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PubMed2000

Androgen excess contributes to altered growth hormone/insulin-like growth factor-1 axis in nonobese women with polycystic ovary syndrome.

OBJECTIVE: To investigate the relationship between ovarian androgen excess and impaired growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis in nonobese women with polycystic ovary syndrome (PCOS). DESIGN: A prospective, controlled clinical study. SETTING: Reproductive Endocrine Unit, Department of Obstetrics and Gynecology, Jinling Hospital, Nanjing University School of Clinical Medicine. PATIENT(S): Six patients with PCOS with both clomiphene resistance and gonadotropin hyperreponsiveness and six controls with regular cycles, matched for age and body mass index (BMI). INTERVENTION(S): Bilateral ovarian wedge resection (OWR) was performed to induce ovulation surgically for these refractory women with PCOS. A GH stimulation test with oral L-dopa was arranged for controls and for patients with PCOS before and again 6 months later after OWR. MAIN OUTCOME MEASURE(S): Plasma GH, IGF-1, FSH, LH, testosterone, androstenedione, estradiol, progesterone, prolactin, insulin, and glucose. RESULT(S): Basal levels and areas under the response curve of GH and GH-IGF-1 ratio to L-dopa were significantly lower in patients with PCOS before surgery than those of controls. The OWR in patients with PCOS obviously reduced their androstenedione and testosterone levels and insulin-glucose ratios, and increased the GH and GH-IGF-1 responses to L-dopa. CONCLUSION(S): Impaired somatotrophic axis caused by a defect in central dopaminergic activity may be responsible for severe anovulation in these women with PCOS, which could be reversed by removing excessive androgens with OWR.

Adult↗
PubMed1997

The role of catecholamines in the etiology of infertility in diabetes mellitus.

Patients suffering from diabetes mellitus often develop reproductive dysfunction including anovulation, infertility and disrupted pregnancy. The biochemical basis of these phenomena is yet to be provided. The current study utilizes a neuroendocrine paradigm involving an in vitro microdissection technique in conjunction with jugular catheterization to examined the proestrus dynamics of norepinephrine (NE) and the preovulatory luteinizing hormone (LH) surge in streptozotocin (STZ) treated female rats, an animal model for insulin dependent diabetes mellitus. Radioimmunoassays revealed that in control subjects LH was at basal level during the morning of proestrus (900-1200 h); the first significant increase in the level of this pituitary hormone occurred at 1400-1500 h. A maximum peak concentration of LH was attained at 1700 h. In contrast, plasma levels of LH in diabetic subjects showed the first significant increase at 1500 h and peaked at 2000 h. The peak of the LH curve in diabetic rats was reduced by about 65% with a 3 h shift to the right. Alpha-methyl-p-tyrosine-induced blockade of newly synthesized NE-based assay showed that NE turnover rates in several hypothalamic nuclei (e.g. medial preoptic nucleus, MPN; median eminence, ME; suprachiasmatic nucleus, SCN; arcuate nucleus, AN) of control subjects were at basal level during the morning of proestrus (0900-1100 h). However, they increased by the 1200-1400 h interval and remained elevated during the 1500-1700 h. This time dependent increase in hypothalamic NE turnover rates during proestrus was not observed in the STZ diabetic rats. Most of the above metabolic derangements were partially reversed following the institution of insulin replacement therapy. Overall, our data support the concept that the endocrine abnormalities (e.g. infertility, delayed preovulatory LH surge) in diabetes are due, at least in part, to a functional deficit in noradrenergic neurons within the hypothalamus.

Animals↗
PubMed1997

A single dose of mifepristone induces ovulation in pseudopregnant rats.

