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PubMed2003

Clinical evidence for an LH 'ceiling' effect induced by administration of recombinant human LH during the late follicular phase of stimulated cycles in World Health Organization type I and type II anovulation.

BACKGROUND: The objective of these studies was to test the hypothesis that over-dosing with recombinant human LH (rLH) during the late follicular phase would suppress the development of follicles. METHODS: Two double-blind studies were conducted. In study A, WHO I anovulatory patients received treatment with rFSH and rLH. When at least one follicle reached a mean diameter of 10-13 mm, patients were randomized using a computer-generated randomization list (stratified by centre) to rFSH and rLH (225 IU/day) (n = 8) or rLH alone (n = 6) or rFSH alone (n = 6). In study B, WHO II anovulatory patients with a hyper-responsive FSH were randomized to rLH (225 IU/day) (n = 4) or rLH 450 IU/day (n = 8) or placebo (n = 5). RESULTS: Study A: the mean number of follicles >/=11 mm was 4.2 +/- 0.3 in the rFSH group, 1.5 +/- 0.7 in the rLH group and 6.0 +/- 2.3 in the rFSH/rLH group (P = 0.07). 0/8 patients presented follicular growth arrest in the rFSH group, but 4/6 in the rLH group and 1/6 in the rFSH/rLH did. Study B: 5/12 patients presented follicular growth arrest in the rLH groups, but none in the placebo group. The mean number of follicles >/=11 mm was 4.6 +/- 1.8 for the placebo group, 2.5 +/- 1.9 for the rLH 225 IU group and 4.2 +/- 1.4 in the rLH 450 IU group (not significant). CONCLUSIONS: Results of this pilot study suggest that rLH alone can trigger follicular growth arrest in a significant number of patients, suggesting the existence of an 'LH ceiling' during late follicular maturation.

Adult↗
PubMed2006

Does meloxicam increase the incidence of anovulation induced by single administration of levonorgestrel in emergency contraception? A pilot study.

BACKGROUND: Levonorgestrel (LNG) consistently prevents follicular rupture only when it is given before the onset of the ovulatory stimulus. As locally synthesized prostaglandin (PG) plays a crucial role in follicular rupture and cyclooxygenase-2 (cox-2) catalyses the final step of PG synthesis, we reasoned that adding a cox-2 inhibitor to LNG would prevent follicular rupture even after the ovulatory process had been triggered by the gonadotrophin surge. METHODS: Forty-one women were divided into two groups. One was treated when the size of the leading follicle was 15-17 mm (n=10) and the other when it was >or=18 mm (n=31). Each woman contributed with one cycle treated with LNG 1.5 mg single dose plus placebo and another treated with LNG + meloxicam (Melox) 15 mg, in a randomized order. Serial blood sampling for the assay of LH and follicular monitoring by transvaginal ultrasound were performed before and after treatment. RESULTS: Follicular rupture failed to occur within the 5-day period that followed treatment in 50 and 70% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the 15-17 mm group (P=0.15) and in 16 and 39% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the >or=18 mm group (P < 0.052). The overall proportion of cycles with no follicular rupture or ovulatory dysfunction increased significantly by the addition of Melox to LNG (66 versus 88%, P < 0.012; n=41-matched pairs). CONCLUSIONS: The trend towards increased incidence of no follicular rupture when Melox was combined with LNG suggests that the addition of a cox-2 inhibitor has the potential to improve the contraceptive efficacy of LNG by a pre-fertilization effect.

Adolescent↗
PubMed1988

Improved treatment for anovulation in polycystic ovarian disease utilizing the effect of progesterone on the inappropriate gonadotrophin release and clomiphene response.

The treatment of anovulatory, clomiphene-resistant patients with polycystic ovarian disease (PCOD) is difficult. Ten such women were given progesterone, 50 mg/day i.m. for 5 days to achieve luteal phase concentrations. Immediately following progesterone treatment, plasma concentrations of FSH were reduced in all patients (P = 0.001) and seven of the 10 had reduced plasma LH concentrations. Following the withdrawal bleeding these seven all became responsive to clomiphene as shown by ovulation, and three conceived after a single progesterone/clomiphene cycle. LH pulsatility, studied in five women over 4 h, before and immediately following progesterone treatment, showed a slowing of the pulse frequency (62 +/- 26 min to 105 +/- 51 min, P less than 0.05) and an increase in pulse amplitude (6 +/- 1.9 IU/l to 16.7 +/- 20 IU/l). The LH and FSH response to GnRH was blunted by progesterone. It would thus appear that progesterone modulates LH pulsatility and reduces pituitary sensitivity to GnRH, reducing LH levels and possibly inducing more FSH synthesis and storage, similar to its action in the normal ovulatory cycle. These changes provide a more favourable environment for ovulation induction by clomiphene and we suggest that short-term progesterone treatment may be utilized to improve the efficiency and results of clomiphene treatment in PCOD.

