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PubMed2005

Urofollitropin and ovulation induction.

Anovulation is a common cause of female infertility. Treatment for women with anovulation is aimed at induction of ovulation. Ovulation induction with follicle-stimulating hormone (FSH) is indicated in women with WHO type II anovulation in whom treatment with clomifene citrate (clomifene) has failed. The majority of these women have polycystic ovary syndrome. The major disadvantages of ovulation induction with FSH are the risk of ovarian hyperstimulation syndrome and the risk of higher order multiple pregnancies. To reduce the rate of complications due to multiple follicular development, FSH should be administered using a chronic low-dose protocol with small dose increments. In women with WHO type I anovulation, an exogenous supply of luteinizing hormone (LH) is required to achieve an adequate follicular response to FSH treatment. Thus, ovulation induction with FSH is not the treatment of choice in these women. FSH is a hormone that stimulates follicle growth and oocyte maturation. Endogenous FSH is produced by the pituitary gland and exists as a family of isohormones exhibiting distinct oligosaccharide structures. FSH for exogenous administration is derived from urine or is produced as recombinant FSH. The commercially available FSH products all contain different mixtures of FSH isoforms. To determine the effectiveness of urofollitropin (urinary-derived FSH), a comparison with the other available gonadotropins was made (i.e. recombinant FSH and human menopausal gonadotropin). Urofollitropin and recombinant FSH appear to be equally effective and well tolerated for ovulation induction. Human menopausal gonadotropin is comparably effective to urofollitropin in terms of pregnancy outcomes. It remains unclear whether human menopausal gonadotropins have a higher risk of overstimulation and ovarian hyperstimulation syndrome compared to urofollitropin in women with polycystic ovary syndrome. In practice, recombinant products are more convenient to use but are also more expensive. Therefore, if availability is not an issue but costs are, there is still a place for the use of urofollitropins for ovulation induction.

Anovulation↗
PubMed1992

Clomiphene-dexamethasone treatment of clomiphene-resistant women with and without the polycystic ovary syndrome.

We used clomiphene and dexamethasone in 40 infertile women to treat chronic anovulation resistant to the use of clomiphene alone. Eighteen (45%) of the women had the polycystic ovary (PCO) syndrome; the remaining 22 (55%) had clomiphene-resistant anovulation from idiopathic causes. Both groups of women were similar in regard to age, parity, duration of infertility and absence of other causes of infertility besides chronic anovulation. Ovulation could be induced in approximately 90% of the women in each group. Altogether, 19 of 36 women (52.8%) conceived without any side effects or complications. The cumulative probability of conception at nine months of treatment was 87.5% in PCO patients and 46% in the non-PCO group. Clomiphene plus dexamethasone was highly effective in the treatment of clomiphene-resistant anovulation associated with infertility in women with and without the PCO syndrome.

Adult↗
PubMed1976

Selection of patients for clomiphene citrate therapy.

Ninety-three infertile women were treated with clomiphene citrate alone or in combination with human chorionic gonadotropin (hCG) for absent or infrequent ovulation. The patients were divided into eight categories according to the diagnosis obtained: ovarian androgenic hyperplasia, adrenal androgenic hyperplasia, mixed ovarian and adrenal androgenic hyperplasia, hypothalamic anovulation, postpill anovulation, follicular phase defect, luteal phase defect, and amenorrhea-galactorrhea syndrome. Each group was analyzed individually to compare the ovulation and conception rates and the complications involved. A survey of the data presented in this study shows that the best response was noted in patients with ovarian androgenic hyperplasia. Patients with a functional pathologic adrenal component responded favorably when dexamethasone was used as an adjuvant to clomiphene therapy. Those with hypothalamic anovulation responded better when hCG was added to clomiphene therapy. Women with postpill anovulation as well as those with follicular phase defect were found to be good candidates for clomiphene therapy. In properly selected patients with poor luteal phase defect, hCG secured excellent results both in ovulation and conception. Patients with lactation amenorrhea failed to ovulate when treated with clomiphene alone.

17-Ketosteroids↗
PubMed2006

Relationship between the first ovulation within three weeks postpartum and subsequent ovarian cycles and fertility in high producing dairy cows.

