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PubMed2000

[Treatment of hyperprolactinemic anovulation with the dopamin-agonist quinagolide].

Quinagolide has a strong dopaminerg activity, suppresses prolactin secretion and restores gonadal function in women with hyperprolactinemic anovulation. The aim of our study was to investigate the effectiveness of quinagolide in the treatment of 16 hyperprolactinemic patients. The clinical diagnosis was functional hyperprolactinemia in 13 patients, microprolactinoma in 2 and empty sella syndrome in 1. The drug was administered orally and initially daily dose was 0.025 mg for the first three days, 0.050 mg for the next three days and 0.075 mg for the following 6 months. The serum prolactin level was measured monthly before pregnancy, three monthly during the pregnancy and six weeks after delivery. Serum prolactin levels decreased in most of the patients during the first month and only in one case remained in the pathological range after six months quinagolide++ treatment. Prolactin secretion changed (mean and range) from 3120 (780-5790) mU/l to 370 (84-1076) mU/l. Out of 16 hyperprolactinemic patients nine women were infertile. During quinagolide treatment 5 pregnancies occurred. In conclusion, our results show that quinagolide has a good efficacy on regulation of prolactin secretion and it is a well tolerated dopamin-agonist drug.

Adult↗
PubMed2001

[Effects of metformin on hyperinsulinemic anovulation].

OBJECTIVE: To investigate the effects of metformin on serum testosterone (T) levels and ovulation in hyperinsulinemic women. METHODS: Twenty-nine patients with hyperinsulinemic anovulation were treated with metformin for 12 weeks. Among them 19 had history of clomiphene(CC) treatment with 11 cases failure. CC was given again after one month of metformin treatment. Serum T, luteinizing hormone, follicle-stimulating hormone, insulin(Ins) levels were measured after 4 weeks of treatment. Basic body temperature was also observed. RESULTS: Serum T and Ins levels declined significantly after 4 weeks of metformin treatment [(2.7 +/- 1.6) nmol/L Vs (1.9 +/- 1.0) nmol/L, (49.2 +/- 34.1) mU/L Vs (25.3 +/- 23.9) mU/L, P < 0.05, P < 0.05 respectively]. Eight cases ovulated spontaneously and 8 cases with history of CC failure became ovulatory during CC treatment. CONCLUSIONS: Metformin is effective for suppressing serum T levels and improving the outcome of ovulation.

Adult↗
PubMed1976

Treatment of anovulation with human menopausal gonadotrophin.

A method is presented of gonadotrophin administration and serum 17beta-oestradiol monitoring for the treatment of anovulation. Four of the 6 patients treated have conceived without any undesirable effects due to hyperstimulation. The advantages of this method of treatment and monitoring are discussed.

Adult↗
PubMed1992

Maternal behavior and neuroendocrine regulation of suckling-mediated anovulation in cows.

Although it is clear that the initial endocrine deficit contributing to the length of the postpartum anovulatory period in suckled cows is of pituitary origin, this limitation is only operative for about the first 2 weeks of the puerperium. Thereafter, the pattern of LH secretion required for the final stages of follicular development and ovulation is blocked or attenuated through a more centrally regulated phenomenon. Hence, much of the recently published work in this area has focused on regulatory processes within the hypothalamus. This focus ignores the critical issue of exteroceptive signalling. Recent observations in this laboratory suggest that exteroceptive cues responsible for suckling-mediated anovulation are specifically attributable to the dams' own calf, but are not teat-specific. In fact, suckling does not produce an extended anovulatory state in the absence of a maternal-offspring bond. This review provides an historical perspective of investigations leading to this conclusion, and proposes a conceptual working model that links the special senses, maternal behavior and neuroendocrine centers that drive gonadotropin secretion during the puerperium.

Animals↗
PubMed1992

Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women.