Anovulation↗
PubMed1994

Association of dopamine D2 receptor gene haplotypes with anovulation and fecundity in female Hispanics.

Dopamine is an important neurotransmitter in the hypothalamic control of gonadotrophin secretion. Neuron response is mediated through one of five different dopamine receptors. We explored the association of D2 receptor gene polymorphisms with disorders of ovulation. We utilized a multiplex allele specific polymerase chain reaction (PCR) to detect two bi-allelic polymorphisms (four potential haplotypes) in intron 5 and exon 6 of the D2 receptor gene. A second PCR/restriction endonuclease digest was utilized to verify this. Using these assays, 185 female Hispanics (51% with known ovulatory dysfunction and 49% with normal function) were haplotyped. One allele (3) was not present in the population and there were no significant differences in remaining allele distribution between ovulatory and anovulatory patients. However, significant associations were noted between alleles and gonadotrophins and fecundity. The 4 allele had a different reproductive profile compared to the 2 allele. The 4 allele was associated with significantly higher concentrations of luteinizing hormone (LH) (means +/- SE) (19.2 +/- 2.2 versus 12.3 +/- 1.3 mIU/ml, P < 0.02) and follicle stimulating hormone (FSH) (13.2 +/- 2.0 versus 10.0 +/- 0.6 mIU/ml, P < 0.05), significantly lower concentrations of prolactin (7.9 +/- 0.8 versus 14.9 +/- 3.5 ng/ml, P < 0.02) and higher parity (1.4 +/- 0.12 versus 0.92 +/- 0.13) and lower miscarriage rates (0.89 +/- 0.1 versus 1.33 +/- 0.24, P < 0.04). We conclude that D2 receptor alleles may be associated with reproductive success through altered gonadotrophin secretion and that this effect may be independent of ovulatory function.

Adult↗
PubMed1991

Post-partum anovulation in nursing mothers.

An analysis of breastfeeding and ovulation data from 72 nursing mothers is presented. A proportional hazards model of the data strengthens the hypothesis that a pattern of short, frequent bouts of nursing defines a risk-set of women less susceptible to post-partum ovulation than those who choose to nurse on a schedule of relatively lengthy and infrequent bouts. In contrast, no effect of maternal weight-for-height on the month-specific rate of post-partum ovulation could be detected in the study population comprised of American mothers trained in self-observation of fertility signs.

Anovulation↗
PubMed1987

Relationships between histological signs of atresia, steroids in follicular fluid, and gonadotropin binding in individual bovine antral follicles during postpartum anovulation.

Two experiments were conducted to determine the relationship between histological signs of atresia, gonadotropin binding, and steroids in fluid of medium-sized bovine follicles during postpartum anestrus. In Experiment I, ovaries of 21 cows were removed on Days 7, 14, 28, 42, or 56 after parturition. In Experiment II, ovaries of 29 cows were removed between Days 20 and 30 postpartum after 48 or 96 h of either saline (0.9% NaCl, 5 ml) or luteinizing hormone-releasing hormone (LHRH; 500 ng/5 ml saline) injections given every 2 h via jugular cannulas. Two to 10 follicles, 4.0-7.9 mm in diameter, were removed per pair of ovaries. Follicles were classified as normal, intermediate, atretic, or luteinized-atretic, depending on their micromorphology. In both Experiments I and II, follicles classified as normal had 50-80% lower (p less than 0.05) concentrations of progesterone and 2- to 7-fold greater (p less than 0.05) concentrations of estradiol than atretic follicles. However, concentrations of androstenedione and gonadotropin-binding sites were similar in normal and atretic follicles. Atretic follicles had degenerative granulosa with several pyknotic nuclei, thick theca, and little distinction between theca and granulosa. Intermediate follicles showed slight signs of degeneration and had 2- to 3-fold greater (p less than 0.05) concentrations of progesterone than normal follicles. Concentrations of estradiol did not differ (p greater than 0.10) between normal and intermediate follicles. Equal proportions of normal and atretic medium-sized follicles were located on the ovaries bearing the corpus albicans from pregnancy (CAP).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Enhanced ovarian inhibin subunit gene expression in aging rats is due to chronic anovulation.

