menotropins and Primary-Ovarian-Insufficiency

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche or premature depletion of ovarian follicles before the age of 40 years. However, in several instances the distinction between definitive or intermittent POF may be difficult on clinical bases, therefore the more appropriate term Primary Ovarian Insufficiency (POI) has been recently proposed and will be used in this review. POI is a heterogeneous disorder affecting approximately 1% of women <40 years. The most severe forms present with absent pubertal development and primary amenorrhea, whereas forms with post-pubertal onset are characterized by disappearance of menstrual cycles (secondary amenorrhea) associated with a defective folliculogenesis. POI is generally characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Heterogeneity of POI is reflected by the variety of possible causes, including autoimmunity, toxics, drugs, as well as genetic defects. Several data indicate that POI has a strong genetic component. In this manuscript we discuss the X chromosome abnormalities that are associated with POI.

Topics: Age of Onset; Amenorrhea; Autoimmunity; Bone Morphogenetic Protein 15; Chromosomes, Human, X; Estrogens; Female; Fragile X Mental Retardation Protein; Humans; Menotropins; Oophoritis; Ovary; Primary Ovarian Insufficiency; Sex Chromosome Aberrations; Turner Syndrome

Topics: Diagnosis, Differential; Estrogen Replacement Therapy; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Menotropins; Mutation; Oocyte Donation; Ovulation Induction; Primary Ovarian Insufficiency; Prognosis; Receptors, FSH

Ovarian failure is heterogeneous in etiology and may occur at various points in a woman's life. As such, it may interfere with fertility. Clinical presentation ranges from complete cessation of menses to oligomenorrhea to the continuation of menses with elevated gonadotropins. Various therapies have been used in an attempt to induce fertility, including sex steroids and gonadotropin-releasing hormone agonists to suppress circulating gonadotropin alone or in combination with estrogen or gonadotropin-releasing hormone agonists to induce ovulation. Corticosteroids are also used to overcome autoimmunity. Randomized therapeutic trials are rare and fail to demonstrate any significant improvement in ovulation and pregnancy rates. Donor oocytes have demonstrated high success rates and have proven to be useful in patients with both premature ovarian failure and natural menopause. Pregnancies have been initiated and maintained in women through 60 years of age. Thus, for those accepting of the technique, oocyte donation appears to be the treatment of choice for hypergonadotropic hypogonadism.

Topics: Adrenal Cortex Hormones; Biopsy; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Gonadal Steroid Hormones; Gonadotropins; Humans; Infertility, Female; Menopause; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Outcome; Primary Ovarian Insufficiency

To assess the psychological impact (Hospital Anxiety and Depression Scale) of an investigational ovarian stimulation protocol in women with premature ovarian failure (POF).. Prospective longitudinal study.. Ten women with POF.. Women with idiopathic POF were placed on three consecutive treatment cycles consisting of gonadotropin ovarian stimulation after estrogen priming, gonadotropin-releasing hormone agonist pituitary desensitization, and corticosteroid immune suppression.. Median anxiety and depression scores increased significantly from baseline following three consecutive treatment cycles from 4.0 (range 2.0-8.0) to 11.0 (range 10.0-14.0) (p-value 0.041) and from 1.5 (range 0-6.0) to 9.0 (range 7.0-10.0) (p-value 0.039), respectively. There were nine "probable" anxiety (90%) and three "probable" depression (30%) cases on the final treatment cycle compared with none (0%) on baseline (p-value 0.004 and 0.250, respectively).. The use of investigational ovarian stimulation protocols in women with idiopathic POF was associated with excessive psychological strain. Women with POF should be cautioned against the potentially harmful aspect of similar treatments of unproven benefit.

Topics: Adolescent; Adult; Anxiety; Buserelin; Chorionic Gonadotropin; Depression; Estrogens; Estrogens, Conjugated (USP); Female; Glucocorticoids; Humans; Infertility, Female; Insemination, Artificial; Longitudinal Studies; Medroxyprogesterone Acetate; Menotropins; Ovary; Ovulation Induction; Prednisone; Primary Ovarian Insufficiency; Prospective Studies; Psychiatric Status Rating Scales; Reproductive Control Agents; Ultrasonography; Young Adult

Turner syndrome (TS) is associated with hypergonadotropic hypogonadism due to gonadal dysgenesis, which results in premature ovarian failure and subsequent infertility. Therefore, counseling and evaluation for fertility preservation are required as early as possible for women with TS.. A 23-year-old unmarried woman with mosaic TS (45, X [4/30] 46, XX [26/30]) presented to the pediatric department of our hospital for fertility counseling; she was accompanied by her mother. She was referred to the reproduction center of our hospital for ovarian reserve assessment and counseling regarding fertility preservation. We decided to retrieve oocytes using DuoStim as the controlled ovarian stimulation protocol. During the first and second oocyte retrievals, a total of 17 (9 and 8, respectively) mature metaphase II oocytes were cryopreserved.. DuoStim may be a useful option for fertility preservation for women with TS and reduced ovarian reserve. This new strategy may obtain the required number of oocytes in the shortest time and preserve the future fertility of women with TS.