OBJECTIVE: To evaluate the contribution of anovulation and luteal phase defects to lactational infertility. DESIGN: Prospective longitudinal follow-up. SETTING: Outpatient clinic. SUBJECTS: Forty-nine women fully nursing and amenorrheic on day 75 postpartum and 25 cycling, interval non-nursing women. INTERVENTIONS: Plasma prolactin, luteinizing hormone, estradiol (E2), and progesterone (P) levels twice a week up to the second postpartum menses. MAIN OUTCOME MEASURES: Ovulation rate and endocrine profile of the menstrual cycles. RESULTS: Ovulation rates were 37% and 97% at 6 and 12 months postpartum; 67% of ovulations occurred in amenorrhea. The luteal phase was shorter, and E2 and P levels were lower in lactating women than in non-nursing women. These parameters were closer to normal in the second cycle than the first, in spite of active nursing. The risk of ovulation and pregnancy in amenorrhea was 27.7% and 0.9% at month 6 postpartum. After the first menses, these risks were 93% and 7%, respectively. CONCLUSION: The abnormal endocrine profile of the first luteal phase offers effective protection to women who ovulate during lactational amenorrhea within the first 6 months after delivery. Later luteal phases are improved and women are at risk of pregnancy.

Adolescent↗
PubMed2004

Metformin versus sibutramine in the treatment of hyperinsulinemia in chronically anovulating women.

Aim of this study was to compare the effects of metformin and a body weight reduction regimen using sibutramine on insulinemia, insulin sensitivity, and ovarian function in women with anovulatory cycles or infertility. 30 women with anovulatory cycles and hyperinsulinemia were treated with metformin and 15 anovulating women with obesity were treated with sibutramine in combination with a caloric restriction diet and physical exercise. In the metformin group there was a mild decrease of the body mass index (BMI), a decrease of fasting and stimulated insulinemia (I0, p < 0.05, I120, p < 0.01), a significant reduction of insulin resistance calculated as index FIRI (p < 0.05), serum LH (p < 0.05) and testosterone levels (p < 0.05). There was an improvement of menstrual cycles in 21 (70 %) of women, and 6 of them became pregnant. In the sibutramine group we found a significant decrease of BMI (p < 0.01), waist circumference (p < 0.01), fasting and stimulated insulinemia (p < 0.05, p < 0.01) and a significant improvement of insulin sensitivity (FIRI, p < 0.01). However, the levels of FSH, LH, and testosterone were not significantly changed. There was a significantly greater reduction of insulin levels and FIRI after sibutramine treatment compared with metformin treatment, while the changes of LH were not signifcantly different. Testosterone was changed more after metformin therapy. We conclude that although the body weight reduction using sibutramine has a more pronounced effect on insulinemia and insulin sensitivity, metformin may be more effective in the prompt restoration of ovarian function. (Tab. 3, Ref. 24.).

Adult↗
PubMed2005

The diagnosis and treatment of stress-induced anovulation.

Behaviors that activate the hypothalamic-pituitary-adrenal (HPA) axis or suppress the hypothalamic-pituitary-thyroidal (HPT) axis can disrupt the hypothalamic-pituitary-gonadal (HPG) axis in women and men. Individuals with functional hypothalamic hypogonadism typically engage in a combination of behaviors that serve as psychogenic stressors and present metabolic challenges. Complete recovery of gonadal function depends upon restoration of the HPA and HPT axes. Hormone replacement strategies have limited benefit because they do not promote recovery from these allostatic endocrine adjustments in the HPA and HPT axes. Indeed, the rationale for the use of sex steroid replacement is based on the erroneous assumption that functional forms of hypothalamic hypogonadism represent only an alteration in the hypothalamic-pituitary-ovarian (HPO) axis. Further, use of sex hormones masks deficits that accrue from altered HPA and HPT function. Long-term deleterious consequences of stress-induced anovulation may include an increased risk of cardiovascular disease, osteoporosis, depression, other psychiatric conditions, and dementia. Although fertility can be restored with exogenous administration of gonadotropins or pulsatile GnRH, fertility management alone will not permit recovery of the HPA and HPT axes. Failure to reverse the hormonal milieu induced by stress may increase the likelihood of poor obstetrical, fetal, or neonatal outcomes. In contrast, behavioral and psychological interventions that address problematic behaviors and attitudes have the potential to permit resumption of ovarian function along with recovery of the HPT and HPA axes. Full endocrine recovery offers better individual, maternal, and child health.

