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PubMed1996

Ovarian cancer after successful ovulation induction: a case report.

BACKGROUND: Questions have been raised regarding the potential association of ovulation-inducing drugs and ovarian cancer. Worldwide there have been 13 cases of ovarian carcinoma reported to occur in women previously treated with ovulation-inducing drugs (clomiphene citrate and/or gonadotropins). CASE: A 40-year-old woman complained of secondary infertility. She conceived after five cycles of human menopausal gonadotropins with intrauterine insemination. Eight months after cesarean delivery, she presented with right lower quadrant pain and a right adnexal mass. At exploratory laparotomy the patient was found to have a poorly differentiated papillary serous carcinoma of the ovary. CONCLUSION: Ovarian carcinoma developed within 18 months of exposure to ovulation-inducing agents, human menopausal gonadotropins. It would be prudent to gather a registry of cases to assess the risk associated with human menopausal gonadotropins with or without gonadotropin-releasing hormone analogs.

Adult↗
PubMed1996

Induction of ovulation with the sole use of clomiphene citrate in late-onset 21-hydroxylase deficiency.

Late-onset 21-hydroxylase deficiency (21-OHD) is a congenital enzymatic defect in the glucocorticoid and mineralocorticoid steroidogenic pathways. The manifestations, including hirsutism and infertility, usually occur at puberty or young adulthood. In infertile, anovulatory women with late-onset 21-OHD, the usual therapy is glucocorticoids for ovulation induction. In this case, we report the sole use of clomiphene citrate to induce ovulation in a patient with late-onset 21-OHD. A hirsute and oligomenorrheic woman was diagnosed as having polycystic ovary syndrome at age 25. Her hirsutism responded to oral contraceptives. At age 31, she was given clomiphene citrate alone for ovulation induction and conceived in her fourth cycle. At age 36, because of increased hirsutism she was diagnosed with late-onset 21-OHD by an ACTH stimulation test. The induction of ovulation in late-onset 21-OHD patients has been with glucocorticoids. Given the success in inducing ovulation with clomiphene citrate alone in this patient with well-documented late-onset 21-OHD, it may be worthwhile to study the sole use of clomiphene citrate for ovulation induction in these patients.

17-Hydroxycorticosteroids↗
PubMed1985

Ovulation induction and pregnancy in women with hypothalamic amenorrhea treated with intermittent gonadotropin-releasing hormone.

We induced ovulation in 34 cycles in 16 women following the administration of gonadotropin-releasing hormone (GnRH). In two patients two control cycles were induced. The patients self-administered GnRH through an indwelling intravenous catheter every 2 hours for 18 hours per day. In subsequent cycles the dose interval, dosage and infusion site, intravenous or subcutaneous, were varied. In all patients the estradiol, follicle-stimulating hormone and luteinizing hormone were measured, and follicular development was assessed ultrasonographically. Based on this preliminary study, a total of 34 cycles were studied in 16 women treated with 10 mg of self-administered GnRH intravenously every two hours during the day. Apparent ovulation was documented in all 34 cycles, and 11 pregnancies occurred. It appears that self-administered GnRH is economical and safe and achieves satisfactory results with respect to both ovulation and pregnancy.

Adult↗
PubMedDate not supplied

Premature luteinization and ovulation induction using human menopausal gonadotrophin or pure follicle stimulating hormone in patients with polycystic ovary syndrome.

High ovulation rates can be achieved in women with PCOS, using hMG or FSH to induce ovulation, but the pregnancy rate is lower than expected. To determine whether this might be due to premature luteinization, progesterone levels were measured in the follicular phase of 49 infertile women with PCOS treated with hMG or FSH. The ovulation rate was 88.6% overall and 20 patients conceived. Six pregnancies aborted within four weeks of ovulation. Premature luteinization occurred in 32% of treatment cycles, of which three resulted in conception, compared to 17 conceptions in the 68% of cycles not associated with premature luteinization (p = 0.06). Of the 17 conceptions not associated with premature luteinization, three aborted and 14 proceeded to term; all three conceptions associated with premature luteinization aborted (p = 0.01). These results indicate that premature luteinization in women with PCOS is common, and has a deleterious effect on the rate of conception, and may also be a causal factor in early pregnancy loss.

