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PubMed1998

Use of urine biomarkers to evaluate menstrual function in healthy premenopausal women.

A total of 403 healthy, premenopausal women, residing near Santa Clara, California, were recruited from a large health care plan in California for a study of menstrual function. After a telephone interview, participants collected daily urine samples and recorded bleeding and other information in diaries. Data were collected during 1990-1991. Urine samples were analyzed for creatinine and for estradiol and progesterone metabolites by enzyme-linked immunoassay. Computer algorithms were developed to derive menstrual segment length, ovulatory status, day of ovulation, and other parameters from the urine and diary data. (We use "segment" rather than "cycle" to avoid implying that normal cycling occurred.) The average length of participation was 141 (standard deviation, 45) days. The mean segment length was 28.8 (standard deviation, 4.4) days; follicular phase length, 16.0 (standard deviation, 4.4) days; and luteal phase length, 12.9 (standard deviation, 1.7) days; 19 (4.7%) women experienced anovulatory episodes. In exploratory multivariate analyses, important associations included the following: age of > or = 35 years with decreased segment and follicular phase lengths; heavier weight (upper quartile) with anovulation and increased follicular phase and decreased luteal phase lengths; Hispanic ethnicity with anovulation and increased segment length; and past difficulty in achieving pregnancy with anovulation and increased length and variability of segments and follicular phases. Urine biomarkers can be used successfully to evaluate menstrual function in epidemiologic studies.

Adult↗
PubMed2002

Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility.

OBJECTIVE: To assess whether the rate of bacterial vaginosis (BV) is higher in women with tubal factor infertility compared with those with other causes of infertility. DESIGN: Cross-sectional study. SETTING: Assisted conception unit of a teaching hospital in Leeds. POPULATION: Consecutive women undergoing in vitro fertilisation. METHODS: Women undergoing in vitro fertilisation (IVF) had a vaginal smear taken at the time of their egg collection. The smear was Gram-stained and graded as normal, intermediate or BV. MAIN OUTCOME MEASURES: The presence of bacterial vaginosis and the causes of infertility. RESULTS: A total of 749 women were included. The vaginal smears were normal in 63.6%, intermediate in 12.1%, and BV in 24.3%. The rates of BV in women with different types of infertility were 36.4% in tubal factor, 15.6% in male factor, 33.3% in anovulation, 12.5% in endometriosis and 18.9% in unexplained infertility. After controlling for the effects of age and smoking using a multivariate logistic regression model, women with tubal infertility were significantly more likely to have BV than women with endometriosis OR 3.63 (95% CI 1.52-8.67); male factor OR 2.98 (95% CI 1.80-4.90); and unexplained infertility OR 2.20 (95% CI 1.35-3.59). The adjusted figures for the increase of BV in women with anovulation were: endometriosis OR 3.77 (95% CI 1.28-11.08); male factor OR 3.09 (95% CI 1.37-6.96); and unexplained infertility OR 2.29 (95% CI 1.02-5.12). CONCLUSIONS: Women with tubal infertility were three times more likely to have BV than women with endometriosis, male factor or unexplained infertility. These findings support the association between BV, pelvic inflammatory disease (PID) and tubal damage but do not help distinguish between cause and effect. Women with anovulation were also three times more likely to have BV than women with endometriosis or male factor infertility, supporting suggestions of hormonal influence on vaginal flora.

Adult↗
PubMed1984

Endocrine comparison of obese menstruating and amenorrheic women.