Amenorrhea↗
PubMed1992

Atmospheric temperature & anovulation in south Indian women with primary infertility.

An attempt at correlating atmospheric temperature, humidity and histologically diagnosed anovulatory endometrium has been made. A total of 140 women who had anovulatory endometrium among 1036 patients who had a clinical diagnosis of primary infertility, over a 5 yr period were studied. The principle of Edwards' test was used to analyse the seasonal trends and the seasonal index for the occurrence of anovulatory endometrium, atmospheric temperature and humidity was calculated using the average percentage method. The results suggest that anovulatory cycles in women with infertility tended to occur more during those months in the year when temperature increased (r = 0.63). However, humidity was not related to anovulation.

Adolescent↗
PubMed1992

[Gonadotropin releasing hormone loading test with bromocryptin therapy: a new possibility in the differential diagnosis of normo-prolactinaemic anovulation].

An anovulation group with normal basal prolactin level (less than 600 mU/l) was found during GnRH loading tests. After GnRH administration there was a definite increase in prolactin value together with an insufficient hypophyseal response. Bromocriptine treatment was commenced on the 10th day (daily 2.5 mg) before carrying out the GnRH loading tests again. During the repeated tests prolactin levels remained normal, basal FSH and LH values increased and reactive hypophyseal responses occurred. On the basis of the examination a group ("latens hyperprolactinemia") responding with increased prolactin production during GnRH administration was found. This higher prolactin level inhibits gonadotropin release from hypophysis. In these cases ovulation induction with bromocriptine is adviseable in spite of basal prolactin level is normal.

Anovulation↗
PubMedDate not supplied

Role of metformin in correcting hyperinsulinemia, menstrual irregularity and anovulation in polycystic ovary syndrome.

BACKGROUND: Previous studies suggest that metformin by reducing hyperinsulinemia is clinically useful in the treatment of polycystic ovary syndrome (PCOS). Our Objective was to observe the role of metformin in correcting oligomenorrhea/amenorrhea and anovulation within six month in hyperinsulinemic women with PCOS. Another aim was to assess the decrease in hyperinsulinemia and body weight by metformin in our population. METHODS: This study was carried out at the Department of Obstetrics and Gynaecology, Islamic International Medical Complex (IIMC) Islamabad, from October 2001 to March 2003. Fifty women fulfilling the clinical and biochemical criteria for PCOS and hyperinsulinemia were enrolled. Metformin was started at an oral dose of 500mg/day and maintained at 1500mg for 6 months. Besides ultrasonography and body weight. serum FSH, LH, fasting insulin, fasting blood sugar and creatinine levels were performed. After six months menstrual cyclicity, fasting insulin levels, day 21 serum progesterone and body weights were assessed. RESULTS: After six months of Metformin therapy, menstrual regularity was achieved in 19 out of 22 women (86%). Out of these 11 women (50%) were ovulating at six months. On Metformin, the median fasting serum insulin decreased from 23.6 micro U/ml to 20.2 micro U/ml (P<0.05). There was no significant weight reduction (p=0.096) with Metformin in six months. Data was analyzed using SPSS by paired t-test.

Adolescent↗
PubMed1989

[Treatment of anovulation in polycystic ovary syndrome with clomiphene citrate in 10-day cycles].

The efficacy of a new schedule for the use of Clomiphene citrate (50 mg daily, during the first ten days of the cycle) is reported, in relation to ovulation induction and fertility. We treated 41 patients with the syndrome of polycystic ovary, who were anovulant and desired fertility. Ovulation was successfully induced in 35 of them (85.4%). Pregnancy was achieved in 28 patients (68.3%). In 87.5% of those becoming pregnant, gestations was achieved with less than 6 months of treatment. Our results are equally good or better than those reported in the literature with conventional treatment. Pregnancies obtained were normal. No congenital malformations were observed. There were only two abortions, spontaneous. No patient presented ovarian hyperstimulation syndrome. This new schedule is recommended because it is effective and it may give less complications. Also, it is not necessary to increase progressively the dose of clomiphene citrate.