We used mifepristone (M) to evaluate the role of progesterone in maintaining pseudopregnancy. Cycling rats were made pseudopregnant (psp) by cervico-vaginal stimulation (CVS) on the day of estrus (day 0) and received 10 mg/kg M or vehicle (control groups) on day 3. Blood samples were taken at 06.00 h on days 4, 6 or 7 or at 18.00 h on days 3, 4, 6 or 10. M induced proestrus 2 days later (day 5), estrus on day 6, and a second prolonged diestrus afterwards. Prolactin and progesterone levels were similar in the control and M treated groups excepting on day 6, when both were reduced in the M-treated animals, and these rats were in estrus, suggesting a temporary impairment of luteal function. To demonstrate activated corpora lutea the endometrium was scratched on the fourth day of the first or second diestrus in additional control and M-treated groups. The deciduomal response was seen in the control and M groups after scratching the endometrium on day 4 of the first or second diestrus, respectively, but M blocked the deciduomal response in the first diestrus. Ovulation was confirmed by finding that 66.7% of the M-treated rats showed ova in the Fallopian tubes on the M-induced estrus and 4 out of 10 of the M rats placed with males on the M-induced proestrus showed spermatozoa in the vaginal smears. Half of these became pregnant, delivering 2 pups each. The results show that M can induce ovulation in psp rats, demonstrating that the anovulation observed after CVS is dependent on progesterone, yet luteal function persists after M in pseudopregnancy. Progesterone may act either by suppressing LH secretion or by permitting prolactin secretion, or both. Moreover, progesterone is required to maintain endometrial responsiveness.

Animals↗
PubMed2000

Synergistic effects of insulin-like growth factor-I and human chorionic gonadotropin in the rat ovary.

Insulin and low doses of lutenizing hormone (LH) activity (human chorionic gonadotropin [hCG]) act synergistically in the rat to produce anovulation, large ovarian cysts, and elevated plasma androstenedione levels. Further, both insulin and insulin-like growth factor-I (IGF-I) affect the ability of gonadotropins to enhance both ovarian theca and granulosa cell function in vitro. The present series of experiments were performed to determine if recombinant human IGF-I (rhIGF-I) can act in a manner similar to insulin when combined with subovulatory doses of hCG in adult normally cycling rats. Fifty-four female Sprague-Dawley rats were randomly assigned to the following treatment groups at the age of 64 days: (A) vehicle alone (controls, phosphate-buffered saline containing 0.09% pig gelatin), (B) twice-daily subcutaneous injections of 0.5 to 3.0 U insulin, (C) twice-daily subcutaneous injections of 1.5 U hCG, (D) both insulin and hCG, (E) twice-daily subcutaneous injections of rhIGF-I (2.5 mg/kg/d), and (F) both hCG and rhIGF-I. After 22 days of treatment, the animals were killed on day 23, trunk blood was collected, and the ovaries were excised for histological study. Eight of 9 control rats and 5 or 6 of 9 rats treated with insulin, hCG, or rhIGF-I alone displayed normal estrus cycles throughout the in vivo treatment period as assessed by daily vaginal smears. In marked contrast, only 1 animal treated with hCG + insulin and 2 animals treated with hCG + rhIGF-I continued to display vaginal smears indicative of normal cycling. Multiple large ovarian follicular cysts were found only in these latter 2 groups (3 of 9 animals in each group). Mean serum testosterone levels were significantly elevated in animals receiving insulin + hCG (0.72 +/- 0.28 v 0.17 +/- 0.03 ng/mL in controls, P = .05). Mean serum androstenedione levels were significantly elevated in animals receiving hCG and animals receiving rhIGF-I + hCG (5.57 +/- 0.99 and 2.39 +/- 0.68 ng/mL, respectively, v0.14 +/- 0.14 ng/mL in controls, P< .01 and P< .05, respectively). We conclude that rhIGF-I and insulin act synergistically with subovulatory doses of hCG to disrupt normal reproductive cycling, elevate serum androgen concentrations, and induce large ovarian cysts in intact adult rats.

Androstenedione↗
PubMed2002

ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists: number 41, December 2002.

Polycystic ovary syndrome (PCOS) is a condition of unexplained hyperandrogenic chronic anovulation that most likely represents a heterogenous disorder. Its etiology remains unknown, and treatment is largely symptom based and empirical. Recent findings suggest PCOS has substantial metabolic sequelae, including risk of diabetes and possibly cardiovascular disease, and that primary treatment should focus on metabolic sequelae. The purpose of this document is to examine the best available evidence on the diagnosis and clinical management of PCOS.