10 examine the relationship between obesity and chronic anovulation, we compared basal serum LH, FSH, and PRL levels, determined at 20-min intervals, and basal C21 [progesterone, 17- hydroxyprogesterone , pregnenolone, 17-hydroxypregnenolone ( 17Pe ), and cortisol], C19 [testosterone (T), delta 4-androstenedione (A), and dehydroepiandrosterone] and C18 (estrone and estradiol) steroid hormone concentrations measured at 1- to 2-h intervals for a 24-h period in five normal weight cycling women (NC) and in two groups of weight-matched obese women. Five of the obese women were regularly cycling (OC), and six were amenorrheic (OA). Sex hormone-binding globulin (SHBG) and non-SHBG-bound T and estradiol concentrations were also measured in each woman. Compared to NC women, OC women had normal basal protein and steroid hormone concentrations, except for reduced 17Pe levels (P less than 0.05). Mean SHBG concentrations were reduced by approximately 30%, and non-SHBG-bound T was increased by 70%, although the differences were not significant. In addition, when six precursors of testosterone (pregnenolone, 17Pe , dehydroepiandrosterone, progesterone, 17-hydroxyprogesterone, and A) were considered together as a group and the data analyzed by the kappa 2 test, a reduction in basal levels of these precursors was found in OC women relative to those in NC women (P less than 0.005). In OA women, mean concentrations of SHBG were markedly reduced and those of total T, A, estrone, and non-SHBG-bound T were significantly increased compared to those in both NC and OC women. Mean 24-h concentrations of LH tended to be greatest and FSH lowest in this group, but were not significantly different from those in the other groups. The mean LH pulse frequency was significantly greater in OA than in OC women (P less than 0.05). Mean 24-h PRL and cortisol levels were also reduced in OA women relative to those in NC women. These data suggest the possibility of a compensatory decline in total T production in OC women in an attempt to maintain normal hormonal homeostasis; as a consequence, ovulation continues in a cyclic fashion. In OA women, such compensatory mechanisms are no longer operative. Instead, a central and/or peripheral defect, resulting in overproduction of androgen, may also exist and lead to anovulation in OA women. In conclusion, our data imply that obesity is not a primary factor causing chronic anovulation. However, obesity may aggravate an already existing subtle defect in some women and result in amenorrhea.

Adult↗
PubMedDate not supplied

Ovarian factor infertility.

The diseases of the ovary which most frequently cause infertility are: anovulation from follicular atresia, the empty follicle syndrome, the luteinized unruptured follicle syndrome; chronic anovulation syndromes, within which polycystic ovarian syndrome plays a major role; ovarian endometriosis. Sonography and Color Doppler US are the first choice procedures in the monitoring of ovarian cycles, which combined with serum hormone values, are able to identify possible changes in the physiologic sequence of the cycle. In follicular atresia, ovaries with minute follicles (3mm or less) and early disappearance of primary follicle are observed on sonography. The empty follicle syndrome characterized by the lack of oocytes within the primary follicle, is of difficult sonographic diagnosis, a possible sign being the missed visualization of cumulus oophorus. The luteinized unruptured follicle syndrome consists in the absence of oocyte expulsion from primary follicle persisting more than 48 hours after LH blood peak. Doppler spectra of blood flow in perifollicular ovarian arteries maintain the features of the follicular phase, i.e. low diastolic velocities and high resistances. Among chronic anovulation syndromes, hyper-and hypogonadotropism cause ovarian amenorrhea where ovaries are similar to those of women in menopause: small size, very few or absent follicles. The polycystic ovarian syndrome is characterized by an abnormal pulsatile GnRH release which causes LH hypersecretion and FSH hyposecretion. The latter is not able to stimulate the growth and maturation of follicles, while the former causes hyperandrogenism with hirsutism and obesity and is responsible for hypertrophy and stromal hyperechogenicity. The sonographic diagnosis of polycystic ovarian syndrome is based on standardized morphostructural signs as increased volume of the ovaries (> 10 cm3), the presence of numerous (> or = 10) peripheral microfollicles (< or = 5 mm) with hyperechoic stroma. The endometrial cyst, usually present in ovarian endometriosis is visualized with sonography as a round neoformation with ill-defined walls, filled with a uniformly hypoechoic, corpuscular, partly hemorrhagic fluid; less frequently the appearance is that of a more complex structure posing differential diagnostic problems, mainly with the hemorrhagic corpus luteum; both pathological conditions appear poorly vascularized at Color Doppler, with tracings of high resistance arterial flow. Among the procedures of second choice, CT can show the high blood density common to the two conditions while on MRI the signal is mostly hyperintense in T1-weighted sequences with areas of lower signal intensity in T2-weighted sequences.

Female↗
PubMed2000

Association of metformin and pregnancy in the polycystic ovary syndrome. A report of three cases.

