other cases of anovulation result from serious pathology or congenital anomalies which may be difficult to diagnose and even more difficult to correct. The right medical intervention can usually return the woman to a state of good overall health, but pregnancy may not always be achievable. This article reviews the physiology of ovulation, the reasons for its failure, the diagnostic process and the latest in therapeutic management.

Topics: Anovulation; Bromocriptine; Clomiphene; Dexamethasone; Drug Combinations; Female; Humans; Hypothalamic Diseases; Menotropins; Ovary; Ovulation; Ovulation Induction; Pituitary Diseases; Pituitary Hormone-Releasing Hormones; Pregnancy

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

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Syndrome

Gonadotropins are released in a pulsatile fashion at a frequency of between 1 and 2 hours in the follicular phase of the menstrual cycle. Human menopausal gonadotropins are usually administered intramuscularly. We evaluated the gonadal response to intravenous human menopausal gonadotropins administered in a pulsatile fashion over nine treatment cycles in three anovulatory infertile women. Human menopausal gonadotropin pulses in doses up to 12 IU follicle-stimulating hormone at frequencies between 2 to 3 hours over 3 to 17 days resulted in ovulation in five cycles with one pregnancy being conceived. In the ovulatory cycles (5,000 to 10,000 IU of human chorionic gonadotropin was used to induce ovulation), the 17 beta-plasma estradiol level was 961 +/- 128 versus 326 +/- 95 pg/ml (mean +/- SEM) in the anovulatory cycles (p = 0.015). The dose of human menopausal gonadotropins (in ampules of Pergonal, 75 IU of follicle-stimulating hormone and 75 IU of luteinizing hormone) in the intravenous cycles needed to induce ovulation was 12.3 +/- 1.4 versus 20.4 +/- 0.9 for intramuscular cycles (n = 80 in 23 women, p = 0.008). Treatment was well tolerated and without complications. We are continuing to explore the use of this apparently more efficient mode of administering human menopausal gonadotropins to anovulatory patients resistant to other techniques of ovulation induction therapy.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Resistance; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections, Intravenous; Menotropins; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

Follicular fluid was obtained from anovulatory patients (n = 12), stimulated with human menopausal gonadotropin, clomiphene, and human chorionic gonadotropin to evaluate the relative responses of inhibin, follicle regulatory protein, and steroid levels in follicles from ovaries requiring exogenous stimulation for follicular development. Follicular fluid concentrations of estradiol, progesterone, androstenedione, testosterone, dihydrotestosterone, and 3 alpha-androstenediol were determined by radioimmunoassay. Follicular fluid inhibin activity was determined by suppression of rat pituicyte follicle-stimulating hormone, and follicle regulatory protein activity was determined by suppression of porcine granulosa cell aromatase. The mean level of steroids were progesterone (7529 +/- 1601 ng/ml), estradiol (1082 +/- 158 ng/ml), androstenedione (15.2 +/- 3.17 ng/ml), 3 alpha-androstenediol (0.90 +/- 0.13 ng/ml), testosterone (2.23 +/- 33 ng/ml), and dihydrotestosterone (0.77 +/- 0.11 ng/ml). Follicle regulatory protein activity was 16.6% +/- 4.3% and mean inhibin level was 62.9 +/- 7.52 U. These results are in contrast to reports of follicular fluid steroid levels from normal ovulatory patients treated with exogenous gonadotropin. Although altered levels of hormones were present within these follicles, they clearly were not atretic, as evidenced by elevated estradiol levels and estradiol/androstenedione ratios. Alterations in the normal follicular response to pharmacologic gonadotropin stimulation in the follicles of anovulatory women suggest the presence of granulosa cell dysynchrony .