Contraceptives, Oral↗
PubMedDate not supplied

Progestins and menopause: epidemiological studies of risks of endometrial and breast cancer.

Estrogen replacement therapy (ERT) increases a woman's risk of developing endometrial cancer approximately 120% for each 5 years of use. ERT increases a woman's risk of developing breast cancer approximately 10% for each 5 years of use. To reduce the greatly increased endometrial cancer risk, progestins have been added to ERT (estrogen-progestin replacement therapy; EPRT) for between 5 and 15 days (usually 7 or 10 days) per month in a sequential fashion (sequential EPRT; SEPRT) or with each dose of ERT (continuous-combined EPRT; CEPRT). We conducted two large case-control studies in postmenopausal women in Los Angeles to evaluate the effects of these changes on endometrial and breast cancer risks. As expected CEPRT was not associated with any increased risk of endometrial cancer. SEPRT with the progestin being given for 10 days per month also did not increase endometrial cancer risk. SEPRT with the progestin being given for 7 days per month did increase endometrial cancer risk with only a relatively slight reduction in risk compared to ERT effectively proportional to the reduction in the number of days of unopposed estrogen. The sharp contrast between the effects of 7 days and 10 days of progestin in SEPRT suggests that the extent of endometrial sloughing or of 'terminal' differentiation at the completion of the progestin phase may play a critical role in determining endometrial cancer risk. This may provide an explanation of why endometrial cancer risk increases so sharply with age in young women even in countries where obesity-associated anovulation is very uncommon; extended periods of unopposed estrogen is not an explanation but less than 10 days of an 'adequate' progesterone level may be. EPRT significantly increased the risk of breast cancer. EPRT was associated with an approximately 24% increase in risk for each 5 years of use; the effect was some 212-fold greater than the effect of ERT, which we had previously predicted on theoretical grounds. This effect could also be predicted from the results on mammographic densities seen in the PEPI randomized trial of different forms of hormone replacement therapy (HRT). In the PEPI trial EPRT increased mammographic densities to a much greater extent than ERT. Progestins need to be given to protect the endometrium. They need to be delivered to the endometrium in a manner that will have the least effect on the breast. This can be carried out by using a vaginal or direct endometrial route of administration. The vaginal route will provide adequate endometrial progestin levels with low blood levels so that the effects of the progestin on the breast should be small; with the direct endometrial route the blood progestin levels are even lower, and the effects of the progestin on the breast will be effectively zero. If this is unacceptable to a woman, then giving progestins by mouth (or transdermally) for 10 days every 3 to 4 months should provide satisfactory protection of the endometrium when used with standard-dose conjugated estrogen (CE). This regimen has much less effect on the breast than monthly SEPRT or CEPRT. Two clinical trials of 10 mg per day of MPA for 14 days every 3 months and 0.625 mg/day of CE have been published. Both studies suggest that this approach may be satisfactory in that the extent of hyperplasia was minimal. More studies of this approach are urgently needed.

Breast Neoplasms↗
PubMedDate not supplied

The use of progesterone antagonists and progesterone receptor modulators in contraception.

Progesterone antagonists (PAs) and progesterone receptor modulators (PRMs) have contraceptive potential by suppressing follicular development, delaying the surge of luteinizing hormone (LH), retarding endometrial maturation, and promoting endometrial bleeding. Mifepristone, in daily doses of 2-10 mg, blocks the LH surge and ovulation. Many of the studies were conducted in women not at risk of pregnancy, and thus the contraceptive efficacy is not yet known. Nevertheless, there is evidence that daily doses of 2 or 5 mg of mifepristone have contraceptive potential. Because of anovulation, there may be an unopposed estrogen effect on the endometrium, although this risk may be mitigated by the noncompetitive anti-estrogenic activity exhibited by both PAs and PRMs. Low doses of PAs and PRMs, which do not affect ovulation, retard endometrial maturation, indicating that the endometrium is exquisitely sensitive to these compounds. This raises the prospect of endometrial contraception, i.e. prevention of endometrial maturation without disturbing ovulation or producing alterations in bleeding patterns. This approach works well in monkeys but was not found to be very promising when given to women not using contraception. On the other hand, 200 mg mifepristone administered 48 h after the LH surge, which has minimal or no effect on ovulation and bleeding patterns, is an effective contraceptive; yet, it is not a practical approach to contraception. Late luteal phase administration of mifepristone produces menstrual bleeding. However, when mifepristone was administered every month at the end of the cycle either alone or together with prostaglandins, it was not very effective in preventing pregnancy. In contrast, a mifepristone-prostaglandin combination has been shown to be a very effective treatment for occasional menstrual regulation, with vaginal bleeding induced in 98% of pregnant women, with menses delay of 11 days or less. Mifepristone is an excellent agent for emergency contraception when used within 120 h of unprotected intercourse. It is also possible that PAs and PRMs may be used to reduce the occurrence of bleeding irregularities induced by progestin-only contraceptive methods. Both classes of progesterone receptor ligands may also have contraceptive efficacy by having a pharmacological effect on the embryo or altering tubal transport or other aspects of tubal physiology.