Female↗
PubMed2002

Successful pregnancy in a 42-year-old woman with imminent ovarian failure following ovulation induction with ethinyl estradiol without gonadotropins and in vitro fertilization.

PURPOSE: To describe the methodology used to induce ovulation in a 41-year-old woman with imminent ovarian failure and tubal factor so that in vitro fertilization-embryo transfer (IVF-ET) could be performed. METHODS: Ethinyl estradiol was used to suppress elevated serum follicle stimulating hormone (FSH) levels, thus theoretically allowing restoration of down-regulated FSH receptors and response to endogenous gonadotropins. RESULTS: One oocyte was retrieved and fertilized and one embryo was transferred. The patient conceived and is presently in her last trimester. CONCLUSION: Successful pregnancy following IVF-ET is possible in women with imminent ovarian failure - even in women older than age 40.

Adult↗
PubMed1986

Induction of ovulation in the postpartum rhesus monkey: factors determining success in obtaining primate luteal tissue.

Ovulation induction in the postpartum rhesus monkey was attempted with the use of purified human pituitary gonadotropins for assessment of (1) whether this procedure could be used to provide a source of luteal tissue; (2) the extent of ovarian responsiveness to gonadotropic stimulation; (3) factors that might facilitate ovulation induction during the peurperium; and (4) factors that might be a contributory cause of induction failure. Twenty rhesus monkeys were treated with purified human follicle-stimulating hormone (hFSH) and human luteinizing hormone (hLH) twice daily, beginning on days 0, 10, or 20 postpartum, with or without prior administration of bromocriptine. Laparotomies were performed during the midluteal phase. Ovaries were examined, and all corpora lutea were removed. Neither the day of beginning the gonadotropin treatment nor bromocriptine administration had a significant effect on the success rate of ovulation induction, which averaged 60% overall. Inductions begun during July had a significantly (P less than 0.025) lower success rate than those started at other times of the year. Antibodies to hFSH and hLH were detected in serum from monkeys that had undergone ovulation induction. Antibodies to hFSH, but not hLH, were associated with significantly reduced induction success (P less than 0.05). Plasma estradiol rose in response to gonadotropin treatment, and the induced follicular phase averaged 13.6 +/- 0.7 days. In all animals judged to have ovulated, corpora lutea were observed at laparotomy, and plasma concentrations of progesterone were significantly elevated (13.8 +/- 3.8 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Ovulation induction in women with polycystic ovary syndrome.

To date, clomiphene citrate (CC) remains the first therapeutical step for inducing ovulation in anovulatory PCOS patients. Metformin alone or combined with CC is a valid second step approach, whereas the laparoscopic ovarian diathermy can be useful only in selected cases.

Adult↗
PubMed2002

Pre-ovulatory events in the rhesus monkey follicle during ovulation induction.

Pituitary gonadotrophins, notably LH, and ovarian steroids, such as progesterone, play essential roles in the events leading to ovulation of the mature follicle and development of the subsequent corpus luteum. Rhesus monkeys (Macaca mulatta) undergoing controlled ovarian stimulation cycles comparable to those in clinical IVF/assisted reproduction treatment protocols provide a non-human primate model for studying peri-ovulatory events. The ability to manipulate the intrafollicular steroid milieu, via oral administration of a steroid synthesis inhibitor, with or without steroid replacement, allows one to distinguish between gonadotrophin-initiated, steroid-dependent versus steroid-independent processes. The length of the peri-ovulatory interval (onset of the LH surge to follicle rupture) is long (36-40 h) in primates and can be considered in terms of early (< or = 12 h) versus later (> or = 24 h) events. Granulosa cells lose their proliferative activity and differentiate into progesterone-secreting cells during the early peri-ovulatory interval. The rapid increase in progesterone synthetic capacity and expression of progesterone receptors suggests that this steroid has early actions, e.g. in controlling cell cycle machinery or differentiation. However, it is not until later that morphological luteinization is evident. By this stage, progesterone may serve as a potent anti-apoptotic factor and regulator of tissue remodelling through control of protease expression and activity, angiogenesis, or other events. Application of modern techniques to study LH- and progesterone-responsive gene expression will further unravel ovulatory and luteinization processes in specific compartments of the primate follicle.

Animals↗