Thirty-seven candidate genes for polycystic ovary syndrome: strongest evidence for linkage is with follistatin

Polycystic ovary syndrome (PCOS) is a common endocrine disorder of women, characterized by hyperandrogenism and chronic anovulation. It is a leading cause of female infertility and is associated with polycystic ovaries, hirsutism, obesity, and insulin resistance. We tested a carefully chosen collection of 37 candidate genes for linkage and association with PCOS or hyperandrogenemia in data from 150 families. The strongest evidence for linkage was with the follistatin gene, for which affected sisters showed increased identity by descent (72%; chi(2) = 12.97; nominal P = 3.2 x 10(-4)). After correction for multiple testing (33 tests), the follistatin findings were still highly significant (P(c) = 0.01). Although the linkage results for CYP11A were also nominally significant (P = 0.02), they were no longer significant after correction. In 11 candidate gene regions, at least one allele showed nominally significant evidence for population association with PCOS in the transmission/disequilibrium test (chi(2) >/= 3.84; nominal P < 0.05). The strongest effect in the transmission/disequilibrium test was observed in the INSR region (D19S884; allele 5; chi(2) = 8.53) but was not significant after correction. Our study shows how a systematic screen of candidate genes can provide strong evidence for genetic linkage in complex diseases and can identify those genes that should have high (or low) priority for further study.

Polycystic ovary syndrome and implications for the menopause

Polycystic ovary syndrome (PCOS) is the most common endocrine condition of premenopausal women and has significant metabolic abnormalities that could have an impact after the menopause. Diabetes mellitus, hyperlipidemia and hyperinsulinemia could potentially affect health in this era of life. Endometrial cancer, due to unopposed estrogen action, is more common where progestins have not been given for menstrual dysfunction. Preventive management earlier in life will avoid postmenopausal problems in PCOS.

Redescriptions of the species of Physaloptera Rudolphi, 1819 (Nematoda: Spirurida) parasitic in bandicoots (Marsupialia: Perameloidea) in Australia

The species of Physaloptera Rudolphi, 1819 (Nematoda: Spirurida) occurring in bandicoots (families Peramelidae and Thalacomyidae) in Australia were re-examined and re-described. Physaloptera peramelis Johnston & Mawson, 1939 was found in Perameles nasuta Geoffroy and occasionally in Isoodon macrourus (Gould) in eastern Australia. Ph. peragale Johnson & Mawson, 1940 from Macrotis leucura (Thomas) from the Northern Territory is treated as a junior synonym of Ph. peramelis. Ph. thalacomys Johnston & Mawson, 1940, originally described from Macrotis leucura from the Northern Territory was also found to occur in Perameles gunnii Gray in Victoria. Specimens here identified simply as Physaloptera sp. were found in both Perameles nasuta and Isoodon macrourus from north-eastern New South Wales. They may be Ph. parvicollaris Johnston & Mawson, 1940 or Ph. sarcophili Johnston & Mawson, 1940, but current deficiencies in the descriptions of these two named species preclude an unequivocal identification of the specimens found in bandicoots.

Colony stimulating factor-1 concentrations in blood and follicular fluid during the human menstrual cycle and ovarian stimulation: possible role in the ovulatory process

To evaluate a possible role for colony stimulating factor-1 (CSF-1) in human ovarian function, the peripheral blood CSF-1 concentration throughout the human menstrual cycle and during ovarian stimulation was monitored. Blood was sampled across the menstrual cycle (n = 10) and at specific times during ovarian stimulation. In addition, the CSF-1 concentrations in follicular fluid (FF) during the follicular phase and during the luteinizing hormone (LH) surge of natural cycles, as well as 35-37 h after human chorionic gonadotrophin (HCG) during ovarian stimulation, were determined. There was no significant variation in CSF-1 concentrations during the natural menstrual cycle (median 470, range 212-1364 pg/ml). CSF-1 concentrations in FF (n = 11) were about four-fold higher (P < 0. 0001) than those in plasma of the same patients. CSF-1 concentrations in these FF showed some stage dependent variability, with significantly higher values during the ovulatory phase (median of 2017 pg/ml, range 1131-2236 pg/ml), compared to mid-follicular phase (median 961 pg/ml, range 830-1340 pg/ml; P = 0.02). During ovarian stimulation (n = 20), the plasma concentrations were similar to a time prior to stimulation up to and including 35-37 h after HCG. On day 9 after HCG, the values (median 644, range 357-1352 pg/ml) were significantly higher compared to pre-stimulation (median 422, range 253-1598 pg/ml; P < 0.05) and 35-37 h after HCG (median 458, range 250-658 pg/ml; P < 0.01). FF concentrations (n = 27) of CSF-1 at oocyte retrieval (median 3116, range 1824-5883 pg/ml) were about seven-fold higher than blood concentrations (median 472, range 250-1055 pg/ml; P < 0.0001). These results suggest that the intra-ovarian CSF-1, possibly induced by LH/HCG, plays an important role during ovulation and luteinization.

Variations in peripheral blood levels of immunoreactive tumor necrosis factor alpha (TNFalpha) throughout the menstrual cycle and secretion of TNFalpha from the human corpus luteum

OBJECTIVE

Several cytokines have been implicated as important mediators in the cyclic processes occurring in the reproductive organs. In the present study the peripheral blood concentrations of the cytokines interleukin(IL)-2, IL-6, and tumor necrosis factor (TNF) alpha, as well as the secretion of TNFalpha from the human corpus luteum were investigated.

STUDY DESIGN

The study was undertaken at infertility clinics at large teaching hospitals. Eight women with unexplained infertility undergoing investigations with measurements of endocrine profiles throughout a cycle prior to IVF treatment were included in the study of blood concentrations of cytokines. Blood plasma were taken daily or every second day from a time 3-4 days before expected LH peak until menstruation. The levels of immunoreactive IL-2, IL-6 and TNFalpha were measured by ELISA technique and evaluated (repeated measures ANOVA and Scheffes test) in relation to levels on the day of the LH surge. To investigate a possible ovarian source of TNFalpha, corpus luteum (CL) tissue and cells obtained during the luteal phase from another group of women during abdominal surgery for benign uterine diseases, were cultured for 24 h to assess (ANOVA and Bonferroni test) the release of TNFalpha.

RESULTS

There were no significant fluctuations in the levels of IL-2 and IL-6 throughout the menstrual cycle. The concentration of TNFalpha showed significant fluctuations over the menstrual cycle. Compared to the values on the day of the LH surge, the concentrations were significantly increased during the late follicular phase and during the mid luteal phase. In the early luteal phase the levels were significantly decreased. Measurable levels of TNFalpha were found in the conditioned media from one out of three CL obtained from the early luteal phase, and in all media from CL obtained from mid- and late-luteal phases. Luteal cells in culture secreted TNFalpha, and the levels in the media were not influenced by the presence of hCG (100 IU/L). The conditioned media of luteal cells from late luteal phase contained higher levels than media of cells from early luteal phase, with the levels being higher in media of a mixture of all luteal cells, and large luteal cells as compared to small luteal cells.

