menotropins and Ovarian-Diseases

Topics: Biopsy; Chorionic Gonadotropin; Clomiphene; Endometrium; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Luteal Phase; Menotropins; Ovarian Diseases; Ovulation; Ovulation Induction

Luteal phase defect is an ovulatory disorder of considerable clinical importance that is implicated in infertility and recurrent spontaneous abortion. As a subtle disruption of ovulatory or luteal function, it may be the most common ovulatory disorder in women. Pathophysiologic alterations of the complex reproductive process that lead to delayed endometrial maturation characteristic of LPD include disordered folliculogenesis, defective corpus luteum function, and abnormal luteal rescue by the early pregnancy. A variety of clinical conditions, such as hyperprolactinemia, hyperandrogenic states, weight loss, stress, and athletic training may result not in overt oligo- or anovulation, but rather may be manifest as LPD. Reasonable consensus exists regarding the use of endometrial biopsy for diagnosis of LPD, although issues regarding timing, number of samples needed, method of interpretation, and the adjunctive use of hormone assay and ultrasonography are still not settled. Other tests, including assay of progesterone-associated endometrial protein, analysis of decidual steroid receptors, or determination of decidual prolactin production, may in the future contribute to the accurate diagnosis of this condition. In the absence of an identifiable correctable underlying cause of LPD, progesterone replacement and clomiphene citrate are the usual treatment options for consideration. Combination therapy, gonadotropins, and other treatments are reserved for refractory cases. No data at present suggest a difference in efficacy between progesterone and clomiphene. When abnormal luteal endometrial biopsy is corrected, conception and live birth rates are high.

Topics: Biopsy; Chorionic Gonadotropin; Clomiphene; Endometrium; Female; Humans; Luteal Phase; Menotropins; Ovarian Diseases; Ovary; Progesterone; Prolactin; Ultrasonography

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

Topics: Chorionic Gonadotropin; Dose-Response Relationship, Drug; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovulation; Syndrome

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

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

The value of luteal phase supplementation with human chorionic gonadotropin (hCG) was assessed after a combined protocol of ovarian stimulation, using a long acting gonadotropin releasing hormone analog (GnRH-a) and human menopausal gonadotropins (hMG), in a randomized prospective study of 36 consecutive cycles in an in vitro fertilization (IVF) program. The patients were allocated on the transfer day to either luteal phase supplementation with hCG (Group A, n = 18) or none (Group B, n = 18). Nine patients of Group A conceived as compared with 3 in Group B. Five patients, all in Group A, developed ovarian hyperstimulation syndrome (OHSS) (3 moderate and 2 severe forms). Analysis of the hormonal profiles disclosed similar progesterone (P), estradiol (E2), and E2/P ratio up to the 6th post ovum pick-up day. Then, E2 and mainly P levels decreased only in Group B resulting in a rising E2/P ratio. These findings stress the importance of luteal support in IVF cycles treated with GnRH-a. In light of the increased risk of OHSS among hCG treated patients, further studies are needed to assess the optimal preparation needed.

Topics: Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Menstruation; Ovarian Diseases; Ovary; Pregnancy; Progesterone; Prospective Studies; Syndrome; Triptorelin Pamoate

The present study was undertaken to verify the efficacy of preparations for inducing follicular maturation and ovulation in patients with polycystic ovary syndrome (PCOS). Successful induction of ovulation in patients with PCOS was observed in treatment cycles with daily injections or pulsatile subcutaneous administration of human menopausal gonadotropin (hMG), the combination of clomiphene citrate and bromocriptine, or the combination of clomiphene citrate and hMG. The incidence of ovarian hyperstimulation syndrome varied with the different clinical conditions in which ovulation was induced, the types of preparations administered, and the doses and schedules administered.

Topics: Bromocriptine; Buserelin; Clomiphene; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

The present study was undertaken to determine whether ovulation can be induced in patients with polycystic ovary syndrome (PCOS) by pulsatile subcutaneous administration of hMG after the pituitary secretion of LH and FSH was suppressed with a gonadotropin releasing hormone (GnRH) analogue. The results of the combined regimen cycles (group II) were compared with those of hMG (group I) or FSH (group III) pulsatile administration in the same PCOS patients. The ovulation rate (89.1% of 46 cycles) in group I was significantly greater (p less than 0.01) than that found in group II (65.9% of 41 cycles). In group III, ovulation occurred in 89.5% of the 19 treatment cycles. Ovarian hyperstimulation syndrome (OHSS) occurred in 28.3% of cycles in group I, 7.3% in group II, and 26.3% in group III, respectively. The incidence of OHSS in group II was significantly lower than that found in group I or III. The rates of pregnancy were 10.9% of cycles in group I, 4.9% in group II, and 21.1% in group III, respectively. All 10 fetuses were singleton conceptions, and the pregnancies continued successfully to term. The present data demonstrate that pulsatile subcutaneous administration of hMG or FSH is effective in the induction of successful ovulation and the establishment of singleton pregnancy in patients with PCOS.

Topics: Adult; Buserelin; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovulation Induction; Periodicity; Pituitary Gland; Polycystic Ovary Syndrome; Pregnancy

Forty-six women remaining infertile with clomiphene citrate (CC) with or without human chorionic gonadotropin (hCG) were treated by either human menopausal gonadotropin (hMG, 44 cycles) or CC + hMG (33 cycles) and monitored by serum estradiol (E2) and ultrasonography. Ovarian hyperstimulation syndrome (OHS) and pregnancy outcome were compared in both regimens. In the presence of dominant follicles (greater than or equal to 18 mm) alone or with a single secondary follicle (14 to 16 mm) at hCG administration, OHS did not develop. A significant increase in OHS was noted when three or more secondary follicles were observed. Overall pregnancy rates were similar in both regimens but significantly higher when hCG was injected before rather than after the E2 peak. The results suggest secondary follicles rather than dominant follicles are a valuable sign of possible OHS development; and CC + hMG should be considered in CC-failure patients.