BACKGROUND: Infertility is a common manifestation of the polycystic ovary syndrome (PCOS), a condition characterized by chronic anovulation, hyperinsulinemia and hyperandrogenism. Hyperinsulinemia leads to increased ovarian androgen production, resulting in follicular atresia and anovulation. Metformin, a medication that improves insulin sensitivity and decreases serum insulin levels, restores menstrual cyclicity and ovulatory function and may improve fertility rates in women with PCOS. We present three consecutive cases from our clinic that support this premise. CASES: Three patients were seen in the reproductive endocrinology clinic with documented PCOS, long-standing infertility and clinically diagnosed insulin resistance. The first patient had hyperandrogenic, insulin-resistant acanthosis nigricans syndrome and had been resistant to multiple courses of clomiphene citrate; the second exhibited hypertension, hyperlipidemia and glucose intolerance along with anovulation; and the third presented with poorly controlled type 2 diabetes and a desire to conceive. Each patient received metformin, which led to restoration of menstrual cyclicity and conception in all three cases. CONCLUSION: These three patients reflect the heterogeneous nature of PCOS, and treating their underlying insulin resistance with metformin resulted in pregnancy. These findings suggest that metformin may be a useful adjunct for treatment of infertility in patients with PCOS.

Adult↗
PubMed2000

Polycystic ovary syndrome: it's not just infertility.

Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.

Female↗
PubMed2000

[Effect of tiangui recipe on expressions of hypothalamic leptin receptor and messenger ribonucleic acid of neuropeptide Y in androgen-sterilized rats].

OBJECTIVE: To explore the effect of Tiangui Recipe (TGR) on obesity and anovulation in androgen-sterilized rats (ASR) from the gene transcription level. METHODS: In situs hybridization and autoradiography were adopted, using alpha-32 P-radiolabelled leptin receptor (OB-R) and neuropeptide Y (NPY) oligonucleotides probes and integrating with image pattern analysis, to observe the effect of TGR on changes of OB-R, NPY mRNA expression in the hypothalamic arcuate nucleus (ARC). RESULTS: Compared to the normal rats, the levels of hypothalamic OB-R mRNA expression decreased, NPY mRNA expression elevated significantly in ASR (P < 0.01). ASR characterized by obesity and anovulation. There was no significant difference in hypothalamic OB-R, NPY mRNA expressions between normal rats and ASR with TGR administration. CONCLUSION: The increased hypothalamic NPY and decreased OB-R mRNA expression may be important contributing factors to the development of obesity and anovulation in ASR. TGR may play a role in reducing weight and inducing ovulation by regulating NPY/OB-R mRNA expression.

Animals↗
PubMed2002

[Gynecologic and obstetric complications in eating disorders].

OBJECTIVE: This report summarizes recent clinically relevant findings concerning gynecological psychosomatic symptoms of eating disorders the implications for psychiatric diagnosis and management. METHOD: The author conducted selective reviews of the literature from the last 15 years. RESULTS: Malnutrition, low body weight are also an important cause of anovulation and amenorrhoea. Eating disorders such as anorexia nervosa, bulimia nervosa are associated with potential negative consequences during pregnancy, including higher rates of miscarriage, low birth weight, obstetric complications and post partum depression. CONCLUSION: The most suitable treatment for infertility secondary to weight related amenorrhoea or anovulation is therefore dietary rather than induction of anovulation. This highlights the importance of early detection and treatment by primary care teams. There is a need to develop preventive intervention strategies.

Bulimia↗
PubMed2006

[Exploration of the classification of polycystic ovarian syndrome].