CONCLUSION

This study demonstrates that there are marked fluctuations of blood levels of TNFalpha during the menstrual cycle and that the human CL secretes TNFalpha, with indications of higher secretion during late luteal phase as compared to early luteal phase.

Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone

Weight reduction and exercise have been shown to help with menstrual disturbance and infertility in obese women with polycystic ovary syndrome. We studied the relationship between insulin sensitivity and ovulation patterns in 18 infertile anovulatory obese polycystic ovary syndrome (PCOS) women (NO) with normal glucose tolerance, aged between 22-39 yr with a body mass index of 27-45 kg/m2, before and after a 6-month diet and exercise program. This program promotes healthy lifestyle factors, but does not lead to rapid weight loss. The anthropometric, metabolic, and endocrine factors of these subjects were compared to those of 10 age- and weight-matched PCOS women with regular monthly ovulation (RO). Before lifestyle modification, the anovulatory subjects had greater central obesity than regular ovulators, as assessed by percent central fat (NO, 45.7 +/- 0.8%; RO, 42.2 +/- 1.6%; P < 0.05), higher glucose increment after glucose challenge (NO, 10.1 +/- 1.0 mmol/L; RO, 6.4 +/- 1.1 mmol/L; P < 0.02), lower insulin sensitivity index (NO, 1.2 +/- 0.2; RO, 2.8 +/- 0.6 micromol/kg x min/pmol/L; P < 0.005), higher plasma LH (NO, 8.9 +/- 0.9; RO, 4.6 +/- 0.9 IU/L; P < 0.005), and lower plasma sex hormone-binding globulin (NO, 18.0 +/- 2.5; RO, 27.8 +/- 5.7 nmol/L; P < 0.05]. Anovulatory subjects were classified as responders (R) to the intervention if they regained ovulation during the study. As a result of intervention, R showed an 11% reduction in central fat, a 71% improvement in insulin sensitivity index, a 33% fall in fasting insulin levels, and a 39% reduction in LH levels. None of these parameters changed significantly in nonresponders (NR). At the end of the study, R had lower fasting insulin (R, 13.6 +/- 1.7; NR, 23.0 +/- 3.5 mU/L) and LH levels (R, 5.0 +/- 1.7; NR, 7.4 +/- 1.4 IU/L), but similar androgen levels compared to NR. We conclude that lifestyle modification without rapid weight loss leads to a reduction of central fat and improved insulin sensitivity, which restores ovulation in overweight infertile women with PCOS. Lifestyle modification is the best initial management for obese women seeking to improve their reproductive function.

Characterization of the translated products of the alternatively spliced luteinizing hormone receptor in the ovine ovary throughout the oestrous cycle

The luteinizing hormone receptor (LHR) is alternatively spliced. It is not known if the alternatively spliced mRNAs are translated in vivo, or indeed if they have any vital role to play. The B splice form has been detected in every species examined, and it encodes a putative protein with a high affinity LH/CG binding domain but no trans-membrane or intra-cellular domains. We raised antisera that recognize the putative protein of the B form, and the closely related G form, and showed that the B form mRNA is translated in the ovine ovary, but not kidney or liver. It localized to the luteal cytosolic and microsomal fractions and the levels declined during regression induced by treatment with prostaglandin F2alpha. We examined alternative splicing by RNase protection analyses and RT-PCR analyses of healthy pre-ovulatory follicles, atretic or steroidogenically-inactive follicles, and of newly formed, mid-luteal and regressing corpora lutea. There was approximately 5-fold more B form mRNA than A form. Thus we have evidence that the LHR B form is translated in vivo, but no evidence that alternative splicing of the LHR mRNA is differentially regulated, throughout the oestrous cycle.

No association between the -308 polymorphism in the tumour necrosis factor alpha (TNFalpha) promoter region and polycystic ovaries

The tumour necrosis factor (TNF)2 allele appears to be linked with increased insulin resistance and obesity, conditions often found in overweight patients with polycystic ovary syndrome (PCOS). The significance of TNFalpha polymorphism in relation to the clinical and biochemical parameters associated with PCOS was investigated in 122 well-characterized patients with polycystic ovaries (PCO). Of these, 84 had an abnormal menstrual cycle and were classified as having PCOS, while the remaining 38 had a normal menstrual cycle and were classified as having PCO. There were a further 28 individuals without PCO (non-PCO) and 108 individuals whose PCO status was undetermined (reference population). The promoter region of the TNFalpha gene was amplified by polymerase chain reaction (PCR), and the presence or absence of the polymorphism at -308 was determined by single-strand conformational polymorphism (SSCP) analysis. The less common TNF allele (TNF2) was found as TNF1/2 or TNF2/2 in 11/38 (29%) of PCO subjects, 25/84 (30%) of PCOS subjects, 7/28 (25%) of non-PCO subjects, and 45/108 (42%) of the reference population. There was no significant difference in the incidence of the TNF2 allele between the groups. The relationship of TNF genotype to clinical and biochemical parameters was examined. In both the PCO group and the PCOS group, the presence of the TNF2 allele was significantly associated with lower glucose values obtained from the glucose tolerance testing (P<0.05). The TNF genotype was not significantly associated with any clinical or biochemical parameter measured in the PCO, PCOS or non-PCOS groups. Thus, the TNFalpha -308 polymorphism does not appear to strongly influence genetic susceptibility to polycystic ovaries.

Expression, characterisation and immunoassay of recombinant marmoset chorionic gonadotrophin dimer and beta-subunit

A specific and sensitive ELISA for measuring marmoset chorionic gonadotrophin (mCG) in culture medium, urine and plasma was developed using a polyclonal antibody raised against recombinant mCG, tagged with six histidine molecules (rmCG-6His), as the capture antibody. A well-characterised monoclonal antibody (518B7), which was generated against bovine luteinising hormone (bLH) and has been shown to detect CG and LH in Callithrichid monkeys, was biotinylated and used as the secondary antibody. Purified rmCG, calibrated against human CG (hCG; CR127) by bioassay, or the beta-subunit (rmCGbeta), quantified from amino acid analysis and carbohydrate analysis, was used as the standard. The assay was able to detect CG activity in medium collected from cultured marmoset embryos before attachment and through to the trophoblastic vesicle stage, plasma and urine collected from pregnant marmosets, marmoset placenta and pituitary homogenates. The assay was validated and its performance compared with a bioassay based on MA10 cell response to CG, with hCG as the standard. The sensitivity was 103 pg/ml (5 pg/well) of rmCGbeta and 476 pg/ml (24 pg/well) of the heterodimer rmCG. The mean recovery of standard added to embryo culture medium, marmoset urine and plasma was 104, 112 and 92% respectively. The intra- and interassay variation was less than 10 and 16% respectively. The low cross-reactivity with cynomolgus monkey and baboon LH, their beta-subunits, cynomolgus monkey and baboon follicle-stimulating hormone and hCG suggests that the assay is specific for mCG.