Topics: Chorionic Gonadotropin; Clinical Trials as Topic; Clomiphene; Drug Administration Schedule; Drug Therapy, Combination; Estradiol; Female; Humans; Male; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Random Allocation; Syndrome; Ultrasonography

The aim of this study was to examine the effects of ovulation induction agents on the ovarian surface epithelium in rats. Sixty adult females were randomly divided into six groups, each containing 10 rats. In four of these groups ovulation induction was applied with six cycles of clomiphene citrate, human menopausal gonadotrophin (HMG), recombinant FSH (rFSH) or human chorionic gonadotrophin (HCG), respectively, followed by unilateral oophorectomy, and another six cycles of the same treatment. After a total of 12 cycles of ovulation induction, the remaining ovary was taken out and the alterations in ovarian surface epithelium were examined. No malignancies were observed on the ovarian surface epithelium of the rats that were given clomiphene citrate, rFSH or HMG as ovulation induction agents, while identification rates of histopathological parameters constituting epithelial dysplasia were found to be significant (P < 0.05). There was no significant dysplasia in the epithelium of the group which was given HCG only, relative to control groups. The findings suggest that the ovulation induction agents except for HCG bring about dysplasia in the ovarian surface epithelium. It is not clear whether these dysplasias are precursory lesions of ovarian malignancies.

Topics: Animals; Chorionic Gonadotropin; Clomiphene; Drug Evaluation, Preclinical; Epithelium; Female; Fertility Agents, Female; Humans; Menotropins; Ovarian Diseases; Ovary; Ovulation Induction; Random Allocation; Rats

Topics: Adenocarcinoma, Clear Cell; Adult; Clomiphene; Endometriosis; Female; Fertility Agents, Female; Humans; Hysterectomy; Infertility, Female; Menotropins; Neoplasm Staging; Ovarian Diseases; Ovarian Neoplasms; Ovariectomy; Ovulation Induction; Treatment Outcome

In-vitro fertilization (IVF) is an effective infertility treatment for women with endometriosis, but most women need to undergo several cycles of treatment to become pregnant. This case-control study was designed to assess how consistently women with ovarian endometriosis respond to ovarian stimulation in consecutive treatment cycles compared to women with tubal infertility. We compared outcome measures in 40 women with a history of surgically confirmed ovarian endometriosis and 80 women with tubal infertility, all of whom had at least three IVF treatment cycles. The groups were matched for age and early follicular follicle stimulating hormone (FSH) concentration at their first IVF cycle. Outcome measures included number of follicles, number of oocytes, peak oestradiol concentration and number of FSH ampoules required per follicle. Cumulative pregnancy and live birth rates were calculated in both groups. The ovarian endometriosis group had a significantly poorer ovarian response and required significantly more ampoules of FSH per cycle, a difference that became greater with each subsequent cycle. However, cumulative pregnancy (63.3 versus 62.6% by fifth cycle) and live birth (46.8 versus 50.9% by fifth cycle) rates were similar in both groups. In conclusion, despite decreased ovarian response to FSH, ovarian endometriosis does not decrease the chances of successful IVF treatment.

Topics: Adult; Case-Control Studies; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Nafarelin; Oocytes; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Pregnancy; Prospective Studies

Three cases including two sisters and one brother with blepharophimosis are described. Their father also had blepharophimosis. Moreover, the elder sister initially presented with resistant ovary syndrome and thereafter true premature menopause, while the younger one presented with resistant ovary syndrome. The explanation for the association of blepharophimosis with primary ovarian dysfunction is unknown, but the possibility of a microdeletion of genetic material containing two geographically associated, but independent genes could not be confirmed or excluded. All families affected by blepharophimosis should be counselled about the high incidence of ovarian dysfunction and female infertility, at least in one form of the syndrome.

Topics: Adult; Blepharophimosis; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Karyotyping; Luteinizing Hormone; Male; Menopause, Premature; Menotropins; Ovarian Diseases

Topics: Abscess; Adult; Bacteroides Infections; Buserelin; Female; Gamete Intrafallopian Transfer; Goserelin; Humans; Menotropins; Ovarian Diseases; Ovulation Induction

Topics: Adult; Danazol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Menopause, Premature; Menotropins; Ovarian Diseases; Pregnancy

The study was undertaken to minimize the rate of ovarian hyperstimulation and to avoid cancellation of human treatment cycles in women treated with human menopausal gonadotropin (hMG) for induction of ovulation.. Patients were treated in the fertility clinic and in vitro fertilization unit of our institution, which is a government, university-affiliated hospital.. Ninety anovulatory patients were treated with hMG. Of these, 12 were at high risk for ovarian hyperstimulation. The criteria for potential ovarian hyperstimulation syndrome were rising excessive 17 beta-estradiol levels of greater than 1,500 pg/mL in the presence of multiple follicles with a mean diameter greater than 15 mm. These patients were transferred for continuation of treatment to our in vitro fertilization-embryo transfer (IVF-ET) unit.. The patients underwent ova retrieval by the ultrasonically guided transvaginal approach.. Of the 12 patients, 5 conceived (41.6%). Two patients had a mild ovarian hyperstimulation syndrome, and 1 had a moderate syndrome and was hospitalized for observation for 48 hours.. In view of the results, we suggest that IVF-ET should be considered in cases in which ovarian hyperstimulation syndrome is imminent, rather than withhold human chorionic gonadotropin and cancelling the treatment cycle.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Syndrome

Abdominal paracentesis is a well-tolerated therapeutic alternative to relieve the severe pulmonary compromise caused by severe ascites and pleural effusion in the ovarian hyperstimulation syndrome. An improvement in renal function may be another benefit that deserves further investigation.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Lung Diseases; Menotropins; Ovarian Diseases; Ovulation Induction; Punctures; Reproductive Techniques; Syndrome

A 38-year-old woman ovulated and conceived after administration of human menopausal gonadotropins despite a previous diagnosis of ovarian failure at age 18. Possible explanations include restoration of down-regulated gonadotropin receptors by development of a prolactinoma, spontaneous remission of autoimmune oophoritis, or prior tumor secretion of biologically inert gonadotropins.

