menotropins and Galactorrhea

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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