The aim of this study was to investigate the relationship between the first ovulation within 3 weeks postpartum and subsequent ovarian cycles and fertility in high producing dairy cattle in Hokkaido, Japan. In Experiment 1, 110 cows (44 primiparous and 66 multiparous) were used to determine the effects of the first ovulation within 3 weeks postpartum on subsequent ovarian cycles. Milk samples were collected twice weekly from 7 to 100 days postpartum. The first ovulation was identified by an increase in milk progesterone (P4) to more than 1 ng/ml within 3 weeks postpartum. The numbers of cows showing ovulation and anovulation within 3 weeks postpartum were 31 (70.5%) and 13 (29.5%) in the primiparous cows and 35 (53.0%) and 31 (47.0%) in the multiparous cows, respectively. The patterns of ovarian resumption after calving were classified into two types (normal ovarian cycles and abnormal ovarian cycles) on the basis of milk P4 concentrations. Initiation of normal ovarian function in cows ovulated within 3 weeks postpartum occurred earlier than in anovulated cows regardless of the number of calvings (primiparous, 27.8 days vs. 44.4 days; multiparous, 30.6 days vs. 55.7 days; P<0.01). Out of the multiparous cows that ovulated within 3 weeks postpartum, initiation of normal ovarian function followed by a normal luteal phase was earlier than when it was followed by an abnormal luteal phase (25.5 days vs. 40.4 days; P<0.05). Milk P4 concentrations after the first ovulation were lower than those after the second ovulation in both the primiparous and multiparous cows (P<0.05). In Experiment 2, 22 multiparous cows were used to determine the effects of the first ovulation within 3 weeks postpartum on subsequent fertility. Blood samples were collected once a week from 0 to 3 weeks postpartum. The interval from parturition to first service in ovulated cows was shorter than in anovulated cows (68.4 days vs. 94.8 days; P<0.05). The conception rate by 100 days after calving tended to be higher in ovulated cows than in anovulated cows (50.0% vs. 16.7%, P=0.09). In conclusion, our data strongly suggests that ovulation within 3 weeks postpartum is a crucial phenomenon for subsequent resumption of ovarian function and conception, and thus it can be used as an index of subsequent reproductive performance.

Animals↗
PubMed1983

Insulin resistance in polycystic ovary syndrome.

Patients with polycystic ovary syndrome (PCO) who are obese and exhibit acanthosis nigricans have been reported to have insulin resistance. We studied 21 euglycemic, euprolactinemic patients with PCO without acanthosis nigricans. Eleven of these patients were hirsute and the remaining 10 were not. Eight women with chronic anovulation, who were weight matched with the PCO patients, were studied along with the 11 ovulatory control subjects. Compared to control subjects, women with chronic anovulation had similar levels of immunoreactive luteinizing hormone (LH), bioactive LH, 17 beta-estradiol, testosterone (T), and dehydroepiandrosterone sulfate but significantly higher fasting immunoreactive insulin levels (p less than 0.05). The nonhirsute patients with PCO had higher immunoreactive insulin levels compared to patients with chronic anovulation and control subjects (p less than 0.05) while hirsute patients with PCO had higher immunoreactive insulin levels than nonhirsute ones (p less than 0.05). There was a significant positive correlation between fasting immunoreactive insulin levels and serum T. Fasting immunoreactive insulin also showed a significant correlation with serum LH and bioactive LH. After receiving 100 gm of oral glucose, hirsute patients with PCO had significantly higher insulin responses compared to those of control subjects despite similar glucose responses. Red blood cell insulin-binding sites and receptor affinities were similar in hirsute patients and control subjects. These data suggest that the hyperinsulinemia of patients with PCO may be related, in part, to the elevated LH and androgen levels and may be a postreceptor defect.

Adult↗
PubMed1989

The relation of fertility and ovarian histology after bilateral ovarian wedge resection.

