Irregular cycles and steroid hormones in polycystic ovary syndrome

BACKGROUND

This cross-sectional study was undertaken to evaluate the factors that relate to menstrual status (oligo-amenorrhoea versus eumenorrhoea) in polycystic ovary syndrome (PCOS).

METHODS

A total of 234 women with clinical and biochemical features suggestive of PCOS underwent metabolic and hormonal evaluation. A forward stepwise logistic regression model was created based on the results to determine variables related to ovulatory status.

RESULTS

Only follicular phase progesterone and estradiol (E(2)) were retained in the final model. This model correctly classified 80% of PCOS women by ovulatory status. Univariate analysis revealed no difference in progesterone between ovulatory groups but E(2) was higher in anovulatory groups. This suggested interaction between progesterone and E(2) and the single interaction variable (progesterone/E(2)) also classified 80% of women by ovulatory status correctly.

CONCLUSION

The results suggest that a low ratio of progesterone to E(2) is associated with menstrual irregularity and ovulatory status in PCOS.

The relationship between the endocrine characteristics and the regularity of menstrual cycles in the approach to menopause

OBJECTIVE

There is currently little longitudinal data available on the serum hormonal characteristics of the menstrual cycles observed in women as they approach their final menstrual period (FMP) or menopause. We sought to determine whether the onset of irregular menses, marking the menopause transition, signifies the occurrence of anovulatory, potentially infertile cycles.

DESIGN

We studied 12 subjects, initially aged 45 to 47 years, who provided daily menstrual diaries, and had blood samples collected annually, three times weekly for 4 consecutive weeks, over a period of 36 to 98 months until FMP, for measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone, estradiol, and progesterone. The definition of entry into the early menopause transition was the occurrence of more than two cycles, in any consecutive sequence of 10, where cycle length was less than 23 or more than 35 days. Entry into the late transition was determined from the first observation of either 60-day or 90-day amenorrhea. Cycles were characterized endocrinologically as normal ovulatory, abnormal luteal phase, and anovulatory with evidence of ovarian follicular activity.

RESULTS

The early transition had an average duration of 47 months from onset until FMP. Ten of the 12 subjects had one or more ovulatory cycles during the transition. Anovulatory cycles with ovarian activity were noted in 9 of the 12 subjects, only after entry into early and/or late transition.

CONCLUSIONS

Ovulatory cycles occurred both before and after entry into the early and/or late menopause transition in subjects older than 45 years of age, whereas anovulatory cycles were observed only during the transition. The ovulatory cycles were generally associated with normal menses, whereas anovulatory cycles showed long duration and/or abnormal bleeding patterns. The occurrence of cycle irregularity is associated with an increasing frequency of anovulatory cycles, which herald the occurrence of FMP. No conclusion could be drawn regarding the appropriate definition of entry into the late transition. The definition adopted for entry into the early transition merits further validation.

Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study

BACKGROUND

Elevated levels of plasma homocysteine (Hcy) have been implicated as a significant risk factor for cardiovascular disease. Although long-term treatment with metformin can increase Hcy levels in patients with type II diabetes mellitus or coronary heart disease, it is becoming an increasingly accepted and widespread medication in polycystic ovary syndrome (PCOS). In the literature, only one study has demonstrated that metformin increases Hcy levels in PCOS patients, but the effect of other insulin sensitizers on Hcy levels have not been reported previously in women with PCOS. We aimed to assess the effects of metformin and rosiglitazone on plasma Hcy levels in patients with PCOS.

METHODS

Thirty women were randomized to two groups: 15 women in group 1 received 850 mg of metformin twice daily for 3 months. In group 2, 15 women received 4 mg of rosiglitazone for 3 months. In both groups, body mass index, menstrual pattern, and plasma total Hcy, insulin, glucose and lipid metabolism parameters were recorded at baseline and at 3 months.