OBJECTIVE: To investigate the clinical presentation, hormonal profile and metabolic abnormalities in subgroups of women with PCOS and explore a reasonable classification for PCOS. METHODS: A cross-sectional study of 192 women with PCOS (14 - 38 years of age) was performed. The patients were divided into 3 groups of A, B and C according to the revised 2003 consensus on diagnostic criteria and also divided into 2 groups according to body mass index (BMI): group A (n = 110), long term anovulation, clinical and biochemical evidence of high androgen level, ovary enlargement with its size larger than 10 ml or number of small follicles of 2 - 9 mm >or= 12 under ultrasound with exclusion of other diseases caused by high androgen; group B (n = 46), long term anovulation, clinical and biochemical evidence of high androgen level; group C (n = 36), long term anovulation, ovary enlargement with its size larger than 10 ml or number of small follicles of 2 - 9 mm >or= 12 under ultrasound with exclusion of other disease caused by high androgen; obesity PCOS group (OB-PCOS, n = 70), BMI >or= 25 (kg/m(2)); no obesity PCOS group (NOB-PCOS, n = 122), BMI < 25 (kg/m(2)). One hundred and four women with bilateral tubal block factor caused infertility served as control group. Anthropometric measurements, Ferriman Gallwey hirsutism scoring, presence of acne and acanthosis nigricans were noted. Hormonal profile was assessed by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone (FT), prolactin (PRL), sex hormone binding globulin (SHBG). The metabolic profile was investigated by measurements of oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Hyperinsulinemia was estimated by measurement of fasting insulin (FINS) and insulin area under the curve (IAUC). The extent of insulin resistance (IR) and hyperandrogenism was estimated by homeostasis model assessment (HOMA) and free androgen index (FAI) respectively. RESULTS: (1) Clinical phenotypes: the presence of obesity was 36.4% (70/192), among which 80.0% (56/70) were central obesity. Higher rates of acanthosis nigricans were observed in OB-PCOS group (35.7%, 25/70) compared with NOB-PCOS group (7.4%, 9/122; P < 0.01). Waist to hip ratio (WHR) was lower in group C than those in groups A and B (P < 0.05). (2) Endocrinology: FAI level was higher in OB-PCOS group than in NOB-PCOS group (P < 0.01), whereas LH/FSH ratio was lower in OB-PCOS group compared with NOB-PCOS group (P < 0.01). FAI level was higher in groups A and B than in group C (P < 0.01). SHBG, LH/FSH ratio did not differ between groups A, B, and C. (3) Metabolism: the prevalence of IR was 43.2% (83/192). A higher prevalence was observed in group OB-PCOS (82.8%, 58/70) compared with group NOB-PCOS (20.5%, 25/122; P < 0.01). FINS, HOMA-IR, glucose area under the curve (GAUC), IAUC and TG were higher in group OB-PCOS than in group NOB-PCOS (P < 0.01), whereas HOMA-IR, lipid profile did not differ between groups A, B, and C. CONCLUSION: The classification according to the revised 2003 consensus on diagnosis reflects the basic characteristics of PCOS; while the classification based on obesity shows the severity of hyperandrogenism and degree of IR, and thus has substantial significance for evaluation of metabolic complications.

Adolescent↗
PubMed1991

The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time.

We have studied a large group of Australian women breastfeeding for an extended period of time to determine the duration of lactational anovulation (n = 89) and amenorrhea (n = 101). Salivary progesterone assays were used to determine ovulation. These women had a mean of 322 days of anovulation and 289 days amenorrhea. Less than 20% had ovulated and less than 25% had menstruated by 6 months postpartum. The latest ovulation was at 750 days and the latest menstruation at 698 days. There was no significant correlation between any measure of maternal nutritional status and the duration of anovulation or amenorrhea. Neither the time of first supplement introduction to the baby nor the amount of supplement given was an accurate predictor of the return of ovulation or menstruation. However, our results clearly show that lactational amenorrhea can provide good protection against pregnancy in the 1st 6 months postpartum, even in well-nourished women who are giving their babies supplemental feeds.

Adult↗
PubMed1991

Endometrial biopsy in women with primary infertility.

Of 2616 endometrial biopsies received over a 55 month period, 1022 (39.1%) were from patients with primary infertility. All endometria from these patients were reviewed and while most diagnosis agreed with the primary diagnosis made by the reporting pathologist, an interobserver difference of 6.8 per cent was found. This difference occurred only on biopsies with anovulatory endometrium. Of the 1022 patients, 238 had definite hormonal derangements as assessed by morphological means on endometrial biopsy. Anovulation as assessed by glandular stromal dissociation and as a cause of infertility was noted in 12.6 per cent patients. The incidence of anovulation increased over the age period of 20-25 yr, with a peak at 25 yr. A close parallel was found of the period of anovulation and the period of nubility. An inflammatory cause for the infertility appeared to be negligible in our series.

