menotropins and Oligomenorrhea

Nineteen women were treated with the gonadotropin-releasing hormone (GnRH) agonist buserelin in order to suppress the pituitary prior to gonadotropin treatment. Eight women were oligomenorrheic, 6 had polycystic ovarian disease (PCOD) and 5 women had normal cycles. Buserelin was administered for 3 weeks before ovarian stimulation, and the pituitary down-regulation was proven by provocative tests. Ovarian stimulation was then achieved by human menopausal gonadotropin (hMG) 2 ampules a day. Several abnormal responses to the combined buserelin/hMG treatment were noted in some patients. This included a sudden decrease in E2 level without LH surge (2 patients), induced follicular growth with buserelin instead of ovarian suppression (2 patients) and ovarian hyperstimulation syndrome in 3 patients with PCOD. From this we conclude that although pituitary suppression can easily be achieved by GnRH analog administration, this does not ensure the prevention of unwanted responses. It is possible that the common denominator for these abnormal responses is that they are ovarian in origin, hence they occur in spite of pituitary down-regulation. Close monitoring of the suppression and stimulation stages will detect most cases of such failures. Furthermore it is possible that not all patients are suitable for the combined treatment of gonadotropin and GnRH agonist.

Topics: Adult; Buserelin; Down-Regulation; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Oligomenorrhea; Ovary; Ovulation Induction; Pituitary Gland; Polycystic Ovary Syndrome

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

The ovarian function of infertile women with normal menstrual rhythm was investigated by daily plasma hormone (estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone) analyses throughout the menstrual cycle, and patients were diagnosed as showing a subnormal profile of progesterone in the early luteal phase or as showing no abnormality. Women with oligomenorrhea and elevated luteinizing hormone levels were diagnosed as having polycystic ovary syndrome primarily on the basis of endocrinology. All patients were treated with a gonadotropin-releasing hormone analog to suppress endogenous luteinizing hormone and follicle-stimulating hormone so that ovulation induction with exogenous gonadotropins could be undertaken as in patients with hypogonadotropic hypogonadism. Interference in the process of ovulation by endogenous luteinizing hormone fluctuations was eliminated and pregnancies were achieved. The pregnancy rate in the group with polycystic ovary syndrome was 77% per treatment course (six cycles) while that in the group with subnormal progesterone profiles was 61.5%. Patients showing no abnormality achieved no pregnancy, demonstrating the redundancy of interference with normal ovarian function.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Menstrual Cycle; Oligomenorrhea; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone

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

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

Eight oligomenorrhoeic patients with increased luteinizing hormone (LH) and androgen levels who had failed to conceive during prolonged anti-oestrogen therapy received a new treatment. Large doses of an LH-releasing hormone (LHRH) analogue (HOE 766) were used to suppress circulating gonadotrophin concentrations and block the positive feedback gonadotrophin surge. Ovulation was induced during continued LHRH analogue treatment with exogenous gonadotrophins without interference from the patient's own pituitary. Seven of eight patients conceived rapidly without premature luteinization and without excessive ovarian enlargement. These complications had occurred in control treatment cycles using exogenous gonadotrophins in the absence of the LHRH analogue.

Topics: Adult; Buserelin; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Oligomenorrhea; Ovary; Ovulation Induction

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

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

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

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

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

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

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

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

A patient with classical Albright's pseudohypoparathyroidism was investigated because of oligomenorrhoea. Hypo-oestrogenism was associated with elevated basal gonadotrophin values [mean basal serum LH and FSH were 272 +/- 84 (SD) ng/ml and 593 +/- 83 ng/ml, resplectively (normal less than or equal to 220 and less than or equal to 400, respectively)]. The response to gonadotrophin releasing hormone (Gn-RH) was exaggerated, with maximal LH and FSH increments of 1688 and 458 ng/ml, respectively. These results and the findings on ovarian biopsy were compatible with partial ovarian resistance to gonadotrophins. This resistance could be overcome by administration of human menopausal gonadotrophins. This is the first evidence for gonadotrophin resistance in pseudohypoparathyroidism. The plasma cyclic adenosine-3',5'-monophosphate response to glucagon administration by two different protocols was about 70% that of normal control subjects. Other endocrine glands whose responses to hormones are mediated via the adenylate cyclase system evidenced minor abnormalities of questionable significance. This indirect evidence is compatible with a more extensive defect in the adenylate cyclase system in pseudohypoparathyroidism than has hitherto been suspected.

Topics: Adenylyl Cyclases; Adolescent; Adult; Cyclic AMP; Estrogens; Female; Follicle Stimulating Hormone; Glucagon; Humans; Luteinizing Hormone; Male; Menotropins; Oligomenorrhea; Pituitary Hormone-Releasing Hormones; Pseudohypoparathyroidism

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

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

Topics: Adult; Ascites; Chorionic Gonadotropin; Female; Humans; Hydrothorax; Menotropins; Nausea; Oligomenorrhea; Ovarian Diseases; Vomiting