Topics: Adult; Androstenediols; Androstenedione; Anovulation; Body Fluids; Chorionic Gonadotropin; Clomiphene; Dihydrotestosterone; Estradiol; Female; Gonadal Steroid Hormones; Humans; Inhibins; Menotropins; Ovarian Follicle; Progesterone; Proteins; Radioimmunoassay; Testosterone

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

With proper patient selection, appropriate pretreatment studies and careful monitoring will ensure that patients ovulate safely. Table 7 is a summary of the results that may be expected following properly monitored hMG therapy. Among estrogen-deficient patients without other causes of infertility, the cumulative pregnancy rate after six cycles will exceed 90%. However, among normoestrogenic patients with no other infertility factors the cumulative conception rate has been reported to be only 50% after 12 courses of therapy, although with the use of ultrasound monitoring it is likely that this latter figure will improve. Nevertheless, these data may be used to afford couples with a realistic prognosis.

Topics: Abnormalities, Drug-Induced; Anovulation; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infant, Newborn; Medroxyprogesterone; Menotropins; Menstruation Disturbances; Ovarian Follicle; Ovulation Induction; Pregnancy; Progesterone; Ultrasonography

A new protocol of estrogen-priming and cervical mucus monitoring for individualized hMG therapy was devised. Prior to treatment, the amount of cervical mucus ("a" mm3) should be determined. Then the peak value ("b" mm3) on the amount of cervical mucus resulting from the exogenous 2-day injection of 1 mg of estradiol benzoate is confirmed. After a decrease of the amount of cervical mucus is noted, daily dose of 225(1 - a/b) IU of hMG is administered until the amount of cervical mucus reaches or exceeds the "b" value. hCG is given 36 hours later than the last previous injection of hMG. This new individualized hMG therapy induced 51 ovulations (69.9%), 9 pregnancies (17.6%), and no multiple pregnancies (0%) out of 73 treated anovulatory cycles. This new protocol appears promising for prevention of multiple pregnancy due to hMG therapy, perhaps based on the mechanism of estrogen priming and individualization of both daily dose and duration of hMG administration.

Topics: Anovulation; Cervix Mucus; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation Detection; Ovulation Induction; Pregnancy

The introduction of powerful ovulation induction agents, such as gonadotropins, has made an important contribution to the temporary elimination of the anovulation syndrome. Since the treatment is expensive and not without significant medical complication, it is vitally important to conduct therapy according to a well-defined monitoring system. In the past, clinicians have tended to monitor gonadotropin therapy by biophysical signs, but they were found to be insufficient monitors if used alone. Estrogen secretion from the ovaries does reflect the follicular maturation process. In this study a combined individualized method for hMG/hCG therapy is presented. Fifty-one infertile anovulatory women were treated for a total of 124 treatment cycles. All courses of therapy were judged to have induced ovulation. There was a good clinical correlation between cervical score and increasing estrogen levels. The pregnancy rate was 62.7%, with 60% of patients becoming pregnant within the first three cycles of treatment. In spite of the complications of less than 1% of severe hyperstimulation, 15.5% multiple gestation, and 28% of abortion rate, gonadotropin therapy is a most efficient tool in the treatment of infertility due to anovulation.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple

Serum hormonal profiles were characterized in 126 treatment cycles from 24 anovulatory women who underwent ovulation induction therapy with sequential human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Of the 98 presumptively ovulatory treatment cycles, 18 had luteal phases lasting 11 days or less. Sixteen of these 18 cycles had one or more of the following features: serum hCG concentrations of less than 75 mIU/ml 24 hours after hCG administration or peak preovulatory estradiol (E2) levels either less than 200 pg/ml or greater than 2000 pg/ml. Midluteal serum progesterone levels were less than 10 ng/ml in seven of the shortened cycles. Only one of these features (E2 greater than 2000 pg/ml) was present in any cycle (n = 2) resulting in pregnancy. Our observations suggest that serum E2 and hCG levels will reflect the apparent adequacy of luteal function during hMG/hCG treatment cycles.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Luteal Phase; Menotropins; Menstruation; Ovulation Induction; Pregnancy; Progesterone; Retrospective Studies

Topics: Adult; Anovulation; Estrogens; Female; Humans; Menotropins; Pregnancy; Pregnancy, Multiple; Progesterone