Obesity and reproductive disorders: a review

Obesity has significant consequences for the reproductive system, depending upon the amount and distribution of body fat. Epidemiological evidence clearly shows that being overweight contributes to menstrual disorders, infertility, miscarriage, poor pregnancy outcome, impaired fetal well-being and diabetes mellitus. Central adiposity is particularly important in clinical sequelae associated with an increased body mass index. The advent of assisted reproduction highlights the problems of being overweight, and the use of gonadotrophins in ovulation induction and in vitro fertilization is more difficult when the subject is overweight. Weight loss has marked effects on improving the menstrual cycle and promoting spontaneous ovulation and fertility. Results indicate that fertility is improved through exercise and sensible eating patterns when conducted in a group environment. The mechanisms for this are unclear but may be associated with changes in sensitivity to insulin.

Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment

Obesity affects ovulation, response to fertility treatment, pregnancy rates and outcome. In this prospective study, a weight loss programme was assessed to determine whether it could help obese infertile women, irrespective of their infertility diagnosis, to achieve a viable pregnancy, ideally without further medical intervention. The subjects underwent a weekly programme aimed at lifestyle changes in relation to exercise and diet for 6 months; those that did not complete the 6 months were treated as a comparison group. Women in the study lost an average of 10.2 kg/m2, with 60 of the 67 anovulatory subjects resuming spontaneous ovulation, 52 achieving a pregnancy (18 spontaneously) and 45 a live birth. The miscarriage rate was 18%, compared to 75% for the same women prior to the programme. Psychometric measurements also improved. None of these changes occurred in the comparison group. The cost savings of the programme were considerable. Prior to the programme, the 67 women had had treatment costing a total of A$550,000 for two live births, a cost of A$275,000 per baby. After the programme, the same women had treatment costing a total of A$210,000 for 45 babies, a cost of A$4600 per baby. Thus weight loss should be considered as a first option for women who are infertile and overweight.

Effects of interleukin (IL)-6 on luteinizing hormone- and IL-1beta-induced ovulation and steroidogenesis in the rat ovary

Evidence that cytokines have important roles in ovulation is accumulating, with various cytokines having been found to influence the ovulatory cascade. Interleukin (IL)-6 is a pluripotent cytokine involved in inflammatory reactions, and it has been demonstrated in high concentrations in human ovarian follicular fluid and in vitro in secretions from the ovary. We set out to determine the effect this cytokine has on ovulation rate and steroidogenesis in the in vitro-perfused rat ovary. Preovulatory ovaries were taken from eCG-primed animals, and ovulation was induced by LH (100 ng/ml) alone or in combination with cytokine. Ovaries in the IL-6/LH groups (IL-6 concentration of 0.19 nM or 1.9 nM) did not have ovulation rates different from ovaries in the LH-only group. Ovaries in the LH/IL-1beta group ovulated more oocytes than ovaries in the LH-only group (LH/IL-1beta =11+/-1.8 oocytes; LH alone=4.9+/-1.1; p=0.015) and the IL-6/LH/IL-1beta group (LH/IL-1beta/IL-6 [0.19 nM]=4+/-1.40; LH/IL-1beta=11+/-1.8; p=0.009). We have found that 1) exogenous IL-6 did not significantly alter the LH-induced ovulation rate but significantly reduced the LH/IL-1beta-induced ovulation rate; 2) exogenous IL-6 did not alter LH-induced progesterone levels measured at time points during the perfusion period, but the average increase in progesterone over basal level was stimulated by IL-6; 3) exogenous IL-6 did not affect LH-induced estradiol production; 4) exogenous IL-6 did not affect LH-induced androstenedione production but increased LH/IL-1beta-induced production; 5) exogenous IL-6 did not affect LH-induced prostaglandin E2 production. This study demonstrates that IL-6 does not play a role in regulating ovulation induced by LH in vitro but is capable of reducing LH/IL-1beta-enhanced ovulation rates. In addition, IL-6 may play a role in the regulation of ovarian steroid production.

Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates

The optimal time period for intrauterine insemination (IUI) in relation to either luteinizing hormone (LH) surge or human chorionic gonadotrophin (HCG) administration leading to the best pregnancy rates has not been determined. In this study, 856 consecutive human menopausal gonadotrophin (HMG)-stimulated and 49 natural unstimulated IUI cycles carried out at a reproductive medicine unit affiliated with a tertiary centre were analysed in a retrospective fashion. There were three scenarios in the temporal relationship of the LH surge, HCG administration and artificial insemination. These were (group A) subjects who had an endogenous LH surge but were not given HCG; (group B) subjects who were given HCG after an observed LH surge, and (group C) subjects who were given HCG before the LH surge. The overall pregnancy rate (PR) was 16% per cycle. The PR was 9% in group A, 20% in group B and 14% in group C. The PR in group B was significantly better than group C (P = 0.04). In group B, the longer the time interval between the LH surge and HCG administration, the better the PR up to 20 h (P = 0.025); the timing of IUI based on the LH surge was not critical to the achievement of pregnancy within 3 days. In group C, PR improved with the increasing interval between HCG and IUI from <28 h up to 60 h. We conclude that a better PR is achieved if a spontaneous LH surge occurs before HCG administration, especially where the administration of HCG is delayed 8-20 h after an observed LH surge; the timing of IUI based on the LH surge is not critical to the achievement of pregnancy within 3 days.

Tetraphyllidean cysticerci in the peritoneal cavity of the common dolphin

Cysticerci of the cestodes Monorygma grimaldii and Phyllobothrium delphini were encountered during necropsy of an adult common dolphin (Delphinus delphis) found dead on the southeastern coast of Australia. Monorygma grimaldii cysticerci were found within highly organized retroperitoneal cysts, whereas P. delphini cysticerci in the subcutaneous blubber did not occupy specialized structures. There was a localized lymphoplasmacytic host response to the presence of cysticerci of both species, but M. grimaldii provoked a more severe suppurative response than P. delphini. The systematics and life history of both parasites are incompletely known, but sharks postulated as the potential definitive hosts are found in the region. A unique cysticercus of M. grimaldii was found lying free in the peritoneal cavity of this dolphin. Two rare records of M. grimaldii cysticerci in pinnipeds from the literature include one case of aberrant migration to the testis.