Animals↗
PubMed2003

Premature prostaglandin F2alpha secretion causes luteal regression in GnRH-induced short estrous cycles in cyclic dairy heifers.

This study aimed to confirm that the luteolysis in normal-cycling dairy heifers seen during short estrous cycles induced with cloprostenol (Clp) and GnRH administered 24h apart is caused by a premature release of prostaglandin F(2alpha) (PGF(2alpha)). A further aim was to study the PGF(2alpha) release pattern more closely to determine whether it resembles the spontaneous release occurring during normal regression of the corpus luteum (CL) or whether PGF(2alpha) is continuously secreted after the induced ovulations, leading to short estrous cycles. Twenty-four Ayrshire heifers were allotted to four equally sized groups. After estrus synchronization with 0.5mg of Clp, a new luteolysis was induced with 0.5mg of Clp on Day 6 (groups T-d6 and C-d6) or Day 7 (groups T-d7 and C-d7) after ovulation. Gonadorelin (0.1mg i.m.) was given to groups T-d6 and T-d7 to induce premature ovulation 24h later. Groups C-d6 and C-d7 served as controls. Ovaries were examined daily by transrectal ultrasonography, while blood samples (for progesterone and 15-ketodihydro-PGF(2alpha) analyses) were obtained via a jugular catheter every 3h, starting from the second Clp treatment and continuing for 9 days postovulation. Unresponsiveness to Clp or anovulation resulted in 4 C-d6 heifers being excluded. Four heifers in group T-d6 and three in group T-d7 had a short estrous cycle of 8-12 days, while all others had a cycle of normal length. Significant elevations in 15-ketodihydro-PGF(2alpha) concentrations with recurrent high peaks coincided with a decrease in progesterone concentration and were detected in all heifers that showed a short estrous cycle, but not in any heifers with normal estrous cycles in groups T and C. In conclusion, a premature release of PGF(2alpha), which closely resembles its release during spontaneous luteolysis, causes luteal regression in these short cycles.

Animals↗
PubMed1998

Length of postpartum anestrus in goats in subtropical Mexico: effect of season of parturition and duration of nursing.

The aim of this study was to determine whether season of birth and length of nursing affected the duration of postpartum anestrus in Creole female goats maintained on a constant plane of nutrition in subtropical Mexico. Three experiments were conducted in the Laguna region in the State of Coahuila, Mexico (26 degrees N). In the first experiment, 34 goats gave birth in January; in the second, 31 females gave birth in May; and in the third, 22 goats kidded in October. At parturition, females were allocated to 1 of 3 groups based on body weight and date of parturition: kids were weaned at 2, 30 or 90 d according to their group. After weaning, females were milked manually once a day until the end of the study. All animals were kept in a shed and were fed alfalfa ad libitum and given 200 g of concentrate daily. Starting 1 wk after parturition, estrous behavior was detected twice daily using an apron-bearing male, and blood samples were obtained twice weekly to determine ovarian activity from the plasma progesterone levels. A strong effect of month of parturition was found on the duration of postpartum anestrus (P < 0.0001), which was longer in females kidding in January (about 200 d) than in those kidding in May (about 100 d) or October (about 50 d). A tendency for an interaction between season of parturition and length of nursing was observed in the length of anovulation (P < 0.07): for parturition in October, anestrus was longer when kids were weaned after 90 d than after 2 or 30 d (P < 0.01). Season of parturition also affected dates of reinitiation of ovulatory and estrous activity (P < 0.001). Proportions of normal, short and long cycles and of associations between estrous and ovulations were not influenced by season of parturition or the age of weaning. These data demonstrate that in subtropical latitudes, season of parturition can dramatically influence the duration of postpartum anestrus independently of the availability of food.