Adult↗
PubMed1987

Alteration of follicle regulatory protein levels in human reproductive disorders: anovulation.

Recently, a follicle regulatory protein was identified that suppresses ovarian response to gonadotropins. In this study, the serum levels of follicle regulatory protein were measured in five groups of women: reproductive age undergoing oophorectomy (N = 10), postmenopausal (N = 10), ovulatory (N = 13), anovulatory (N = 16), and anovulatory receiving clomiphene citrate therapy (N = 14). Follicle regulatory protein-related immunoreactivity was measured by a competitive enzyme-linked immunosorbent assay, while peripheral estradiol and progesterone levels were determined by established radioimmunoassay. Concentration of follicle regulatory protein in serum in all ovariectomized patients decreased significantly from preoperative levels. The postmenopausal women had significantly lower follicle regulatory protein levels than did ovulatory and anovulatory women. Patients with low levels of serum estradiol in the early follicular phase exhibited either significantly elevated or suppressed follicle regulatory protein levels compared with patients with normal estradiol concentrations, suggesting two different etiologies for ovarian dysfunction. Eleven to 12 and 22-23 days after the onset of the last menstrual period, patients with elevated follicle regulatory protein levels were found to be anovulatory. These observations suggest that elevated intraovarian levels of follicle regulatory protein may cause a disruption of follicular maturation that leads to anovulation and, in some cases, to resistance to clomiphene citrate therapy.

Adult↗
PubMed1983

[Hormone levels, celioscopy and ovarian histology in the hirsutism-anovulation syndrome].

Among 50 women with hirsutism, spanio- or amenorrhoea and anovulation, coelioscopy and histological examination of ovarian biopsies showed that 26 had typically polycystic ovaries (PCO), 17 had "borderline ovaries" (BO)--i.e. apparently normal or subnormal but with histological abnormalities identical to those of PCO--and 7 had normal ovaries. The hormonal profiles of BO and PCO were very similar. An increase in LH or in LH response to LHRH, which is regarded as characteristic of polycystic ovarian disease, was only observed in 75% of women with PCO or BO. The PCO and BO detection value of simple basal LH determination was slightly enhanced by the LHRH test, and no further enhancement was observed after repeated LHRH injections. 38% of PCO's and 75% of BO's were associated with adrenal hyperandrogenism, as evidenced by a rise in dehydroepiandrosterone values. Thus, more than one half of hirsute and non-ovulating women have polycystic ovaries. Most of these can be diagnosed by hormonal investigations without having recourse to coelioscopy. However, some do not display, at least permanently, the hormonal profile characteristic of polycystic ovarian disease.

17-alpha-Hydroxyprogesterone↗
PubMed1982

Estrogen provocation test: lack of correlation between LH and 17-beta-estradiol basal levels and LH peak response in hypothalamic chronic anovulation.

Estrogen provocation test was performed in 27 women with hypothalamic chronic anovulation: all patients received I mg of estradiol benzoate (EB) as a single im injection. Plasma 17-beta-estradiol (E2) levels were monitored during the test performed and then compared; no significant correlation was found between mean basal values of LH and E2 and the LH peak response (r = 0.246, P = 0.108 for LH; r = 0.124, P = 0.278 for E2). These data seem to indicate that basal LH values reflect the tonic secretion but not the hypothalamic responsiveness to the estrogen positive feedback; moreover, this latter seems not be influenced by the endogenous E2 levels.

Adult↗
PubMed1995

ACOG technical bulletin. Hyperandrogenic chronic anovulation. Number 202--February 1995. Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists.