The aim of this study is to advocate the delivery of human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) therapy to patients with hypergonadotropic ovarian anovulation (Hyper-OA). HMG-HCG therapy was carried out in six patients (16 cycles) with Hyper-OA and nine patients (26 cycles) with hypogonadotropic pituitary anovulation (Hypo-PA) as controls. In this study, two patients with Hyper-OA ovulated after HMG-HCG therapy, and one of them conceived in the next cycle of the therapy. This patient is presented in detail as a case report. The ovulation rate in Hyper-OA proved to be 33.3% of patients and 12.5% of cycles as compared with 100% of patients with Hypo-PA and 65.3% of their cycles. These results suggest that although ovulation and pregnancy rate are very low, it is worth trying HMG-HCG therapy in patients with Hyper-OA, at least for one or two cycles.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation; Pregnancy; Progesterone

After treatment with human gonadotropins, 289 anovulatory women with apparently normal fallopian tubes became pregnant 379 times. Ten ectopic pregnancies in nine women were diagnosed, for an incidence of 2.7% of all conceptions. All the ectopic pregnancies were found in the fallopian tubes. Four patients had also an intrauterine pregnancy. Five of the patients showed ovarian overstimulation, and hormonal modifications at the time of ovulation might explain the high incidence of tubal gestation.

Topics: Abortion, Induced; Adult; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovary; Pregnancy; Pregnancy Complications; Pregnancy, Tubal; Progesterone

A retrospective study on the success of induction of ovulation with human menopausal gonadotropin and human chorionic gonadotropin (hMG/hCG) in 267 women was performed. Galactorrheic women had a higher pregnancy rate (55%) than nongalactorrheic women (22%). Galactorrhea was a far better indicator of the success of the treatment than hyperprolactinemia at present. The results obtained may suggest that in "bromocriptine failure" it is not mandatory to lower prolactin levels prior to induction of ovulation with hMG/hCG, and these women may be treated with menotropins alone.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Galactorrhea; Humans; Lactation Disorders; Menotropins; Ovulation Induction; Pregnancy; Prolactin; Retrospective Studies

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

Rheometric properties of cervical mucus were studied with the Ovutimer in 26 women. 14 women had regular menstrual cycles, 12 had menstrual irregularities and received treatment to induce ovulation. In 21 women (80.7%) a significant correlation was found between the ovulation time as established by the luteinizing hormone surge, and ovulation time as established by the Ovutimer test. The instrument was found satisfactorily accurate in establishing the day of ovulation in almost all cases.

Topics: Anovulation; Cervix Mucus; Chorionic Gonadotropin; Estradiol; Female; Humans; Luteinizing Hormone; Menotropins; Ovulation Detection; Rheology

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

In order to evaluate relationship between circulating androgens levels and development of ovarian hyperstimulation syndrome (OHS) in anovulatory patients treated sequentially with hMG and hCG, serum concentrations of androstenedione (A), testosterone (T) as well as estradiol (Ed) were measured serially in a total of 17 anovulatory patients including 9 who did not develop OHS and 8 who developed mild or moderate OHS. Increase of Ed levels during the period of hMG treatment varied remarkably in individual patients with OHS ranging from 7.2 to 190.1 times as much the pretreatment value. On the other hand, increase of A levels during the hMG treatment was recorded in the range from 2.0 to 3.2 times as much the pretreatment value in 4 patients with mild OHS, and from 1.5 to 5.9 in 4 patients with moderate OHS. However, the ratio of A increase remained within 1.4 times in patients without OHS. A transient increase of circulating T was observed in 2 days after commencement of hCG treatment, ranging between 1.4 and 3.2 times in patients without OHS, between 1.8 and 2.4 times in patients with mild OHS and between 3.8 and 6.8 times in patients with moderate OHS. It is concluded that serial measurements of A and T during the course of hMG and hCG treatments respectively appear to be an additional index other than Ed to predict development of OHS.