Topics: 17 alpha-Hydroxyprogesterone Caproate; Buserelin; Cryopreservation; Dydrogesterone; Female; Fertility Agents, Female; Fertility Preservation; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Mosaicism; Oocyte Retrieval; Ovarian Reserve; Ovulation Induction; Primary Ovarian Insufficiency; Turner Syndrome; Young Adult

We report on a successful ovarian stimulation and pregnancy in a patient with 'resistant ovary syndrome' (ROS) and antigonadotrophin antibodies. ROS is characterized by high endogenous gonadotrophins, low estradiol, normal ovarian antral follicle counts and normal antimuellerian hormone values.. After cyclical hormone treatment, downregulation with GnRH analogue and ICSI procedure followed. Granulosa cells were treated with LH, FSH or hMG and expression of receptors for FSH, LH, oestrogen receptor beta (ERb) and progesterone receptor A (PR-A) was determined. Serum of the patient was analysed for antibodies directed against hMG.. After fertilization of ten metaphase II oocytes and transfer of two blastocysts, a singleton pregnancy was established. Stimulation of granulosa cells with FSH, LH and hMG upregulated ERb and PR-A. Dot blot analysis showed strong reactivity with hMG but not with recFSH.. This patient with normal expression of gonadotrophin receptors showed antibodies directed to hMG but not to recFSH.

Topics: Adult; Autoimmune Diseases; Female; Humans; Immunoglobulin G; Immunoglobulin M; Menotropins; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency

To present the first gonadotropinoma presenting as pseudo-menopause in a teenager.. Human menopausal gonadotropins (hMG) were given to a 37-year-old woman whose hypergonadotropic amenorrhea with estrogen deficiency as a teenager was changed to hypogonadotropic amenorrhea by the growth and prolactin secretion of a macroprolactinoma.. The patient responded multiple times, and every time to stimulation with hMG and each time produced several dominant follicles. She delivered two babies including conception at age 40.. The fact that this woman could respond consistently to hMG 20 years after the diagnosis of premature menopause, it is clear that initially the etiology of the extremely high LH and FSH levels in an estrogen-deficient 18-year-old was the presence of gonadotropinoma secreting inert LH and FSH. Since serum prolactin was measured the first time at age 37, it is not clear whether the endogenous biologically active gonadotropine were suppressed by replacement of the gonadotroph cells with tumor cells or suppression of endogenous gonadotropins by hyperprolactinoma.

Topics: Adult; Amenorrhea; Diagnosis, Differential; Estrogen Replacement Therapy; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Neoplasms; Pregnancy; Primary Ovarian Insufficiency; Progesterone; Prolactin; Prolactinoma

We report the first case, to the best of our knowledge, of successful conception following ovarian induction in a patient with premature ovarian failure and undetectable serum anti-Müllerian hormone. A 34-year-old woman was referred because of ovarian amenorrhea. After endogenous gonadotrophins were normalized by hormone-replacement therapy and gonadotrophin-releasing hormone agonist, ovarian induction was performed using exogenous gonadotrophins. On ovarian induction day 8, one follicle had reached a mean diameter of 19.6 mm, the serum estradiol level had increased to 516 pg/mL, and human chorionic gonadotrophin (HCG) was injected. On HCG injection day 7, ultrasonography was unable to detect the follicle, and serum progesterone levels had increased to 6.1 ng/mL. One month after HCG injection, ultrasonography detected an intrauterine fetus with beating heart. Even with serum anti-Müllerian hormone levels below the threshold of detection, there is a chance for patients with premature ovarian failure.