The immediate and long term fertility after bilateral ovarian wedge resection in 53 women with clomiphene citrate-resistant hyperandrogenic chronic anovulation is related to the histology of the ovarian wedges. Patients with polycystic ovaries and hyperplastic stromal abnormalities had most spontaneous conceptions and a normal fertility during follow-up. Apparently, chronic anovulation in these cases had been caused by ovarian disease in the face of normal hypothalamic function. Patients with polycystic ovaries without stromal abnormalities often needed postoperative stimulation of ovulation in order to conceive, which may indicate hypothalamic involvement. Patients with large ovaries, normal stroma, and small follicles, who as a group had the lowest serum levels of luteinizing hormone, and patients whose ovaries contained large follicles and cysts without theca cell activity did not benefit from the bilateral ovarian wedge resection. Generally, their postoperative response to medical induction of ovulation did not improve either. Measures to prevent adhesions were not completely successful. Nevertheless, our results suggest that anovulation rather than formation of adhesions causes persistent infertility after bilateral ovarian wedge resection.

Adult↗
PubMed2004

Re-evaluation of secondary amenorrheic patients one year after initial diagnosis: a prospective study.

OBJECTIVES: The aim of the study was to re-evaluate women with secondary amenorrhea one year after the first visit evaluation. STUDY METHODS: One hundred and seventy-five women with secondary amenorrhea were evaluated on the first visit. Their ages ranged from 18 to 29. Secondary amenorrhea was defined by the absence of menses for more than 3 months after excluding pregnancy. Women who were attempting to conceive were excluded from the study. 1) One hundred and two women were anovulatory (2) 36 had hypogonadotropic hypogonadism, 3) 11 had hypergonadotropic hypogonadism, and 4) 21 had hyperprolactinemia, 5) and five fell into other categories. The one hundred and forty-nine women in categories 1) to 3) were followed up for one year after the first diagnosis was made. A monthly progestational agent or HRT (hormone replacement therapy) was given to women with anovulation or hypogonadism, respectively. RESULTS: Of the 149 women in categories 1) to 3), 100 could be evaluated one year after the first diagnosis. There were 31 women whose diagnosis was changed. Anovulation changed to hypogonadotropic hypogonadism in 11 women, oligomenorrhea in four, and normal ovulatory cycle in two. Hypogonadotropic hypogonadism changed to anovulation in nine women, and to normal ovulatory cycle in one. Hypergonadotropic hypogonadism changed to normal ovulatory cycle in two women. CONCLUSIONS: A significant finding is that approximately one third of the women initially diagnosed with secondary amenorrhea, upon re-evaluation within one year had their diagnosis changed. Therefore evaluation of amenorrhea at an appropriate time is critical for proper management.

Adolescent↗
PubMed1982

Plasma progesterone levels during long-term treatment with levonorgestrel silastic implants.

Plasma progesterone levels were measured in 113 women using a subdermal implant containing 200 mg levonorgestrel (NORPLANT) in an attempt to assess the roles of anovulation and inadequate luteal function in the contraceptive action of this method. Twenty-two women using an IUD (Copper T 200) served as a control group. Blood samples were taken twice a week for 6 consecutive weeks. This was done one to four times in each subject during the first 7 years after insertion of NORPLANT. Plasma progesterone was measured by a specific RIA and criteria based upon normal values in this laboratory were used to define each set of samples as ovulatory, uncertain or anovulatory. The rate of anovulation varied between 25 and 80% throughout the 7 years. The highest rate was observed during the first year of treatment of treatment. The rate of anovulation was significantly correlated with the plasma levels of levonorgestrel. Varying degrees of inadequate corpus luteum function were detected among NORPLANT users. All sets of samples in the control group were ovulatory and compatible with normal luteal function. These results clearly show that continuous administration of levonorgestrel by means of NORPLANT interferes with ovulation and/or luteal function in a significant proportion of cycles throughout the first 7 years of use.

Adult↗
PubMed2006

Thiazolidinediones for the therapeutic management of polycystic ovary syndrome : impact on metabolic and reproductive abnormalities.