A health profile of adults in a Northern Territory aboriginal community, with an emphasis on preventable morbidities

We conducted a brief health survey of adults in an isolated Northern Territory Aboriginal community, whose standardised mortality rates are the second highest in Australia. The screen revealed high rates of smoking and excessive drinking, of preventable infections and their sequelae, and of hypertension, insulin resistance, diabetes and renal disease. The infectious morbidities were more pronounced and the life-style morbidities almost entirely new since a health screen in 1957. Most morbidities were strongly associated with identifiable risk factors, such as overweight, smoking, excessive drinking, skin sores and scabies, all of which which are amenable to modification. Problems with food supply and pricing, poor food choices and diversion of money to cigarettes, beer and gambling all contributed to poor nutrition. Low birthweight probably compounds the risk for serious adult disease associated with these environmental influences. This profile highlights the failure of current systems to deal with health needs. Improvements in infrastructure, education and employment, and reinvigoration of preventive and primary health care programs, assumption of responsibility for health by the community and by individuals themselves, and better management of existing morbidities are essential to rectifying this shameful situation.

Circulating leptin concentrations in polycystic ovary syndrome: relation to anthropometric and metabolic parameters

OBJECTIVE

To determine the relation between metabolic and anthropometric parameters and circulating leptin concentrations in women with polycystic ovary syndrome (PCOS).

DESIGN AND PATIENTS

Correlation of fasting serum leptin concentrations with anthropometric measures and multiple metabolic parameters including insulin and glucose responses to a 2-hour 75-g oral glucose tolerance test (OGTT) in 85 women with PCOS (17-36 years, body mass index (BMI) 29.9 +/- 0.9 kg/m2, mean +/- SD) and 18 control women (25-47 years, BMI 25 +/- 1.7 kg/m2). Diagnostic criteria for PCOS: characteristic ovarian morphology on ultrasound plus at least two of (1) elevated serum testosterone; (2) elevated serum androstenedione; and (3) reduced serum SHBG concentrations.

MEASUREMENTS

Concentrations of androgens, lipids, PRL, gonadotrophins, and leptin were measured in the baseline fasting blood sample from an OGTT. Insulin and glucose were measured throughout OGTT. Serum leptin concentrations were measured by radioimmunoassay.

RESULTS

Log leptin levels in the PCOS group correlated significantly with BMI (r = 0.85, P < 0.0001) and with 8 other parameters including waist/hip ratio (r = 0.51, P = 0.0005). By stepwise regression analysis, only BMI (P < 0.0001) and plasma high density lipoprotein concentration (P = 0.02) were independently correlated with log leptin levels, both positively. There was no effect of fat distribution, as measured by waist/ hip ratio, on leptin concentrations. Comparison of control subjects to a BMI-matched subgroup of 55 PCOS subjects revealed significantly higher circulating concentrations of LH, testosterone, DHEAS, progesterone and androstenedione, and higher glucose and insulin responses to OGTT in the PCOS group. Leptin levels were not different between the PCOS subgroup and control group (14.8 +/- 1.3 vs 12.1 +/- 2.3 micrograms/l, mean +/- SE, P = 0.26) and the relation of BMI to leptin levels determined by linear regression analysis also did not differ between the two groups.

CONCLUSIONS

Our results indicate that circulating leptin concentrations in women with PCOS, a condition characterized by hyperandrogenaemia, increased LH concentrations and insulin resistance, are strongly related to BMI and not independently affected by circulating levels of insulin, gonadotrophins or sex hormones.

Localisation of mRNA for interleukin-1 receptor and interleukin-1 receptor antagonist in the rat ovary

Interleukin-1 (IL-1) is a multifunctional cytokine with profound effects on ovarian function. The effects of IL-1 on ovarian steroidogenesis have been demonstrated in several species. IL-1 mRNA levels are increased in the thecal layer of the ovulating follicle and IL-1 beta has been shown to induce ovulations in vitro. In this study we have investigated the presence and distribution of the mRNAs for type I IL-1 receptor (IL-1RtI) and for the naturally occurring IL-1 receptor antagonist (IL-1ra) in ovaries of adult cycling rats, to elucidate the target cells for IL-1 action. We have demonstrated the presence of mRNA for both substance by in situ hybridisation and reverse transcription PCR. mRNA for IL-1RtI was not found in primordial follicles but was abundant in the granulosa and thecal layer in developing follicles with stronger signals in the granulosa layer. In the preovulatory and ovulatory follicles, there was a further increase in the signal for IL-1RtI mRNA in the thecal layer compared with the granulosa layer. Corpora lutea were weakly positive at all stages and atretic follicles were largely negative. No mRNA was detected in oocytes of any stage mRNA for IL-1ra showed a similar distribution to that of IL-1RtI. The changes in distribution suggest an action of IL-1 on rat granulosa cells during follicular development and on thecal cells during ovulation.

Hyperinsulinemia is common in family members of women with polycystic ovary syndrome

OBJECTIVE

To determine whether disorders of insulin secretion are common in male and female family members of subjects with polycystic ovary syndrome (PCOS).

DESIGN

Family study of siblings and parents of PCOS subjects (five families). All proband cases met the criteria of polycystic ovaries (PCO) by ultrasound (US) and hyperandrogenism.

SETTING

University Reproductive Medicine Unit.

PATIENT(S)

Family members of PCOS subjects.

INTERVENTION(S)

Oral glucose tolerance testing (OGTT), insulin, and lipids were measured. Clinical examination including assessment of premature baldness in men and US of ovaries in female members.

MAIN OUTCOME MEASURE(S)

Insulin, lipids, and clinical parameters.

RESULT(S)

Hyperinsulinemia (69%) and hypertriglyceridemia (56%) was common in family members as were PCO in 79% of 24 females and premature baldness in men in 88% of eight subjects.

CONCLUSION(S)

Hyperinsulinemia is a potential metabolic and genetic marker for subjects who may be carriers of a familial tendency for PCO.

Granulocyte-macrophage colony-stimulating factor: presence in human follicular fluid, protein secretion and mRNA expression by ovarian cells

In recent years it has become evident that a leukocyte-cytokine network contributes to the paracrine regulation of ovarian function. The objectives of this study were to examine the presence of a potent lympho-haemopoietic cytokine, granulocyte-macrophage colony-stimulating factor (GM-CSF), in tissues and fluids from human ovaries. In a prospective study, follicular fluid and plasma were collected from naturally cycling women and women undergoing hyperstimulation for in-vitro fertilization (IVF). Granulosa-lutein cells were collected at the time of oocyte recovery for IVF and corpora lutea were collected at the time of hysterectomy for non-ovarian reasons. Culture supernatants from ovarian cell and tissue cultures were harvested on completion of a 48 h incubation. Immunoactive GM-CSF was measured by enzyme-linked immunosorbent assay, and was found to be present at statistically significantly higher levels in follicular fluid (8.9 +/- 0.7 pg/ml) and plasma (11.3 +/- 0.8 pg/ml) of women undergoing hyperstimulation compared to follicular fluid (5.3 +/- 0.3 pg/ml) and plasma (7.1 +/- 0.5 pg/ml) from naturally cycling women. Immunoactive GM-CSF was also detected in culture supernatants of granulosa-lutein cells (47.6 pg/10(5) cells), early luteal phase corpora lutea (0.52 pg/microgram DNA) and mid-luteal phase corpora lutea (0.98 pg/microgram DNA). Furthermore, transcripts for GM-CSF, and both the alpha and beta subunits of the GM-CSF receptor, were detected by reverse transcription polymerase chain reaction (RT-PCR) in granulosa-lutein cell culture preparations and corpora lutea collected during the early, mid- and late luteal phase of the menstrual cycle. These results show that GM-CSF is expressed and secreted by cells within the human ovary, and, together with the finding of expression of mRNA for GM-CSF receptor, suggest a role for GM-CSF in the local regulation of ovarian events.

