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PubMed2002

[Gynecologic and endocrinologic sequelae of bulimia--hormonal changes].

INTRODUCTION: Gynecological problems are one of the most frequent somatic complications of eating disorders. AIMS: The purpose of the present study was to assess the role of improper eating habits causing menstrual disturbances, anovulation and related hormonal changes. Latent bulimia nervosa is in the focus of attention since amenorrhea is considered as a diagnostic criterion of anorexia nervosa. METHOD: Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test were infertile patients (n = 34) of the gynecological outpatient departments after medical examination, blood-test (LH, FSH, androstenedione, DHEAS, progesterone, testosterone, SHBG, prolactin) and ultrasonic examination (uterus and ovaries). RESULTS: Symptoms and severity subscales of the BITE test and body mass index (BMI) were close correlation (p = 0.003, p = 0.033). In comparison with previous results, EDNOS (Eating Disorders Not Otherwise Specified) prevalence was 48%. Of hormonal changes, low LH and FSH levels (6/6) and hyperandrogenism (5/6) were significant in patients with subclinical eating disorders (n = 6) by infertile women as compared with the "normal" infertile group (n = 18; 7/18, 8/18). CONCLUSION: The recent results suggests that unsatisfactory nutrition (bulimic binges, "crash diet") is as relevant in hormonal dysfunction, menstrual disturbances and infertility as pathologically low weight in anorexia nervosa. Excessive application of contraceptives in therapy has to be taken into consideration.

Adult↗
PubMed2003

[Cyclic psychosis associated with the menstrual cycle].

Cyclic psychosis associated with the menstrual cycle is an uncommon disorder, not included under the accepted definitions of functional psychoses. We present three female adolescents who developed an acute psychosis a few days before menstruation, which resolved completely upon bleeding or several days later, only to reappear in the same form in subsequent cycles. The clinical presentation was not in line with that of the typical functional psychoses. An extensive medical work-up did not show any significant disturbances, with the exception of anovulatory cycles in one youngster. Psychotropic treatment had no effect on the course of the psychosis. Treatment with progesterone in the second half of the cycle in one case, and with a combined progesterone/estrogen contraceptive agent in another, resulted in full recovery within several cycles. The third girl showed a spontaneous remission within four cycles. Remission continued in all cases after discontinuation of the hormonal treatment, and with no need to reintroduce any psychotropic agent, for a period of 2-4 years. We discuss several possible etiologic mechanisms for cyclic psychosis associated with the menstrual cycle, including it being a cycloid non-specific affective disorder, and its association with a temporary functional hypothalamic-pituitary dysfunction, and with anovulation. We also discuss the role of psychotropic and hormonal treatment in this disorder.

Adolescent↗
PubMedDate not supplied

Comparison of intrauterine insemination, intracervical insemination, and timed intercourse in women treated with human menopausal gonadotropin.

The effects of intrauterine insemination (IUI), intracervical insemination (ICI), and timed intercourse (TI) in women who were treated with human menopausal gonadotropin (hMG) for anovulation were evaluated. The pregnancy rates per cycle following IUI (70 cycles), ICI (62 cycles) and TI (158 cycles) were 20%, 9.6%, and 17.7%, respectively; these differences are not statistically significant. The abortion rate and the multiple pregnancy rate were also not significantly different. This report suggests that in women who are undergoing treatment with hMG, there is no added benefit from artificial insemination (either intrauterine or intracervical insemination) over timed intercourse.

Adult↗
PubMed1965

INDUCTION OF OVULATION.

Every effort should be made to find the cause of anovulation since specific therapy directed at correction of a specific hormonal deficiency or excess is, of course, much more effective than any empiric treatment. Moreover, some patients with disorders of ovulation may have serious, even fatal, underlying disorders. The use of thyroid or cortisone has been disappointing except in the treatment of an overt deficiency of thyroid or cortisone or an excess of adrenal androgens. Estrogens and progestational agents have not been consistently effective in the induction of ovulation. The use of clomiphene citrate, which apparently stimulates the release of gonadotropins, and the use of purified gonadotropins of human origin have been quite successful in the induction of ovulation in a variety of disorders of ovarian function. Because of real and potential hazards, the use of these new agents should be restricted to women for whom pregnancy is the primary goal or in whom standard methods of therapy have failed. Neither drug has been released by the Food and Drug Administration for routine clinical use.

Amenorrhea↗
PubMed2003

Ovulation induction with a starting dose of 50 IU of recombinant follicle stimulating hormone in WHO group II anovulatory women: the IO-50 study, a prospective, observational, multicentre, open trial.