RESULTS

Hcy levels increased from 8.93+/-0.49 to 11.26+/-0.86 micromol/l (P = 0.002) and from 10.70+/-0.86 to 12.36+/-0.81 micromol/l (P = 0.01) in the metformin and rosiglitazone groups, respectively. Apolipoprotein (Apo) A1 levels increased from 127.10+/-6.85 to 145.7+/-7.18 mg/dl (P = 0.018) in the metformin group. Total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and Apo B levels decreased in the metformin group, but the change was not significant. Total-C levels decreased from 161.15+/-8.94 to 150.23+/-8.73 mg/dl (P = 0.026), HDL-C decreased from 43.13+/-2.65 to 39.15+/-2.52 mg/dl (P = 0.005) and LDL-C levels decreased from 93.83+/-6.06 to 80.7+/-2.30 mg/dl (P = 0.021) in the rosiglitazone group.

CONCLUSION

Treatment with insulin sensitizers in women with PCOS may lead to increases in Hcy levels.

Plasma concentrations of inhibin A in cattle with follicular cysts: relationships with turnover of follicular waves and plasma levels of gonadotropins and steroid hormones

We investigated the profiles of circulating levels of inhibin A and total inhibin in beef cows with follicular cysts in relation to the patterns of follicular development and circulating gonadotropins and steroid hormones. Turnover of follicular waves was monitored in five cows every 2 days for 70 days from 10 days after detection of estrus without ovulation. The mean interwave intervals were 19.6 +/- 1.0 days (n = 18 waves with cysts from the five cows). Circulating levels of inhibin A were approximately 170 pg/ml before emergence of follicular waves with cysts and increased (P < 0.05) concomitantly with follicle emergence. High concentrations of inhibin A (greater than 300 pg/ml) were noted for 7 days during the growth phase of cystic follicles, but inhibin A levels decreased gradually when development of the cysts reached a plateau. This profile of inhibin A was similar to those of total inhibin and estradiol, but was inversely related to the changes in plasma FSH concentrations. LH pulse frequency and mean concentrations of LH in cows with cysts were higher than those observed in the luteal phase of normal cyclic cows. These results indicate that the capacity to secrete inhibin, as well as estradiol, is maintained in cystic follicles, the growth of which is extended by LH secretion at levels greater than those seen in the normal luteal phase. Inhibin A plays an important role in the extension of interwave intervals by suppressing recruitment of a new cohort of follicles.

[GnRH antagonists in natural cycles]

Since the introduction of IVF treatments, natural cycle has been largely replaced by ovarian stimulation. However, natural cycle IVF has several advantages. It is associated with a close to zero multiple pregnancy rate, and a zero risk of ovarian hyperstimulation syndrome. Per cycle, natural cycle IVF is less time consuming, physically and emotionally less demanding for patients, and cheaper than stimulated IVF, but also less effective. Many cycles are cancelled because of a premature LH surge. GnRH antagonists prevent LH surge and therefore improve the results of natural IVF cycles. The GnRH antagonist should be started at day 8, at the daily dose of 0.5 mg. The natural cycle is a successful option of treatment in poor responders and implantation failure.

[Antagonist protocols: residual LH levels and the value of exogenous LH supplementation]

When administered in the late follicular phase to prevent any LH surge, GnRH antagonists induce a sharp decrease in serum LH levels that may be detrimental for assisted reproductive technology cycle outcome. This decrease in LH levels is dose-dependant. Supplementation with recombinant LH when introducing GnRH antagonist leads to significant changes in E2 secretion. This is consistent with a key role of LH to ensure adequate steroidogenesis. This also indicates that a single dose of GnRH antagonist is able to decrease bioactive LH below a minimal threshold for optimal steroidogenesis. However, supplementation with rLH does not modify the number of retrieved oocytes, obtained embryos and the pregnancy rate. This is in line with the concept that folliculogenesis is mainly dependent on FSH and that the role of LH and E2 is not primordial. Indeed, the findings of our prospective randomized study do not support a systematic supplementation with rLH when introducing antagonist. However, further studies are necessary to determine whether a specific sub group of patients characterized by a low E2/oocyte ratio could benefit from rLH supplementation.