Dental and mandibular injury in an Antarctic fur seal, Arctocephalus gazella, at Heard Island, Southern Ocean

The skull of an adult male Antarctic fur seal (Arctocephalus gazella) collected at Heard Island, Southern Ocean, October 1992, had chronic changes attributable to a fracture of the left lower canine, luxation of the mental symphysis, osteomyelitis of the left and right mandibles, and periostitis of the left maxilla.

Inhibition of nitric oxide: effects on interleukin-1 beta-enhanced ovulation rate, steroid hormones, and ovarian leukocyte distribution at ovulation in the rat

The ovulatory process resembles an inflammatory reaction with an infiltration of leukocytes, production of inflammatory mediators such as cytokines, and a general edema and hyperemia. Nitric oxide (NO), a potent vasodilator and the main mediator of macrophage tumoricidal and bacteriocidal activities, is known to participate in inflammatory reactions and has been shown to mediate the interleukin-1 beta (IL-1 beta)-directed tissue-remodeling events within the ovary. The regulation by NO of ovulation rate, leukocyte distribution, and steroid release in the rat ovary was investigated through use of a combination of in vivo and in vitro models of ovulation and a competitive inhibitor, N-omega-nitro-L-arginine methyl ester (L-NAME), of the NO synthase (NOS) enzyme. Subcutaneous L-NAME (1.5 x 10(-4) mol/kg) administration significantly reduced the in vivo ovulation rate of eCG/hCG-primed rats (L-NAME-treated: 10.6 +/- 1.8 [mean +/- SEM] oocytes per ovary [O/O], 11.0 +/- 1.2 rupture sites per ovary [RS/O]; saline-treated: 18.0 +/- 1.8 O/O, 19.4 +/- 1.1 RS/O; p < 0.01) at 20 h post-hCG. These results were reflected in vitro, where addition of L-NAME (3.5 x 10(-5) mol/L) to LH (0.1 microgram/ml)-perfused ovaries decreased ovulation rate from 8.2 +/- 1.6 to 2.7 +/- 1 ovulations per ovary (p < 0.05) and simultaneously decreased nitrite accumulation at the completion of perfusions from 16.5 +/- 1.9 to 4.1 +/- 0.5 nmol/ml (p < 0.001). The addition of L-NAME to LH+IL-1 beta (4 ng/ml)-perfused ovaries decreased ovulation rate from 15.2 +/- 2.4 to 0.8 +/- 0.8 ovulations per ovary (p < 0.001) and simultaneously decreased nitrite accumulation at 22 h from 22.8 +/- 2.2 to 1.9 +/- 0.6 nmol/ml (p < 0.001). Studies analyzing and manipulating perfusion flow rate indicated that the L-NAME effects on ovulation rate are primarily due to a reduction in flow rate resulting from inhibition of NO, which may be a consequence of the known vasoconstrictor effects of NOS inhibitors. The observed reduction of in vivo ovulation rate by NO inhibition at 20 h post-hCG was associated with a significant reduction in thecal MCA149+ neutrophils at 12 h post-hCG, the expected time of ovulation (L-NAME-treated: 98.4 +/- 9.2 cells per thecal area; saline-treated: 211.5 +/- 11.5 cells per thecal area; p < 0.001), while ED1+ monocytes/macrophages underwent similar but nonsignificant changes. Plasma (20 h post-hCG) and perfusate progesterone were not different with L-NAME treatment, while perfusate estradiol levels were markedly reduced upon addition of L-NAME, suggesting a role for NO in ovulation but not in the process of luteinization. In summary, deprivation of NO by use of the competitive inhibitor, L-NAME, led to fewer ovulations, reduced accumulation of nitrite, a decreased neutrophil count in the theca of preovulatory follicles, and reduced estradiol secretion, while progesterone release remained unaffected. The NO pathway may therefore play an important role in the regulation of ovulation and the mediation of IL-1 beta's pro-ovulatory effects. There are likely to be primarily vascular effects, but also a nonvascular component, to the NO regulation of ovulation, with both components indirectly affecting ovulatory leukocyte distribution and steroid secretion.

Cytokines in the ovary: pathophysiology and potential for pharmacological intervention

The ovary and testis are sites for interaction between the endocrine and immune system via leukocytes and their secreted products, the cytokines. There are convincing data available to show that the gonads are sites of cytokine action and production. In the ovary, cytokines and leukocytes are intimately involved in follicular development, ovulation, and luteal function. A variety of clinical situations may be due to cytokine action in the gonads, and therapeutic manipulation of the immune system may affect reproductive function.

Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women

Obesity can affect ovulation and the chances of pregnancy. In this prospective study, a weight loss programme was assessed to determine whether it could help infertile overweight anovulatory women to establish ovulation and assist in achieving pregnancy, ideally without further medical intervention. The subjects acted as their own historical controls. They underwent a weekly programme of behavioural change in relation to exercise and diet over 6 months; those who did not complete the 6 months were treated as the comparison group. Women in the study group lost an average of 6.3 kg, with 12 of the 13 subjects resuming ovulation and 11 becoming pregnant, five of these spontaneously. Fitness, diet and psychometric measurements all improved. Fasting insulin and testosterone concentrations dropped significantly, while sex hormone binding globulin concentrations rose. None of these changes occurred in the comparison group. Thus, weight loss with a resultant improvement in ovulation, pregnancy outcome, self-esteem and endocrine parameters is the first therapeutic option for women who are infertile and overweight.

Reduction of ovulation rate in the rat by administration of a neutrophil-depleting monoclonal antibody

To investigate the effect of systemic neutrophil depletion on ovulation rate, rats were synchronised with eCG and hCG, and concurrently were administered neutrophil-specific, cytotoxic RP-3 monoclonal antibody (mAb), or an irrelevant, class-matched mAb. Neutrophils in the peripheral blood and in the thecal-luteal area of corpora lutea were detected by immunohistochemical analysis with the neutrophil-specific mAb MCA149 and were found to be reduced in number by 70% and 38% respectively following RP-3 treatment compared to the control group. Ovulation rate, as assessed by counting the number of oocytes in the ampullary region of the oviduct 20 h after hCG administration, was found to be reduced by 27% in the neutrophil-depleted rats. This result provides further evidence that neutrophilic granulocytes play an active role in ovulation in the rat.