Adolescent↗
PubMed1983

[Screening for incomplete enzymatic blocks of 21-hydroxylase. Study of 17-OH progesterone with tetracosactide in the follicular and luteal phases in hirsute women].

It seemed to us worth while when taking plasma samples to prove the presence or absence of ovulation and the presence or absence of a 21-hydroxylase block by estimating the levels of 17-hydroxyprogesterone under stimulation with tetracosactide. The results are as delta hydroxyprogesterone (ng/dl/mn). Eighteen women were studied in this way in the follicular phase (delta OHP: 1.21 +/- 0.71 ng/dl/mn) and 9 women in the luteal phase (delta OHP: 0.76 +/- 0.55 ng/dl/mn). This, while reliable, was not significant statistically. The explanation seems to be linked to anovulation. In the five cases with anovulation delta OHP was 0.233 ng/dl/mn, while in other cases where ovulation was proved to exist it was 1 ng/dl/mn. It seems to us that the so-called "luteal phase" should not have been retained when we wanted to test for a hormonal block, except where ovulation has been proved previously to be present, because of the possibility of anovulation. The interrelationships between the polycystic ovary syndrome and the therapeutic implications are discussed.

17-alpha-Hydroxyprogesterone↗
PubMed1995

[Polycystic ovarian dystrophies. Diagnostic criteria and treatment].

Polycystic ovary syndrome (PCOS) is an association of oligomenorrhoea, anovulation, hyperandrogenism, obesity and enlarged polycystic ovaries. It provides a model of loss of cyclic ovarian function. It is classical to distinguish between type I and type II PCOS. In type I, the primary mechanism seems to be hypothalamic dysfunction, which causes an increase in the frequency and amplitude of LH pulses, with diminished FSH release. LH hypersecretion stimulates ovarian stroma hyperplasia while FSH insufficiency results in the failure of folliculare maturation and hence anovulation. Aromatization of androgens to oestrogens is responsible for permanent oestrogen overproduction, which favours LH hypersecretion. Type II PCOS is more frequent and may have multiple causes (local, endocrine, systemic, iatrogenic) that interfere with the gonadotropic axis and alter the FSH/LH ratio. The most efficient treatment of hirsutism is cyproterone acetate which alone has both antiandrogenic and antigonadotropic properties. Clomifene citrate remains the "first choice" treatment of infertility associated with anovulation.

Clomiphene↗
PubMedDate not supplied

[Treatment of the anovulatory sterility with LH-RH (author's transl)].

Thirthy one infertile women with different forms of anovulation were treated with LH-RH on various schemes of application: continuous intravenous (i.v.) infusion, intramuscular (i.m.) unique injection, continuous i.v. infusión plus i.m. unique injection, repeated i.v. injection, repeated i.m. injection and estrogens plus unique i.m. injection. On 46 cycles treated, ovulation was obtained in 18 (39.1%), 13 patients ovulated at least one cycle (41.8%) and six became pregnant (19.3%) three during the treatment and three during the first cycle post-treatment. The best results were obtained (63.2%) of ovulation) with the repeated i.v. injection scheme. Though the results obtained with LH-RH in relation to pregnancies, are lower than those obtained with other therapies of anovulation, the fact that we have been sucessful in cases on which other therapies of anovulation had been unsuccessful, the report up to now of only one case of mild ovary hyperestimulation, and the recent development of LH-RH analogs of more powerful and longer action, justifies the continuing of therpeutic assays with this hormone as to find the most effective scheme to induce ovulation.