OBJECTIVE: To assess the efficacy and safety in clinical practice of a low dose regimen of 50 IU of recombinant follicle stimulating hormone in induction of ovulation. DESIGN: Prospective, observational, non-comparative, open, multicentre study. SETTING: Eighty-eight infertility clinics and teaching hospital fertility units throughout Spain. POPULATION: Women with normogonadotrophic chronic anovulation (WHO group II) with or without echographic diagnosis of polycystic ovary syndrome. METHODS: Low dose step-up protocol of recombinant follicle stimulating hormone administration (follitropin beta, Puregon) with a starting dose of 50 IU and weekly increments according to follicular response monitored prospectively by transvaginal ultrasonography. Patients were followed for a minimum of one cycle and a maximum of six. MAIN OUTCOME MEASURES: Rate and size of follicular growth, cumulative ovulation rate, follicle stimulating hormone doses and duration of treatment, pregnancy and cycle cancellation rate, ovarian hyperstimulation syndrome and multiple pregnancy. RESULTS: A total of 945 treatment cycles were evaluated. In 817 cycles, ovulation was induced with human chorionic gonadotrophin (hCG) and in 501 (61.3%) unifollicular development (a follicle of > or =18 mm) was achieved. A total of 128 cycles (13.5%) were cancelled because of ovarian hyper-responsiveness or spontaneous ovulation. The cumulative ovulation rate (confirmed by mid-luteal serum progesterone concentrations) after six treatment cycles was 84%. There were 136 clinical pregnancies (14.4% pregnancies per cycle). The cumulative pregnancy rate after six treatment cycles was 53.1%. Eight twin pregnancies occurred. Thirteen women miscarried and there were two cases of ectopic pregnancies. The median of average daily doses of follitropin beta in all cycles was 50 IU. Between 68% and 86% of patients received treatment with follitropin beta for a maximum of 14 days. Ovarian hyperstimulation syndrome occurred in 64 (6.8%) cases but no case of severe ovarian hyperstimulation developed. CONCLUSIONS: Low dose regimen of 50 IU of recombinant follicle stimulating hormone (Puregon) is efficient, safe and well tolerated for inducing follicular development in WHO group II anovulatory women.

Adult↗
PubMed2003

Minireview: Up-date management of non responder to clomiphene citrate in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which chronic anovulation is a common feature despite the presence of multiple micro- structures in the ovaries. A growing body of evidence has suggested that serum hyperinsulinemia contributes to the excess ovarian androgen secretion observed in women with PCOS. The standard therapy for anovulatory women with PCOS is oral administration of clomiphene citrate (CC). However, a significant proportion of women with PCOS fail to ovulate with the use of standard dosage of CC and are called CC-resistant PCOS. The recent introduction of the insulin-sensitizing agents as adjuvants to clomiphene citrate and gonadotropins has changed the treatment strategy. This is a comprehensive review of the literature, with an emphasis on the role of hyperinsulinemia in the pathogenesis of PCOS and on randomized controlled trials of the medical and surgical treatment options for women with CC-resistant PCOS. Although both standard and novel treatments were addressed in the present review, special attention was paid to the evidence in support of the recent introduction of insulin-sensitizing agents in the management of anovulatory woman with CC-resistant PCOS.

Anovulation↗
PubMed2004

[Clinical observation on treatment of Stein-Leventhal syndrome caused sterility by combined use of clomiphene and Chinese nourishing shen and activating blood circulation drugs].

OBJECTIVE: To observe the efficacy of combination therapy of clomiphene and Chinese drugs for nourishing Shen and activating blood circulation (NSABC) in treating Stein-Leventhal syndrome caused sterility. METHODS: Sixty-two patients with anovulation caused sterility were randomly divided into the treated group (n = 32) and the control group (n = 30). The treated grop was treated with the combination therapy and the control group treated by the same dosage of clomiphene alone. RESULTS: After treatment, when comparing with that before treatment, the endocrine hormones in the treated group improved significantly, showing a markedly decrease of androgen and luteotropic hormone, and increase of estrogen (P < 0.001). The periodic ovulation rate in the treated group reached 87%, the total pregnancy rate being 65.6%, with no occurrence of ovarian hyperstimulation syndrome (OHSS) and luteinized unruptured follicle syndrome (LUFS), while in the control group, the periodic ovulation rate was 66%, the total pregnancy rate 36.6%, with LUFS occurred in 4 patients. Comparison of the therapeutic effects between the two groups showed significant difference (P < 0.05). CONCLUSION: The combination therapy of clomiphene and NSABC has a better therapeutic effect in treating Stein-Leventhal syndrome caused sterility than that of using clomiphene alone.

Adult↗
PubMed2004

[Peculiar relationships between endometrial carcinoma and body in young women].