Topics: Androgens; Androstenedione; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovarian Diseases; Syndrome; Testosterone

Serum estradiol (E2) and progesterone (P) levels were radioimmunoassayed every or every other day for monitoring the HMG-HCG therapy in six anovulatory patients, and the clinical significance of measuring steroid hormones as precautionary counterplot against the ovarian hyperstimulation syndrome and multiple pregnancies was evaluated. Administration of HCG is recommended to trigger ovulation when serum E2 levels reach 400-600 pg/ml. Mean peak P level in 7-8 days after ovulation induced by HMG-HCG was 22.9 ng/ml, which is significantly higher than P levels of the same period in spontaneous and clomiphene-induced ovulations. This result suggests that there may occur multiple ovulations which result in multiple pregnancies in HMG-HCG therapy.

Topics: Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation Induction; Pregnancy; Progesterone

Topics: Adult; Anovulation; Capillary Permeability; Chorionic Gonadotropin; Clomiphene; Estradiol Congeners; Female; Humans; Menotropins; Ovulation; Pericardial Effusion; Pregnancy; Superovulation

The dosage, duration of treatment, and plasma hormone levels were analyzed statistically between and within groups of treatment cycles with (n = 46) and without (n = 10) ovulation. A significant difference was observed in the dosage of human menopausal gonadotropins (hMG) over various days of treatment, but not in the mean dosage of hMG and human chorionic gonadotropin (hCG) administered per cycle. Follicle-stimulating hormone (FSH):luteinizing hormone (LH) ratios, prolactin (PRL) levels, and the magnitude and the duration of the estradiol response were greater in the ovulatory cycles. Additionally, in the ovulatory cycles, the dose of hMG correlated with the plasma levels of estradiol, FSH, and LH, while in the anovulatory cycles, hMG dosage correlated only with the LH concentrations. After administration of hCG, the mean plasma concentrations of its beta subunit peaked within 1 day and remained detectable for up to 10 days thereafter. In the ovulatory cycles, the mean progesterone level was maximal 6 days following hCG administration. In these cycles, luteal phase progesterone levels correlated positively with the preovulatory estradiol and inversely with concentrations of the beta subunit of hCG. The data demonstrate that, in contrast to anovulatory follicles, ovulatory follicles were exposed to a relative "dominance" of FSH over LH, with higher concentrations of estradiol and PRL for several days before hCG was administered. Apart from hMG dosage, the endogenous discharge of LH appeared to be an important determinant of the ovarian response. A single 10,000 IU dose of hCG was adequate for inducing ovulation and maintaining luteal function.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Cyclic AMP; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Peptide Fragments; Progesterone

Repeatedly, we tried to give an devized treatment of HMG-HCG therapy to the three women who had different degree ovulatory disorder. Throughout the study, we observed BBT, cervical mucus and the changes of blood hormones levels until all three women got pregnant. 1) As much difference was bound in the individual ovarian sensitivity to gonadotropin, we observed the ovarian reaction administering of HMG (150 IU) every day. 2) When we observed some maturity of ovarian follicles, we decreased amount of HMG to the level of FSH in the normal menstrual cycle. 3) Considering the days needed to form follicular maturation, we changed HMG to HCG 4 or 5 days after cervical mucus increased to 0.2 ml. or more and showed 2-grade of crystallization.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Luteinizing Hormone; Menotropins

To study the effects of the addition of clomiphene citrate to human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), 23 cycles of clomiphene citrate-hMG-hCG (CHH) were administered to 10 anovulatory women. Of these 10 women, 5 also received 15 cycles of hMG-hCG (HH). Although there was a significant increase in the ovulation rate in the CHH group (p less than 0.01), there was no difference in the pregnancy rate (p less than 0.05). Patients in the CHH group required significantly less hMG for ovulation induction than the HH group (p less than 0.01). Patients receiving CHH who had low serum levels of follicle-stimulating hormone required significantly more hMG than those with normal values. The luteinizing hormone releasing hormone test may predict those patients who will require less hMG during CHH therapy. The relative safety of the CHH treatment is discussed.