Subjects with polycystic ovaries without hyperandrogenaemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome

Polycystic ovaries (PCO) are detected using ultrasonography in a proportion of women who do not have clinical symptoms of the polycystic ovary syndrome (PCOS). The aim of this study was to compare the metabolic and endocrine differences between women with such ultrasound-detected PCO and women with PCOS, and to relate these changes to clinical presentation with particular reference to cycle irregularity. A group of 118 women showing PCO on vaginal ultrasound scan was divided into those who had no hyperandrogenaemia (n = 21) and those who had increased androgens and a clinical presentation normally associated with PCOS (n = 97). These were compared with a reference group of 26 normal subjects. Glucose tolerance, lipid concentrations and endocrine profiles were compared between groups. Apart from higher concentrations of androgens in the PCOS group, there were no significant differences between the PCO and PCOS groups in either fasting and stimulated insulin and glucose or in concentrations of sex hormone-binding globulin, gonadotrophins and blood lipids or in ovarian volume. Both PCO and PCOS subjects with cycle irregularity had significantly higher concentrations of serum fasting and stimulated insulin independent of androgens and body mass index than those with normal cycles. It was concluded that: (i) PCO and PCOS patients have equivalent disturbances in relation to insulin and glucose metabolism as well as lipid and lipoprotein disturbances compared to reference subjects; (ii) higher serum insulin values are associated with menstrual irregularity in both groups; (iii) ultrasound evidence for PCO predicts similar metabolic sequelae to PCOS and can therefore be used for studies of the genetics and long term risks for this condition.

Luteinizing hormone/chorionic gonadotropin bioactivity in the common marmoset (Callithrix jacchus) is due to a chorionic gonadotropin molecule with a structure intermediate between human chorionic gonadotropin and human luteinizing hormone

Chorionic gonadotropin (CG), a pregnancy-specific heterodimeric hormone found in primates, is responsible for CL rescue with pregnancy maintenance. Of the primates, the human and baboon gene sequences are the only structures so far determined. In order to study the structure and function of CG in other primates, we have isolated and sequenced the coding regions for the two subunits of marmoset CG (mCG) by the reverse transcription/polymerase chain reaction method. Study of multiple clones confirmed a high degree of homology with the human sequences (88% and 80% for the alpha and beta nucleotide sequences, respectively). Marmoset CG alpha has an extra four amino acids compared to hCG alpha, whereas the mCG beta sequence has a 3-bp deletion that maintains the reading frame and C-terminal amino acid sequence. Most of the differences between hCG beta and mCG beta peptides occur in the C-terminal region, which includes the loss of two of the O-linked glycosylation consensus sequences and the presence of an N-linked glycosylation consensus sequence. When mCG alpha and beta were co-expressed in CHO cells, assembly of biologically active hormone was confirmed by induced steroid secretion by MA10 cells. Partially purified mCG beta was used to raise anti-mCG antibodies. To date, an antibody has been obtained that is capable of detecting recombinant mCG beta, recombinant mCG dimer, and mCG dimer secreted by cultured marmoset trophoblast. Marmoset CG alpha and beta were also detectable at the transcriptional level in cultured trophoblast by in situ hybridization. This suggests that the LH/CG bioactivity reported from marmoset placentae and embryos is due to a molecule with structural features common to hLH (glycosylation pattern) and hCG (CG beta C-terminal structure).

Immunoactive interleukin-1 beta and tumour necrosis factor-alpha in thecal, stromal and granulosa cell cultures from normal and polycystic ovaries

Previous studies of follicular fluid from stimulated human ovaries have shown detectable amounts of immunoactive interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF). Other reports have shown the presence of IL-1 receptors, mRNA and antagonists for IL-1 in the human ovary. The aim of this study was to measure IL-1 and TNF concentrations in follicular fluid from unstimulated normal or polycystic ovaries (PCO) as well as concentrations in media conditioned by granulosa cells or thecal or stromal tissue. TNF concentrations were easily detected in follicular fluid (77 fmol/ml, range 20-95) and concentrations in PCO were similar to those in normal ovaries (70 versus 82 fmol/ml). TNF was virtually undetectable in all tissue culture media. IL-1 concentrations in all culture media were readily detected but showed no differences between different tissues or between PCO and normal ovaries. It was concluded that human ovaries readily produce immunoactive IL-1 in culture but produce less TNF despite detectable amounts of TNF in follicular fluid. There appears to be no difference between PCO and normal ovaries with respect to IL-1 and TNF.

Distribution of leukocyte subtypes in the sheep ovary after laser drilling

The distribution of leukocyte subtypes in the sheep ovary following laser drilling of the ovarian capsule was examined to understand a possible mechanism by which this treatment promotes ovulation in polycystic ovarian syndrome. Ovaries were removed from sheep at different time-points following laparoscopic laser drilling and immunohistochemical detection of leukocyte subtypes, using specific monoclonal antibodies; standard histological staining was performed. Migration of leukocytes into the laser-drilled site was observed as early as 6 h after laser drilling and the total number of leukocytes in the site was found to increase up to the 12th day after surgery. In the earlier period, polymorphonuclear leukocytes were the dominant leukocyte subtypes, while macrophages and lymphocytes were the major cellular components on the 12th day and later. These results show that the tissue changes in the ovary following laser drilling are consistent with a local inflammatory reaction. The prolonged appearance of numerous macrophages following the acute inflammatory phase could lead to the secretion of cytokines and other substances suggested to be important in promoting ovulation. These data indicate that part of the effectiveness of the laser drilling in polycystic ovarian syndrome may be attributable to the secretory products of these leukocytes.

Metabolic approaches to the subclassification of polycystic ovary syndrome

OBJECTIVES

To examine the relationship between various hormonal and metabolic variables in a large group of women with unequivocal evidence of polycystic ovarian syndrome (PCOS) to dissect out the metabolic heterogeneity of this condition.

DESIGN

Cross-sectional observational study of PCOS (n = 122) and non-PCOS (n = 26) subjects.

SETTING

Reproductive medicine unit in a tertiary teaching hospital.

PATIENTS

Subjects with presumed PCOS were recruited from the Reproductive Medicine and Gynaecological Clinics and later confirmed as PCOS with recognized criteria. Several other subjects were identified through recruiting reference subjects. The PCOS population consisted of 122 patients. Reference subjects were recruited from partners of male factor infertility patients in the clinics and from the general population (n = 27).

INTERVENTIONS

A 75 g 2-hour oral glucose tolerance test was performed on all subjects in their midluteal phase. Blood was taken at fasting and at 30, 60, 90, and 120 minutes.

MAIN OUTCOME MEASURES

Age, body mass index (BMI), waist to hip ratio, levels of integrated glucose and insulin, concentrations of maximum insulin, sex hormone-binding globulin, T, triglyceride, apolipoproteins (Apo A1, B), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDLC).