The persistent-estrous (PE) state in aging rats, characterized by a lack of ovulation and absence of estrous cycles, is associated with enhanced inhibin alpha and beta A subunit mRNA expression in the ovaries. It has been shown that the PE state can be interrupted by successive treatments with a progesterone implant (P-implant) and that estrous cycles can be transiently restored after implant removal. The present study examined whether restoration of estrous cycles in PE rats could reverse the altered ovarian inhibin alpha and beta A subunit gene expression. PE rats were treated with subcutaneous P-implants for 6 wk. After implant removal, the return of estrous cyclicity was confirmed by characteristic cyclic changes in vaginal cytology. Ovaries collected from the P-implant-treated animals at 1100 h on diestrus Day 2 or proestrus showed significantly decreased levels of both inhibin alpha and beta A subunit mRNAs compared to those of PE controls and young cyclic females. In situ hybridization revealed that the decreased inhibin alpha subunit mRNA after P-implants was due to decreased gene expression in the granulosa cells of large preovulatory follicles and to a compete absence of gene expression in large, cystic follicles devoid of granulosa cells and oocytes. In addition, inhibin alpha subunit mRNA was expressed in the newly developed follicles after implant removal. The beta A subunit mRNA was detected only in maturing follicles, not in newly developing follicles or in the large cystic follicles. The patterns of ovarian inhibin alpha and beta A subunit gene expression mimicked those of cyclic animals. These data indicate that loss of estrous cycles in aging rats results in an overexpression of inhibin alpha and beta A mRNAs in large and anovulatory follicles and that reinstatement of ovarian cycles in aged rats restores inhibin gene expression to normal levels.

Aging↗
PubMed2001

Obesity, polycystic ovary syndrome and anovulation--how are they interrelated?

Polycystic ovary syndrome remains a mystery with respect to its aetiology, consequences and management. There is an increasing emphasis on its familial origins although the genes involved are unknown. There are significant changes in risk profiles for cardiovascular disease but no clear clinical evidence of morbidity or mortality. There is evidence of improvement in insulin resistance or insulin sensitivity drugs but uncertainty about improvement in pregnancy outcomes. This review looks at the latest advances in understanding polycystic ovary syndrome, particularly in obesity.

Anovulation↗
PubMed1984

Chronic anovulation.

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Adrenocortical Hyperfunction↗
PubMed1978

Stimulation of follicular growth with "pure" FSH in patients with anovulation and elevated LH levels.

Ovarian follicular growth was stimulated in 4 patients with clomiphene resistant polycystic ovary (PCO)-like disease, with "pure" human pituitary FSH during 10 cycles. In 8 cycles additional hCG was given to induce ovulation. Serum LH and FSH and plasma estradiol and progesterone were determined daily. From the response patterns of steroidogenesis, four functional stages of follicular development can be distinguished, each subsequent stage being characterized by an increasing spontaneous estradiol production and a decreasing capacity to produce extra estradiol in response to stimulation with additional hCG. It is concluded that the unpredictable response to gonadotropin stimulation of patients with PCO-like disease is due to the varying state of development of the follicles at the start of the stimulation. The suggestion is made, based on the different responses in 3 cycles of the same patient (EW), that the lack of positive estrogen feedback in patients with PCO-like disease may be a hyposensitivity to estrogens rather than an absolute insensitivity.

Anovulation↗
PubMed1979

Oestrogen modulation of gonadotrophin and prolactin release in women with anovulation and their responses to clomiphene.

An LHRH test was performed before and at both 44 and 92 h after the administration of 2.5 mg oestradiol benzoate in eleven patients with hyperprolactinaemia, eight with idiopathic secondary amenorrhoea and seven with oligomenorrhoea. The basal serum hormone concentrations and the responses to LHRH were compared with the same tests performed on ten normal subjects during the early follicular phase of their menstrual cycles (days 4--6). Mean basal concentrations of oestradiol in each group of patients and oestrone in those with hyperprolactinaemia were significantly lower than in the normal subjects. The mean concentration of prolactin in women with secondary amenorrhoea remained lower than in the normal women throught the tests (P less than 0.05). The LH and FSH responses to LHRH before oestrogen in patients with hyperprolactinaemia and of FSH in those with secondary amenorrhoea, were greater than in the normal subjects (P less than 0.001). After oestrogen treatment the responses were similar in all groups except in those with oligomenorrhoea where LH and FSH responses at 44 h (P less than 0.05 and P less than 0.01 respectively) and LH responses at 92 h (P less than 0.01) were lower than in normal controls. The responses at 92 h in all groups were greater than at 44 h (amplification) but the amplification at 92 h and at 44 h compared to the pre-treatment responses, tended to be lower in each group of patients compared to the normal controls. In the hyperprolactinaemic group of patients there was a negative correlation between the basal prolactin concentration and the gonadotrophin amplifications at 92 h (P less than 0.01), and a positive correlation between the basal oestrone levels and the amplifications at 92 h (P less than 0.01). The results of the oestrogen amplification test in eleven of the non-hyperprolactinaemic anovular patients were compared with the ovulatory response to 100 mg clomiphene given for 5 days. Six showed a normal oestrogen amplification and they all ovulated. Two patients failed to show greater amplification at 92 than at 44 h and required human chorionic gonadotrophin (HCG) as well as clomiphene to ovulate. The other three showed a diminished LH amplification at 92 h; they required 200 mg clomiphene and showed a prolonged follicular phase. The responses of the hyperprolactinaemic patients to clomiphene were poor and there was a negative correlation between prolactin concentration and oestrogen production (P less than 0.01). All ten hyperprolactinaemic patients treated with bromocriptine ovulated and eight conceived. The oestrogen amplification test appears to have some value in predicting the subsequent response to clomiphene in non-hyperprolactinaemic anovular women.

