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PubMed1986

Ovulation induction with bromocriptine in normoprolactinemic anovulatory women.

Afternoon-evening and nocturnal serum PRL levels and PRL responsiveness to metoclopramide (MCP) were determined in 34 women with normoprolactinemic anovulation (nPRL-Anov) and in the early follicular phase (EFP) in 6 normal women. Subsequently, the nPRL-Anov women were treated with 5 mg bromocriptine (Br) twice daily for 2 months, and its action on ovulation was determined. Those women who did not respond to Br received 50-150 mg clomiphene for 5 days. The nPRL-Anov patients were classified into 3 groups in terms of the efficacy of Br treatment: group I, those who ovulated with Br (n = 13); group II, those who ovulated after receiving Br and clomiphene (n = 7); and group III, those who failed to ovulate after the above treatments (n = 10). Four patients dropped out of the study. Diurnal serum PRL levels were approximately 10 ng/ml in all patients, and no statistical difference was found among the groups. Peak nocturnal serum PRL levels (the highest PRL value during the 0000-0400 h period) were 38.0 +/- 23.9 (+/- SD) ng/ml in group I patients, higher (P less than 0.05) than in groups II and III and normal (EFP) women (20.1 +/- 9.1, 20.7 +/- 7.7, and 16.3 +/- 2.7 ng/ml for the group II and III patients and the EFP women, respectively). MCP induced rapid and marked elevation in serum PRL levels in all subjects. The maximum post-MCP PRL value in the group I patients was 224.2 +/- 89.7 ng/ml, which was significantly higher (P less than 0.002) than the maximum value in the remaining groups (120.5 +/- 25.8, 121.3 +/- 54.2, and 101.9 +/- 28.1 ng/ml, respectively). Ten (76.9%) and 12 (92.3%) group I patients had nocturnal PRL levels above 25 ng/ml and maximum PRL values after MCP above 150 ng/ml, respectively. We conclude that some nPRL-Anov patients have elevated nocturnal serum PRL levels or enhanced PRL responsiveness to MCP, indicative of nocturnal or latent hyperprolactinemia. Br effectively induced ovulation in these patients. A MCP provocation test can predict the outcome of Br treatment in such nPRL-Anov patients.

Adult↗
PubMed1987

Ovulation induction in anestrous bitches by pulsatile administration of gonadotropin-releasing hormone.

Preliminary studies in anestrous Beagle bitches demonstrated that a single injection of gonadotropin-releasing hormone (150 micrograms) produced a rapid, physiological rise in serum estradiol lasting 1-3 days while progesterone remained below 1 ng/ml, whereas serial injections of FSH rapidly produced greater elevations in estradiol and a rapid rise in progesterone over 2 ng/ml. Consequently, attempts to induce fertile ovulation by means of pulsatile intravenous administration of GnRH (1 pulse/1.5 hours for 6-12 days; 0.04-0.43 micrograms/kg body weight/pulse) were conducted in eight anestrous bitches. Willingness to mate, serum progesterone levels and results of mating were monitored. In six of the eight bitches, vulval and vaginal signs of proestrus occurred by Day 2-4 after initiation of treatment (Day 0); but, two bitches showed negligible responses. In five of the six bitches in which proestrus was induced, behavioral (n = 4) and vaginal (n = 5) correlates of early estrus occurred by Day 5-7 of treatment and breedings occurred over a period of 4-12 days. Following onset of estrus, four of the five bitches had increases in serum progesterone levels between Days 14 and 18 after initiation of treatment (and 4-11 days after cessation of treatment); three of them became pregnant and whelped normal litters (ranging from 9 to 11 pups). The fifth bitch did not have elevated progesterone during the induced estrus, and upon return to estrus one month later was successfully bred and whelped a normal litter of 10 pups.(ABSTRACT TRUNCATED AT 250 WORDS)

Anestrus↗
PubMed1982

Use of ultrasound in monitoring ovulation induction with human pituitary gonadotropins.