Topics: Adenoma; Adult; Female; Humans; Hypophysectomy; Menotropins; Ovarian Diseases; Ovulation; Pituitary Neoplasms; Postoperative Period; Pregnancy

Stimulation with human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was compared in 34 patients with polycystic ovarian syndrome after pituitary gonadotrope suppression with buserelin acetate. No differences were seen in the hormone parameters observed. Also, the duration of the stimulation period and the dose of gonadotropin used were the same. In both groups a multifollicular response was seen. Oocyte retrieval and in vitro fertilization resulted in identical ratios of mature to total oocytes and cleavage rates. Nine pregnancies occurred, four in the hMG group and five in the FSH group. Of the nine pregnancies, two were the result of transfer of frozen-thawed embryos in estradiol and progesterone substituted cycles.

Topics: Adult; Buserelin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadal Steroid Hormones; Humans; Menotropins; Ovarian Diseases; Pituitary Gland; Polycystic Ovary Syndrome; Pregnancy

Therapy with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG) has proved effective for induction of ovulation in patients with hypogonadotropic hypogonadism showing anovulation or sterility. However, two important complications, the ovarian hyperstimulation syndrome (OHSS) and multiple gestations, are observed in a few patients treated with these hormones. In the past, follicular maturation was evaluated by the cervical mucus score (CM) and serum estradiol level (E2). But recently, ultrasonographic monitoring (USG) and the measurement of urinary estrogen (E) with a commercial kit of sufficiently high sensitivity have been advocated for the prevention of these complications. In this study, we investigated the relationships between the monitoring methods during hMG-hCG treatment and the rates of the OHSS, ovulation, pregnancy and multiple pregnancy.

Topics: Chorionic Gonadotropin; Female; Follicular Phase; Humans; Menotropins; Monitoring, Physiologic; Ovarian Diseases; Ovulation

Topics: Adolescent; Adult; Amniotic Fluid; Child; Child, Preschool; Estradiol; Female; Humans; Infant; Infant, Newborn; Male; Menotropins; Monitoring, Physiologic; Ovarian Diseases; Ovarian Function Tests; Ovulation Induction; Placental Function Tests; Pregnancy; Radioimmunoassay; Reference Values

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

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

A 32-year-old nulliparous woman underwent hMG induction of superovulation, started on the third day of "menses." The presence of hyperstimulation confused the clinical picture of ectopic pregnancy conceived during the previous cycle. This case illustrates that (1) the clinical findings of hyperstimulation may mask those of ectopic pregnancy; (2) the ovary is not refractory to hMG in the presence of circulating hCG; and (3) an inappropriately high beta-hCG value is suggestive of gestation initiated during a previous cycle.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Menotropins; Ovarian Diseases; Ovary; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Superovulation

It has been suggested that the presence of periovarian adhesions might impair the ovarian response to gonadotropins. Periovarian adhesions were recorded in 49 women, and the total percentage of accessible ovarian cortex was described at the initiation of the operative procedure. Adhesiolysis was performed as needed for oocyte recovery. Ovarian access did not correlate with serum estradiol level on either the day of human chorionic gonadotropin (hCG) administration or the day after hCG administration. Similarly, neither the total number of follicles on the day of hCG or on the day after hCG, nor the number of follicles 1.0 to 1.4 cm or greater than or equal to 1.5 cm correlated with ovarian access. We conclude that periovarian adhesions are not a major determinant of the ovarian response to gonadotropin stimulation.

Topics: Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovary; Tissue Adhesions

Topics: Adult; Clomiphene; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation Induction; Syndrome

In order to maximise the chances of pregnancy, most successful in vitro fertilisation programmes use a combination of ovulation induction agents. This treatment can lead to the hyperstimulation syndrome. Aspiration of the follicles is believed to avoid this syndrome. Despite this approach, hyperstimulation syndrome may still develop. The clinical picture and treatment of a patient with severe hyperstimulation is discussed.

Topics: Adult; Clomiphene; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Diseases; Ovarian Follicle; Suction

Human menopausal gonadotropin (hMG) with different ratios of FSH to LH content (FSH: LH = 1.2:1 (GNR 1.2), FSH:LH = 1.6:1 (GNR 1.6), FSH:LH = 3:1 (GNR 3) in biological activity, respectively) was used in this study to examine the effects of these hMGs on ovary, and subsequent follicular maturation and ovulation. In 5 women, 300 IU of hMG (GNR 1.2, GNR 1.6 and GNR 3) was injected in turns during different midfollicular phases of the cycle (day 5-day 9) and serum estradiol (E2) was measured at 0, 24 hrs, 48 hrs, 72 hrs after injection to assess ovarian response to different hMG. Serum E2 response at 24 hrs, 48 hrs, 72 hrs after injection of hMG compared to the preinjected E2 level were 2.2, 1.8, and 1.5 fold with GNR 1.2; 2.6, 2.4 and 1.9 fold with GNR 1.6; and 2.2, 2.4 and 2.3 fold with GNR 3, respectively. These hMGs were administered in turns to women who were suffering from amenorrhea (6 cases), anovulatory (8 cases) and luteal phase dysfunction (10 cases) for treatment of ovarian dysfunction. The mean doses of hMG per cycle required to induce ovulation were 1,125 IU with GNR 1.2, 1,050 IU with GNR 1.6 and 925 IU with GNR 3 in these 24 women. The success rates for ovulation with GNR 1.2, GNR 1.6 and GNR 3 were 70.8, 79.2 and 87.5%. The appearance rates for ovarian hyperstimulation syndrome (OHSS) with GNR 1.2, GNR 1.6, and GNR 3 were 4.2, 8.3 and 8.3%, respectively. These results infer that a different ratio of FSH to LH in hMG has an effect on follicular maturation and ovulation, and that the increase in the rate of ovulation and prevention of OHSS may accompany the regulating of this ratio, and that hMG with a higher FSH content (ratio of FSH to LH is more than three) should be studied further as a promising agent to use in inducing ovulation in women.

