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PubMed1986

[Serum prolactin levels during sleep and in metoclopramide stimulation in normoprolactinemic anovulation and ovulation induction with bromocriptine].

Diurnal and nocturnal serum prolactin (PRL) levels were determined in 37 normoprolactinemic anovulatory (nPRL-Anov) patients and 6 normal cycling women each in the early follicular phase (EFP) and the luteal phase (LP). PRL responsiveness to metoclopramide (MCP) was assessed. The nPRL-Anov patients received 5mg/day bromocriptine (CB-154) for 2 months and ovulation was investigated. To the CB-154 non-responders was added 150mg/day clomiphene (CL) for 5 days. The nPRL-Anov patients were classified into 3 groups; i.e. I: those who ovulated with CB-154 (n = 14), II: those who ovulated with CB-154 + CL (n = 6), and III: those who failed to ovulate (n = 10). Nocturnal serum PRL levels in I (42.0 +/- 26.2ng/ml; M +/- SD) were significantly higher than those in EFP, II and III (p less than 0.05). Eleven (78.6%) of I had nocturnal PRL levels higher than 25ng/ml. The peak PRL values at MCP provocation were significantly higher in I (213.3 +/- 89.1ng/ml) than in EFP, II and III (p less than 0.01). Thirteen (92.9%) of I had peak PRL values more than 150ng/ml. The peak PRL values and nocturnal PRL levels correlated. There were some exhibiting nocturnal or latent hyperprolactinemia, who responded effectively to CB-154, among nPRL-Anov patients. A MCP provocation test could be used in prediction of the efficacy of CB-154 treatment when applied to nPRL-Anov patients.

Anovulation↗
PubMed2005

Successful pregnancy, achieved by ovulation induction using a human menopausal gonadotropin low-dose step-up protocol in an infertile patient with Kallmann's syndrome.

A 25-year-old woman, diagnosed with Kallmann's syndrome and wanting to become pregnant, visited our hospital. Because her serum gonadotropin levels indicated hypogonadotropic hypogonadism, a main symptom of Kallmann's syndrome, we attempted to induce ovulation using a low-dose human menopausal gonadotropin (hMG) step-up protocol. In this protocol, 75 IU of hMG was used as an initial dose and this was continued for the first 14 days because adequate follicular development was not achieved. The dose of hMG was subsequently increased to 150 IU for the next 7 days. After 22 days from the start of stimulation, two follicles had developed, and were ovulated using an injection of human chorionic gonadotropin. She became pregnant, and her pregnancy was uneventful during the first trimester; however, in the second trimester both uterine contractions and blood pressure could not be controlled, and at 27 weeks' gestation she delivered a male infant weighing 830 g by cesarean section.

Adult↗
PubMedDate not supplied

Is the corpus luteum normal after ovulation induction?

Repeated ultrasound examinations and blood samplings for determination of estradiol (E), progesterone (P), and luteinizing hormone (LH) were carried out in 15 normal and 11 clomiphene citrate (CC)/human menopausal gonadotropin (hMG) stimulated cycles. Human chorionic gonadotropin (hCG) was administered in the stimulated cycles on the day of the expected LH-peak as determined in each woman's normal cycle. Ovulation and normalcy of the luteal phase were confirmed by the hormonal values. Ultrasound examinations showed development of a single follicle in the normal group and development of 4.1 follicles on average, of 15 mm or more in diameter in the stimulated group (total of 45 follicles). Midluteal phase images at the site of the former follicle showed echogenic structures of echo-free structures with scattered echoes in 25 cases in the stimulated group and in 11 cases in the normal group. There was no sign of the former follicle in 1 and 3 cases, respectively, in the two groups. A significantly higher number of "persistent follicles" was seen in the stimulated group: 42% vs. 7%. It is discussed whether a compromised corpus luteum function occurs after stimulation despite a normal luteal phase.

Clomiphene↗
PubMed2004

Is ovulation induction still a therapeutic problem in patients with polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases affecting women of fertile age, and is characterized by hyperandrogenism, chronic anovulatory cycles and oligomenorrhea or amenorrhea. Given the repercussions of chronic anovulation on sterility, PCOS is a heavy social burden. Here we describe the procedures used to induce ovulation in PCOS patients, the surgical approach and medical treatments that are still being experimented.

Aromatase Inhibitors↗
PubMed1990

Follicular phase gonadotropin-releasing hormone agonist and human gonadotropins: a better alternative for ovulation induction in in vitro fertilization.

Leuprolide acetate was used in 189 in vitro fertilization (IVF) cycles. Patients were allocated prospectively into two groups: In group A (96 cycles), leuprolide acetate was started on the 2nd menstrual cycle day of the actual IVF attempt. In group B (93 cycles), leuprolide acetate was started on the 3rd luteal phase day of the preceding IVF cycle. Ovulation was induced with a combination of pure follicle-stimulating hormone (FSH) and human menopausal gonadotropins (hMG), starting on or before the 5th cycle day, respectively. Leuprolide acetate and gonadotropins were continued until the day of human chorionic gonadotropin (hCG) administration. Follicular aspiration was carried out either by laparoscopy or by transvaginal ultrasound guidance. Group A required a lower number of FSH and hMG ampules than group B; nevertheless, there was no difference in the number of follicles, percentage of preovulatory oocytes or fertilization rate between the groups. The number of embryos transferred was 3.3 and 3.4, respectively. A significantly higher pregnancy rate was observed in group A (40.6% versus 27.7%) and a lower miscarriage rate (22.8% versus 36%) than in group B. In short, this study suggests that there is no need to administer leuprolide acetate routinely during the luteal phase of the preceding IVF cycle.

Abortion, Spontaneous↗
PubMed1993

[Ovulation induction with human menopausal gonadotropins in hypothalamic-hypophyseal disfunction].

This is a report on the institutional experience of the use of Human Menopausal Gonadotropins (HMG) in anovulatory women diagnosed as hypothalamic-hypophysiary dysfunction of Group II of WHO with previous failure to chlomifen citrate therapy. In a period of three years 180 patients were gathered with 420 cycle of treatment, obtaining ovulation in 340 cycles (81%). The ovarian hyperstimulation syndrome (OHS) was present in 15 cases (3.5%). There were 115 pregnancies that correspond to 33.8% of oculatory cycles and to 63.8% of the amount of patients. Multiple pregnancy incidence was 10.4%, and the gestational loses rate was 26%; these results are similar to what has been reported in literature. It is concluded that this medication is a good option of treatment for this type of patients, provided that there are the necessary means to expert and adequate surveillance.

Adult↗