Anestrus↗
PubMed2003

Polycystic ovary syndrome and endometrial carcinoma.

CONTEXT: An association between polycystic ovary syndrome (PCOS)and endometrial carcinoma was first suggested in 1949, 14 years after the original description of the syndrome. Since then several studies have been published that seem to support this association. The prescription of hormonal treatment to reduce the risk of this complication is supported by the Guidelines for Good Clinical Practice of the Royal College of Obstetricians and Gynaecologists, UK, the Health Information website of the National Library of Medicine, USA, and in textbooks of gynaecological oncology. STARTING POINT: A recent practice bulletin from the American College of Obstetricians and Gynecologists on the clinical management of PCOS (Obstet Gynecol 2002; 100: 1389-402) says that there is still no consensus on the "optimal progestin, duration and frequency of treatment to prevent endometrial cancer in women with PCOS". Chronic anovulation, obesity, and hyperinsulinaemia are all associated with PCOS as well as with endometrial carcinoma. It has been assumed that PCOS predisposes to endometrial cancer. However, the evidence for such an association is inconclusive. Although PCOS is associated with risk factors for endometrial cancer, it does not necessarily follow that the incidence or mortality from endometrial cancer is increased. WHERE NEXT: Large-scale studies of morbidity and mortality in unselected populations of women with PCOS are needed. Women with PCOS are increasingly aware of the possible risks, and it will be necessary to identify which of them, if any, are at increased risk and how this risk can be effectively reduced.

Adult↗
PubMed2000

The effect of seizures and kindling on reproductive hormones in the rat.

Reproductive dysfunction and endocrine disorders are common among both women and men with epilepsy, and, in particular, with temporal lobe epilepsy. In clinical studies, it is hard to separate the effects of seizures from the effects of medication and life style. Studies in rodents, however, suggest that seizures per se can contribute to reproductive dysfunction. In female rats, generalized seizures disrupt normal ovarian cyclicity in adults, and repeated electroshock seizures delay the onset of puberty in juveniles. Right amygdala kindling in adult female rats causes acyclicity, the development of polycystic ovaries and premature aging of the hypothalamic-pituitary neuroendocrine axis, leading to chronic anovulation and continuous estrogen exposure. In adult male rats, repeated electroshock seizures result in transient hypogonadism, characterized by decreased serum testosterone levels and lowered gonadal tissue weight. In contrast, right amygdala kindling increases serum testosterone, estradiol levels and gonadal weight. These findings suggest that reproductive dysfunction in women and men with epilepsy may result from recurrent seizure activity, due to seizure-related interference with the normal functions of the hypothalamic-pituitary-gonadal axis.

Animals↗
PubMed2001

Autoantibody studies of female patients with reproductive failure.

The aim of this study was to investigate the prevalence and character of autoimmune derangements in women with reproductive failure. A total of 108 females (age range 17-43, mean 27.5 years), including 16 with primary menstrual cycle disturbances and polycystic ovaries (PCO), 20 with polycystic ovary syndrome (PCOS), 38 with endometriosis (E), and 34 with chronic anovulation, luteal phase insufficiency, subfertility or unexplained infertility (INF) were investigated. A control group of 392 women was formed from an unselected population sample (age range 17-43, mean 31.0 years). All sera were tested by indirect immunofluorescence method to assess common autoantibodies: nuclear (ANA), smooth muscle (SMA), parietal cell (PCA), thyroid microsomal (TMA), reticulin (ARA), mitochondrial (AMA) and liver/kidney microsomal autoantibodies (LKMA). Enzyme-linked immunosorbent assay was used to detect antibodies against beta2-glycoprotein I (anti-beta 2GPI) and carbonic anhydrase (anti-CA). Our results showed that 40.7% of patients' sera and 14.8% of control sera contained one or more common autoantibodies, ANA and SMA were most frequently detected (difference between two groups P<0.005). Anti-beta 2GPI were found in eight cases (7.4%), including two patients with INF but without other autoantibodies. Anti-CA were revealed in nine cases (8.3%) including patients' PCOS, E and INF. A comparison of patients' clinical data with antibody assay results did not reveal any significant associations. Our results indicate a high prevalence of autoimmune reactions in women with reproductive failure due to the most common causes PCO, PCOS and E as well as in unexplained infertility. This might reflect the propensity to develop autoimmune reactions in such patients, including pathogenic autoimmune reactions to specific target antigens.