Topics: Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary; Ovulation

This study was undertaken to clarify discriminative roles of multiple epidemiologic, hormonal, and biophysical variables for causation of ovarian hyperstimulation syndrome. Three hundred ninety-six patients with anovulatory infertility had ovulation induction with human menopausal gonadotropin throughout 1822 treatment cycles; 54 cycles (3%) were complicated by ovarian hyperstimulation syndrome. Early follicular serum estradiol and prolactin levels were higher in this group than in controls: 75.5 versus 46.2 pg/ml and 18.5 versus 11.7 ng/ml, respectively (p less than 0.01). On the day of human chorionic gonadotropin administration (day 0) the mean serum estradiol level was 1047 +/- 381 in the group with ovarian hyperstimulation syndrome and 719 +/- 339 pg/ml in controls (p less than 0.0001). In all follicular sizes and in all grades of ovarian hyperstimulation syndrome there was a tendency for more recruited follicles, with significantly more small follicles (12 to 14 mm) present on day 0 in all grades of ovarian hyperstimulation syndrome than in controls. Stepwise logistic regression performed on 22 variables identified a high-risk group for this syndrome; the major features are illustrated by young, lean patients who, after relatively few ampules of human menopausal gonadotropin, develop high estradiol levels and multiple small follicles.

Topics: Adult; Cell Count; Estradiol; Female; Humans; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Predictive Value of Tests; Prognosis; Prolactin; Risk Factors; Syndrome

This study tests the hypothesis that serial measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) are useful in identifying a subset of patients with premature ovarian failure (POF) who may respond to high-dose human menopausal gonadotropin (hMG) therapy. Nineteen patients with POF were studied with weekly measurements of serum FSH, LH, and E2 for five consecutive weeks. Nine patients (group I) showed episodic increases in E2 (greater than 50 pg/ml), seven accompanied by decreases in FSH, and an FSH/LH ratio that was periodically less than 1.0. Ten patients (group II) displayed persistent, nonvarying low E2 and high FSH and LH levels. There was no significant difference in the E2 response to high-dose hMG (48 to 100 ampules hMG/trial) in the two groups, all patients failing to respond. In conclusion, serial assays for FSH, LH, and E2 in patients with POF fail to predict ovarian responsiveness to a trial of high-dose hMG.

Topics: Adult; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary

Topics: Female; Humans; Liver; Menotropins; Ovarian Diseases; Ovary; Syndrome

Plasma renin activity (PRA) and aldosterone were measured throughout the luteal phase in 21 anovulatory patients who developed ovarian hyperstimulation syndrome (OHSS) during menotropin induction of ovulation. The pattern of PRA in hyperstimulated cycles is characterized by a midluteal peak, which declines to normal in the late luteal phase in nonconceptual cycles, whereas a sustained elevation of PRA occurs in conceptual cycles. Midluteal PRA is significantly (P less than 0.001) elevated in patients with OHSS compared with controls. In the mild form of the disease, the median of PRA is 7.5 (range 6 to 11) ng angiotensin I (AI)/ml/hr, significantly higher than the median for controls, 3.0 ng AI/ml/hr (range, 1.4 to 5). In moderate OHSS, PRA was 24.5 (range, 10 to 40) ng AI/ml/hr, whereas, in the severe form of OHSS, PRA was 55.0 (range, 29 to 95) ng AI/ml/hr. A significant correlation (P less than 0.05) was demonstrated between PRA and either progesterone or 17 beta estradiol (E2). The renin-angiotensin cascade is implicated in new vessel formation. Angiogenesis itself is associated with a rapid increase in capillary permeability. The recent demonstration of high plasma renin-like activity in human follicular fluid and the present observation of high PRA in patients with OHSS may imply that the locally active renin angiotensin system, through induction of new vessel formation and increase in capillary permeability, may have a casual relationship to the ovarian enlargement and extracellular fluid accumulation that are the hallmarks of OHSS.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Iatrogenic Disease; Luteal Phase; Menotropins; Neovascularization, Pathologic; Ovarian Diseases; Ovary; Ovulation Induction; Renin; Renin-Angiotensin System; Syndrome

Monitoring of human menopausal gonadotropin (hMG) treatment for induction of ovulation according to either preovulatory estrogen levels or the presence of a dominant ovarian follicle was found insufficient to prevent ovarian hyperstimulation syndrome (OHS). In 65 infertile patients treated with hMG and human chorionic gonadotropin (hCG), a possible correlation between the number and size of all ovarian follicles on the day of assumed ovulation and the occurrence of OHS was evaluated in order to assess the value of ultrasonography in predicting OHS. It was found that patients with OHS had significantly more follicles at the time of hCG than patients without OHS. Mild OHS was characterized by the presence of eight to nine follicles, 68.7% of which were of intermediate size (9 to 15 mm). In moderate to severe OHS 95% of the preovulatory follicles were less than 16 mm, most of them (54.7%) less than 9 mm in diameter. It can be concluded that a specific preovulatory follicular configuration characterizes mild and severe hyperstimulation. This is important information before hCG administration and emphasizes the value of ovarian ultrasonography in predicting OHS.

Topics: Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovary; Ovulation; Ovulation Induction; Pregnancy; Prospective Studies; Stimulation, Chemical; Syndrome; Ultrasonography

The treatment of infertile women by gonadotropins is more effective in hypogonadotropic than in normogonadotropic ovarian insufficiency. In order to induce a hypogonadotropic state the luteinizing hormone-releasing hormone analog (LHRHA) buserelin was administered in eight cycles of four infertile patients suffering from luteal phase defect. Buserelin was infused subcutaneously in a dosage of 400 micrograms/d for 26-44 days using a portable external osmotic minipump system. Following suppression of estradiol-17 beta below 35 pg/ml within 11 +/- 5 days, gonadotropins were injected intramuscularly to stimulate ovarian function. In all cycles treated, ovulation and formation of a functional corpus luteum were observed without signs of premature luteinization. Whereas constant administration of LHRHA by a slow release system seems very useful for long-term reversible suppression of follicular maturation, further studies should evaluate the clinical usefulness of combined LHRHA/gonadotropin treatment in cases of infertility.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Infusion Pumps; Injections, Intramuscular; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Diseases

Elevated levels of CA-125, an antigen expressed by malignant ovarian tissue, have been found in women who developed OHSS in response to treatment with exogenous gonadotropins for IVF. In contrast, CA-125 concentrations in women who were treated with an identical regimen but who did not show signs of OHSS remained in the normal range. We conclude that the expression of CA-125 is not restricted to neoplastic ovarian tissue but can also occur as a consequence of supraphysiologic stimulation of the ovary with exogenous gonadotropins.