Polycystic ovary syndrome (PCOS) is a diagnosis made between late adolescence and the menopause in 5-10% of women. PCOS is a heterogeneous disorder of unknown etiology characterized by hyperandrogenic chronic anovulation. This syndrome consists of a diverse constellation of signs and symptoms, such as hirsutism, acne, acanthosis nigricans, obesity, menstrual irregularities, anovulation, and/or infertility. Features of the metabolic syndrome, including obesity, insulin resistance, and dyslipidemia, are common in this patient population. Recent insights into the pathophysiology of PCOS have shown insulin resistance and hyperinsulinemia to play a substantial role. Insulin resistance is increasingly recognized as a chronic, low-level, inflammatory state. Recent studies show that serum levels of inflammatory mediators, such as tumor necrosis factor-alpha and interleukin-6, are increased in the insulin-resistant conditions of obesity and PCOS. The optimal modality for long-term treatment should have positive effects on androgen synthesis, sex hormone-binding globulin production, the lipid profile, insulin sensitivity, inflammatory mediators, and clinical symptoms including acne, hirsutism, and irregular menstrual cycles. Treatment with insulin-sensitizing agents is a relatively new therapeutic strategy in women with PCOS. Current research has shown that the use of diabetes mellitus management practices aimed at reducing insulin resistance and hyperinsulinemia (such as weight reduction and the administration of oral antidiabetic drugs) can not only reverse testosterone and luteinizing hormone abnormalities and restore menstrual cycles, but can also improve glucose, insulin, proinflammatory cytokine, and lipid profiles.Clinical treatment with troglitazone, a member of the thiazolidinedione family, for the management of PCOS complications such as insulin resistance, hyperandrogenism, and anovulation was found to have beneficial effects; however, it was taken off the market over concerns of hepatotoxicity. Although troglitazone is no longer available in the US, numerous clinical trials have established the role of thiazolidinediones in the treatment of women with PCOS. Clinical data emerging regarding the utility of two of the newer, safer thiazolidinediones, pioglitazone and rosiglitazone, for this patient population, consistently demonstrate effective improvements of endocrine and ovulatory performance in women with PCOS. The benefit and importance of lifestyle modification and weight reduction, when it can be achieved, is still an important component in the long-term treatment of PCOS. Pharmacologic reduction in insulin levels using thiazolidinediones appears to offer another therapeutic modality for PCOS, which may ameliorate the progress of both hyperinsulinemia and hyperandrogenism. However, additional studies of patients so treated are necessary before these agents can be considered first-line treatment for PCOS. Convincing data from randomized controlled trials with sufficient power to detect both the benefits and risks of long-term treatment with thiazolidinediones in women with PCOS remain to be obtained.

Anovulation↗
PubMed1995

Partial uncoupling of luteinizing hormone and prolactin pulse coincidence in hyperandrogenemic women.

A partly synchronized pulsatile secretion of luteinizing hormone (LH) and prolactin has previously been suggested as an indication of the coupling of the respective pulse generators under certain conditions. In women with hyperandrogenemic chronic anovulation, episodic LH secretion is disturbed. It was, therefore, the aim of the present study to evaluate possible changes in episodic prolactin secretion pattern and in LH/prolactin co-pulsatility, and to relate the results to the accelerated LH pulse frequencies often seen in patients with hyperandrogenemic chronic anovulation. Blood samples of 32 patients with hyperandrogenemia were taken at 10-min intervals between 10.00 and 20.00. Nine regularly cycling women with normal hormone levels served as controls. In the women with hyperandrogenemia, despite an average 41% rise of LH pulse frequency, prolactin pulse frequency decreased slightly by 14% as compared to controls; no correlation between the two parameters was found (r = 0.162). The number of coincident LH and prolactin pulses increased continuously with accelerating LH frequency. The best fitting function was a hyperbola which was limited by the maximal observed prolactin frequency. As a consequence, the fraction of LH pulses that were co-secreted with prolactin episodes decreased with higher LH pulse frequencies, while the fraction of prolactin pulses concomitant with LH pulses increased. Our data provide evidence that in women with hyperandrogenemic chronic anovulation a pathological LH pulse frequency is no longer coupled with pulsatile prolactin secretion, suggesting an isolated alteration of the central neuronal control mechanism for LH secretion.

Adolescent↗
PubMed2007

Prevalence and risk factors for postpartum anovulatory condition in dairy cows.

