menotropins and Postoperative-Complications

We report on two males with prolactinoma in whom hyperprolactinaemia and hypogonadism persisted for several years postoperatively despite the administration of a dopamine agonist or bromocriptine. In these patients, a GnRH test revealed no response in the levels of serum LH or FSH. An hCG stimulation test provoked no response in the serum levels of testosterone. Case 1, who was 28 years old at the first visit, received parenteral testosterone and appreciable virilization of the genitalia was noted within a few months. When he married and desired to father a child, the treatment was switched to hCG/hMG combined therapy and spermatozoa appeared subsequently in the ejaculate, although their numbers were low. His wife conceived and delivered a healthy baby girl. Case 2 was a single young man who presented with hypogonadotrophic hypogonadism and hyperprolactinaemia. He was started on hCG injections three times per week and the maturation of his genitalia was advanced rapidly. Semen analyses showed sperm concentration and motility to be within the normal range. Post-treatment GnRH test revealed no improvement in gonadotrophin responses for LH or FSH. In both cases, the hCG test repeated after the gonadotrophin treatment showed normal basal and stimulated testosterone levels. During the course of gonadotrophin treatment in these cases, serum prolactin levels remained elevated, and it is suggested that, in the two cases, the hypothalamo-pituitary function was disturbed by the tumour or its manipulation and the capacity of the pituitary gland to secrete gonadotrophin was impaired. Under such circumstances with persisting hyperprolactinaemia, hCG and/or hCG/hMG combination treatment can induce normal virilization and advance spermatogenesis sufficiently to achieve fertility.

Topics: Adult; Chorionic Gonadotropin; Gonadotropins; Humans; Hyperprolactinemia; Hypogonadism; Male; Menotropins; Pituitary Neoplasms; Postoperative Complications; Prolactinoma

A previously hypophysectomized man with azoospermia, who was on androgen replacement therapy since 11 years, was studied with regard to his intratesticular steroid conversion capacity in vitro after which he was given combined hCG/hMG therapy. Before therapy a steroid conversion pattern similar to that seen in prepubertal boys was found, i.e. a high proportion of 20 alpha-dihydroprogesterone was produced while only smaller amounts of 17 alpha-hydroxyprogesterone was produced from the substrate 3H-progesterone. After only five weeks of hCG/hMG treatment, sperm counts and serum testosterone levels increased dramatically and a child was conceived. The steroid conversion pattern simultaneously switched to the mature, adult type with a low production of 20 alpha-dihydroprogesterone and large amounts of 17 alpha-hydroxyprogesterone being produced in vitro. Thus gonadotrophin substitution therapy may still be very effective after long term androgen replacement.

Topics: Chorionic Gonadotropin; Combined Modality Therapy; Craniopharyngioma; Drug Therapy, Combination; Female; Humans; Infertility, Male; Long-Term Care; Male; Menotropins; Oligospermia; Pituitary Irradiation; Pituitary Neoplasms; Postoperative Complications; Seminiferous Epithelium; Sexual Maturation; Sperm Count; Sperm-Ovum Interactions; Spermatogenesis; Testis; Testosterone

This report provides a detailed description of a method by which mature or maturing human oocytes can safely be recovered by follicular aspiration during laparoscopy. By combining gonadotropin administration with laparoscopic recovery, oocytes which have resumed or completed meiotic division can be obtained for study without subjecting the patient to more hazardous surgical procedures. Fifteen oocytes were obtained from sixteen patients. On electron microscopic examination, four were found to have extruded polar bodies and were therefore classified as mature. Daily rather than intermittent administration of HMG, larger HMG dose, longer HCG aspiration intervals, and controlled aspiration pressures appeared to be the factors which produced the best yield of mature oocytes.

Topics: Adult; Blastocyst; Carbon Dioxide; Chorionic Gonadotropin; Chromatin; Chromosomes; Female; Follicle Stimulating Hormone; Humans; In Vitro Techniques; Infertility, Female; Laparoscopy; Luteinizing Hormone; Menotropins; Microscopy, Electron; Microtubules; Ovum; Postoperative Complications

Topics: Adenoma, Acidophil; Adenoma, Chromophobe; Adult; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Hydrocortisone; Infertility, Female; Injections, Intramuscular; Menotropins; Ovulation; Pituitary Neoplasms; Postoperative Complications; Pregnancy; Progesterone; Thyroid Hormones