Topics: Antigens, Neoplasm; Antigens, Tumor-Associated, Carbohydrate; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Diseases; Pregnancy; Ultrasonography

Endometrial morphology and ultrastructure are studied in 17 spontaneous, 23 stimulated, and 18 artificial cycles in cases of primary ovarian failure. Normal light-microscopic aspect was found, but impaired development of nucleolar channel system and stronger intercellular junction have been observed by electron-microscopic studies in stimulated cycles with relative excess of luteal estrogen. Normal glandular maturation can be obtained in patients with premature menopause, given adequate steroid replacement, but an abnormally dense fibrocytic aspect of the stroma is characteristic of the first treatment cycles.

Topics: Biopsy; Chorionic Gonadotropin; Clomiphene; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Menotropins; Menstrual Cycle; Microscopy, Electron; Ovarian Diseases; Progesterone; Steroids

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

Topics: Female; Humans; Menotropins; Ovarian Diseases

The effects of pharmacologic doses of gonadotropin-releasing hormone, danazol, and indomethacin on the clinical and endocrinologic features of the ovarian hyperstimulation syndrome were studied in the rabbit. The ovarian hyperstimulation syndrome was induced with Pergonal (75 IU of follicle-stimulating hormone and 75 IU of luteinizing hormone) and a follicle-stimulating hormone-dominant gonadotropin preparation (85 IU of follicle-stimulating hormone and 53 IU of luteinizing hormone). None of the three agents tested were effective in suppressing the ovarian enlargement and ascites formation in these animals. Ascites developed despite quite significant variations in plasma and intraovarian sex steroid hormone and intraovarian prostaglandin F levels induced by danazol and indomethacin. Ascites develops in hyperstimulated women in association with both follicular and luteal hyperstimulation. In contrast, the ascites response in the hyperstimulated rabbit develops in the presence of follicular hyperstimulation alone without a significant degree of luteal hyperstimulation.

Topics: Animals; Ascites; Danazol; Female; Follicle Stimulating Hormone; Indomethacin; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovary; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnadienes; Rabbits; 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

Lysis of adhesions, bilateral salpingectomy, and ovarian suspension were carried out in 54 normal ovulatory patients with long-standing infertility that was associated with severe pelvic adhesions after multiple laparotomies for reimplantation of the fallopian tubes, salpingostomy, lysis of adhesions, or severe endometriosis. Ovulation was induced in 39 patients after laparotomy for in vitro fertilization, with the use of human menopausal gonadotropin, pure follicle-stimulating hormone, and human chorionic gonadotropin. Oocyte retrieval by laparoscopy was accomplished in 37 patients, and embryo transfer was carried out in 36. Pregnancy after in vitro fertilization and embryo transfer occurred in 14 patients. Although severe adhesions recurred in four patients, a significant improvement was obtained after the procedure in the others.

Topics: Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Laparoscopy; Laparotomy; Ligaments; Menotropins; Menstrual Cycle; Ovarian Diseases; Pelvis; Pregnancy; Pregnancy, Ectopic; Reoperation; Tissue Adhesions

This study was designed to determine the effect of periovarian adhesive disease upon follicular development. Forty-one clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin-stimulated cycles for in vitro fertilization and embryo transfer were studied. Each patient was assessed ultrasonographically before laparoscopic oocyte recovery. The number of follicles in each ovary greater than 1.2 cm was counted. By laparoscopy it was possible to determine the degree of periovarian adhesive disease. Sixteen patients had bilateral adhesion-free (AF) ovaries, 12 had bilateral adherent (A) ovaries, and 13 had one AF and one A ovary. In the 13 patients with one ovary AF and the other A, the mean number of follicles +/- 1 standard deviation (SD) was 3.4 +/- 1.4 and 1.2 +/- 1.1 (P less than 0.001), respectively. A total of 116 follicles was noted in 45 AF ovaries (mean +/- 1 SD, 2.6 +/- 1.3) and 59 follicles in 37 A ovaries (mean +/- 1 SD, 1.6 +/- 1) (P less than 0.001). From these data it was concluded that the presence of periovarian adhesive disease inhibits folliculogenesis by a yet undetermined mechanism.

Topics: Clomiphene; Female; Fertilization in Vitro; Follicular Phase; Humans; Laparoscopy; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Tissue Adhesions; Ultrasonography

The case of a patient with gonadotropin-resistant ovary syndrome is discussed. Ovulation was successfully induced by the administration of human chorionic gonadotropin and by estrogen replacement therapy. A total of three pregnancies occurred. The first two pregnancies resulted in blighted ova. The third pregnancy resulted in a normal term delivery.

Topics: Adult; Chorionic Gonadotropin; Drug Resistance; Estrogens, Conjugated (USP); Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Medroxyprogesterone; Menopause, Premature; Menotropins; Osteoporosis; Ovarian Diseases; Ovulation; Pregnancy

Ovarian stimulation with hMG/hCG is most effective in hypogonadotropic patients. In normogonadotropic/estrogen-positive patients in whom gonadotropin therapy is also indicated after failure of other forms of treatment, it is much more difficult and considerably less effective. The objective of this study was to change the endocrine status in patients from a normogonadotropic and estrogen-positive status, by administration of a GNRH analogue, to a hypogonadotropic, estrogen-negative status, in order to create better conditions for gonadotropin stimulation. For this purpose Buserilin was administered either intranasally or intravenously and the endocrine reaction was observed. The endocrine changes observed were very varied. In the majority of cycles a fall in plasma FSH concentrations resulted (20 out of 28), in 2 a rise, while in 6 of the 28 there was no change. In 12 out of 28 cycles the plasma LH concentration decreased; it rose in 3 and was unchanged in 13. The LH fluctuation was suppressed or irregular in all cases. Estrogen secretion was unaffected in 16 cycles; it increased continuously in 6 cycles and temporarily in a further 6. The reaction to the hMG injections did not show the hoped-for improvement with simultaneous administration of an RH analogue. A complete and constant suppression of pituitary function, and thus the creation of a hypogonadotropic state, could not be achieved by medication with 8 X 300 micrograms Buserilin or intravenous injection of 5 and 10 micrograms every 90 minutes.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovarian Diseases; Pituitary Gland; Progesterone; Testosterone