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Pregnancy

To elucidate the relationship between estrogen and thrombosis, we studied blood coagulation parameters in women whose ovaries were stimulated with human menopausal gonadotropins (hMG). Daily hMG administration over 1 to 2 weeks in seven anovulatory women increased plasma 17 beta-estradiol levels fivefold over the pretreatment value. Of the coagulation parameters, the fibrinogen level increased significantly from an initial value of 248 +/- 11.7 mg/dl (mean +/- SEM) to 353 +/- 32.2 mg/dl after hMG treatment (P less than 0.05), with a significant positive correlation between estrogen and fibrinogen levels (r = +0.762). In addition, a thrombokinetics study showed that the maximal rate of change in optical density of the prothrombin time and activated partial thromboplastin time was significantly increased, suggesting that the coagulation factors involved in extrinsic, intrinsic, and common pathways could be increased by estrogen. Antithrombin III levels decreased gradually during hMG administration. Thus, increased endogenous estrogen levels appear to induce the so-called "hypercoagulable state" through both an increase in coagulation factors in the coagulation cascade system and a decrease in antithrombin III, a potent natural inhibitor of activated coagulation factors. Patients on a regimen of hMG treatment for induction of ovulation serve as excellent models for the study of alteration of "natural" estrogen-mediated coagulation parameters.

Topics: Adult; Anovulation; Blood Coagulation; Estradiol; Female; Humans; Menotropins

Topics: Adult; Anovulation; Drug Evaluation; Female; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction

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

Twenty-five cycles induced by human menopausal gonadotropin (hMG) were serially studied by ultrasound. The developing follicles were observed up to and beyond human chorionic gonadotropin (hCG) administration. Ovulation as determined by subsequent pregnancy or a sustained elevation of basal temperature was seen in 18 of these cycles. Among these patients the follicular size ranged between 24 and 13 millimeters. No pregnancies occurred where the follicular size was below 15 mm. A shortened luteal phase was noted in three cycles where the follicular size was either 13 or 14 mm. Multiple follicles greater than 10 mm were observed in 14 of the ovulating cycles, but in no case did a multiple pregnancy occur. Fifteen millimeters is therefore suggested as a minimum size for satisfactory ovulation, but it does not appear that an optimum size exists. We conclude that ultrasound can play an important role in the monitoring of ovulation induction but does not replace the present methods.

Topics: Anovulation; Body Temperature; Chorionic Gonadotropin; Female; Humans; Hypothalamic Diseases; Menotropins; Ovarian Follicle; Ovulation Induction; Pituitary Diseases; Pregnancy; Ultrasonography

Menotropins (human menopausal gonadotropin [hMG]) are used to induce follicular maturation and ovulation in anovulatory infertile women. To determine how hMG stimulation affected ovarian androgen production during such therapy, plasma androstenedione (A) and testosterone (T) levels were measured at the beginning and end of hMG therapy in 5 patients with anovulatory hypogonadotropism (group 1) and 15 patients with anovulatory polycystic ovary syndrome (group 2). Mean pretreatment levels of plasma estradiol (E2), T, and A were significantly higher in group 2 compared with group 1. Stimulation with hMG caused E2 levels to reach the same maximum value in both groups. Testosterone levels increased from 0.2 +/- 0.03 ng/ml (mean /+- SE) to 0.4 %/- 0.038 ng/ml for group 1 patients, and from 0.53 +/- 0.06 ng/ml to 0.8 +/- 0.1 ng/ml for group 2 patients. Androstenedione levels increased from 1.5 +/- 0.47 ng/ml to 2.1 +/- 0.4 ng/ml and from 4.37 +/- 0.77 ng/ml to 5.8 +/- 1.1 ng/ml in groups 1 and 2, respectively. The influence of hMG on plasma androgen levels was studied in women who received several treatment cycles before they became pregnant. In these women plasma androgen levels reached the same values in all cycles, including the final cycle in which the patient became pregnant. The data indicate that patients treated with hMG become pregnant despite marked gonadal androgen production. These observations suggest that hMG therapy promotes steroidogenesis in both the granulosa and theca cells of the follicle.