The paper is concerned with certain peculiar relationships between tumor and body in 150 endometrial carcinoma patients of 45 years or younger. Metabolic and generative disorders were detected in 70%. Such disturbances as chronic anovulation (80%). infertility and/or ovarian polycystosis (32%) were identified. They developed prior to neoplastic alterations had taken place and promoted various hyperplastic processes in the endometrium which are generally detectable in 70%. The most frequent localization of endometrial carcinoma was tubular angle area (76.9%). Lack of symptoms in some patients was due to the absence of morphological evidence on invasion into myometrial stroma (68.7%). We identified typical predisposition to endometrial carcinoma as well as an optimal sequence of cytological, ultrasound, endoscopic and morphological procedures which might help detect the disease in younger women at an early stage.

Adenocarcinoma↗
PubMed1992

Acute hepatitis induced by cyclofenil: a case report.

The case of a 47-year old woman suffering from acute hepatitis caused by cyclofenil, a drug proposed for the treatment of anovulation and scleroderma, is presented. Hepatitis developed seven weeks after the beginning of administration of the drug and its course was reversible after withdrawal. The case is documented on the basis of liver histology and the exclusion of other causes of acute hepatitis.

Acute Disease↗
PubMed1992

Dysfunctional uterine bleeding.

DUB is a common adolescent problem usually related to HPO axis immaturity and anovulation. Modern hormonal and other medical therapies enable physicians to treat DUB effectively, regardless of the cause. The evaluation provides the physician with an opportunity to offer confidential education, reassurance, treatment, and appropriate intervention in cases in which a systemic or coagulation disorder may be the underlying pathophysiology involved.

Adolescent↗
PubMed1992

[Ovulation induction with gonadotropins aided by cervix mucus analysis and echography].

Induction of ovulation was performed in 148 cycles using human menopausal gonadotropins (HMG) in 52 patients, seven with hypothalamic-pituitary failure and 45 suffering dysfunction at this level. Several induction schemes were used beginning on the second day of the cycle, until one or more follicles larger than 14 mm were found, to administrate 10,000 UI of human chorionic gonadotropin (HCG). Clinical valuation of cervical mucus and ultrasound of the ovaries to assess follicular development were done, from day eight of the cycle. Twenty five pregnancies resulted in 23 patients (44%), three in patients with failure and 22 in the dysfunction group. A total of 19 healthy babies were taken home, however three neonatal deaths, four miscarriages and one ectopic pregnancy occurred. Multiple gestation was present in three patients (12%), one was quadruplet, one triplet and one twin. The ovarian hyperstimulation syndrome (OHS) was detected in seven patients (13.4%), three were mild, two moderate and two severe; two cases of OHS had multiple pregnancies. Although induction of ovulation with HMG in patients with anovulation is a complex procedure requiring strict clinical vigilance and advanced technological resources, in this clinical study it was possible to obtain similar results to other series, using high resolution ultrasound only, without daily measurements of hormones.

Adult↗
PubMed2006

Plasma proinsulin, C-peptide and sex hormone concentrations in regularly menstruating premenopausal females with ovulatory and anovulatory menstrual cycles.

AIM: Highly active females are at risk of athletic menstrual irregularities including anovulatory menstrual cycles, oligomenorrhea and even amenorrhea. On the other hand, the functional relationship between endocrine pancreas and ovaries is supported by numerous studies indicating that disturbed female sex hormone secretion coexists with insulin resistance and glucose intolerance. However, the relationship between circulating beta islet and ovarian hormones in regularly menstruating active women with ovulatory and anovulatory menstrual cycle has not been studied. METHODS: A total of 32 regularly menstruating women participated in the study. Prospective subjects monitored their BBT for 3 months before the study. The determination of plasma progesterone levels between days 5-8 and again between days 19-22 of the menstrual cycles made possible the classification of subjects as ovulating or non-ovulating. Plasma 17-beta-estradiol, testosterone, insulin, proinsulin, C-peptide and glucose concentrations were assayed on the same menstrual cycle days as progesterone. RESULTS: There were no differences in circulating insulin, C-peptide and glucose between non-ovulating and ovulating women. In contrast, in non-ovulating subjects plasma proinsulin concentrations between days 19-22 were slightly, but significantly higher than between days 5-8 of the menstrual cycle (P<0.05). Exclusively in non-ovulating women significant and positive correlation was noted between circulating proinsulin and 17-beta-estradiol in data collected from both days 5-8 and 19-22 of the menstrual cycle (P<0.008). CONCLUSIONS: Our results indicate that in the face of low circulating progesterone and subsequent anovulation circulating 17-beta-estradiol slightly, but significantly, affect either pancreatic beta-cell biosynthetic activity or proinsulin hepatic and/or renal clearance.