Adolescent↗
PubMed1981

The menstrual cycle and plasma testosterone levels in women with acne.

A prospective study of the ovarian function and plasma testosterone levels was conducted in a group of 139 women presenting with a chief complaint of acne. In 90% of the patients the plasma testosterone levels were above the normal mean. Amenorrhea was present in 17.2%, anovulation in 18.4%, and variable degree of ovulatory dysfunction in 57.2% of the patients. The severity of ovarian dysfunction was directly proportional to the plasma testosterone levels. Age was inversely related to both plasma testosterone levels and severity of ovarian dysfunction. The results of this study suggest that acne may be associated not only with a hyperandrogenic state but also with ovarian dysfunction. They emphasize the need for a careful investigation of androgen levels and ovarian function in women with chief complaint of acne.

Acne Vulgaris↗
PubMed1987

Reproductive function in patients with renal insufficiency.

Hypogonadism is prevalent in patients with renal insufficiency and is manifested as sexual dysfunction and infertility in males and as anovulation and amenorrhea in females. Although many investigators believe that the defect represents primary gonadal damage by uremic toxins, we propose the coexistence of central neuroendocrine disorders in the regulation of gonadotropin secretion. Evidence supporting such a hypothesis is discussed.

Erectile Dysfunction↗
PubMed1977

Prolactin.

Prolactin exists in man as a distinct and separate anterior pituitary hormone from growth hormone. It is important in lactation and the control of gonadal function, although it may have a much wider and basic metabolic role, similar to its role in lower forms. In clinical endocrinology it is important as an index of pituitary and hypothalamic diseases; thus prolactin levels are elevated in association with these conditions and this reflects the normal tonic inhibitory hypothalamic control of prolactin by PIF; DA is the most important PIF. Hyperprolactinaemia causes hypogonadism in both men and women; it may present in women with amenorrhoea, oligomenorrhoea, polymenorrhoea, regular cycles with anovulation or a defective luteal phase, and impotence in men. In either sex galactorrhoea is reported to occur in only 30 per cent of patients. Neurotransmitter therapy, with dopamine agonists which act as functional analogues of PIF, restores prolactin levels to normal and leads to a return of normal gonadal function. The mechanism of the hypogonadism is not clear and is discussed together with the problems associated with inducing pregnancy in these patients, who may harbour microadenomata of the pituitary.

Age Factors↗
PubMed1997

Estrogen dermatitis.

The aim of the present study was to evaluate the estrogen dermatitis of women who have chronic skin disorders with exacerbations or premenstrual dermatitis in a cyclic pattern. Twenty-three women exhibiting skin disorders of pruritus, urticaria, eczema, papulovesicular eruption, hirsutism-acne with hyperpigmentation (hirsutism and/or its related disorders such as acne) and 18 healthy control subjects were included in the study. Sensitivity to estrogen was described in 14 of 23 women. Of the 14 estrogen sensitive women, nine had a premenstrual flare of their skin lesions and five had a chronic dermatitis with exacerbations. In the evaluation of endocrine profile, mean serum testosterone and LH levels of the patient group were significantly higher than controls (2.814 +/- 0.839 vs. 1.561 +/- 0.645 nm/l, P < 0.001; 10.843 +/- 2.538 vs. 4.539 +/- 1.215 IU/l, P < 0.0001). The LH/FSH ratio of the patient group was also significantly higher than controls (1.765 +/- 0.329 vs. 0.810 +/- 0.0116, P < 0.0001). Mean serum progesterone level of the patient group was significantly lower than the control group (0.499 +/- 0.201 vs. 0.977 +/- 0.396 ng/ml, P < 0.001). Hyperandrogenism and anovulation were the two more common outcomes in the patient group. Skin lesions of estrogen sensitive women were all cured with the administration of tamoxifen 20 mg daily for 7 days premenstrually.