Topics: Adult; Anti-Mullerian Hormone; Embryo Implantation; Estrogen Replacement Therapy; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency; Severity of Illness Index

It has been previously reported that a group of 12 infertile women, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins, developed ovarian failure within a few months. Based on this observation, we carried out a controlled retrospective cohort study to examine whether non-response to ovarian stimulation is linked to early ovarian failure.. All patients aged 35-40 years who had cancelled IVF cycles for non-response between 1991 and 1993 in our centre were asked to report on the subsequent development of menopausal symptoms, menopause or commencement of hormone replacement therapy. A control group consisted of patients with the same age and similar medical history, who had IVF the same year and responded well.. Eleven out of the 12 patients of the non-response group developed menopausal symptoms within 7 years, compared with only four out of 24 in the control group. Similarly, eight out of 12 non-responders either went into menopause or started using hormone replacement therapy compared with one out of 24 in the control group. Using Fisher's exact test, the differences were highly significant (P < 0.0001). The median age at development of menopausal symptoms in the study group was 40 years (range 38-45). The median time between non-response and development of menopausal symptoms was 4 years (range 1-7).. We carried out a controlled retrospective cohort study that showed a strong association between an extremely poor response to ovarian hyperstimulation and early ovarian failure.

Topics: Adult; Aging; Cohort Studies; Drug Resistance; Estrogen Replacement Therapy; Female; Humans; Male; Menopause; Menopause, Premature; Menotropins; Ovulation Induction; Primary Ovarian Insufficiency; Reference Values; Retrospective Studies

We report a successful pregnancy in a woman with severe ovarian dysfunction and infertility associated with a variant beta-subunit of luteinizing hormone (LH).. A 35-year-old woman consulted our unit for infertility. Laparoscopy and ultrasonography showed obstruction of the right tube and ovulation from the right ovary only. Human menopausal gonadotrophin (hMG) therapy was used for six subsequent cycles, but did not result in conception. Subsequently, marked elevation of follicle-stimulating hormone (FSH) and testosterone, together with polycystic ovary (PCO) were noted. The patient failed to respond to ovarian stimulation by hMG. Severe ovarian dysfunction such as premature ovarian failure (POF) was strongly suspected. Sequence analysis of the LH beta-subunit gene indicated heterozygosity for point mutations Trp(8) to Arg(8) and Ile(15) to Thr(15) in the coding sequence. LH hypersecretion resembling that seen in PCO syndrome was observed. Induction of ovulation by hMG was successful in the first cycle in which the basal LH and FSH were well controlled with gonadotrophin-releasing hormone analog following estrogen-progesterone replacement. She conceived and delivered a healthy male infant at term.. Clinicians should be clinically aware of patients with immunologically anomalous LH variant who might be at risk of developing ovarian failure within a relatively short time span. Pertinent treatment should be applied without delay in such cases.

Topics: Adult; Female; Follicle Stimulating Hormone; Humans; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Mutation; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency

Our report concerns a patient with a climacterium praecox and an X-chromosomal anomaly (86% 46, XX; 7% 47, XXX; 7% 45, X0) desiring to give birth. She conceived once after down-regulation of the gonadotrophins by means of a cyclical hormone replacement therapy followed by gonadotrophin stimulation, as well as a second time under down-regulation with a GnRH-analogue and gonadotrophin stimulation. On the basis of the case report and of the literature, a possible interval therapy in such a patient, especially one even with increasing ovarian insufficiency, will be portrayed and discussed.

Topics: Adult; Down-Regulation; Estradiol; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Primary Ovarian Insufficiency; Sex Chromosome Aberrations; X Chromosome

To evaluate the outcome of an oocyte donation program using synthetic estrogen and progestational agents for uterine preparation.. Conjugated estrogen, 1.25 mg per day at increasing doses and dydrogesterone, a synthetic progestogen, 30 mg per day were used for uterine priming. All embryo transfers were done on day 2 of progestogen supplementation.. The pregnancy rates were 38% per embryo transfer. The ongoing pregnancy rate was 31% with an abortion rate of 20%.. Endometrial preparation in an oocyte donation program using orally administered synthetic estrogen and progestogen gives pregnancy rates comparable to those reported with natural products.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Dydrogesterone; Embryo Transfer; Endometrium; Estradiol; Estrogens, Conjugated (USP); Female; Humans; Menopause; Menotropins; Oocyte Donation; Ovarian Follicle; Pregnancy; Primary Ovarian Insufficiency; Progesterone Congeners; Ultrasonography