Thirty-two infertile patients with basal FSH/LH ratios of less than 0.5 were treated with a pure human urinary FSH preparation in various doses, in 57 cycles. With initially low FSH doses and increase in the dose according to the individual reaction (analogous to hMG therapy) ovulation and a normal luteal phase were achieved in 22 out of 25 cycles, and 6 pregnancies. In one cycle there was a clinical overstimulation syndrome in early pregnancy. Treatment with high doses of FSH at the beginning of the cycle proved unsuitable: normal follicle stimulation, ovulation and luteal phase only occurred in 12 out of 23 cycles, and there was no pregnancy. The combination of FSH therapy with initially high doses and subsequent stimulation with hMG resulted in ovulation in 9 out of 10 cycles without ensuing pregnancy. The behaviour of the endogenous LH under FSH therapy varied: with an initially high dose of FSH there was a clear drop in serum LH concentrations in 8 out of 23 cycles, and with an initially low dose in 5 out of 25 cycles. In 5 cycles the serum LH concentrations rose under FSH therapy. The results of the investigation confirm earlier observations that ovarian stimulation with FSH is possible in cases with low endogenous FSH/LH ratios, and that it is best accomplished by individualized therapy with an initially low dose. However, because of the different reaction of endogenous LH secretion, a better ovarian reaction than with hMG therapy could not be achieved with regard to ovulation and pregnancy rate, course of the luteal phase and overstimulation.

Topics: Adult; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovarian Diseases; Ovarian Follicle; Stimulation, Chemical; Testosterone; Ultrasonics

The therapeutic effect of glucocorticoid therapy in infertile patients with hyperandrogenemic ovarian insufficiency was verified in a clinical study and compared with the results of other forms of therapy. Of 40 patients treated with 0.5 mg/d dexamethasone only one conceived. Of 47 patients treated with 7.5 mg/d prednisone 6 became pregnant. A combination therapy of dexamethasone and clomiphene resulted in 3 pregnancies among 20 patients; a combination of prednisone and clomiphene in 18 patients led to one pregnancy. In the majority of these patients previous treatment with clomiphene only had been unsuccessful. In the patient in whom both clomiphene and glucocorticoid therapy was unsuccessful, hMG/hCG therapy was applied. The pregnancy rate, 24% in the dexamethasone group and 36% in the prednisone group, was much higher. Plasma testosterone concentrations were not significantly suppressed under corticoid therapy. Neither at the beginning of a cycle nor at the time of ovulation were FSH and LH levels changed by the administration of corticoids. There was no significant correlation between the plasma testosterone values and the length of the cycle, the duration of the follicular phase, the duration of the rise in basal temperature or the length thereof. There was a significant correlation between testosterone and the LH/FSH quotient at the beginning of the cycle both in the spontaneous cycles and under corticoid therapy, though not under clomiphene therapy. In the control cycles there was a significant correlation between testosterone and LH; in the corticoid cycles it was not significant, and under corticoid therapy there was no correlation. A negatively significant correlation between testosterone and FSH was found in the control cycles. This correlation was not significant under glucocorticoid therapy and there was no correlation under clomiphene therapy. As testosterone concentrations increased a decrease in the percentage of biphasic cycles was observed in all groups. Regardless of the testosterone concentration, the pregnancy rate in patients showing signs of androgenization, at 22%, was higher than in patients without these symptoms. In patients who conceived under corticoid therapy there was no uniform correlation either to the pretherapeutic testosterone levels or to the degree of testosterone suppression. Neither the initial testosterone level nor the degree of its suppression is of any prognostic value for corticoid therapy. The more pronounced

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Glucocorticoids; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Diseases; Testosterone

An iatrogenic disease resulting from the induction of ovulation is described. It would appear that it is uncommon in southern Africa.

Topics: Adult; Ascites; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Pleural Effusion

A patient with the resistant ovary syndrome is reported. To evaluate the hypothesis that the hypogonadism might be the result of circulating antibodies to gonadotropin receptors or to an abnormal gonadotropin molecule, a series of clinical and laboratory studies was carried out. Administration of human menopausal gonadotropin had no effect on the serum estradiol level. The patient's serum did not affect follicle-stimulating hormone binding to a membrane preparation of monkey testes, suggesting the absence of antibodies to follicle-stimulating hormone receptors, nor did the patient's serum affect in vitro responsiveness of human granulosa cells to human menopausal gonadotropin. Unresponsiveness to exogenous gonadotropins, combined with anatomically normal follicular apparatus and the absence of serum antibodies to gonadotropin receptors, supports the concept of a gonadotropin receptor or a postreceptor defect.

Topics: Adult; Autoantibodies; Cytotoxicity Tests, Immunologic; Estradiol; Female; Follicle Stimulating Hormone; Granulosa Cells; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary; Receptors, Cell Surface; Receptors, FSH; Receptors, LH; Syndrome

The effects of chlorpheniramine maleate, an H-1 receptor blocker, on clinical and endocrinologic features and intraovarian prostaglandin F (PGF) content were assessed in the rabbit model of the ovarian hyperstimulation syndrome. H-1 receptor blockade prevented ascites, attenuated ovarian enlargement (2.68 +/- 0.37 gm versus 4.15 +/- 0.056 gm; p less than 0.05), and augmented intraovarian PGF content (8.4 +/- 0.84 versus 3.95 +/- 1.12 pg/mg protein; p less than 0.05). Steroidogenesis was unaffected. In the control group, in which weights remained stable, animals with minimal ascites (scores less than or equal to 2; n = 4) were compared to other control animals with a greater accumulation of fluid (scores greater than or equal to 3; n = 4). The former also exhibited lower ovarian weights (2.94 +/- 0.41 versus 5.35 +/- 0.59 gm; p less than 0.05) and higher PGF ovarian content (6.05 +/- 1.56 versus 1.8 +/- 0.75 pg/mg of protein; p less than 0.05). This triad of minimal ascites, lower ovarian weights, and elevated intraovarian PGF seen both in treated animals and in inherently more resistant control animals did not appear to depend on changes in body weight. The conclusion reached was that H-1 receptor blockade prevented ascites, reduced ovarian enlargement, and augmented PGF content but did not affect steroidogenesis. This protective effect of chlorpheniramine may be mediated at least in part by prostaglandins.