[Optimizing ovarian stimulation for IVF using GnRH antagonists]

ART teams have failed to predict that pregnancy rates in GnRH antagonist regimens will be lower compared to the agonist regimens. No evidence appears to exist for an adverse effect of GnRH antagonists on oocyte/embryo quality. Abnormal development of endometrium at OPU is present in all cycles stimulated with GnRH antagonists and it is also encountered in all stimulation schemes using gonadotropins. Endometrium advancement is negatively associated with the probability of pregnancy. Endometrium histology at oocyte retrieval is positively associated with LH levels at initiation of stimulation and the duration of rec FSH stimulation prior to antagonist initiation. The presence of elevated serum progesterone on day two of the cycle is associated with a higher exposure to progesterone and a decreased probability of pregnancy. The higher the LH levels on day 8 of stimulation, the lower the probability of pregnancy. Low E2 levels on the day of hCG administration are not associated with a decreased probability of pregnancy. Ovarian stimulation for IVF alters steroid receptor kinetics in the follicular phase. Prolongation of follicular phase is associated with a decreased probability of pregnancy. Prolongation of follicular phase results in secretory changes of endometrium at OPU.

Serum resistin levels in women with polycystic ovary syndrome

OBJECTIVE

To measure serum resistin levels in women with polycystic ovary syndrome (PCOS) and assess possible correlations of resistin to the hormonal and metabolic parameters of the syndrome.

DESIGN

Clinical study.

SETTING

University hospital.

PATIENT(S)

Ninety selected women were classified as follows: group I: 35 anovulatory women with PCOS (body mass index [BMI] >25 kg/m(2)); group II: 35 anovulatory women with PCOS (BMI <25 kg/m(2)); group III: 20 ovulating women (controls) without hyperandrogenemia (BMI <25 kg/m(2)); women of group III were volunteers.

INTERVENTION(S)

Blood samples were collected between the 3rd and the 6th day of the menstrual cycle of the ovulating women, and between the 3rd and the 6th day of a spontaneous bleeding of the anovulatory women, at 9 a.m., after an overnight fast.

MAIN OUTCOME MEASURE(S)

Serum levels of FSH, LH, PRL, 17alpha-hydroxyprogesterone, sex hormone-binding globulin, androgens, insulin, resistin, and glucose.

RESULT(S)

Resistin levels were found to be significantly increased in group I compared with those of group II and those of group III. No significant difference in resistin levels was found between groups II and III, despite significant differences in insulin levels and the glucose-to-insulin ratio. Multiple regression analysis showed that resistin levels do not correlate with any parameter independent of BMI.

CONCLUSION(S)

Based on the above findings, we presume that resistin is unlikely to be a major determining factor of PCOS-associated insulin resistance and is not actively involved in the pathogenesis of the syndrome.

[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.

Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age

Anti-Müllerian hormone (AMH) concentrations correlate with the number of antral follicles as well as age and constitute an endocrine marker for ovarian aging. In normogonadotropic anovulatory infertile women [World Health Organization (WHO) class 2], the number of early antral follicles is usually increased. To investigate whether AMH concentrations are increased, serum levels in 128 WHO 2 women were compared with those in 41 normoovulatory premenopausal women of similar age. Serum AMH concentrations are significantly (P < 0.001) elevated in WHO 2 patients [median, 7.6 micro g/liter (range, 0.1-40.0)], compared with controls [median, 2.1 micro g/liter (0.1-7.4)]. In 106 patients presenting with polycystic ovaries (PCOs) (>/==" BORDER="0">12 follicles/ovary measuring 2-9 mm and/or an ovarian volume > 10 ml), AMH levels were elevated [9.3 micro g/liter (1.8-40.0)], compared with 22 patients without PCOs [6.4 micro g/liter (0.1-22.1)] (P < 0.0001). In WHO 2 patients, AMH concentrations correlated with features characteristic for polycystic ovary syndrome such as LH concentrations (r = 0.331; P = 0.0001), testosterone levels (r = 0.477, P = 0.0001), mean ovarian volume (r = 0.421; P = 0.0001), and the number of ovarian follicles (r = 0.308; P = 0.0001). AMH levels correlated well with age in WHO 2 patients (r = -0.248; P = 0.002) as well as in controls (r = -0.465; P = 0.005). However, the relative decline in AMH with age is less pronounced in WHO 2 patients. In a subset of patients no significant correlation was found between AMH serum concentrations and the FSH response dose, the duration of stimulation, and the total number of ampoules of FSH used. In conclusion, serum AMH concentrations are elevated in WHO 2 women, especially in those patients exhibiting PCOs. Because AMH concentrations correlated well with other clinical, endocrine, and ultrasound markers associated with polycystic ovary syndrome, AMH may be used as a marker for the extent of the disease. A less pronounced AMH decrease over time in these women may suggest retarded ovarian aging. The latter hypothesis, however, should be confirmed by longitudinal studies.

[Serum steroid hormones in female Russian sturgeon (Acipenser gueldenstaedtii Br.) with normal oocyte maturation and with gonadal function disorders after hormonal stimulation]

Blood serum cortisol, testosterone, and 11-ketotestosterone levels were determined by ELISA methods in female Russian sturgeon after hormonal stimulation for induction of ovulation. All females were divided into 5 groups depending on their initial reproductive status and response to hormonal stimulation; 1) normal ovulation, 2) ovulation followed by release of non-viable eggs, 3) normal state of ovary without ovulation, 4) lack of ovulation, early stage of oocyte resorption, 5) lack of ovulation, advanced stage of oocyte resorption. Cortisol levels in all five groups did not differed significantly. Testosterone levels were low (15-24 ng/ml) in females after ovulation and in females without response to hormonal stimulation because of early stage of oocyte resorption. Non-matured females with normal state of oocytes had significantly higher testosterone levels--82 +/- 16 ng/ml. Non-matured females with advanced stage of resorption were subdivided into 2 subgroups--with low (approximately 7 ng/ml) and high (> 100 ng/ml) levels of serum testosterone. 11-ketotestosterone levels were similar in all investigated groups of sturgeon.

Follicle-stimulating hormone receptor polymorphisms in women with normogonadotropic anovulatory infertility

OBJECTIVE

To assess the incidence of different FSH receptor genotypes in normogonadotropic anovulatory infertile women (World Health Organization class II) and normo-ovulatory controls and to correlate these genotypes with baseline characteristics and ovarian responsiveness during ovulation induction.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PATIENT(S)

Thirty normo-ovulatory controls and 148 normogonadotropic anovulatory infertile women.

INTERVENTION(S)

All participants underwent a standardized evaluation that included cycle history, body mass index measurement, and transvaginal ultrasonography of ovaries. Fasting blood samples were obtained for endocrine evaluation. Ovarian responsiveness to FSH in normogonadotropic anovulatory infertile women was assessed during ovulation induction, and DNA was analyzed to determine the FSH receptor genotype.

MAIN OUTCOME MEASURE(S)

Prevalence of FSH receptor polymorphisms, baseline serum FSH levels, amount of FSH administered, duration of stimulation, and ovarian response dose.

RESULT(S)

The Thr/Thr 307 genotype was significantly less prevalent (52% vs. 23%) and the Ser/Ser 680 polymorphism was significantly more prevalent (40% vs. 16%) in patients compared with controls. Normogonadotropic anovulatory infertile women with the Ser/Ser 680 polymorphism presented with higher median FSH serum levels (5.2 IU/L [range, 2.4-9.7 IU/L]) than did those with the Asn/Asn 680 (4.6 IU/L [range, 1.4-5.8 IU/L) and Asn/Ser 680 (4.5 IU/L [range, 1.8-9.7 IU/L) variants. However, ovarian responsiveness to FSH was similar among anovulatory women with the various polymorphisms.