Adult↗
PubMed1989

The role of chronic anovulation in the polycystic ovary syndrome: normalization of sex-hormone-binding globulin levels after clomiphene-induced ovulation.

A group of anovulatory patients with polycystic ovaries (PCO) was given clomiphene citrate and compared with three control groups: normal women having spontaneous, ovulatory cycles, patients with PCO having spontaneous, regular, ovulatory cycles, and anovulatory patients without PCO. Comparisons were made at precise points of the menstrual cycle (taking the day of ovulation as day 0), using ultrasound estimates of mean follicular diameter, uterine volume, and endometrial thickness, and biochemical measurements of LH, FSH, oestradiol (E2), testosterone (T), progesterone (P) and sex-hormone-binding globulin (SHBG). Before clomiphene treatment, the anovulatory patients with PCO had significantly lower levels of SHBG and higher follicular phase concentrations of LH than all three control groups. After two cycles of clomiphene-induced ovulation, the serum LH concentration fell significantly and levels of SHBG increased significantly to levels similar to those found in spontaneously ovulating women with normal ovaries. It is likely that the loss of the usual considerable rise in E2 in both the follicular and luteal phases of ovulatory cycles is the main reason for the low SHBG found in the PCO syndrome. The loss of the normal P-induced gonadotrophin suppression may be a factor in allowing LH levels to rise.

Adolescent↗
PubMed1991

Treatment of anovulation due to polycystic ovarian syndrome by laparoscopic ovarian electrocautery.

Our experience of ovarian electrocautery for the treatment of polycystic ovarian syndrome (PCOS) in ten women is described. We found that nine responded favourably, either ovulating spontaneously or becoming more responsive to ovulation induction. There was a significant and persistent fall in serum testosterone levels, and a transient fall with subsequent rise in inhibin. We recommend that laparoscopic ovarian electrocautery is considered as an alternative to ovulation induction with gonadotrophins, in women with PCOS who fail to respond to clomiphene citrate.

Adult↗
PubMed1994

Postpartum anovulation in non-nursing monkeys: hypothalamic-pituitary-ovarian refractoriness is not induced by the milieu of early pregnancy.

To evaluate the role of the early pregnancy milieu in inducing postpartum refractoriness of the hypothalamic-pituitary-ovarian axis, pregnancies in rhesus monkeys were terminated on either day 35 of gestation or near term at 162 days. Non-nursing mothers with gestations interrupted near term resumed ovulation at a mean of 56 +/- 12 (mean +/- SE) days postpartum, in contrast to the 17 +/- 2 days required for the females having had abortions at day 35. These results demonstrate that the early pregnancy milieu is not determinant of the hypothalamic-pituitary-ovarian refractoriness observed in non-nursing mothers delivering at term.

Abortion, Induced↗
PubMed1997

Anovulation and monophasic cycles.

Normal pubertal development is often considered complete when the adolescent experiences her first menstrual period. However, sexual maturity is not attained until the onset of regular ovulatory cycles, which may take a number of months to years to accomplish. This maturation process is orchestrated by a neuroendocrine cascade and modified by autocrine and paracrine events in the ovary. The control of these complex relationships takes time and could not be expected to be fully functional with menarche. During the first menstrual months, the hypothalamic-pituitary-ovarian axis is immature, resulting in the secretion of only estrogens from the developing follicles; positive feedback to trigger ovulation develops later. Consequently, estrogen secretion is variable and unopposed by progesterone, which would normally be produced in ovulatory cycles. Estrogen-only primed endometrium often leads to irregular menstrual cycles with variable flow. Surprisingly, most adolescents do well and have few complaints in spite of these anovulatory cycles. If an abnormality is experienced with the menstrual cycle, once understood physiologically, it can be managed simply, by watchful expectancy or intermittent progestin therapy. Occasionally, sever menstrual bleeding is encountered, and in a proportion of these patients a thorough assessment will delineate an underlying medical problem that needs to be addressed. The management of these patients requires ingenuity from the pediatric reproductive endocrinologist and aggressive hormonal manipulation. Most patients do well, but some require long-term continuing care.

Adolescent↗