Topics: Animals; Chlorpheniramine; Estradiol; Female; Histamine H1 Antagonists; Humans; Menotropins; Ovarian Diseases; Ovary; Ovulation Induction; Progesterone; Prostaglandins F; Rabbits; Syndrome

Eight women were treated for ovarian hyperstimulation syndrome (OHSS), grades 2-4, with indomethacin. The treatment was initiated 2-7 days after human chorionic gonadotropin administration and the period of treatment ranged between 3-8 days. The total dose was between 700-1200 mg. Nine live babies were born weighing between 2200-3950 gr. Except for a mild degree of hypospadias in one baby, there were no congenital malformations. This seems to indicate that indomethacin given under the described conditions has no apparent teratogenic effect.

Topics: Adult; Chorionic Gonadotropin; Female; Fertilization; Humans; Indomethacin; Infant, Newborn; Menotropins; Ovarian Diseases; Ovulation Induction; Pregnancy; Pregnancy Complications

Topics: Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovulation

Topics: Adult; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Suction

Ovarian resistance to exogenously administered gonadotropins and elevated serum gonadotropins, especially follicle-stimulating hormone (FSH), are considered virtually diagnostic of ovarian failure. However, similar clinical findings can be caused by circulating antibodies to gonadotropins which can neutralize the biologic activity of exogenously administered gonadotropins and can also cause falsely high gonadotropin determinations by routine double-antibody radioimmunoassay (RIA). We have used a primate model with anti-FSH antibodies to demonstrate that an acute course of combined estrogen-progestin therapy will suppress the pituitary secretion of FSH, which is markedly elevated in ovarian failure, while the false FSH elevations caused by circulating anti-FSH antibodies are not reduced by steroid negative feedback. Thus, gonadotropin (RIA) determinations before versus during an acute course of estrogen and progesterone therapy can distinguish true ovarian failure from the presence of circulating anti-gonadotropin antibodies.

Topics: Animals; Antibodies; Female; Follicle Stimulating Hormone; Macaca fascicularis; Menotropins; Neutralization Tests; Ovarian Diseases; Ovary; Radioimmunoassay

Etiologic factors in hypergonadotropic hypogonadism are discussed. On the basis of these data a classification system is proposed for women with hypergonadotropic hypogonadism to be used in future investigations of the natural history of this disorder. The classification system can also be used in attempts at therapeutic intervention in these women. Recommendations for clinical management and future studies of women with hypergonadotropic hypogonadism are provided.

Topics: Adult; Antineoplastic Agents; Estradiol; Estrogens; Female; Humans; Hypogonadism; Infertility, Female; Karyotyping; Menopause, Premature; Menotropins; Ovarian Diseases; Radiation Dosage

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

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

In the rabbit model of the ovarian hyperstimulation syndrome, animals given ovine prolactin with human menopausal gonadotropins (hMGs), as compared to animals receiving hMGs alone, demonstrated an increase in the formation of ascitic fluid, a decrease in mean plasma estradiol, and an increase in the mean plasma progesterone concentrations. The ovarian estradiol and progesterone content reflected that of the peripheral blood. These data suggest that, under the conditions of these experiments, prolactin may play a role in the pathogenesis of ascites formation but not the ovarian enlargement observed in this syndrome. Although the plasma estradiol levels were lower and the progesterone levels were higher in the animals treated with prolactin and gonadotropins, this did not prevent the occurrence of ascites, a cardinal clinical sign of this gonadotropin-induced syndrome.

Topics: Animals; Ascites; Estradiol; Female; Menotropins; Ovarian Diseases; Ovary; Progesterone; Prolactin; Rabbits; Syndrome

In order to compare the effectiveness of 8:00 A.M. plasma 17 beta-estradiol (E2), 24-hour urinary estriol glucuronide (E3G), and ultrasound as predictors of ovarian hyperstimulation, 70 cycles of induction of ovulation with 5:00 P.M. to 8:00 P.M. injection of menotropins from 28 subjects were evaluated. Hyperstimulation was four times more frequent in pregnancy than in nonpregnancy cycles (P less than 0.005). The hyperstimulation score (range, 0 to 6) was correlated with plasma E2 (0.63, P less than 0.01), the number of follicles (0.31, P less than 0.05), the duration of treatment (0.31, P less than 0.05), and urinary E3G (0.25, P less than 0.05). Plasma E2 was the best predictor of the hyperstimulation score, and plasma E2 was far superior to both urinary E3G and the number of follicles. Management with ultrasound alone is insufficient to prevent severe ovarian hyperstimulation. With this protocol, human chorionic gonadotropin may be given as soon as the first follicle reaches 1.4 cm in diameter as long as plasma E2 is less than 4000 pg/ml. The values of plasma E2 are dependent on the interval between blood sampling and injection of menotropins.

Topics: Estradiol; Estriol; Evaluation Studies as Topic; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Pregnancy; Statistics as Topic; Ultrasonography

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation Induction; Pregnancy; Pregnancy Complications; Syndrome; Torsion Abnormality

Ovarian hyperstimulation syndrome was induced in rabbit by administration of human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG). In an attempt to establish whether serotonin plays a part in the induction of this syndrome, the hyperstimulated rabbits were divided into two groups and were administered known anti-serotonin drugs, cyproheptadine and methysergide, respectively. The group treated with cyproheptadine, a non-specific serotonin antagonist, exhibited significant acceleration in the regression of the syndrome. Methysergide, a specific serotonin antagonist, administered to the second group, neither prevented the occurrence of the syndrome nor accelerated its regression. The results of this work indicate that serotonin does not seem to be directly involved in the production of the ovarian hyperstimulation syndrome in rabbits.