Serial follicular growth was studied using real-time ultrasound scanning in 26 anovulatory patients in 55 cycles stimulated with exogenous human pituitary gonadotropin (hPG) and human chorionic gonadotropin (hCG). Dosage was monitored with urinary total estrogen estimations. The ultrasound findings were not made known to the attending physician. Forty-four cycles (80%) were ovulatory, and conception occurred in 13. The mean follicular diameter of 17 to 25 mm at ovulation corresponded with the range observed in spontaneous cycles, although the rate of follicular growth was faster with hPG. On the day the ovulatory dose of hCG was given, as determined by the first urinary estrogen value greater than 50 microgram/24 hours, estrogen excretion was similar whether single or multiple follicles of potential ovulatory size were present, but mean follicular diameters were significantly smaller when there was more than 1 follicle. During the last 4 days before ovulation, the mean diameters in conceptual cycles increased from 14.2 mm to 19.7 mm, values similar to those observed in spontaneous cycles, but different growth patterns occurred in some nonconceptual cycles. Ovarian hyperstimulation was identified by ultrasound scan in 4 of 5 cycles before urinary estrogen excretion exceeded the normal range. Although ultrasound scan does not supplant estrogen monitoring, it can assist in the early detection of hyperstimulation, in the more accurate timing of the ovulatory dose of hCG, and in the withholding of hCG when 3 or more ovulations are possible. It is recommended that ultrasound examination be performed in all patients before the ovulation-inducing dose of hCG is given to provide information on the number of follicles that are likely to ovulate and thus avoid conception of more than twins.

Chorionic Gonadotropin↗
PubMed1982

Neocept: a simple, sensitive urine test of early pregnancy in women undergoing ovulation induction.

Fifty-five anovulatory women undergoing hMG-hCG treatment in order to become pregnant had daily first morning urine specimens and blood samples drawn, starting from the 11th postovulatory day. The urine was tested with Neocept and the blood with a radioreceptor assay or a radioimmunoassay for beta-subunits of hCG. Twenty-two of the women became pregnant. The pregnancies were detected by Neocept within a span of 12 to 19 days after ovulation. On the day of the first positive urine test, the mean serum concentration of the beta-subunit of hCG in 17 women was 103 +/- 10.1 (S.D.) mIU/ml (range, 39 to 200), and the mean serum level of 5 women tested by the radioreceptor assay was 206.5 +/- 6.5 mIU/ml (range, 170 to 220). Of 8 women with a positive urine test on day 15 or sooner, only 1 aborted, whereas 7 of the 14 women who were found thereafter to be positive aborted. None of the treated women who ovulated but did not conceive had a positive urine test. Of these women there were nine with a prolonged luteal phase (18 to 22 days).

Chorionic Gonadotropin↗
PubMed1983

Ovulation induction with pulsatile gonadotrophin releasing hormone (GnRH).

Anovulatory infertility has been successfully treated in 7 out of 13 women by means of pulsatile gonadotrophin releasing hormone (GnRH) therapy. Women with primary or secondary amenorrhoea received a bolus of GnRH (2.1-20 micrograms) subcutaneously once every 60, 90 or 120 min around the clock from a programmable, battery operated, syringe driver worn under the clothing. Duration of treatment varied from 1 week to 8 months (mean 2.5 months); 7 women ovulated and 2 conceived in the first month of treatment. We conclude that anovulatory women with normal prolactin levels, who are refractory to clomiphene with or without HCG, and who are unlikely to respond to anything but human pituitary FSH and HCG may now be treated with GnRH.

Adult↗
PubMed1988

Ovulation induction for in-vitro-fertilization and embryo transfer applying decapeptyl (DTRP-6 LH/RH) in combination with HMG or FSH.