RESULTS

Five clusters could be identified. They are characterized as a nonobese group, a moderately obese group, and three very obese groups. The nonobese group (n = 41, BMI = 24.1) exhibited the lowest level of integrated insulin (236.4 mIU/L or microU/mL) and concentration of serum T (5.5 nmol/L). The moderately obese group had the second lowest level of integrated insulin (497.1 mIU/L) whereas the three very obese groups (n = 15, 13, and 5, respectively) had significantly higher but different levels of integrated insulin (group 3: 850.8 mIU/L; group 4: 1,131.5 mIU/L; and group 5: 1,531.9 mIU/L), triglyceride (group 3: 1.39 mmol/L; group 4: 1.76 mmol/L; and group 5: 2.78 mmol/L [1 mmol/L = 88mg/mL]), Apo B (group 3: 1.18 g/L; group 4: 1.08 g/L; and group 5: 1.55 g/L) and LDLC (group 3: 3.81 mmol/L; group 4: 3.05 mmol/L; and group 5: 5.06 mmol/L [1 mmol/L = 38.6 mg/100 mL]).

CONCLUSIONS

The metabolic heterogeneity of the PCOS population is reflected at least partly in patients' levels of insulin, lipids, and lipoproteins, dependent and independent of BMI.

Cellular composition of primary cultures of human granulosa-lutein cells and the effect of cytokines on cell proliferation

The cellular composition of cells collected from the follicular fluid obtained during the IVF procedure and cultured in vitro was examined, as well as the effects of two cytokines, interleukin-2 (IL-2) and tumour necrosis factor-alpha (TNF alpha), on the proliferation of individual cell types. After 48 h in culture, most of the cells were granulosa-lutein cells exhibiting positive staining against 3-beta-hydroxysteroid dehydrogenase (3 beta-HSD). About one-third of the total cell population stained positive with monoclonal antibodies against specific antigen sites on lymphohaemopoietic cells, including B-lymphocytes, T-lymphocytes, natural killer cells, monocytes and macrophages. During this 48-h period, IL-2 and TNF alpha significantly (P < 0.05) increased the proportion of leukocyte common antigen (LCA)-positive cells and monocytes. At the end of 144 h in culture, although LCA-positive cells and monocytes were still present, there were fewer. The main targets for the proliferative effects of IL-2 and TNF alpha in this culture system during the first 48 h are leukocytes rather than steroid-producing cells. Thus, any observed effects from the addition of cytokines in this system may be due to indirect effects of cytokine-activated leukocytes on granulosa-lutein cells.

Interleukin-1β inhibits luteinizing hormone-induced plasminogen activator activity in rat preovulatory folliclesin vitro

The effects of interleukin-1β (IL-1β) and tumour necrosis factor-α (TNFα) on ovulation-associated plasminogen activator (PA) activity were investigated using preovulatory follicles excised 48h after equine chorionic gonadotrophin (16IU)-priming of immature rats. Follicles were incubated for 6 and 14h with a single dose of LH (1 μg/ml) only, or various cytokine doses in the presence or absence of LH. PA activity in follicular homogenates was determined by a radioactively labelled fibrin-coated plate method and secreted levels of the ovulatory mediators progesterone (P) and prostaglandin E (PGE) were measured by radioimmunoassay. LH induced timedependent rises in PA (2.5-fold over control at 6h and fourfold over control at 14h), while IL-1β and TNFα alone had no effect over either time period. LH and cytokine coincubations over 14h revealed that IL-1β dosedependently inhibited the LH-induced increase in PA activity, up to 85%. The effects of TNFα on LH-induced PA activity were not significant. Both IL-1β and TNFα increased P and PGE secretion time- and dose-dependently. In summary, IL-1β dose-dependently inhibits the LH-induced increase in PA activity in rat preovulatory folliclesin vitro while, as with TNFα, increasing P and PGE synthesis. This study, shows that the earlier reported pro-ovulatory action of IL-1β is not likely to be mediated by activation of the PA-system and suggests that IL-1β may mediate a regulatory loop controlling the extent and distribution of LH-induced PA activity in rat preovulatory follicles.

Effects of tumour necrosis factor alpha (TNF alpha) on ovulation in the rat ovary

The effects of tumour necrosis factor alpha (TNF alpha) on ovulation rate, ovarian secretion of steroids, and on tissue concentrations of the ovulatory mediators plasminogen activator (PA) and prostaglandins were examined in rat ovaries perfused in vitro for 20 h. Unstimulated control ovaries did not ovulate whereas luteinizing hormone (LH; 100 ng mL-1) induced ovulations in all ovaries (2.6 +/- 0.7). TNF alpha (40 ng mL-1) induced ovulations in 3 of 5 ovaries (0.8 +/- 0.4). When TNF alpha was added concomitantly with LH, the LH-induced ovulation rate was increased four-fold (10.6 +/- 1.3). This effect was not seen when TNF alpha was added 5 h after LH (3.2 +/- 0.6). More progesterone was released when TNF alpha was combined with LH by comparison with LH alone. Tissue concentrations of prostaglandin F2 alpha (PGF2 alpha) and PGE were increased by the addition of TNF alpha when compared with the control group, but did not exceed those observed in the LH group, when TNF alpha was combined with LH. PA activity in the tissue was unaffected by TNF alpha and the LH-induced increase in PA activity was inhibited when TNF alpha was combined with LH. The results demonstrate that the proinflammatory cytokine TNF alpha promotes ovulations in the rat ovary.

Ethnic differences in insulin and glucose response to glucose between white and Indian women with polycystic ovary syndrome

OBJECTIVE

To examine different patterns of glucose and insulin secretion in women (of both Indian and white ethnic backgrounds) with polycystic ovary syndrome (PCOS).

DESIGN

A 75-g oral glucose tolerance test was performed in 11 subjects from each group.

SETTING

Reproductive Medicine and Gynecological Clinics from The Queen Elizabeth Hospital, Woodville, South Australia, and King Edward the VIIIth Hospital, Durban, South Africa.

PATIENTS

Couples were grouped as follows: Indian nonobese and obese PCOS, Indian nonobese and obese reference subjects, white nonobese and obese PCOS, white nonobese and obese reference subjects.

MAIN OUTCOME MEASURE

Insulin and glucose in plasma after oral glucose testing.

RESULTS

Indian PCOS and nonobese reference subjects had higher insulin responses than whites. The ethnic difference was less pronounced in obese women. There were no ethnic differences in glucose response.

CONCLUSION

This study demonstrates that the ethnic background of subjects with PCOS needs to be considered in studies on the metabolic parameters in this condition.