The evaluation and treatment of chronic anovulation requires knowledge of the many disorders which may present as menstrual abnormalities. The evaluation should document physical findings suggestive of androgen excess. Initial evaluation includes an orderly approach to laboratory testing. Underlying disorders may include life-threatening diagnoses. The goals of therapy include correction of life-threatening disorders, protection of endometrial health, preservation or restoration of fertility, and reversal of cosmetically disturbing hirsutism.

Adult↗
PubMed1977

[Effect of sigetin on anovulation in rats].

The effect of sygethin on anovulatory cycle was studied in mature female rats. Anovulation was experimentally induced in rats on the one hand by stress effect (keeping rats in crowded conditions), and on the other hand by removing one ovary (hemicastration). Sygethin therapy (10 mg/kg for 4-5 days) proved to restore normal ovulation. When higher sygethin doses were used, and when it was administered for longer periods (for 2 to 3 weeks) no such effect proved to ensue. The results of these experiments suggest that small doses of sygethin stimulated luteinizing hormone secretion.

Animals↗
PubMed1991

A role for a non-androgenic anovulant in the management of hirsutism.

Sixty-nine patients who had Ferriman/Gallwey hirsutism scores (FG) of greater than or equal to 8 were treated with Diane, an anovulant containing cyproterone acetate, 2 mg, an anti-androgenic progesterone and ethinyl oestradiol, 5.0 micrograms. Twenty-one of these had been previously treated with dexamethasone (DEX) and did not respond, i.e. FG greater than 50% of pre-treatment value. Prior to Diane treatment, plasma total testosterone (T) values, 1.4 +/- 0.5 nmol/l, mean +/- S.D., were similar to those in 43 normal women, 1.23 +/- 0.3 nmol/l, as were plasma androstenedione levels, 6.8 +/- 2.5 and 6.0 +/- 1.7 nmol/l respectively. However, plasma sex hormone-binding globulin (SHBG) values were suppressed being 36.2 +/- 16 nmol/l in hirsute women and 45.8 +/- 15 nmol/l in normal women, p less than 0.01. The T/SHBG ratio, an index of free testosterone, was elevated in hirsute women, 4.8 +/- 4.1, compared to values in normal women, 2.9 +/- 1.0, p less than 0.001. Following Diane therapy (2-24 months), 73% of patients responded clinically. There was no change in T, but SHBG was increased to 181 +/- 54 nmol/l, p less than 0.001 and T/SHBG was decreased markedly to 0.9 +/- 0.4, p less than 0.001. Androstenedione fell also to 4.8 +/- 1.7 nmol/l, p less than 0.001. The clinical and hormone response to Diane was similar in both DEX-resistant and previously untreated groups. We conclude that Diane is an effective agent in the treatment of hirsutism while it avoids the adverse effects of androgenic progesterone and of high dose cyproterone acetate therapy.

Androgen Antagonists↗
PubMed2001

Comparison of the effectiveness of recombinant and urinary FSH preparations in the achievement of follicular selection in chronic anovulation.

In order to compare the effectiveness of urinary and recombinant FSH (rFSH) preparations in achieving the threshold of follicular growth, stimulated cycles from patients with chronic anovulation, treated with a constant dose of FSH until the emergence of a selected follicle, were retrospectively analysed. Sixty-four cycles were performed using a similar starting dose of either urinary FSH (group 1) or rFSH (group 2), which was kept constant up to the time of follicular selection, assessed on ultrasound (follicular diameter >10 mm). The results of this study showed that, while the number of selected follicles was similar, the mean daily FSH dose required to achieve the threshold of follicular selection was significantly lower in group 2 (70.4 +/- 3.4 IU/day) than in group 1 (86.5 +/- 4 IU/day; P < 0.005). Furthermore, at the time of human chorionic gonadotrophin (HCG) administration, the total FSH dose was significantly lower in group 2 than in group 1, but plasma oestradiol values were equivalent. These data suggest that the higher effectiveness of rFSH preparations over urinary ones may be explained by a lower threshold dose required to achieve follicular selection.

Journal Article↗