Topics: Androstenedione; Anovulation; Estradiol; Female; Fertilization; Humans; Menotropins; Ovary; Polycystic Ovary Syndrome; Pregnancy; Stimulation, Chemical; Testosterone

Monitoring of human follicular development by real-time ultrasound during HMG-HCG treatment is presented. With the aid of ultrasound monitoring, the ovulation rate is raised to 94.3% (formerly 80% without ultrasound). Serious side effects such as ascites and/or hydrothorax did not occur in this study (1.2% without ultrasound controls). The pregnancy rate was 21/47 (44%) of all hormonally treated patients. By means of real-time sector scan examination, the growing follicle could be detected in 103/106 (97.3%) of HMG-HCG treated cycles. Thus real-time ultrasound examinations provide results comparable to those achieved mostly by time-consuming compound scan in demonstration of the growing follicle.

Topics: Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Monitoring, Physiologic; Ovary; Ovulation Induction; Ultrasonography

In treating infertile couples an understanding of the endocrine system and its relationship to reproduction is essential. The reproductive capacity in women is regulated by the hypothalamic-pituitary-ovarian axis, a system which controls hormonal synthesis, secretion, and inhibition. Unregulated positive feedback systems produce disequilibrium which can cause hormonal imbalance predisposing the individual to possible infertility. The hypothalamus receives, processes, and acts upon various signals associated with reproductive processes. At the pituitary level, short, negative feedback loops inhibit the release of gonadotropin releasing hormone once adequate levels of pituitary hormones are reached. Hypothalamic dysfunction may be attributable to abnormalities in the amount of sequence of estrogen secretion or the inability of the hypothalamus to respond to the estrogen cue. The pituitary gland responds to levels of gonadotropin releasing hormone through inhibition or secretion of follicle stimulating hormone and luteinizing hormone. A direct outcome of pituitary gonadotropin stimulation is the rhythmicity of ovarian function. The key events in the menstrual cycle are dependent on the central role of estrogen. Ovarian failure is generally attributed to the absence of follicular tissue, which presents as some type of gonadal disgenesis. During the initial interview, the infertile couple must be informed as to the time and financial considerations and statistical outcomes of treatments and the couple's psychological status must be determined to some extent as well. Clomiphene citrate is the most widely used drug in the management of anovulatory conditions related to inadequate cycle stimulation by the pituitary gonadotropins; the usual dose os 50 mg for 5 days, increased up to 200 mg for 5 days if success is not achieved. While it does not directly stimulate ovulation, this drug starts a sequence of events that are physiologically similar to a specific phase of the normal menstrual cycle. If this is not successful the couple may be treated with human menopausal gonadotropin, or Pergonal, which brings about follicular growth and menstruation. If the couple fails to achieve pregnancy, support from health professionals is crucial in discussion adoption, child-free living, and other options.

Topics: Anovulation; Clomiphene; Endocrine System Diseases; Female; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Menotropins; Pituitary Hormone-Releasing Hormones

Topics: Anovulation; Clomiphene; Dopamine Antagonists; Drug Therapy, Combination; Estradiol Congeners; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovary; Ovulation Induction; Pregnancy; Progesterone; Prolactin

Topics: Adult; Anovulation; Chorionic Gonadotropin; Decidua; Female; Humans; Menotropins

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

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Cyclofenil; Drug Evaluation; Drug Therapy, Combination; Epimestrol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Monitoring, Physiologic; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy; Progesterone; Prolactin