The objectives of this research were to determine the prevalence of the anovulatory condition within a temperate region of North America and identify cow-level and herd-level risk factors for this condition. A total of 1,341 cows from 18 herds were classified as cycling or anovular based on skim milk progesterone concentration determined at 46 and 60 +/- 7 d in milk. Calving history, periparturient disease incidence, body condition score, milk ketone concentration in the first 2 wk of lactation, and first 305-d mature-equivalent milk projections were recorded. Reproductive and culling information was retrieved monthly from the Dairy Herd Improvement Association. The cow-level prevalence of anovulation was 19.5%, with a herd-specific range from 5 to 45%. Accounting for the effect of clustering at the herd level, cows experiencing a difficult calving, cows with twin calvings, displaced abomasum, and cows with subclinical ketosis in the first week after calving were at greater risk for diagnosis of anovulation. Anovular cows within herds using ovulation synchronization programs were inseminated at the same time postpartum with a 6-percentage point reduction in the probability of pregnancy relative to cycling herdmates (29.7 vs. 35.9%, respectively), whereas anovular cows in herds breeding based on observed estrus were inseminated 8 d later and suffered a 10-percentage point reduction in the probability of pregnancy at first insemination (20.3 vs. 30.5). Time to pregnancy was delayed in anovular cows by 30 d (156 vs. 126 d). Using survival analysis, the impact of anovulation decreased with time. The daily probability of pregnancy (hazard ratio) was similar to cycling cows by 165 d in milk. The results underline the important associations of peripartum health with reproductive function and performance.

Animals↗
PubMed2000

[Polycystic ovary syndrome].

The polycystic ovary syndrome (PCOS) is the most frequent endocrine disease in women of reproductive age. Hyperandrogenism, anovulation and metabolic syndrome are the cardinal features of PCOS. Hyperandrogenism results from a diffuse enzymatic hyperactivity at the theca-interstitial cell level. Anovulation is due to an impairment of the selection of a dominant follicle, while the number of smaller follicles is exaggerated. The molecular grounds of insulin resistance could be an increased Serine phosphorylation of the insulin receptor. The clinical classification of PCOS distinguishes three forms: the classic PCOS, where the three above mentioned features are present, the non classic PCOS and the asymptomatic PCOS, revealed by ultrasonography. Only the increased ovarian volume or surface (>11ml and> 5.5cm(2), respectively) must be viewed as a specific ultrasonic sign of PCOS. Cyproterone acetate remains the basic treatment of hyperandrogenism. The treatment of anovulation and infertility follows a consensual strategy. The insulin sensitizing treatment allows to decrease hyperandrogenism, to reverse the menstrual cycle irregularity and to obtain spontaneous or induced pregnancies.

Anovulation↗
PubMed2003

Obesity is the major factor determining an insulin sensitivity and androgen production in women with anovulary cycles.

Aim of this study was to test the hypothesis that obesity promotes the insulin-sensitivity and ovarian hyperandrogenism in anovulating women independently of the polycystic ovary syndrome (PCOS). We examined 80 women of reproductive age (19-38 years, mean 28.5 +/- 0.6 years) with anovulary cycles. 45 subjects had PCOS and 35 had chronic anovulation without hormonal and ultrasound criteria of PCOS. The control group consisted of 12 healthy females with normal ovulary menstrual cycle (age 26.4 +/- 0.6 years). We evaluated plasma insulin level baselines (I0); 120 min after oral administration of 75g of glucose (I120), we examined FSH, LH, prolactin, testosterone, 17 OH progesterone and DHEAS and calculated indexes of insulin sensitivity, i.e. FIRI and G/I. Women with anovulary cycles yielded a significant increase in I0 (p < 0.01), I120 (p < 0.01), FIRI (p < 0.01), FSH, LH (both p < 0.05) and testosterone (p < 0.01), and a significantly decrease in G/I (p < 0.01) in comparison to controls with normal weight. There was a significant correlation between BMI and insulin levels, BMI and FIRI, and between WHR or waist circumference and FIRI, or G/I. The highest levels of insulinemia and the highest degree of insulin resistance were found in obese women (BMI > 30 kg/m2). In the group of obese anovulating women we found a positive correlation between I0 and testosterone (p < 0.01). In PCOS group, we found a negative correlation between I0 and LH (p < 0.01), and FIRI and LH (p < 0.01). In the group of obese PCOS women there were significantly higher levels of plasma insulin, and lower insulin sensitivity as compared to lean PCOS patients. However, lean PCOS women were more hyperinsulinemic and insulin resistant than the control group of lean women. Our results indicate, that obesity is the important factor determinating the insulin sensitivity and hyperinsulinemia in PCOS women. Moreover, the body weight is the major determinant of insulinemia, insulin sensitivity and ovarian hyperandrogenism, independently of PCOS. (Tab. 5, Fig. 4, Ref. 23.).