CONCLUSION(S)

Normogonadotropic anovulatory infertile patients have a different FSH receptor genotype than do normo-ovulatory controls. Although this characteristic is associated with increased baseline FSH serum levels, altered ovarian sensitivity to exogenous FSH during ovulation induction could not be established.

Does anovulation exist in eumenorrheic women?

OBJECTIVE

To determine whether anovulation exists in normally menstruating women.

METHODS

In a database of 550 consecutive couples seeking pregnancy, results of the midluteal serum progesterone level analysis planned for 7 days before the onset of the next menses were examined in women with predictable cycles shorter than 35 days.

RESULTS

Of the 550 couples seeking pregnancy, 410 of the female partners (74.5%) were eumenorrheic. Fifteen of these women (3.7%) had apparently anovulatory cycles with a progesterone lower than the normal ovulatory value of 15 nmol/L. Further examination showed that four of the 15 women (26.7%) had an isolated prolonged cycle, whereas an additional four (26.7%) failed to have their sample taken at an appropriate time. One (6.7%) had a low progesterone level that was normal in the subsequent cycle. Two patients (13.3%) were older than 40, both having elevated early follicular follicle-stimulating hormone levels. One patient (6.7%) conceived in the following menstrual cycle without further evaluation. The three remaining women (20%) showed consistently apparently anovulatory cycles. However, the levels were exclusively above the follicular range.

CONCLUSION

Our findings cast doubt on the concept of anovulatory cycles in eumenorrheic women and suggest that further examination of the lower level of ovulatory progesterone may indeed be necessary.

Serum leptin concentration in young adult women with ovulatory dysfunction

To investigate the functional role of leptin in human ovulation, we measured serum leptin, LH, FSH and estradiol in 16 young adult women suffering from ovulatory dysfunction with BMI ranging from 17.5 to 24.5 (group A). The control subjects included 12 women with regular ovulation and matched age and BMI (group B). We found that serum leptin concentration in group A subjects was significantly lower than that in group B subjects (4.1+/-0.5 vs. 6.1+/-0.4 ng/ml, p<0.01). The percent body fat, estradiol, LH and FSH concentrations in groups A and B were not significantly different. These results indicate that anovulatory young adult women have lower leptin concentration than women with regular ovulation, thus suggesting a key role for leptin in regular ovulation or ovulatory dysfunction.

Plasma TBARS, blood GSH concentrations, and erythrocyte antioxidant enzyme activities in regularly menstruating women with ovulatory and anovulatory menstrual cycles

BACKGROUND

Vigorous physical activity and subsequent depressed ovarian hormone secretion resulting in anovulatory menstrual cycles can affect erythrocyte antioxidant system in premenopausal women and contribute to attenuated protection against oxidative stress.

METHODS

A total of 17 regularly menstruating women participated in the study. Prospective subjects monitored their basal body temperature (BBT) for 3 months prior to the study. Plasma progesterone concentration was assayed between the 7th and 9th day and again between the 22nd and 25th day of the menstrual cycle and made possible the classification of participants as either ovulating or non-ovulating. Plasma 17-beta-estradiol concentration was determined on the same menstrual cycle days as progesterone. Plasma thiobarbituric acid-reacting substances (TBARS) served as an index of plasma lipid peroxidation. Whole blood-reduced glutathione (GSH) concentration and glutathione peroxidase (GSH-PX) activity and erythrocyte catalase (CAT), superoxide dismutase and glutathione reductase (GSH-RX) represented red cells antioxidants.

