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PubMed1985

The induction of ovulation using pulsatile luteinizing hormone releasing hormone in clinical practice.

Until recently induction of ovulation in patients resistant to clomiphene has required gonadotrophin therapy. This has entailed intensive biochemical monitoring to ascertain the correct dosage and to avoid ovarian hyperstimulation. Described here is a simple, safe effective method of ovulation induction, using pulsed luteinizing hormone releasing hormone and requiring only minimal, readily available monitoring methods.

Adult↗
PubMed1981

The use of gonadotropins for induction of ovulation.

There has been impressive progress in the treatment of anovulation with gonadotropins in the last two decades. At the present time most patients can be helped. The treatment is expensive and complicated. To obtain good results with the fewest complications, patients should be closely monitored by measuring urinary or plasma estrogen levels, and treatment should be given only in centers where the estrogen assay is readily available. Severe hyperstimulation is avoidable, but the high rate of multiple gestations remains unavoidable. Possibly with sonographic monitoring of follicular development this problem will be solved.

Adult↗
PubMed1989

The abnormal response of polycystic ovarian disease patients to exogenous pulsatile gonadotropin-releasing hormone: characterization and management.

Pulsatile GnRH administration for induction of ovulation is often ineffective in polycystic ovarian disease (PCOD) patients. To clarify and correct the endocrine mechanisms underlying this deranged response we gave pulsatile GnRH (5 micrograms, iv, every 60 min) to idiopathic hypogonadotropic hypogonadism (IHH) patients with primary amenorrhea for 19 cycles and to PCOD patients for 24 cycles before (pre-A) and for 25 cycles after (post-A) GnRH analog suppression. Compared to IHH, pre-A cycles were characterized by elevated LH, estradiol, and testosterone; reduced luteal phase progesterone; and low ovulatory (38%) and pregnancy rates (8%). Conversely, LH, estradiol, and follicular phase testosterone levels were lower in post-A than in pre-A cycles, while luteal phase progesterone was higher; the endocrine pattern of post-A cycles closely resembled the one of IHH cycles. The ovulatory and pregnancy rates of PCOD patients improved remarkably in post-A cycles (90% and 38%, respectively). Excessive body weight was associated with a lower incidence of ovulation in both pre-A (15%) and post-A cycles (75%). A worse endocrine pattern and a lower ovulatory rate (50%) were obtained when a second consecutive post-A cycle occurred without repeating GnRH analog suppression. No signs of even mild ovarian hyperstimulation and no multiple pregnancies were recorded in the post-A cycles. We conclude that in PCOD 1) deranged pituitary sensitivity, excessive ovarian androgen secretion, and obesity critically affect folliculogenesis and ovulation; 2) pituitary-gonadal suppression with a GnRH analog markedly improves the endocrine and clinical responses to pulsatile GnRH ovulation induction; 3) optimal results can be achieved only when each pulsatile GnRH cycle is preceded by GnRH analog suppression; and 4) pulsatile GnRH is highly effective and safe for ovulation induction, provided that PCOD subjects are pretreated with a GnRH analog.

Adult↗
PubMed1983

Gender after artificial induction of ovulation and artificial insemination.

Several studies on artificial insemination by donor (AID) semen have suggested that the gender of infants can be influenced by treatment of the women with clomiphene citrate (CC) and by the type of semen used (fresh versus cryopreserved). We conducted a 3-year prospective clinical trial to test these hypotheses. Two groups of pregnant women were evaluated. Group I (n = 130) comprised women whose ovulation was induced by CC; group II (n = 190) comprised those who conceived during spontaneous ovulatory cycles. In a total of 320 pregnancies, 55 spontaneous abortions occurred, 23.1% in group I and 13.2% in group II (P less than or equal to 0.05). Two tubal ectopic pregnancies occurred in group I. Of the 100 and 165 pregnancies carried to term in the treated and control groups, respectively, 11% and 1.8% involved twins (P less than or equal to 0.005). When only single births were considered, group I had 46.1% males in 89 term pregnancies, and group II had 60.5% males in 162 term pregnancies. Significantly more female offspring occurred in the group treated with CC (P less than or equal to 0.05). Because it is possible that a portion of the effects observed in this study were a function of cryopreservation of the AID semen, we compared data on frozen sperm with data on fresh sperm in terms of abortion, gender, and incidence of multiple births; there were no significant differences. Fertil Steril 40:481, 1983.