Adult↗
PubMed1990

Ultrastructural basis for continued steroidogenesis in the rat polycystic ovary.

Because constant light causes persistent estrus in the rat, that animal provides a suitable experimental model for studying the pathogenesis of polycystic ovary disease. We studied the scanning and transmission electron microscopic features of the rat polycystic ovary along with changes in serum estradiol and progesterone concentrations to further elucidate the mechanism of chronic anovulation during persistent estrus. The surface epithelium of the polycystic ovary showed no ovulatory stigmas and contained focal areas of degenerating and proliferating cells. The tunica albuginea was conspicuous, with many fibrils, collagenous materials and fibroblastlike cells adjoining the theca externa layer. The cytoplasm of theca interna cells contained numerous lipid vacuoles and images of extracted cholesterol crystals. The granulosa cells were atrophic and lacked the prominent Golgi apparatus typically found in granulosa cells of proestrous ovaries in cycling rats. With an increasing duration of constant light and chronic anovulation, the mean serum estradiol concentration in persistent-estrus rats was significantly higher and the mean serum progesterone concentration significantly lower than in age-matched controls. Alterations in estradiol-progesterone metabolism in the ovaries may be important etiologic factors in the pathogenesis of chronic anovulation found in polycystic ovary disease in rats.

Animals↗
PubMed1978

Intrauterine development, feto-placental function and pregnancy outcome after induction of ovulation with bromoergocryptine.

18 pregnancies occurred after treatment with bromoergocryptine in 17 patients who wished to conceive, but who suffered from anovulation of varying aetiology. The course of 15 pregnancies was uneventful. Three pregnancies ended in abortion. Nine of the 17 women had hyperprolactinemic amenorrhea. Furthermore, one woman had normoprolactinemic post-pill amenorrhea, another normoprolactinemic anovulatory oligomenorrhea and a third normoprolactinemic anovulatory regular menstruations. With the exception of one woman, all had galactorrhea. The courses of pregnancy were monitored by frequent ultrasound measurements of the fetal biparietal diameter, maternal urinary estriol excretion and radioimmunological measurements of plasma estrone, estradiol, unconjugated and immunoreactive estriol, progesterone, and HPL. All data were within the normal ranges and all babies were healthy at birth and had no teratogenic defects. The data prove the great value of bromoergocryptine in the treatment of hyperprolactinemic anovulation, sometimes even in the treatment of normoprolactinemic anovulation. Moreover, the results indicate no adverse effect on either the course or the outcome of pregnancy.

Abortion, Spontaneous↗
PubMed2004

Effects of abnormal ovarian cycles during pre-service period postpartum on subsequent reproductive performance of high-producing Holstein cows.