Thirteen patients with hypogonadotropic hypogonadism were treated with human menopausal gonadotropins (hMG) and human chorionic gonadotropin (hCG) to induce ovulation. Daily serum 17beta-estradiol (E2) assays were used to monitor the ovarian response to HMG. Apparent ovulation, documented by basal body temperatures, occurred in 41 of 53 hMG-hCG treatment cycles. Thirteen pregnancies occurred in 8 of the 13 patients. One twin pregnancy resulted. The hyperstimulation syndrome did not occur. Our data indicate that an optimal pregnancy rate with a minimum risk of hyperstimulation can be achieved when ovulation is induced 24 hours after the preovulatory serum E2 concentration has reached 500 to 900 pg/ml. Ovulation is induced by administering 10,000 IU and 5000 IU hCG on successive days. In addition, we now routinely give two or three injections of 2500 IU hCG at subsequent 3- to 4-day intervals to support the corpus luteum.. 13 patients with hypogonadotropic hypogonadism were treated with human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) to induce ovulation. Daily serum 17beta-estradiol (E2) assays were used to monitor the ovarian response to HMG. Apparent ovulation, documented by basal body temperatures, occurred in 41 of 53 HMG-HCG treatment cycles. 13 pregnancies occurred in 8 of the 13 patients. 1 twin pregnancy resulted. The hyperstimulation syndrome was absent. The data indicate that an optimal pregnancy rate with a minimum risk of hyperstimulation can be achieved when ovulation is induced 24 hours after the preovulatory serum E2 concentration has reached 500-900 pg/ml. Ovulation is induced by administering 10,000 IU and 5000 IU HCG on successive days. In addition, 2-3 injections of 2500 IU HCG at subsequent 3-4 day intervals to support the corpus luteum are given routinely.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Drug Administration Schedule; Drug Therapy, Combination; Estradiol; Female; Humans; Menotropins; Menstruation; Ovary

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

Topics: Anovulation; Female; Gonadotropins; Humans; Hypothalamus; Infertility, Female; Menotropins; Pituitary Function Tests

Topics: Anovulation; Cervix Mucus; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

Topics: Abortion, Spontaneous; Anovulation; Chorionic Gonadotropin; Female; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Neoplasms; Pregnancy; Pregnancy, Multiple

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

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

A case is presented of bilateral simultaneous tubal pregnancy after ovulation induction with a clomiphene-menotropin combination. Although extremely rare in the general population, the entity of simultaneous pregnancies is far more common with ovulation induction. Care must be taken not to mistake an extrauterine pregnancy for a hyperstimulated ovary.

Topics: Adult; Anovulation; Clomiphene; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Menotropins; Pregnancy; Pregnancy, Tubal

Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol-17beta(E2), progesterone (P), androstenedione (A), and testosterone (T) were analyzed in daily plasma samples of seven cycles of human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) induced ovulation. Plasma FSH rose gradually and remained at a higher level (20 to 30 mlU/ml) during hMG injection while LH stayed at a low tonic level. The FSH/LH ratio of plasma gonadotropins was consistently higher than 1 in spite of injecting an hMG preparation with FSH/LH ratio of 1. A pharmacologically induced high RSH/LH ratio in the late follicular phase is contradictory to the low ratio seen in the normal ovulatory cycle. This may be one of the causes of multiple follicular maturation and ovulation frequently encountered in the hMG-hCG induced ovulation. Higher than normal levels of plasma progesterone commonly seen in the hMG-hCG induced cycle is attributed to the multiple ovulation. Plasma androgen levels, both A and T, in these therapy cycles stayed consistently within normal range. This is a strong contrast to the clomiphene induced cycle in which A and T were frequently elevated in parallel with elevated LH. No significant differences in plasma hormones were observed between the pregnant and nonpregnant patient following hMG-hCG induced ovulation. A consistent and similar ovarian response to hMG-hCG was noted in 1 individual who had 3 consecutive therapy cycles studied. The plasma hormone levels in the multiple ovulation did not show a significant difference from those in the single ovulation with the exception of a higher plasma P level in the former.