Clomiphene↗
PubMed1994

[A possible role of ultrasound-guided follicular aspiration in induction of ovulation in patients with polycystic ovaries].

To investigate a possible role of ultrasound-guided follicular aspiration in the induction of ovulation in patients with polycystic ovaries (PCO). Serum concentrations of immunoreactive LH (I-LH), bioactive LH (B-LH), FSH, androstenedione, testosterone (T), dehydroepiandrosterone sulfate, E1, E2, and progesterone before and after the follicular aspiration were examined. Follicular aspiration was carried out 7 days after hCG administration in twelve patients refractory to ovulation induction with clomiphene-hMG-hCG. Concentrations (mean +/- SEM) of I-LH, B-LH, and T on day 3 of the menstrual cycle after the aspiration were significantly lower than those before the aspiration (4.8 +/- 0.5 vs 12.6 +/- 1.0 mIU/mL, 18.1 +/- 2.1 vs 50.0 +/- 4.1 mIU/mL, 45.4 +/- 5.0 vs 60.8 +/- 7.1 ng/dl, respectively; p < 0.01). The pattern of LH secretion in response to GnRH challenge test was also normalized after the aspiration. A significant decline in serum levels of E2 and T (p < 0.001) was observed 2h after the aspiration. The ovulation rate was 83.3% (10/12), and one patient achieved pregnancy after the aspiration. The present study suggests that an acute decline in serum levels of ovarian steroids after the aspiration possibly acted on the hypothalamo-pituitary axis of the patients to normalize sensitivity, and the treatment could release the patients from an endocrinologically-mediated vicious cycle and result in the achievement of ovulation.

Adult↗
PubMed2006

Hormonal priming, induction of ovulation and in-vitro fertilization of the endangered Wyoming toad (Bufo baxteri).

The endangered Wyoming toad (Bufo baxteri) is the subject of an extensive captive breeding and reintroduction program. Wyoming toads in captivity rarely ovulate spontaneously and hormonal induction is used to ovulate females or to stimulate spermiation in males. With hormonal induction, ovulation is unreliable and egg numbers are low. The sequential administration of anovulatory doses of hormones (priming) has increased egg numbers and quality in both anurans and fish. Consequently, we tested the efficacy of a combination of human Chorionic Gonadotrophin (hCG) and Luteinizing Hormone Releasing Hormone analogue (LHRHa) administered as one dose, or two or three sequential doses to Bufo baxteri on egg numbers, fertilization and early embryo development. Spawning toads deposited eggs into Simplified Amphibian Ringers (SAR) solution to enable controlled in-vitro fertilization (IVF) with sperm from hormonally induced male toads. Unprimed females receiving a single mixed normally ovulatory dose of 500 IU hCG plus 4 micrograms of LHRHa produced no eggs. Whereas females primed with this dose and an anovulatory dose (100 IU hCG and 0.8 micrograms of LHRHa) of the same hormones, or primed only with an anovulatory dose, spawned after then receiving an ovulatory dose. Higher total egg numbers were produced with two primings than with one priming. Moreover, two primings produced significantly more eggs from each individual female than one priming. The cleavage rate of eggs was not found to differ between one or two primings. Nevertheless, embryo development with eggs from two primings gave a significantly greater percentage neurulation and swim-up than those from one priming. Of the male toads receiving a single dose of 300 IU hCG, 80% produced spermic urine with the greatest sperm concentration 7 hours post-administration (PA). However, peak sperm motility (95%) was achieved at 5 hours PA and remained relatively constant until declining 20 hours PA. In conclusion, Bufo baxteri egg numbers and quality benefited from sequential priming with LHRHa and hCG whereas spermic urine for IVF was produced from males with a single dose of hCG. The power of assisted reproduction technology in the conservation of endangered amphibians is shown by the release of nearly 2000 tadpoles produced by IVF during this study.

Animal Husbandry↗
PubMedDate not supplied

Induction of ovulation with epimestrol and luteinizing hormone-releasing hormone (LH-RH).

Luteinizing hormone-releasing hormone (LH-RH) was used to induce LH surge and ovulation in 20 patients in whom follicular maturation was provoked by epimestrol, used in a dose of 5 mg/day from the fifth to 14th day of the cycle. Patients with elevated prolactin levels and galactorrhea were not included in the study. Complete follicular maturation, as inferred by estradiol levels above 200 pg/ml, were observed in 13 of 20 patients following epimestrol treatment. LH-RH induced ovulation in 90% of these patients following a three-day course of treatment. Normal corpus luteum function with progesterone levels above 8 ng/ml was observed in most cases. Five pregnancies occurred in the first two cycles of treatment. In patients with low estradiol levels, following epimestrol priming, the administration of LH-RH did not result in ovulation.

Anovulation↗
PubMed1978

Intrauterine development, feto-placental function and pregnancy outcome after induction of ovulation with bromoergocryptine.

18 pregnancies occurred after treatment with bromoergocryptine in 17 patients who wished to conceive, but who suffered from anovulation of varying aetiology. The course of 15 pregnancies was uneventful. Three pregnancies ended in abortion. Nine of the 17 women had hyperprolactinemic amenorrhea. Furthermore, one woman had normoprolactinemic post-pill amenorrhea, another normoprolactinemic anovulatory oligomenorrhea and a third normoprolactinemic anovulatory regular menstruations. With the exception of one woman, all had galactorrhea. The courses of pregnancy were monitored by frequent ultrasound measurements of the fetal biparietal diameter, maternal urinary estriol excretion and radioimmunological measurements of plasma estrone, estradiol, unconjugated and immunoreactive estriol, progesterone, and HPL. All data were within the normal ranges and all babies were healthy at birth and had no teratogenic defects. The data prove the great value of bromoergocryptine in the treatment of hyperprolactinemic anovulation, sometimes even in the treatment of normoprolactinemic anovulation. Moreover, the results indicate no adverse effect on either the course or the outcome of pregnancy.

Abortion, Spontaneous↗
PubMed1987

Pregnancy following induction of ovulation with pure FSH after suppression of endogenous gonadotropins with subcutaneous buserelin.

Ovarian stimulation in patients with disorders of ovulation or an inadequate luteal phase using human menopausal gonadotropins (hMG) gives a low pregnancy rate with a high incidence of overstimulation and a premature LH surge. In order to overcome these problems, a new approach has been used, namely prior suppression of endogenous gonadotropins with a gonadotropin-releasing-hormone analog (LHRH) and subsequent ovarian stimulation with hMG. We present a case of ovarian stimulation with pure FSH during suppression of endogenous gonadotropins with the LHRH analog Buserelin. A clinical pregnancy was achieved in the first treatment cycle and led us to conclude that follicular development does not depend on LH stimulation. This could be of substantial interest in IVF programs.

Adult↗
PubMed1991

Atypical response to luteinizing hormone-releasing hormone (LH-RH) agonist (suprefact nasal) in induction of ovulation in in vitro fertilization (IVF).

Animal and human research has indicated the presence of receptors to luteinizing hormone-releasing hormone (LH-RH) in the ovaries. However, the role of these receptors is not yet clear. Forty-five patients were treated with Suprefact (D-Serg-Des-Gly10-GnRGH), starting in the midluteal phase of a nonstimulatory menstrual cycle. The Suprefact (300 micrograms t.i.d.) was administered as a nasal spray until the administration of human chorionic gonadotropin (hCG). On the third to fifth day of the following menstrual cycle, the patients were treated with a high dose of human menopausal gonadotropin (hMG). hCG was administered when at least two follicles reached a mean diameter of 18 mm. Five of these patients who ovulated spontaneously and had normal menstrual cycles did not respond to the stimulation with hMG. Treatment was stopped after 12 days of hMG administration. During the following cycle of the five patients, levels of gonadotropins were found to be in the normal range, and all of them responded as expected to hMG administered for 3 days only (hMG test). These findings suggest that LH-RH agonist may interfere with ovarian steroidogenesis.