Topics: Animals; Chorionic Gonadotropin; Cyproheptadine; Female; Menotropins; Methysergide; Organ Size; Ovarian Diseases; Ovary; Ovulation Induction; Rabbits; Serotonin; Syndrome

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

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

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

A case of severe ovarian hyperstimulation syndrome (OHSS) secondary to human menopausal gonadotropin-human chorionic gonadotropin therapy is presented. Draining 4000 ml of exudate by abdominal paracentesis under real-time B-scan imaging induced a marked improvement in the patient's condition. Fluids from the third space were rapidly excreted, renal function improved, and the patient's weight decreased substantially. The underlying physiologic factors responsible for these changes are discussed. Other modes of treatment, including salt and water restriction and the use of volume expanders and diuretics, had no significant effect on the course of the syndrome. Paracentesis has a definite therapeutic value and is recommended in cases of OHSS with tense ascites.

Topics: Adult; Ascites; Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Syndrome; Water-Electrolyte Imbalance

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

After briefly recapitulating present-day knowledge on this recently identified syndrome with its polymorphic clinical and laboratory pattern, the authors describe three cases that have come to their attention. The most interesting was case III which was successfully treated on the basis of analogous reports found in the literature, with large doses of HMG-HCG in spite of the apparent "physiological absurdity" of this treatment. The authors stress the discrepancy frequently observed between functional diagnosis and histological findings; they suggest some possible explanations but stress the need for further research in order to clarify the nature of the functional damage in these patients and the level at which it is situated.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Karyotyping; Menotropins; Ovarian Diseases; Pregnancy; Sex Characteristics; Syndrome

Plasma prolactin, estradiol, progesterone, and testosterone, but not HCG-beta levels, were higher in a patient who developed the ovarian hyperstimulation syndrome while undergoing ovulation induction with human gonadotropins than in two other women who also became pregnant after similar treatment without complications. These results suggest that hyperprolactinema, in association with elevated ovarian steroid levels, may be factors in the pathogenesis of this disorder.

Topics: Blood Proteins; Chorionic Gonadotropin; Estradiol; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Pleural Effusion; Pregnancy; Progesterone; Prolactin; Proteins; Stimulation, Chemical; Syndrome; Testosterone

Ovarian hyperstimulation syndrome was produced in rabbits by administration of human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Histamine levels in the animals' plasma were determined by an enzymatic-isotopic assay. The results of this study show that there is no statistically significant difference between histamine levels in ovarian hyperstimulated animals as compared with control animals. Furthermore, no differences in the number of mast cells in the ovaries could be demonstrated between the 2 groups. It is concluded that histamine probably does not play a role in the pathogenesis of this syndrome. The relevance of this suggestion to other proposed mechanisms on the etiology of ovarian hyperstimulation syndrome is discussed.

Topics: Animals; Clomiphene; Female; Histamine; Humans; Mast Cells; Menotropins; Ovarian Diseases; Ovulation Induction; Rabbits

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

Topics: Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Diseases; Pregnancy; Pregnancy, Multiple; Syndrome

A case of hyperstimulation syndrome secondary to Pergonal therapy is presented. Successful management was based principally on severe sodium and fluid restriction without the use of volume expanders. The rationale for this therapeutic approach is presented and discussed. Although this iatrogenic disease should be virtually eliminated with the monitoring of daily urinary estrogens, severe hyperstimulation may still occur as a result of laboratory error.

Topics: Adult; Anuria; Ascites; Cation Exchange Resins; Chorionic Gonadotropin; Diet, Sodium-Restricted; Estrogens; Female; Humans; Hydrothorax; Iatrogenic Disease; Infertility, Female; Menotropins; Oliguria; Ovarian Cysts; Ovarian Diseases; Pregnancy; Stimulation, Chemical; Syndrome; Water Deprivation

Ovarian hyperstimulation was produced by human menopausal gonadotropin and chorionic gonadotropin in rabbits. A more rapid regression of the hyperstimualted ovaries was observed in an antihistamine-treated group than in a control group. The difference in regression was found to be statistically significant. The possibility of treating the ovarian hyperstimulation syndrome by antihistamine is cited.

Topics: Animals; Chorionic Gonadotropin; Disease Models, Animal; Female; Histamine H1 Antagonists; Iatrogenic Disease; Menotropins; Ovarian Diseases; Rabbits; Syndrome

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

Serum testosterone levels were monitored in female subjects who received therapy with human gonadotropins of urinary origin (menotropins) and human chorionic gonadotropin (hCG). Serum testosterone levels were not elevated in those subjects who did not experience side effects with therapy (Group A); among the other 7 subjects (Group B) with either moderate or severe ovarian hyperstimulation, serum testoterone levels rose distinctly (range 1.4 minus 9.0 ng/ml). Total menotropin dosage and serum estradiol-17beta levels were higher in Group B than in Group A. Ovarian hyperstimulation and elevation of serum testosterone were not restricted to patients with the syndrome of polycystic ovaries.

Topics: Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary; Polycystic Ovary Syndrome; Progesterone; Testosterone

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: Female; Humans; Laparoscopy; Menotropins; Menstruation Disturbances; Ovarian Diseases; Ovulation

Topics: Clomiphene; Cyclofenil; Female; Humans; Menotropins; Ovarian Diseases; Ovulation

Topics: Adult; Ascites; Female; Humans; Infant, Newborn; Infertility, Female; Male; Menotropins; Ovarian Diseases; Pregnancy; Pregnancy Complications, Hematologic; Pulmonary Embolism; Thrombophlebitis

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Drug Evaluation; Ethinyl Estradiol; Female; Fetal Death; Humans; Infant, Newborn; Menotropins; Obstetric Labor, Premature; Ovarian Diseases; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Progesterone; Prognosis; Triplets; Twins

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

Topics: Animals; Ascitic Fluid; Chlorpheniramine; Disease Models, Animal; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovary; Pleural Effusion; Rabbits

Topics: Adult; Arthritis; Clomiphene; Familial Mediterranean Fever; Female; Humans; Hysterosalpingography; Infertility, Female; Intestinal Obstruction; Laparoscopy; Menotropins; Ovarian Diseases; Ovulation; Peritonitis; Physical Examination; Pregnancy; Time Factors; Uterine Diseases

Topics: Clomiphene; Endometriosis; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Uterine Cervical Incompetence; Uterine Neoplasms

Topics: Corpus Luteum; Dose-Response Relationship, Drug; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Diseases; Pituitary Hormone-Releasing Hormones; Progesterone

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

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

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

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

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

Topics: Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases