menotropins and Syndrome

Topics: Chorionic Gonadotropin; Estrogens; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Risk Factors; Syndrome

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

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

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 Gordon Holmes spinocerebellar ataxia syndrome (GHS) is associated with idiopathic hypogonadotrophic hypogonadism (IHH). There are conflicting reports in the literature as to whether the primary neuroendocrine defect is of hypothalamic GnRH secretion, as with most causes of IHH, or of pituitary resistance to GnRH action. Because of the anatomical inaccessibility of the hypophyseal portal circulation, direct measurement of GnRH levels in human subjects is not possible. Previous investigators have attempted to unravel this problem through the use of GnRH stimulation tests and the limitations of this approach may explain the differing results obtained. We used the more physiological approach of treating a male GHS patient for four weeks with GnRH, 7-10 microg/pulse, delivered subcutaneously at 90 minute frequency via a portable minipump. This therapy failed to induce any rise in plasma gonadotrophin and testosterone concentrations. By contrast, eight weeks treatment with exogenous gonadotrophins maintained physiological plasma testosterone concentrations and induced testicular enlargement with induction of spermatogenesis. The data indicate that the primary endocrinopathy in GHS is of pituitary gonadotrophin secretion and not of hypothalamic GnRH. Moreover, the patient did not harbour any mutation of the GnRH receptor gene. Two clinical observations are consistent with progressive involution of gonadotrophic function, rather than a congenital gonadotrophin deficiency. First, the patient's development was arrested at early mid-puberty at the time of original presentation and, second, effective spermatogenesis was induced extremely rapidly during gonadotrophin treatment, suggesting prior exposure of the testes to FSH. Both spinocerebellar ataxia and pituitary dysfunction might thus have been in evolution since late childhood.

Topics: Adult; Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Replacement Therapy; Humans; Hypogonadism; Luteinizing Hormone; Male; Menotropins; Pulse Therapy, Drug; Spinocerebellar Ataxias; Syndrome; Testosterone

A simple approach for ovulation induction in women with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH-S) during in-vitro fertilization (IVF)/freezing/surrogacy cycles was evaluated. Weekly progesterone plasma concentrations were measured in order to accurately establish the luteal phase in MRKH-S women. When a rising titre was detected, a gonadotrophin-releasing hormone analogue (GnRHa) was administered as part of a long protocol. Two weeks later human menopausal gonadotrophin (HMG) therapy was started. Ten treatment cycles in four women with MRKH-S were carried out. In all cases, three or less progesterone estimations were needed. Three of the four women are now, through surrogacy, genetic mothers; one of them has two children. We concluded that weekly determination of progesterone plasma concentration is a convenient, efficient and inexpensive simple approach to identify the luteal phase, and therefore suitable to the start of a GnRHa/HMG protocol in MRKH-S women enrolled in an assisted reproduction technology programme.

Topics: Amenorrhea; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Syndrome

A 17-year-old male diagnosed as having Cat Eye Syndrome (CES) with hypogonadotropic hypogonadism showed short stature and no development of secondary sex characteristics. Exogeneous gonadotropin replacement therapy combining human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) was started. As a result, the short stature and androgen deficiency were relieved. The critical region of CES was tetrasomy of 22 pter-->q11. Abnormalities of other chromosomes which cause hypogonadotropic hypogonadism may exist, thus further investigation is needed.

Topics: Abnormalities, Multiple; Adolescent; Anus, Imperforate; Chorionic Gonadotropin; Chromosomes, Human, Pair 22; Dwarfism, Pituitary; Humans; Hypogonadism; Hypopituitarism; Male; Menotropins; Pituitary Hormones; Puberty, Delayed; Syndrome; Testosterone; Trisomy

A total of 31 clomiphene citrate/human menopausal gonadotrophin (HMG)/human chorionic gonadotrophin (HCG)-stimulated cycles in 28 patients were investigated to determine the fate of each of the matured follicles. A standard stimulation regimen was adhered to, and ultrasound as well as hormonal monitoring was performed. All follicles were measured by vaginal ultrasound at -12, +35 and +45 h relative to HCG administration and at 7 days after HCG administration. Of the 220 follicles, 107 (48.6%) ruptured. The number of ruptured follicles per cycle was correlated with the mid-luteal progesterone concentration (r = 0.63, P = 0.0005). The probability of follicular rupture was related to follicular diameter at 12 h before HCG administration; 6% of follicles < 12 mm in diameter ruptured compared with 87% of follicles 18-19 mm. A complete luteinized unruptured follicle (LUF) syndrome was observed in six cycles (20%). In these cycles, follicular growth and oestradiol, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) concentrations at 12 h before HCG administration were similar to those in cycles with follicular rupture. However, mid-luteal progesterone concentrations were lower in complete LUF cycles (46.97 +/- 8.95 nmol/l versus 108.74 +/- 12.27 nmol/l; P = 0.02). These data demonstrate that in stimulated cycles many follicles, usually the smaller ones, fail to rupture, even after HCG administration. Complete LUF syndrome, despite a strong exogenous ovulatory signal, and the absence of any difference in peri-ovulatory hormonal parameters, indicates that the defect causing LUF resides in the follicle itself and/or hormonal changes during the follicular phase.

Topics: Chorionic Gonadotropin; Clomiphene; Female; Follicular Phase; Humans; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Syndrome; Ultrasonography

To determine a simple predictive test for empty follicle syndrome before oocyte retrieval.. Retrospective correlation analysis.. Patients attending Nottingham University Research and Treatment Unit, a tertiary, university-based assisted reproductive technologies (ART) program between April 1, 1994 and March 31, 1995.. Six women in whom no oocytes were retrieved after superovulation for ART (empty follicle syndrome) were compared with 11 women with successful oocyte retrieval.. Subcutaneous buserelin acetate plus IM hMG and hCG were used for superovulation. Oocyte retrieval was transvaginal and ultrasound guided.. Ultrasound measurement of follicular growth and serum E2 levels during superovulation. Serum beta-hCG levels before and 36 hours after hCG administration IM. Number of oocytes retrieved.. Before hCG administration, beta-hCG was not detectable in the serum. The serum beta-hCG 36 hours after hCG was 209 +/- 16.7 mIU/mL (conversion factor to SI units, 1.0; mean +/- SEM, range 106 to 290 mIU/mL) in women with successful oocyte retrieval and 4 +/- 1.8 mIU/mL (range 0 to 9 mIU/mL) in empty follicle syndrome. This difference was significant.. Empty follicle syndrome is associated with very low bioavailability of beta-hCG and can be predicted by measuring serum beta-hCG level 36 hours after IM hCG administration.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Retrospective Studies; Superovulation; Syndrome

The purpose of this study is to provide evidence that empty follicle syndrome (EFS) is a result of an abnormality in the in-vivo biological activity of some batches of commercially available human chorionic gonadotrophin (HCG). This is a comparative study between six consecutive in-vitro fertilization (IVF) cases with EFS (study group) and 10 IVF pregnancy cycles (control group). Both groups received the same ovarian stimulation protocol consisting of leuprolide acetate and human menopausal gonadotrophin (HMG). An i.m. injection of 10,000 IU of HCG was administered once follicles had reached 18-20 mm and oestradiol/follicle > or = 16 mm was at least 900 pmol/l. Transvaginal aspiration was performed 36 h later. Plasma HCG prior to and 12 h after i.m. injection as well as the follicular fluid (FF) concentrations of oestradiol, progesterone, luteinizing hormone (LH) and HCG were determined in the study group and controls. The in-vitro biological activity of the batch of HCG used by the EFS cases and the control group was determined using a Leydig cell preparation from adult rats. Furthermore, the plasma clearance rate after i.v. injection of 5000 IU of HCG, from the same batches, was studied in three male volunteers. In the IVF cycles, no HCG was detected in plasma prior to the injection of commercial HCG. After 12 h, no HCG was detected in the study group compared to a mean of 207.5 IU/l (110-360) in controls. Mean FF concentration of LH, HCG, progesterone and oestradiol was 0.9 IU/l, 0 IU/l, 3.1 nmol/ml and 4.4 nmol/ml in EFS compared to 1.0, 98.3, 32.0 and 3.7 in pregnancy cycles. The in-vitro biological activity in both HCG batches was not significantly different; however, immunoreactive HCG used in EFS cases was undetectable in plasma of male volunteers as soon as 10 min after i.v. injection of 5000 IU of HCG. The endocrine abnormalities found in follicular fluids of EFS are not a consequence of an ovarian problem but the result of a lack of exposure to biologically active HCG. The rapid clearance of the drug after i.v. injection and the high affinity of desialylated HCG to liver cells suggest this to be a possible explanation for this infrequent but unfortunate event.

Topics: Adult; Chorionic Gonadotropin; Drug Stability; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Humans; Leuprolide; Luteinizing Hormone; Male; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Pregnancy; Progesterone; Syndrome

Several authors have suggested that growth hormone may augment ovarian responses to follicle stimulating hormone in women (Homburg et al., Clin. Endocrinol., 29, 1988; Ibrahim et al., Fertil. Steril., 55, 1991), and that this effect may be mediated by insulin-like growth factor I (IGF-I) (Davoren and Hsueh, Endocrinology, 118, 1986). Menashe et al. (Hum. Reprod., 6, 1991) reported spontaneous pregnancies in women with a deficiency in growth hormone receptors and, consequently, low serum concentrations of IGF-I. In this report, we present the case of a patient with a rare syndrome first described by Oliver and Mcfarlane (Arch. Ophthalmol., 74, 1965). The patient was shown to be growth hormone deficient, with hypopituitarism as part of the syndrome. Adjuvant growth hormone did not influence her ovarian responses to exogenous gonadotrophins during assisted conception treatment, as reflected by the required total number of ampoules of human menopausal gonadotrophin, the number of developing follicles, the rate of follicular growth and the serum oestradiol concentrations.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Growth Hormone; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Puberty, Delayed; Syndrome

We report a very rare case of a girl with hypogonadism probably due to inactive FSH. She had been diagnosed as carbohydrate-deficient glycoprotein syndrome. The 14-year-old patient had no secondary sexual characteristics with the 46,XX karyotype and estradiol (E2) levels were undetectable. Follicle stimulating hormone (FSH) levels were extremely high and responded exaggeratedly to luteinizing hormone-releasing hormone (LH-RH). The E2 levels, on the other hand, were elevated after stimulation with human menopausal gonadotropin (75 units/day) for 5 days, suggesting biologically inactive FSH in the circulation. Abnormal structure in the glycoprotein may be possibly related with hypogonadism.

Topics: Adolescent; Carbohydrate Metabolism, Inborn Errors; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Intellectual Disability; Menotropins; Sexual Maturation; Syndrome

A 37 year-old female with Kallmann syndrome and NIDDM who had two successful deliveries is reported. She had experienced no menstruation until she had treatment with gestagen in her early twenties. She had withdrawal bleeding only once. At the age of 25, she consulted her family doctor, complaining of amenorrhea. Estrogen progesterone cyclic therapy caused withdrawal bleeding, and clomiphene citrate failed to induce apparent ovulation. In January 1978, 150 IU of hMG was administered daily for 9 days, and then 3000 IU of hCG daily for the following 2 days. This therapy induced pregnancy, which failed spontaneously on June 4th. A year later, in January 1979, 150 IU of hMG was again administered daily for 7 days followed by 6000 IU of hCG for 3 days. This therapy again induced pregnancy. On September 27th, 1979, she delivered a girl vaginally, weighing 3830 g. After this delivery, she experienced no menstruation. In June 1985, she consulted her family doctor again, and she was diagnosed as being pregnant. Since her fasting blood glucose was 145 mg/dl, she was admitted to Kosei Hospital to control her blood glucose. On October 15th, she delivered a girl weighing 2600 g. On June 13th, 1989, she was referred to Kosei Hospital by her family doctor to achieve an accurate control of her blood glucose. During this admission, she was diagnosed as having Kallmann syndrome because of congenital anosmia and hypogonadotropic hypogonadism without any abnormal morphological changes. Vitamin B1 infusion test was negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Chorionic Gonadotropin; Diabetes Mellitus, Type 2; Female; Humans; Hypogonadism; Labor, Obstetric; Menotropins; Nervous System Diseases; Pregnancy; Pregnancy in Diabetics; Smell; Syndrome

The ovarian hyperstimulation syndrome is the most serious complication following ovulation induction. It is assuming greater clinical importance now that the indication for ovulation induction is no longer limited to anovulatory women but expands to other infertility problems. In its most severe manifestation the ovarian hyperstimulation syndrome consists of massive ovarian enlargement with multiple cysts, hemoconcentration, ascites, and pleural and pericardial effusion. There is no specific treatment and a reduction in the incidence of this iatrogenic syndrome can be achieved only by preventive measures.

Topics: Adult; Ascites; Female; Humans; Hypertrophy; Iatrogenic Disease; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pleural Effusion; Syndrome

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

Adnexal torsion of enlarged ovaries during early pregnancy is an infrequent but serious complication of menotropin therapy. Over 4 years, we encountered four cases of adnexal torsion among 648 menotropin-induced pregnancies. Multiple gestation may be a predisposing factor. The history of exogenous gonadotropin use, the acute clinical presentation, and the use of pelvic sonography facilitate the diagnosis. Although adnexectomy is well tolerated and pregnancy outcome is acceptable, future efforts should involve identifying preventive measures and more conservative means of therapy in these women.

Topics: Adnexal Diseases; Female; Humans; Menotropins; Ovulation; Pregnancy; Retrospective Studies; Superovulation; Syndrome; Torsion Abnormality

Topics: Abdominal Pain; Adult; Edema; Female; Humans; Menopause; Menotropins; Syndrome; Vomiting

In the present paper we examined, whether the combined GnRH-agonist/hMG therapy implies an increased risk of the ovarian hyperstimulation syndrome (OHS). In a retrospective analysis, 525 GnRH-a/hMG cycles were compared with 643 cycles of hMG stimulation, which were simultaneously performed at the Department of Gynecology and Obstetrics of the University of Hamburg. Two different GnRH-agonists were used: Buserelin (Hoechst) given intranasally (410 cycles) and Triptorelin (Ferring) intramuscularly (115 cycles). The clinical results of hMG "only"-therapy revealed an OHS incidence of 7% for grade II and 0.2% for grade III. In contrast, significantly higher incidences were observed after GnRH-a/hMG treatment. In Buserelin/hMG cycles in 23% OHS grade II and in 1.0% OHS grade III occurred, in Triptorelin/hMG cycles in 40% OHS II and in 5.2% OHS III, respectively. The increased incidence of OHS correlated with higher ovarian estrogen production as well as a higher number of follicles following the GnRH-a/hMG stimulation. Furthermore, in GnRH-a/hMG cycles a prolonged duration of follicular maturation occurred due to an increase of the active phase; in addition the amount of hMG-ampoules needed for ovarian stimulation was higher. After GnRH-a/hMG treatment, an endogenous LH-surge was not detected, whereas in 34% of hMG stimulated cycles irregular LH-fluctuations were observed. There was a higher pregnancy rate in GnRH-a/hMG cycles (15%/525 cycles), as compared to hMG stimulation (8%/643 cycles), but the abortion rate was similar (23%, GnRH-a/hMG, versus 13%, hMG). The demonstration of an increased ovarian response leading to better pregnancy rates but also higher risks of OHS is well known from earlier data of hMG stimulation in patients with hypogonadotropic amenorrhoea (WHO group I). This implies that GnRH-agonist pre-treatment shows similar endocrine conditions in normogonadotropic patients.

Topics: Buserelin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy; Risk Factors; Syndrome; Triptorelin Pamoate

In 143 cycles of in vitro fertilization the ovarian hyperstimulation syndrome (OHSS) occurred in 12 (8.4%) cycles. Six were in the moderate form and 6 severe. Ovarian stimulation by menotropins was preceded by induction of hypopituitary hypogonadism using D-Trp6-LH-RH microcapsules. The OHSS cycles are characterized by improved ovarian response expressed by the increased serum levels of estradiol, number of follicles, oocytes, embryos and pregnancy rate as compared to cycles with no OHSS. All patients recovered uneventfully. The follicular puncture did not have the suggested protective effect against OHSS. It is suggested that the substantial incidence of OHSS is probably related to the excessive ovarian stimulation not interrupted by early luteinization which is practically abolished by this protocol. The role of the given luteal hCG doses in the genesis of OHSS is questioned.

Topics: Adult; Capsules; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovary; Pregnancy; Syndrome; Triptorelin Pamoate

Ovarian cysts persisting after the onset of menses were demonstrated by ultrasound (US) in 40 of 71 (56%) nonconception cycles following ovulation induction with human menopausal gonadotropins (hMG) and human chorionic gonadotropin (hCG). Persistent cysts were self-limited and all resolved spontaneously within two cycles. They developed more frequently during stimulation cycles with (1) higher mean pre-hCG serum estradiol (E2), (2) a greater number of medium and large follicles at peak pre-hCG E2, and (3) a larger leading follicle diameter at peak pre-hCG E2. Persistent ovarian cysts frequently occurred despite a peak pre-hCG E2 lower than 1000 pg/ml. Although ovarian enlargement in the presence of cysts exceeded 5 X 5 cm in 25% of cases, no patient developed clinical symptoms of ovarian hyperstimulation syndrome (OHSS). Repeated induction of ovulation with hMG/hCG in the presence of nonfunctional, persistent cysts resulted in pregnancies in 6 of 15 cases (40%). Asymptomatic persistent ovarian cysts frequently follow an hMG/hCG regimen and, when nonfunctional, are not a contraindication to repeated ovarian stimulation. Persistent ovarian cysts appear to be an attenuated form of OHSS.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Follicle; Ovulation Induction; Recurrence; Syndrome

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

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

A case of Rothmund-Thomson syndrome of a 24-year old woman with primary amenorrhoea is presented. This autosomal recessive disorder is characterised by atrophy, hyperpigmentation and teleangiectasiae of the skin, furthermore by juvenile cataracts and congenital bone defects as saddle nose. Endocrinologic and morphologic parameters suggest a resistant ovary syndrome as cause of this hypergonadotropic hypogonadism.

Topics: Adult; Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Syndrome

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

Severe ovarian hyperstimulation developed in a young woman during ovulation induction with human menopausal and chorionic gonadotropins. This was complicated by acute functional renal insufficiency with vascular overfilling and incipient pulmonary edema, possibly caused by indomethacine and fluid treatment. The pathogenetic mechanisms involved are discussed.

Topics: Acute Kidney Injury; Adult; Anuria; Chorionic Gonadotropin; Female; Humans; Indomethacin; Menotropins; Oliguria; Ovary; Ovulation Induction; Syndrome

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

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

A prospective longitudinal and standardized study is presented, dealing with ultrasonographic and hormonal characteristics of the luteinized unruptured follicle (LUF) syndrome. Among 600 cycles monitored in 270 infertility patients, 40 cycles in 27 patients showed no evidence of follicle rupture, in spite of signs of luteinization, as reflected by basal body temperature recordings and progesterone determinations. In this study, 20 LUF cycles in 20 infertile patients were compared with 45 ovulatory cycles in 45 control women. During the follicular phase, no substantial difference in follicle growth was found, but after the luteinizing hormone peak, LUF follicles, instead of rupturing, showed a typical accelerated growth pattern. Both mean luteinizing hormone peak levels and midluteal progesterone levels were significantly lower in LUF cycles than in the control cycles. However, the duration of the luteal phase was not affected. Both central and local factors can be held responsible for the lack of follicle rupture. Ultrasound offers new possibilities as a noninvasive method in diagnosing the LUF syndrome.

Topics: Adult; Anovulation; Body Temperature; Chorionic Gonadotropin; Female; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Progesterone; Prospective Studies; Syndrome; Ultrasonography

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

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Syndrome

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

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

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Female; Menotropins; Olfaction Disorders; Ovulation Induction; Pregnancy; 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

Report of radiologic and hormonal results of a patient with typical stigmata of the Aarskog-syndrome. X-Ray findings are not been found to give diagnostic clues, whereas the hormonal findings are considered specific-typical: FSH and LH levels prior to orchidopexy are in a range are as seen with hypergonadotropic hypogonadism. One year after the orchidopexy LH values were found to be normal, the FSH again showed increased titer. The growth hormones concentrations are normal but Somatomedin-activity is decreased.

Topics: Abnormalities, Multiple; Bone Diseases, Developmental; Child, Preschool; Cryptorchidism; Humans; Luteinizing Hormone; Male; Menotropins; Postoperative Period; Radiography; Somatomedins; Syndrome

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

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

Among 1099 patients seen over an 8-year period for amenorrhea or oligomenorrhea, 115 (10.5%) had developed amenorrhea after ceasing oral contraception. These patients were the subject of a special study. Those who were treated received either clomiphene alone, hMG/hCG therapy, or both. There was no correlation between the incidence of either spontaneous or treatment-induced ovulation and menstruation and the duration of use of oral contraception, previous parity, or the nature of prior menstrual cycles. The incidence of treatment-induced resumption of menses was essentially the same as that for spontaneous resumption. An average duration of 30 months of oral contraceptive use did not significantly affect urinary excretion levels of estrogens and gonadotropins.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Contraceptives, Oral; Contraceptives, Oral, Synthetic; Drug Therapy, Combination; Estrogens; Female; Humans; Menotropins; Menstruation; Ovulation Induction; Parity; Pregnancy; 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

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Menopause; Menopause, Premature; Menotropins; Pregnancy; Syndrome

Topics: Adult; Chorionic Gonadotropin; Gonadotropins, Pituitary; Humans; Hypogonadism; Leydig Cells; Male; Menotropins; Olfaction Disorders; Spermatogenesis; Syndrome