The primary objective of this study was to investigate the effects of abnormal ovarian cycles during the pre-service postpartum period on subsequent reproductive performance of high-producing Holstein cows. The study was conducted in a commercial dairy farm with approximately 150 lactating cows, in a subtropical region of Japan. Animals were kept in free-stall barn, and fed a total mixed ration. Cows that calved from June 2001 to July 2002 were included in the study. Milk samples were collected twice weekly from 2 to 11 weeks postpartum, and progesterone concentrations in skim milk were determined by ELISA. After a voluntary waiting period of 40 days, cows detected in estrus were bred by artificial insemination (AI). Pregnancy was confirmed by palpation per rectum 40-70 days after AI. Out of a total of 91 cases, 39 (42.9%) had normal ovarian cycles (ovulation within 45 days after calving, followed by normal ovarian cycles), 32 (35.2%) had prolonged luteal phase (i.e. luteal activity for >20 days), and 12 (13.2%) had anovulation or delayed first ovulation (i.e. first ovulation did not occur until >45 days after calving). The remaining (8.8%) had other types of abnormalities. When compared with cows with a normal ovarian cycle, prolonged luteal phase cows had a lower 100 days AI submission rate, conception rate and pregnancy rate (84.2% versus 56.3%; P<0.05, 50% versus 16.7%; P<0.05 and 42.1% versus 9.4%; P<0.01, respectively), and longer intervals to first AI and to conception ( 67+/-6 days versus 98+/-7 days and 95+/-9 days versus 136+/-11 days; P<0.01 for each). Similarly, when compared with cows with normal ovarian cycles, those with anovulation had lower 100 days conception rate and pregnancy rate (50% versus 0%; P<0.05 and 42.1% versus 0%; P<0.01, respectively), and longer intervals to first AI and to conception ( 67+/-6 days versus 93+/-12 days; P<0.05 and 95+/-9 days versus 155+/-14 days; P<0.01, respectively). Survival analysis of the data for calving to conception interval showed that cows with prolonged luteal phase or anovulation were getting pregnant at a slower rate, and took longer to get pregnant than the cows with normal resumption of ovarian cyclicity postpartum. In conclusion, abnormal ovarian cycles during the pre-service period postpartum adversely affected reproductive performance, including AI submission rate, pregnancy rate, interval to first AI, and calving to conception interval in high-producing Holstein cows.

Animals↗
PubMed1995

Luteal phase defects and ectopic pregnancy.

OBJECTIVE: To determine whether luteal phase defect (LPD) may be an etiologic factor in ectopic pregnancy (EP). DESIGN: All patients who were seen over a 6-year period with the chief complaint of infertility underwent an extensive infertility workup and were followed prospectively. The diagnoses of the causes of infertility were assigned retrospectively. SETTING: Two hospital-based tertiary care reproductive endocrine-infertility units. PATIENTS: A total of 1,077 infertility patients were evaluated. Of the 633 who became pregnant, the infertility had been due to LPD in 51 and to anovulation in 210. MAIN OUTCOME MEASURES: All the infertility patients who became pregnant were followed to determine whether they miscarried, developed an EP, or had a viable birth. The incidence of EP and miscarriage in the patients whose infertility was found to be due to LPD were compared with a control group in whom the infertility was due to anovulation. RESULTS: The EP rate in the patients with LPD was significantly higher than in a control group whose infertility was due to anovulation (6 of 51 pregnancies versus 6 of 210 pregnancies, respectively). The spontaneous abortion rate in LPD cases also was highly significantly greater than in the control group (19 of 51 pregnancies versus 12 of 210 pregnancies, respectively). The EP and spontaneous abortion rates also were higher in patients with LPD who were untreated than in those who were treated. CONCLUSIONS: This study suggests that there is a significantly increased incidence of tubal EP in patients with LPD and that when patients with LPD become pregnant early ultrasound should be performed to rule out EP. The study also indicated that spontaneous abortion occurs in a significantly high percentage of LPD cases.

Female↗
PubMedDate not supplied

The polycystic ovary syndrome: what does insulin resistance have to do with it?

About half of infertility cases are attributable to female factors, of which anovulation is the leading cause. Most cases of anovulation are due to the polycystic ovarian syndrome (PCOS). Clinically PCOS, present in 5% of all women, consists of anovulation, acne, hirsutism, reversed LH-to-FSH ratio and often resistance to insulin. In some cases PCOS appears in familial clusters but its genetic cause is unknown. Several genes were suggested as possible culprits for PCOS but their involvement has not been proven. The central paradox regarding the role of insulin in PCOS is the high responsiveness to insulin by the ovary, as opposed to the resistance of the whole body. On the backdrop of knowledge of several paralogous genes for each of the participating proteins in the insulin signal transduction pathways, it is possible that different paralogues propagate the intracellular signal in the ovary as opposed to peripheral tissues. Studies by microarray techniques of the different gene expression profiles in the two ovarian cells and peripheral cells such as adipocytes could clarify whether the ovarian defect in PCOS is identical to the peripheral defect in insulin signal transduction, or whether serum insulin concentrations simply serve to reveal the ovarian defect.

Female↗