RESULTS

In non-ovulating women, the lack of progesterone peak between the 22nd and 25th day of the menstrual cycle was demonstrated. In addition, markedly lower (P<0.008) plasma 17-beta-estradiol concentrations in non-ovulating females than in ovulating ones in the follicular phase was noted. In the luteal phase, plasma 17-beta-estradiol levels in non-ovulating subjects tended to be lower (P<0.06) than in ovulating counterparts. Mean concentrations of plasma thiobarbituric-reacting substances and blood-reduced glutathione and mean activities of glutathione reductase, glutathione peroxidase and catalase did not differ significantly in ovulating and non-ovulating women. In non-ovulating women, both between the 7th and 9th day and the 22nd and 25th day of the menstrual cycle, erythrocyte superoxide dismutase (SOD) activity was higher (P<0.02) than in their ovulating counterparts. In ovulating subjects, significant and inverse correlation was demonstrated between circulating estradiol and SOD activity in collected data from both follicular and luteal phases.

CONCLUSIONS

Current results indicate that persistent ovarian hormone disturbances in regularly menstruating women, and resultant anovulation did not affect plasma lipid peroxidation and GSH-dependent erythrocyte antioxidant defense. However, lower plasma estradiol concentrations resulted in attenuated erythrocyte SOD inhibition and elevated enzyme activity. The mechanism of inhibitory estradiol action on erythrocyte SOD activity as well as the importance of this effect for antioxidant protection merits further studies.

Basal serum levels of FSH and estradiol in ovulatory and anovulatory women undergoing treatment by in-vitro maturation of immature oocytes

BACKGROUND

The study aim was to establish whether basal serum levels of FSH and estradiol are predictive of outcome in women undergoing treatment by in-vitro maturation (IVM) of immature oocytes.

METHODS

Data were obtained from 123 unstimulated IVM cycles. Serum was taken between cycle days 2-4 for analysis. Patients received 10 000 IU of HCG 36 h before immature oocyte recovery that was performed between cycle days 9-14. IVM was performed and mature oocytes fertilized by ICSI, followed 2-3 days later by embryo transfer. Outcome measures included the number of immature oocytes retrieved, and the rates of oocyte maturation, fertilization, cleavage and pregnancy.

RESULTS

A median (range) of 8 (0-36) immature oocytes was retrieved per patient. Oocyte maturation, fertilization, cleavage and pregnancy rates were 83, 76, 93 and 17.9% respectively. Serum FSH levels and the presence of polycystic ovary were significant independent predictors of the number of immature oocytes retrieved, whilst patient age and basal estradiol level were not. A basal serum estradiol level >100 pmol/l was associated with a significantly higher pregnancy rate (26 versus 11% for estradiol <100 pmol/l; P = 0.032).

CONCLUSIONS

Measurement of basal serum levels of FSH and estradiol are useful in predicting the number of immature oocytes retrieved and the pregnancy rate in women undergoing unstimulated IVM treatment.

[Hyperinsulinemia and disorders of the menstrual cycle]

Hyperinsulinaemia and insulin resistance are usually associated phenomena of obesity and the polycystic ovary syndrome (PCO syndrome). On the other hand the PCO syndrome and obesity are often associated with disorders of the menstrual cycle and/or sterility. The authors examined 35 women aged 21 to 38 years (x = 27 +/- 4.4) with a history of anovulation cycles and/or sterility. 24 of them (68.6%) suffered from PCO syndrome. Their mean BMI was 28.95 kg/m2. 11 patients had a normal body weight, 6 were overweight and 18 were obese. The authors used the oral glucose tolerance test (oGTT) and during minute 0 and 120 blood samples were collected for assessment of the blood sugar and plasma insulin. Insulin levels in minute 0 (Io above 20 and in minute 120 (I120) above 65 uIU/ml were classified as hyperinsulinaemia. In the follicular stage of the anovulation cycle the authors assessed FSH, LH, testosterone, progesterone and prolactin. Hyperinsulinaemia ws recorded in 16 of 35 women. The mean insulin level at minute 0 was 11.9 +/- 1.3 and during minute 120 54.2 +/- 8.1 uIU/ml. The authors found significant differences in levels of I0 (6.4 +/- 1.2 vs. 16.1 +/- 1.9 uIU/ml, p < 0.01) and I120 (17.5 +/- 3 vs. 71.3 +/- 10.3 uIU/ml, p < 0.01) between obese and non-obese patients, Also in patients with the PCO there was a statistically significant difference in insulin levels of slim (BMI less than 25) as compared with obese women (BMI more than 30) (p < 0.01). A positive correlation was found between insulin levels and BMI (p < 0.01) and a liminal correlation between insulin and testosterone (p = 0.05). Patients with hyperinsulinaemia were treated with oral antidiabetics from the group of biguanides--metformin for a period of three months. During metformin treatment the insulin level declined and subsequently the menstrual cycle became normal in 11 of 16 patients with hyperinsulinaeia (68.7%), incl. two women who became pregnant. The results indicate a possible new indication of metformin in the treatment of ovarian hyperandrogenism in insulin resistant patients.

Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency

OBJECTIVE

To predict the FSH response (threshold) dose in normogonadotropic, anovulatory infertile women undergoing gonadotropin induction of ovulation.

DESIGN

Prospective longitudinal clinical study.

SETTING

Specialist academic fertility unit.

PATIENT(S)

Normogonadotropic, oligoamenorrheic, infertile women who were resistant to clomiphene citrate or in whom clomiphene citrate therapy had failed.

INTERVENTION(S)

Daily exogenous FSH administration in a low-dose, step-up regimen.

MAIN OUTCOME MEASURE(S)

The FSH dose on the day of ovarian response (follicle growth > 10 mm in diameter).

RESULT(S)

Multivariate analysis was used to devise the following equation to predict the individual FSH response dose (75 to >187 IU/d) before initiation of therapy: [4 body mass index (in kg/m(2))] + [32 clomiphene citrate resistance (yes = 1 or no = 0)] + [7 initial free insulin-like growth factor-I (in ng/mL)] + [6 initial serum FSH level (in IU/L)] - 51. The SE of the predicted dose is 35 IU.

CONCLUSION(S)

The individual FSH response dose for gonadotropin induction of ovulation in anovulatory infertile women can be predicted on the basis of initial screening characteristics. The prediction model developed in this study may increase the safety and efficiency of low-dose gonadotropin protocols (step-up and step-down) by correctly determining the appropriate starting dose for a given patient.

Frequency of anovulation and early menopause among women enrolled in selected adult AIDS clinical trials group studies

To obtain information on the prevalence of anovulation and early menopause and on pituitary-gonadal function among human immunodeficiency virus type 1-infected women, a study was undertaken that used stored serum samples from women aged 20-42 years who participated in selected Adult AIDS Clinical Trials Group protocols. Defined progesterone and follicle-stimulating hormone (FSH) levels were considered presumptive evidence of ovulation and of menopause, respectively. Anovulation occurred in 16 (48%) of 33 women for whom progesterone levels were tested; early menopause occurred in 2 (8%) of 24 women for whom FSH levels were tested. No statistically significant differences were seen in the demographic and clinical characteristics of anovulatory and ovulatory women, although women who ovulated had higher CD4 T cell counts and were less likely to have reported a recent change in menstrual periods. These data support the findings of prior studies of increased frequency of amenorrhea and/or irregular menstrual cycles, particularly among women with lower CD4 T cell counts.

Effects of dopamine d2 receptor agonists in a pituitary transplantation-induced hyperprolactinaemia/anovulation model in rats

