menotropins and Pituitary-Diseases

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

(1) The reference ovarian stimulant for women with severe FSH and LH deficiency and pituitary dysfunction is menotropin (postmenopausal urinary human gonadotrophin (hMG)). (2) A recombinant LH, lutropin alfa, has now been licensed for this use, in combination with recombinant FSH (follitropin alfa or follitropin beta). The evaluation file contains no data from trials comparing the follitropin-lutropin alfa combination with menotropin. (3) Two dose-finding studies involving a total of 78 women, and a double-blind trial comparing follitropin + placebo with follitropin + lutropin alfa, have shown that 75 IU/day lutropin alfa yields satisfactory follicular development in two-thirds of women whose plasma LH concentration is below 1.2 IU/I. Efficacy has not been demonstrated in women with higher plasma concentrations of LH. Similar results have been reported with menotropin. (4) The adverse effect profile of the follitropin + lutropin alfa combination is similar to that of menotropin. The main risk is an ovarian hyperstimulation syndrome. Monitoring of plasma estradiol concentrations, pelvic ultrasound findings, and clinical state are required to avoid severe ovarian hyperstimulation. There is no evidence that the risk differs between menotropin and the follitropin + lutropin alfa combination at adjusted doses. (5) In France, the combination of follitropin alfa + lutropin alfa costs about five times more than menotropin. (6) Menotropin remains the first line ovarian stimulant for women with severe deficiency of FSH and LH.

Topics: Double-Blind Method; Drug Therapy, Combination; Female; Fertility Agents, Female; Follicle Stimulating Hormone; France; Glycoprotein Hormones, alpha Subunit; Humans; Luteinizing Hormone; Menotropins; Pituitary Diseases

We evaluated the efficacy of gonadotropin treatment in stimulating spermatogenesis in men with hypogonadotropic hypogonadism. When 21 men with hypogonadotropic hypogonadism were treated with human chorionic gonadotropin, the sperm count increased to within the normal range in the 6 in whom hypogonadism had begun after puberty, but in only 1 of the 15 in whom it had begun before puberty (P less than 0.002). When the remaining 14 men with prepubertal hypogonadism were treated with human menopausal gonadotropin in addition to human chorionic gonadotropin, the sperm count increased to normal in 5 of the 7 who had not had cryptorchidism, but in only 1 of the 7 who had (P less than 0.05). The need for human menopausal gonadotropin as a replacement for follicle-stimulating hormone could not be predicted by pretreatment serum and urinary levels of follicle-stimulating hormone. We conclude that gonadotropin treatment will usually increase the sperm count to normal in men with hypogonadotropic hypogonadism, unless cryptorchidism has occurred. The need for human menopausal gonadotropin treatment appears to depend on the time of onset of hypogonadism.

Topics: Adult; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadotropins; Gonadotropins, Pituitary; Humans; Hypogonadism; Hypothalamic Diseases; Infertility, Male; Male; Menotropins; Middle Aged; Pituitary Diseases; Pregnancy; Sperm Count; Spermatogenesis; Stimulation, Chemical

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

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

The different methods of inducing ovulation and the results which one can hope to obtain relative to the indications for each of them are discussed. It is interesting to note that the cumulative total of pregnancies over 12 months shows that the prognosis in terms of fertility is similar to that of a normal population, provided that it has been treated under optimal conditions.

Topics: Chorionic Gonadotropin; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Diseases

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

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

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

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

Topics: Animals; Body Fluids; Chorionic Gonadotropin; Gonadotropins; Gonadotropins, Pituitary; Humans; Menotropins; Mice; Pituitary Diseases; Pituitary Gland; Postmenopause; Research; Urine