Adult↗
PubMed2003

Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterised by anovulation, hyperandrogenaemia and insulin resistance. Hyperinsulinaemia is known to be associated with an increase in cardiovascular risk and the development of diabetes mellitus. If insulin sensitising agents such as metformin are effective in treating features of PCOS, then they could have wider health benefits than just treating the symptoms of the syndrome. OBJECTIVES: To assess the effectiveness of insulin sensitising drugs in improving clinical and biochemical features of PCOS. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group trials register (December 2002), the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 4, 2002), MEDLINE (January 1966 to December 2002), and EMBASE (January 1985 to December 2002). SELECTION CRITERIA: Randomised controlled trials which investigated the effect of insulin sensitising drugs compared with either placebo or no treatment, or compared with an ovulation induction agent. DATA COLLECTION AND ANALYSIS: Performed by two reviewers, one blinded to information that could have identified the authors, publisher or results of each study. Fifteen trials were included for analysis, 13 of them using metformin and involving 543 participants. MAIN RESULTS: Meta-analysis showed that metformin is effective in achieving ovulation in women with PCOS with odds ratios of 3.88 (CI 2.25 to 6.69) for metformin versus placebo and 4.41 (CI 2.37 to 8.22) for metformin and clomifene versus clomifene alone. An analysis of pregnancy rates suggests a significant treatment effect for metformin and clomifene (OR 4.40, CI 1.96 to 9.85). Metformin has a significant effect in reducing fasting insulin levels (WMD -5.37, CI -8.11 to -2.63), blood pressure and low-density lipoprotein cholesterol (LDL). There was no evidence of effect on body mass index or waist:hip ratio. Metformin was associated with a significantly higher incidence of nausea, vomiting and other gastrointestinal disturbance, but no serious adverse effects were reported. REVIEWER'S CONCLUSIONS: Metformin is an effective treatment for anovulation in women with PCOS. Its choice as a first line agent seems justified, and there is some evidence of benefit on parameters of the metabolic syndrome. Ovulation rates are higher when combined with clomifene (76% versus 46% when used alone), but there is no evidence to indicate whether there is an increased multiple pregnancy rate with this combination. There is no data regarding its safety in long-term use in young women. It should be used as an adjuvant to general lifestyle improvements, and not as a replacement for increased exercise and improved diet.

Anovulation↗
PubMed1994

Changes in ovarian function after tubal sterilization.

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E2 levels (p < 0.001). Progesterone levels significantly decreased (p < 0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.

Adult↗
PubMed1989

Recognition of ovulatory/anovulatory cycle pattern in adolescents by mucus self-detection.

The high frequency of anovulation during adolescence raises the question of whether a method for the recognition of ovulation by self-detection of cervical mucus patterns is useful in teenagers. We performed a secondary analysis of 1049 completely recorded cycles of 235 teen women 15-17 years of age with a gynecologic age from less than 1 to 7 years. These subjects had learned to monitor their fertility patterns using the Billings Ovulation Method. The cycles were analyzed by the length of the mucus and luteal phases and recorded "peak symptom." Ovulatory cycles were grouped by the length of the luteal phase, short (4-8 days) and average (8-18 days), and plotted against gynecologic age. The frequency of anovulatory cycles was comparable to Vollman's age-stratified monophasic cycle groups. Ovulatory patterns were found at gynecologic ages of 1 year, 49%; 2 years, 60%; 3 years, 72%; 4 years, 61%; 5 years, 86%; and 6 years, 71%. The study proved that teen-age women can distinguish patterns of ovulation and anovulation by self-detection of cervical mucus.

Adolescent↗
PubMed1978

Delayed onset of luteinization as a cause of infertility.

Two groups of infertility patients with regular cycles and apparently normal ovarian function were studied. In group I (n = 28) the infertility could be explained satisfactorily either by tubal occlusion or by infertility of the husband, or the women became pregnant within a few months. In group II (n = 32) no explanation was found for the infertility. Significantly fewer ovulation stigmata were present at laparoscopy in group II than in group I (P less than 0.05). In group I the basal body temperature (BBT) (P less than 0.001) and the plasma progesterone concentrations (P less than 0.05) were significantly elevated on the 1st day following the luteinizing hormone (LH) peak. In group II, THE BBT was slightly elevated on the 1st day following the LH peak (P less than 0.05), but the increase in the plasma progesterone concentrations occurred only on the 2nd day following the LH peak. In four women the onset of the BBT rise followed a normal LH peak with delays respectively, of 3, 4, 4, and 5 days, and in two women no LH peak occurred immediately prior to the onset of the BBT rise. The datings of the endometrial biopsies in these patients were in phase with the onset of the BBT rise but not with the LH peak. It is concluded that anovulation with in situ luteinization may be a rather frequent cause of infertility in regularly cycling women. A hypothesis about the mechanism of anovulation with in situ luteinization is proposed.

Anovulation↗