1. In the present study, we investigated the effects of hyperprolactinaemia, induced by transplantation of anterior pituitary glands under the kidney capsule in female rats, on the relationship between serum and pituitary concentrations of the gonadotropins and on the oestrous cycle. 2. Rats with pituitary transplants showed increased serum prolactin concentrations and decreased serum concentrations of gonadotropins and increased pituitary concentrations of gonadotropins. Moreover, these rats showed persistent dioestrous and anovulation from 3 to 6 days after transplantation. 3. A single oral administration of cabergoline (at doses between 0.001 and 0.1 mg/kg) dose-dependently inhibited the elevated serum prolactin concentrations in hyperprolactinaemic rats. At 0.1 mg/kg, cabergoline induced a continuous reduction in serum prolactin concentrations for 5 days after administration. Terguride (0.1 mg/kg) and bromocriptine (10 mg/kg) also reduced serum prolactin concentrations at 1 and 3 days after administration. All three dopamine D2 receptor agonists increased serum gonadotropin concentrations and ovarian weight at 3 days after administration. 4. In rats exhibiting anovulation, a single oral administration of any one of the three dopamine D2 receptor agonists dose-dependently restored ovulation and a normal oestrous cycle appeared. Oral administration of cabergoline (0.03 mg/kg) or terguride (0.1 mg/kg) restored ovarian function and abolished the anovulation following a reduction in serum prolactin concentrations. However, bromocriptine (10 mg/kg) did not completely abolish anovulation. Following administration of terguride (0.3 mg/kg) or bromocriptine (30 mg/kg), only one normal oestrous cycle appeared; however, following cabergoline (0.1 mg/kg), two normal oestrous cycles appeared. 5. These results suggest that cabergoline has a potent and long-lasting action as a dopamine D2 receptor agonist and, thus, should be a useful drug for the treatment of galactorrhoea and hyperprolactinaemic amenorrhoea and/or anovulation in humans.

[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.

Plasma melatonin profile and hormonal interactions in the menstrual cycles of anovulatory infertile women treated with gonadotropins

The patterns of plasma melatonin, gonadotropins, sex steroids and prolactin were studied in anovulatory infertile females undergoing ovulation induction with hMG/hCG. Melatonin levels were found to fluctuate during the menstrual cycle of these subjects with a nadir at mid-cycle and peak occurring at the early follicular/late luteal phases of the cycle (p < 0.05). Melatonin correlated negatively with estradiol during the follicular phase (r=-0.5180, p < 0.05) and positively with LH (5 + 0.6321, p < 0.05) in the luteal phase, respectively. Correlational analyses by partial and multiple correlations suggest that the effects of estradiol and LH on melatonin in the follicular phase are interdependent whereas the effect of LH on melatonin in the luteal phase is independent of the effects of other hormones. The results suggest that hormonal interactions and phases of the cycle are important variables contributing to the fluctuations in melatonin levels during the menstrual cycle.

Changes in leptin levels during lactation: implications for lactational hyperphagia and anovulation

In these studies we investigated the time course of changes in circulating leptin levels in lactating rats and the dependence of these changes on the energetic cost of lactation and evaluated the contribution of changes in leptin levels to lactational hyperphagia and infertility. In the first experiment, plasma leptin levels were measured on Days 5, 10, 15, 20, and 25 postpartum in freefeeding lactating rats and age-matched virgin females. Retroperitoneal and parametrial fat pads weights were obtained from the same females. In the second experiment the same measures, together with plasma insulin and prolactin levels, were taken on Days 15 and 20 postpartum from galactophore-cut and sham-operated females. In Experiments 3 and 4, the effects of exogenous leptin administration, either subcutaneously (sc) or intracerebroventricularly (icv), on lactational anovulation, maternal food intake, and dam and litter weights were examined. Circulating leptin levels decreased in lactating rats. Leptin levels were highly positively correlated with fat pad weight. Eliminating the energetic costs of lactation by preventing milk delivery induced dramatic increases in plasma leptin and insulin levels and also increased adiposity. Exogenous leptin administration did not affect length of lactational anovulation but reduced food intake, maternal body weight, and litter weight gain when given centrally and maternal body weight when given systemically. Together, these data show that the energetic costs of lactation are associated with a fall in circulating leptin levels but that these do not make a major contribution to the suppression of reproduction in lactating rats; however, they may be permissive to the hyperphagia of lactation.