The most important aspect of diminished ovarian reserve is the associated decline in reproductive potential. Assessment of ovarian reserve is mainly based on measurement of early follicular phase follicle stimulating hormone (FSH) concentration. The objective of this study was to report the identification of a group of 12 infertile women initially diagnosed as having unexplained or anovulatory infertility, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins. All developed ovarian failure within a relatively short time span. Non-response to ovarian stimulation was defined by failure to achieve development of follicles >12 mm and failure to raise oestradiol concentration >350 pmol/l in two successive cycles of human menopausal gonadotrophin (HMG) doses of up to five ampoules per day for 5-8 days. Within a mean of 9 months following the failed attempts of ovarian stimulation the mean day 3 FSH concentrations rose from 5.4 +/- 2.7 IU/l to 53.5 +/- 19.7 IU/l. In these patients, day 3 FSH concentration failed to indicate the low ovarian reserve manifested only by lack of clinical response to treatment with gonadotrophins which was the first sign of impending ovarian failure. We conclude that women with normal early follicular phase serum FSH concentrations who do not respond to ovarian stimulation by HMG are at risk of developing ovarian failure within several months.

Topics: Adult; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovulation; Primary Ovarian Insufficiency

To report successful ovulation induction in a woman with premature ovarian failure (POF) resulting from a partial Xq deletion.. An uncontrolled study.. University hospital.. A 27-year-old woman with 46,X,del(X)(q22) who had hypergonadotropic secondary amenorrhea.. Injections of hMG (225 IU/d) for 8 consecutive days after endogenous gonadotropin suppression with a long-acting GnRH agonist (900 micrograms/d) for 12 weeks, together with cyclic sex steroid replacement therapy.. Serum concentrations of E2 and P as well as ultrasonography.. Folliculogenesis and ovulation.. Ovulation induction is possible in patients with POF caused by X chromosome aberrations.

Topics: Adult; Estradiol; Female; Gene Deletion; Humans; Menotropins; Ovarian Follicle; Ovulation Induction; Primary Ovarian Insufficiency; Progesterone; Treatment Outcome; Ultrasonography; X Chromosome

Numerous anecdotal reports but few scientific approaches have suggested an increase in androgens in early pregnancy. In this study we have compared the concentration of serum androgens, testosterone and androstenedione in early pregnancy, starting within the cycle of conception. We have taken the opportunity to study women with premature ovarian failure where pregnancy develops in the virtual absence of ovarian functions. This study demonstrates that the concentration of testosterone (0.29 +/- 0.04 ng/ml) and androstenedione (1.770 +/- 0.136 ng/ml) in these subjects is as low as, if not lower than, non-pregnant women (0.39 +/- 0.02 and 2.170 +/- 0.025 ng/ml), significantly increased in normal pregnancies (1.190 +/- 0.118 and 3.920 +/- 0.297 ng/ml; P < 0.05) and even further increased in human menopausal gonadotrophin-treated cycles (1.990 +/- 0.230 and 8.19 +/- 0.72 ng/ml; P < 0.05). These studies demonstrate that the ovary is a contributor to the circulating concentrations of testosterone and androstenedione starting within the cycle of conception.

Topics: Androstenedione; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovary; Pregnancy; Primary Ovarian Insufficiency; Testosterone

Our purpose was to evaluate the effect of age on endometrial receptivity and to compare success rates for oocyte donation among groups with differing primary diagnoses.. This was a retrospective analysis of 300 consecutively attempted oocyte donation cycles.. The setting was the in vitro fertilization program at the University of Southern California.. Recipients were divided into groups according to age: Group I, < 30 years (n = 8); Group II, 30-39 years (n = 59); Group III, 40-49 years (n = 107); and Group IV, 50-59 years (n = 18). Additionally, indications for treatment were divided into Classes A-G according to a primary diagnosis given to each patient and included premature ovarian failure (n = 44), surgical castration (n = 9), genetic disease carrier (n = 12), transitional menopause (n = 27), natural menopause (n = 30), multiple IVF failures (n = 62), and postchemotherapy (n = 8). Recipients received oral micronized estradiol and intramuscular progesterone. Oocytes were donated by fertile young women utilizing ovarian hyperstimulation with menopausal gonadotropins.. There were no significant differences among groups or classes related to either the number of oocytes received or the number of embryos transferred per cycle. Rates for embryo implantation and resorption and the clinical and ongoing or delivered pregnancy rates were similarly not different among patients except for women who previously received chemotherapy, where a significantly elevated rate of spontaneous abortion was noted P < 0.05).. The establishment of pregnancy utilizing oocyte donation is not adversely affected by the chronological age of the recipient, inferring that the age-related decline in fertility is due primarily to oocyte aging, and not to loss of endometrial receptivity. Also, prior exposure to chemotherapy may alter endometrial integrity and lead to greater pregnancy wastage in women receiving donated embryos.