47 patients out of the IVF-program of the Department of Obstetrics and Gynecology University of Kiel, who demonstrated in previous stimulation cycles premature LH surges, were treated in two modalities with a down regulation applying the GnRN-analogue decapeptyl (DTRP-6 LH/RH) and a concomitant HMG- or FSH-stimulation. The down-regulation was started after ovulation up to a negative LH/RH test followed by a concomitant gonadotropin stimulation in group 1. In group 2 a parallel treatment with decapeptyl and HMG or FSH was performed from day 2 of the cycle. 10 husbands of the punctured patients had pathological sperm. In both groups 6 patients were discarded from of the stimulation protocol as their oestradiol responses were not adequate, sperm contamination was detected late in one case, and in one patient a premature LH surge occurred once again. In 36 patients vaginal follicular punctures were performed. With respect to pregnancies group 1 revealed a much higher pregnancy rate than group 2. It seemed better to start the down-regulation with the GnRH-analogue decapeptyl in the luteal phase of the previous cycle. The treatment with decapeptyl should not only be applied in patients with previous LH surges but also in order to establish a synchronous follicular maturation in ovulating patients treated for in-vitro fertilization, or gamete-intra-Falloppian-tube-transfer.

Adult↗
PubMed2002

Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome.

OBJECTIVE: To assess pregnancy outcome in anovulatory infertility patients diagnosed with polycystic ovary syndrome (PCOS) who were treated with metformin. DESIGN: Case series. SETTING: Outpatient. PATIENT(S): Anovulatory patients (n = 48) with a diagnosis of PCOS based on clinical, diagnostic, and laboratory evaluations were enrolled in the study over a 15-month period. INTERVENTION(S): Metformin was started at 500 mg b.i.d. for 6 weeks and then increased to 500 mg t.i.d. if no ovulation occurred. Clomiphene citrate (CC; 50 mg) was added if no ovulatory response occurred after 6 weeks. MAIN OUTCOME MEASURE(S): Resumption of menses, presumptive ovulation, and pregnancy. RESULT(S): Nineteen of 48 (40%) patients resumed spontaneous menses following treatment and showed presumptive evidence of ovulation with metformin alone; 15/48 (31%) required CC (50 mg) in conjunction with metformin therapy, and 10 of these 15 (67%) had evidence of ovulation; 20/48 (42%) conceived with a median time to conception of 3 months, and 7 of these 20 (35%) had spontaneous abortions (SAB); 19/48 (40%) had gastrointestinal-related side effects, and 5 of 48 patients (10%) had to decrease the dosage of metformin. Only 1 patient discontinued therapy. CONCLUSION(S): Metformin alone in patients with PCOS results in a substantial number of pregnancies, with 69% (20/29) of those who ovulated conceiving in less than 6 months.

Adult↗
PubMed1986

Ovulation induction with subcutaneous pulsatile gonadotropin-releasing hormone in various ovulatory disorders.

Pulsatile gonadotropin-releasing hormone (GnRH) was administered subcutaneously (SC) to 13 women for a total of 21 cycles. Ten of these women had hypothalamic amenorrhea (HA) and were treated for 16 cycles. Three had polycystic ovarian disease (PCOD) and were treated for five cycles. Endocrine assessment for daily measurements of serum luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, and progesterone and frequent pelvic ultrasound examinations were obtained. Ovulation occurred in 17 of 21 cycles (81%) with four resulting pregnancies (31% of patients, 19% of cycles). Of ten patients with HA, ovulation occurred in 15 of 16 cycles (93.75%), and four women became pregnant (40% of patients, 25% of cycles). Three pregnancies resulted in normal deliveries at term and one spontaneously aborted at 5 weeks. Among the three PCOD patients, ovulation was achieved in two of five cycles (40%). There were no pregnancies in this group. Overstimulation by ultrasound criteria occurred in one of the PCOD patients during an anovulatory cycle. There were no multiple pregnancies or any other complications in either group. We conclude that SC pulsatile GnRH is highly effective in HA patients; SC pulsatile GnRH seems substantially less effective in PCOD patients than in HA patients; and further experience is needed to optimize GnRH administration in PCOD.

Adult↗