Topics: Adult; Androstenedione; Anovulation; Chorionic Gonadotropin; Estradiol; Estrone; Female; Follicle Stimulating Hormone; Gonadal Steroid Hormones; Humans; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Menopause; Menotropins; Pregnancy; Pregnancy, Multiple; Progesterone; Testosterone; Triplets

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

Plasma prolactin concentrations were determined in 16 nonovulatory women during treatment with human meonpausal gonadotropins (hMG). In eight patients with initially normal prolactin levels of less than 20 ng. per milliliter, a significant rise was noted at the end of hMG administration, this is thought to be a response to increased endogenous estrogen concentrations. A similar rise in plasma prolactin levels was seen in some but not all of the eight patients with initially elevated "basal" prolactin concentrations. Three of these hyperprolactinemic patients had radiographic evidence of a pituitary lesion--either a pituitary adenoma or a "microadenoma"--but the variance in prolactin response could not be explained on this basis. The two groups of normo- and hyper-prolactinemic patients showed no significant difference in the required dosage and duration or hMG treatment, plasma estradiol-17 beta response, and ovulatory and pregnancy outcome.

Topics: Adult; Anovulation; Estradiol; Female; Humans; Menotropins; Ovary; Prolactin

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

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

Human menopausal gonadotropin (HMG) was given to 10 patients who failed to ovulate after treatment with clomiphene citrate. Prior to one or more treatment courses, 200 mg. of clomiphene were administered daily for 5 days; at least one other treatment course was not preceded by clomiphene. Before therapy, progesterone in oil was administered and serum FSH, LH, and estrogen were measured. Those patients who had normal serum FSH levels and had withdrawal bleeding following progesterone had a reduction in amount and duration of HMG requirements for those patients with low serum FSH who did not withdraw. Thus, sequential clomiphene-HMG therapy is of benefit only for those women with normal serum FSH levels and is the treatment of choice.

Topics: Adult; Anovulation; Clomiphene; Drug Therapy, Combination; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins

Topics: Adult; Anovulation; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Pregnanediol

A method is presented of gonadotrophin administration and serum 17beta-oestradiol monitoring for the treatment of anovulation. Four of the 6 patients treated have conceived without any undesirable effects due to hyperstimulation. The advantages of this method of treatment and monitoring are discussed.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovulation; Pregnancy; Pregnancy, Multiple; Progesterone

Topics: Adnexa Uteri; Adnexal Diseases; Adult; Anovulation; Chorionic Gonadotropin; Danazol; Endometriosis; Female; Humans; Infertility; Laparoscopy; Laparotomy; Male; Menotropins; Ovarian Neoplasms; Pregnancy; Pregnancy, Tubal; Preoperative Care; Urinary Bladder Neoplasms

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

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

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Ergot Alkaloids; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Tamoxifen

Eighteen patients hospitalized for excessive ovarian hyperstimulation syndrome are reported. In 14 cases the ovarian hyperstimulation was induced by human menopausal -onadotropins and in 4 cases by combined treatment with clomiphene and HCG. In 5 patients the hyperstimulation was associated with conception, which resulted in 1 quintuplet delivery, 1 early quintuplet abortion, 1 twin abortion, 1 normal delivery, and 1 missed abortion. The regimen of treatment was a conservative one. The patients were hospitalized and treated with infusion of plasma expanders. Anticoagulant therapy was administered only in cases that showed clinical evidence of thromboembolic pheomena or laboratory evidence of severe hemoconcentration. The pathogenesis of the ovarian hyperstimulation syndrome, prevention, and management are discussed. This syndrome should be diagnosed early and treated intensively.

Topics: Abdomen, Acute; Adult; Anovulation; Ascites; Body Fluids; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Iatrogenic Disease; Infertility, Female; Menotropins; Menstruation Disturbances; Ovarian Cysts; Ovarian Diseases; Ovary; Plasma Substitutes; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Syndrome

Topics: Animals; Anovulation; Dogs; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Progesterone

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

Topics: Anovulation; Estriol; Estrogens; Female; Humans; Menotropins; Radioimmunoassay

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Female; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple

Topics: Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovary

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Cyclofenil; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Gonadotropins, Equine; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Tamoxifen