Topics: Abortion, Spontaneous; Administration, Oral; Adult; Age Factors; Antineoplastic Agents; California; Drug Administration Schedule; Embryo Implantation; Estradiol; Female; Fertilization in Vitro; Fetal Resorption; Genetic Diseases, Inborn; Humans; Infertility, Female; Injections, Intramuscular; Injections, Subcutaneous; Leuprolide; Maternal Age; Menopause; Menotropins; Middle Aged; Oocyte Donation; Ovariectomy; Pregnancy; Pregnancy, High-Risk; Primary Ovarian Insufficiency; Progesterone; Retrospective Studies; Universities

Currently no treatment has proved successful in inducing ovarian steroidogenic and/or gametogenic recovery in patients with haematological malignancies treated by cytotoxic chemotherapy once biochemical failure becomes manifest i.e., when FSH levels exceed 40 IU/L. This paper reports two such cases with classical biochemical ovarian failure in which ovarian function was induced by brief stimulation with Human Menopausal Gonadotrophin (HMG).

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Transplantation; Carmustine; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Daunorubicin; Doxorubicin; Female; Follicle Stimulating Hormone; Hodgkin Disease; Humans; Leukemia, Myelomonocytic, Acute; Luteinizing Hormone; Melphalan; Menotropins; Ovulation Induction; Podophyllotoxin; Prednisone; Pregnancy; Pregnancy, Multiple; Primary Ovarian Insufficiency; Remission Induction; Teniposide; Thioguanine; Vincristine

Previous data have suggested there is a higher incidence of luteinized unruptured follicle (LUF) syndrome (defined as failure to release any oocyte as determined by sonography) in gonadotropin-treated patients following human chorionic gonadotropin (hCG) versus the gonadotropin releasing hormone agonist (GnRH-a) leuprolide acetate. The present study was designed to determine if an ultra low-dose gonadotropin regimen, designed not to raise the serum estradiol level much above normal for non-stimulated cycles, might result in a decrease in LUF following hCG treatment, and even reduce the rate to that seen following leuprolide acetate. The hypothesis tested was that the higher estradiol levels might suppress the pre-ovulatory follicle stimulating hormone (FSH) surge which, in turn, would inhibit plasmin production, thus preventing detachment of the oocyte from the follicle. The data did show a reduced rate of LUF incidence with either hCG or leuprolide acetate in ultra low-dose human menopausal gonadotropin-(hMG-) treated patients compared to data from previous studies with conventional hMG/hCG therapy. Pregnancy rates were also similar following hCG or leuprolide acetate for release in low-dose hMG-treated patients. Preliminary data show that leuprolide acetate is superior to hCG for causing oocyte release when stimulation is with low-dose purified FSH, and possibly also that low-dose hMG is superior to low-dose purified FSH for producing superior pregnancy rates.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Leuprolide; Luteal Phase; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency; Progesterone

A case of a patient with premature ovarian failure (POF) is discussed. Ovulation failed to occur for 5 years by gonadotropin-releasing hormone agonist (GnRHa) and human menopausal gonadotropin (hMG) treatment following estrogen-progesterone replacement therapy. After laparoscopic ovarian biopsy, ovulation was successfully induced by hMG, although gonadotropins were not suppressed enough, and the patient achieved pregnancy.

Topics: Adult; Biopsy; Female; Gonadotropins; Humans; Menotropins; Ovary; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency

Topics: Adult; Clomiphene; Endometrium; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteal Phase; Menotropins; Primary Ovarian Insufficiency; Progesterone; Superovulation

A prospective crossover study comparing ovulation induction techniques in eight women with premature ovarian failure is presented. These patients were treated with FSH rebound techniques using the GnRH-a, LA, alone in one treatment cycle and the same plus menopausal gonadotropins in the other treatment cycle. Two women ovulated in each group. We conclude that ovulation does occur in women with premature ovarian failure, but that luteal P may be inadequately secreted.

Topics: Adult; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Menotropins; Osmolar Concentration; Ovulation Induction; Primary Ovarian Insufficiency; Prospective Studies

A combination of gonadotropin-releasing hormone agonist and human menopausal gonadotropins was used for ovulation induction in a patient with premature ovarian failure. A paradoxical suppression of any ovarian response was noted despite increasing doses of human menopausal gonadotropins.

Topics: Adult; Delayed-Action Preparations; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Primary Ovarian Insufficiency; Triptorelin Pamoate