Administration, Intranasal↗
PubMed1987

Acid phosphatase levels in follicular fluids following induction of ovulation in in vitro fertilization patients.

Considerable evidence indicates that changes in acid phosphatase (AP) activity at the ovarian level play a role in the process of ovulation. In this study the concentrations of AP were determined in follicular fluids collected from follicles of 52 women at the time of laparoscopy performed in connection with an in vitro fertilization program. In each of the 52 women at least one ovum was harvested. Of the 52 ova, 28 cleaved in vitro, while in 24 ova cleavage was not seen. Levels of AP in follicular fluids of women whose ova did not cleave were significantly lower than those found in follicular fluids of women with at least one ovum undergoing cleavage: 0.45 +/- 0.14 (SE) and 4.78 +/- 0.37 Bess Lowry Units (BLU), respectively. Comparison of AP levels in follicular fluids of women who conceived (5) and women whose ova cleaved, but in whom pregnancy was not achieved (23), did not reveal significant differences: 5.87 +/- 1.29 and 4.55 +/- 0.35 BLU, respectively. Moreover, the enzyme level was typical for a woman and not for a follicle. Fluids of two different follicles of the same woman, when one ovum cleaved and one did not, showed similar AP levels. AP levels were high in all samples follicles of women in whom at least one ovum cleaved. These findings indicate that the presence of certain levels of acid phosphatase represents an important, albeit not the sole, condition for ovum maturation. Moreover, the follicular fluid levels of AP could serve as an indicator of proper timing of the follicular puncture in relation to the human chorionic gonadotropin injection (or the luteinizing hormone peak).

Acid Phosphatase↗
PubMed1983

Induction of ovulation and spawning in the catfish, Clarias batrachus (L.) by prostaglandin F2 alpha.

Administration of low doses of prostaglandin F2 alpha (PGF2 alpha), i.e. 10 and 100 ng/g b.wt, was ineffective in inducing ovulation and spawning in mature catfish. However, doses of 200 ng/g b.wt of PGF2 alpha elicited partial response, and 500 ng/g b.wt of PGF2 alpha induced profuse ovulation and spawning similar to that induced by administration of human chorionic gonadotropin (HCG).

Animals↗
PubMed1980

Induction of ovulation with chronic intermittent (pulsatile) administration of LH-RH in women with hypothalamic and hyperprolactinemic amenorrhea.

Five women with hypothalamic amenorrhea were treated with LH-RH (10-15 microg i.v. at 90 min intervals for 17-20 days). In all women this chronic intermittent LH-RH administration resulted in a normalization of serum gonadotropin levels. Four women exhibited preovulatory estradiol serum levels with subsequent LH peaks. In three women the LH peaks were followed by normal luteal phase serum progesterone levels. One woman with hyperprolactinemic amenorrhea was also treated with the same therapeutic regimen which induced ovulation as judged from normal luteal phase serum progesterone levels. The results indicate that normal pituitary-ovarian function can be established in hypothalamic amenorrhea by chronic intermittent administration of LH-RH. They also suggest that in the human female hypothalamic LH-RH function may be only permissive in that the cyclicity of endocrine events during the menstrual cycle is regulated on pituitary and ovarian levels. Hyperproactinemic amenorrhea appears to be associated with insufficient endogenous LH-RH secretion which can be substituted by exogenous chronic intermittent administration of LH-RH. Elevated prolactin levels per se do not interfere with the pituitary positive feedback mechanisms nor with the gonadotropin action on the ovarian level.

Adult↗