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

1. Only FSH was increased after intravenous administration of 0.025 mg of GnRH in 2 female patients suffering from olfacto-genital syndrome. LH-serum-concentrations increased significantly, only when 0.1 mg GnRH was applicated intravenously twice with an interval of one hour.2. The response of hPRL-secretion to 0.2 mg TRH was found normal in both patients. However, when 25 mg chlorpromacine were administered intramuscularly, only one patient responded with an adequate rise of serum-hPRL. 3. One patient became pregnant during treatment with HMG/HCG. The clinical course of pregnancy was quite normal. HPL- and HCG-levels were in the normal, hPRL in the low normal range during pregnancy.

Topics: Adult; Amenorrhea; Chlorpromazine; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Olfaction Disorders; Pituitary Hormone-Releasing Hormones; Pregnancy; Prolactin; Syndrome; Thyrotropin-Releasing Hormone

This report describes in detail the hormonal and ultrastructural findings in a 21 year old woman with secondary amenorrhoea, who fulfilled all the criteria necessary to establish the diagnosis of resistant ovary syndrome. Ovarian biopsies revealed numerous primordial and primary follicles, which both by light and electron microscopy showed a normal morphology. Nevertheless, the follicles could not be stimulated neither by large doses of human gonadotrophins alone nor by simultaneous administration of cortisone acetate and large doses of human gonadotrophins. The association of a decreased target cell response with increased levels of serum FSH and LH might be explained in different ways. The presence of an inhibitor preventing the normal action of gonadotrophins could not be substantiated, because we did not detect any circulating gonadotrophin antibodies. Furthermore the serum prolactin level was normal.

Topics: Adult; Amenorrhea; Cortisone; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Microscopy, Electron; Oocytes; Ovarian Follicle; Ovary; 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

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

Six theoretically possible syndromes of IGD are shown in Table 1. 1) IBGD is well-substantiated both in males and in females, and appears to be either of pituitary or more frequently of nonpituitary origin. 2) An example of isolated FSH deficiency has been described. The defect appears to reside at the pituitary level and may be localized to the FSH beta subunit. Recently a male patient has been studied with isolated FSH deficiency and a concordant testicular picture viz germinal cell aplasia. However, the syndrome is complicated by an associated chromosomal abnormality (XO/XXY/XY) whose significance is unclear. 3) Several examples of isolated hLH deficiency have been described. Several questions remain about the exact nature of the defect in some of the published reports of this syndrome.

Topics: Amenorrhea; Clomiphene; Estradiol; Eunuchism; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Hypogonadism; Luteinizing Hormone; Male; Menotropins; Sex Characteristics; Syndrome; Testosterone

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Menotropins; Pregnancy; Progesterone; Radioimmunoassay; Syndrome

The syndrome of postpill amenorrhea was investigated retrospectively by studying records of diagnosed cases of amenorrhea (1300) treated or confirmed at the Mayo Clinic. Data are taken from records dating to 1960 (low use of contraceptives) and terminate in 1971. 12 cases are reviewed which were diagnosed as prolonged oversuppression syndrome. No particular oral contraceptive formulation was implicated. 4 of 12 patients had had irregular menstrual cycles before oral contraceptive therapy; whereas 8 had had regular cycles. Bioassay of urinary gonadotropins were consistently in the mid-low normal limits (only 1 determination was available for each patient); some patients had been radioimmunoassayed (single assay) for other pituitary hormones: LH (luteinizing hormone) was at normal basal levels and FSH (follicle stimulating hormone) was also in the normal range. Concentrations of total circulating estrogens were in low or subnormal range in each case. 4 cases had associated galactorrhea, which was attributed to exogenous steroid suppression of the prolactin-inhibiting center of the pituitary. Clomiphene citrate was used to restore functions of the hypothalamic-pituitary axis, and of the 8 receiving clomiphene, 5 responded and 2 conceived.

Topics: Adult; Amenorrhea; Clomiphene; Contraceptives, Oral; Corticosterone; Female; Gonadotropins; Humans; Lactation Disorders; Menotropins; Ovary; Pregnancy; Progesterone; Syndrome; Time Factors

Topics: Adult; Brain Diseases; Chorionic Gonadotropin; Female; Frontal Lobe; Gonadotropins; Humans; Hypogonadism; Limbic System; Menotropins; Olfaction Disorders; Ovary; Ovulation; Pregnancy; Stimulation, Chemical; Syndrome; Thalamus