Acne Vulgaris↗
PubMed2001

Hypothalamic dysfunction.

A pulsatile GnRH stimulus is required to maintain gonadotropin synthesis and secretion. The frequency and amplitude of GnRH pulses determine gonadotropin subunit gene expression and secretion of pituitary LH and FSH. Rapid frequency (more than 1 pulse per h) GnRH pulses favor LH while slower frequencies favor FSH secretion. During ovulatory cycles, an increase in GnRH frequency during the follicular phase favors LH synthesis prior to the LH surge, while following ovulation, luteal steroids slow GnRH pulses to favor FSH synthesis. Thus, a changing frequency of GnRH stimulation of the gonadotrope is one of the mechanisms involved in differential gonadotropin secretion during ovulatory cycles. In hypothalamic amenorrhea a majority of women exhibit a persistent slow frequency of LH (GnRH) pulses, which reflects excess hypothalamic opioid tone and can be temporarily reversed by opioid antagonists. At the other end of the spectrum, in polycystic ovarian syndrome, LH (GnRH) pulses are persistently rapid and favor LH synthesis, hyperandrogenism and impaired follicular maturation. Administration of progesterone can slow GnRH pulse secretion, favor FSH secretion and induce follicular maturation. Thus, the ability to change the pattern of GnRH secretion is an important factor in the maintenance of cyclic ovulation, and loss of this function leads to anovulation and amenorrhea.

Amenorrhea↗
PubMed2001

Intra-follicular activin availability is altered in prenatally-androgenized lambs.

Prenatal exposure of sheep to testosterone (T) disrupts ovarian cyclicity and leads to anovulation in adulthood. We propose that the disruption of ovarian function in prenatally-androgenized sheep is mediated via follicular defects stemming from reduced intrafollicular activin availability/action. The intra-follicular activin availability/action that facilitates follicular development is dictated by the relative proportions of activins, inhibins (antagonists of activin action) and follistatins (FS; binding proteins of activin and negator of activin action). Inhibin alpha, beta A, beta B, and FS mRNA expression were determined by in situ hybridization in 5 week-old ovaries from control (C) lambs or those exposed to testosterone (T) or DHT from 30-90 days of gestation. In utero exposure to T, but not DHT, increased total ovarian weight (0.4+/-0.1,1.5+/-0.5 and 0.3+/-0.1 g, C, T and DHT, respectively) and total number of follicles (16.5+/-2.8,37.8+/-7.9, and 18.8+/-3.0). With the exception of two follicles in T animals, all follicles were < or = 2 mm in diameter. All follicles < or = 2 mm in all groups expressed FSH receptor mRNA in the granulosa cells and LH receptor only in the thecal cells. The percentage of follicles expressing FS mRNA was increased (P<0.05) in sheep prenatally-androgenized with either T (80.4+/-8) or DHT (80.3+/-5.5) as compared to C (50.8+/-8.2). In contrast, the percentage of follicles expressing activin beta B mRNA tended to be lower (P=0.06) in the T (30.9+/-7.1) and DHT (40.5+/-3.3) groups as compared to C (66.1+/-15.6). Increased expression of FS along with the reduced expression of activin beta B mRNA provides evidence for compromised intra-follicular activin availability in the majority of follicles in the androgenized groups. The increase in ovarian weight and follicular number in the T, but not in the DHT group, suggests that the effects of T are mediated through the action of estrogen. We speculate that the decrease in relative abundance of activin may contribute to the selection defects in prenatally-androgenized sheep. If true, this may be a useful model to understand the etiology of polycystic ovarian syndrome.

Activins↗