Adult↗
PubMed2006

Hyperandrogenemia: pathophysiology and its role in ovulatory dysfunction in PCOS.

The most common hormonal disorder that infertile women suffer from is hyperandrogenemia, a disorder believed to show its first signs even from puberty. We discuss the impact of hyperandrogenemia on the normal ovary as well as its potential role and contribution to anovulation and infertility. The early diagnosis and management of hyperandrogenemia in women has been proved to be essential for their health and fertility.

Adolescent↗
PubMed2006

Female infertility: role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation.

Female infertility can be categorised into those who fail to ovulate (anovulatory infertility) because of some defect at hypothalamic-pituitary-ovarian axis and those who are ovulatory (ovulatory infertility), but are infertile because of some lesion present in genital tract. The role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation in the detection of ovulation and various ovulatory dysfunction was studied in 42 infertile female patients. On the basis of cytological findings, of the 42 patients, 14 were found to be ovulatory, 26 anovulatory (which include 5 cases of atrophic changes) and 2 inconsistent due to inflammatory changes. Endometrial biopsy showed evidence of ovulation in 15, anovulation in 27 cases. Hormonal evaluation indicated some sort of endocrinological disorders in 15 patients, which may underlie anovulatory infertility in these patients, while results were within normal range in the rest 27 patients. Results of vaginal cytology and endometrial biopsy showed correlation in respect to ovulation in 93.33% of the cases.

Anovulation↗
PubMed2006

[Infertility structure in patients operated without effect due to polycystic ovaries].

The aim of the investigations was to study the efficiency of demedullation of both ovaries in the case of polycystic ovary syndrome (POS), determination of infertility structure in patients in case of ineffective operation of POS and determination of additional treatment tactics in these patients. In all 245 patients tests of functional diagnostics were carried out as well as the ultrasound investigation of pelvic organs and adrenal glands, X-ray of skull and sella turcica, hysterosalpingography were performed. In blood serum the basal levels of prolactin, LH, FSH, estradiol, progesterone and cortisol were investigated by RIA. In twenty four-hours urine 17 KS, DHA and 17 OKS levels were determined. In all patients laparoscopy, hysteroscopy, chromopertubation with diagnostic curettage of uterus cavity were performed. According to the data in operated patients without a positive effect the most frequent cause of infertility was anovulation. Therefore, even successful surgical intervention and recovery of ovarian function do not guarantee post operational adhesions, which can cause infertility of tuboperitoneal genesis. Treatment tactics of patients operated due to POS without effect can't be standard and depend on revealed pathology discovered in post operational period.

Adult↗
PubMed2006

Endocrinological markers for assessing hyperandrogenemia in women classified as having polycystic ovary syndrome (PCOS) according to the revised 2003 diagnostic criteria.

The aim of this study was to investigate whether free testosterone estimated by calculation from total testosterone and sex hormone-binding globulin or free androgen indexes were more appropriate markers for assessing hyperandrogenemia in patients with polycystic ovary syndrome (PCOS). 107 Caucasian women were presented at our Division of Gynecological Endocrinology and Reproductive Medicine because of their infertility and hirsutism. Hirsutism was quantitatively assessed using a modified Ferriman-Gallwey score; oligo-ovulation or/and anovulation were assessed; polycystic ovaries were assessed; afterwards women were classified as having PCOS according to the revised 2003 consensus on diagnostic criteria for PCOS or classified as controls; endocrinological parameters were assessed using commercial immunoassays or were calculated. 50 women were classified as having PCOS; 57 women were classified as controls because they did not fulfill the criteria of PCOS. Calculated free and bioavailable testosterone, FAI, total testosterone, free testosterone assessed by immunoassay and DHEAS were significantly increased in women classified as having PCOS. All endocrinological markers for assessing hyperandrogenemia were elevated in the PCOS group regardless if they were assessed using commercial immunoassays or were calculated. Calculated values showed no diagnostic advantage in this study.

Adult↗
PubMed1991

[Prevention of iatrogenic multiple pregnancies].

A significant increase of twin and multiple pregnancies induced by infertility treatment has been observed. These high-risk pregnancies should be efficiently prevented. Gonadotrophin treatment for anovulation being the main culprit, it should be undertaken: 1) if other induction methods have failed. 2) under strict echographic and hormonal monitoring. After in vitro fertilization, number of embryos replaced should be selectively limited (to 2 or 3) on the basis of their vitality scores. Partial reduction of a multiple pregnancy should remain an exceptional solution.

Anovulation↗