Finger-prick--an alternative to venipuncture for the assessment of endocrine profiles in women

Traditionally, there has been a reliance on venipuncture to obtain peripheral blood endocrine levels for the assessment of infertility treatment cycles. We have assessed the viability of a finger-prick capillary blood collection method to provide an alternative to venipuncture, assisting in the treatment of patients for whom venous sampling may be difficult to perform. A direct one-to-one relationship was found between the two collection methods with respect to E2, P, and LH measurement. Finger-prick blood collection is simple and easy to perform and provides a viable alternative to venipuncture. It also alleviates the stress involved with multiple attempts at venous sampling in some patients.

Characterization and relative abundance of alternatively spliced luteinizing hormone receptor messenger ribonucleic acid in the ovine ovary

Complementary DNA (cDNA) clones encoding the LH receptor (LHR) were recently isolated from pig, rat, mouse, and human testes or ovaries. Many of the LHR cDNAs isolated from these species encoded incomplete and, therefore, possibly inactive forms of the LHR. The four major incomplete cDNAs, designated B, C, D, and E, were due to alternative splicing of the full-length cDNA, designated the A form. Northern analyses of messenger RNA (mRNA) encoding LHR in these species and in sheep revealed multiple mRNA species in ovarian tissue, but were unable to distinguish between the full-length (functional) form and the splice variants. We have used reverse transcription of mRNA, amplification via the polymerase chain reaction, and cDNA sequencing to determine which alternatively spliced mRNA species were present in ovine ovarian follicles and corpora lutea, and ribonuclease protection assays to confirm these results and determine the relative abundance of these splice variants. Ovine LHR cDNAs of the full-length A form, B form, and two novel splice forms, designated F and G, were isolated and sequenced. By using LHR cDNAs that spanned the regions of the gene in which the majority of splicing variation occurred, ribonuclease-protected fragments of different sizes were generated depending on which mRNA species (A-G) were present. It is estimated that the ratios of the steady state mRNA levels of the splice variant B form/full-length A form/G form/F form were 5-3.5:1:1:0.3. The E, C, and D forms were not detected, even when using the sensitive method of reverse transcription-polymerase chain reaction for the latter two forms. The overall level of expression of LHR mRNA was greater in corpora lutea than follicles, but the relative abundance of the splice variants was similar in follicles and corpora lutea.

Localization of leukocyte subsets in the follicle wall and in the corpus luteum throughout the human menstrual cycle

OBJECTIVE

To determine the presence and localization of leukocyte subsets in the human follicular wall and in the corpus luteum (CL) throughout the menstrual cycle.

DESIGN

Tissue was obtained by biopsy at laparoscopy. Frozen sections were labeled with a panel of monoclonal antibodies against leukocyte subtype markers and detected by immunohistochemical methods.

SETTING

Infertility clinic in large teaching hospital.

PATIENTS

Eighteen women who underwent diagnostic laparoscopy. Women with abnormal endocrinology, endometriosis, or ovarian disease were excluded.

RESULTS

Macrophages and neutrophilic granulocytes were present in high numbers in the collagen-rich tissues, including the thecal layer, of the follicle wall. At ovulation, there was a marked increase in the density of these cells in the follicle wall, especially in the thecal layer. In the CL, there was a higher density of macrophages (2- to 3-fold) and neutrophils (3- to 5-fold) in the theca lutein area compared with the granulosa lutein area. There were no significant changes in the density of these cell types when early and late luteal phase were compared, but the density of macrophages were markedly elevated in regressing CLs obtained during the subsequent follicular phase. T lymphocytes were present in low numbers in the follicle wall and in the CL, and no variation in the density was detected throughout the menstrual cycle.

CONCLUSION

Macrophages and neutrophilic granulocytes are present in high numbers in the follicle wall and are further increased in the theca at ovulation, suggesting an active role for these leukocyte subtypes in tissue remodeling during the ovulatory process. Macrophages and neutrophils are also abundant in the CL, and an increase in the macrophage density at CL regression could imply a role for these cells in luteolysis.

Rat ovary produces cytokines during ovulation

To examine the production of cytokines by the ovary during ovulation, ovaries were obtained from immature rats and from eCG/hCG-primed immature rats at different stages of the ovulatory process (before hCG injection, 10 h after hCG, and 20 h after hCG) and were perfused in vitro for 5 h. Large quantities of interleukin (IL)-6 and granulocyte-macrophage colony-stimulating factor (GM-CSF) bioactivity and smaller amounts of tumor necrosis factor-alpha (TNF alpha) and IL-1 bioactivity were found in the perfusate. IL-2 and IL-3 were not detectable in the perfusion media. The GM-CSF content was significantly higher in the perfusate of ovulating ovaries (obtained 10 h after hCG) compared to the earlier stages. Studies on preovulatory ovaries (prior to hCG injection) revealed that GM-CSF release was not influenced by LH, but was markedly increased when recombinant human IL-1 beta (4 ng/ml) was added to the perfusion medium. IL-6 was released in similar amounts from ovaries at all stages. The identity of bioactive GM-CSF was confirmed by neutralization with a specific polyclonal antibody against murine GM-CSF. Size-exclusion chromatography of perfusion medium revealed peaks of GM-CSF and IL-6 bioactivity at approximate molecular masses of 21-23 kDa and 24-25 kDa, respectively. This study demonstrates that the rat ovary produces IL-6, GM-CSF, TNF alpha, and IL-1 prior to and during the ovulatory process and that there are temporal fluctuations in GM-CSF release with a peak in output at ovulation.

Management of fertiliser nitrogen in dry-seeded, delayed-flood rice

Approaches taken in management of fertiliser nitrogen (N) in dry-seeded, delayed-flood rice (Oryza sativa L.) in the United States of America vary considerably. A 2-year study was conducted in Louisiana to evaluate N fertiliser efficiency and accumulation when applied in single or multiple applications. The cultivars Lemont and Tebonnet, representing semi-dwarf and conventional tall plant types, respectively, were grown on a Crowley silt loam (Typic Albaqualfs soil). Urea N was applied using 1 of 3 strategies: in a single (1-way) preflood (PF) application of 134 kg Nlha; in a 2-way split consisting of 100 kg N/ha PF and 34 kg N/ha at panicle initiation (PI); or in a 3-way split consisting of 66 kg N/ha PF, 34 kg N/ha at PI, and 34 kg N/ha at panicle differentiation. Microplots were established within each whole plot and fertilised with 2 atom% 15N urea. Fertiliser N application time had no influence on plant accumulation of 15N urea or biomass production. Plant accumulation of 15N urea was significant across year and cultivar. Tebonnet accumulated more 15N urea than Lemont. Accumulation was also significantly higher in 1992. Method of application of fertiliser N significantly affected grain yields. The highest average grain yield of 7905 kg/ha occurred with a single PF application. Yields were reduced by 378 kg/ha with a 2-way split application and by 1074 kg/ha with a 3-way split application. Method of application of main crop fertiliser N had no effect on ratoon crop yields. Total grain yield (main + ratoon) was significantly reduced with the 3-way split. This study demonstrates the importance of supplying adequate N to the rice plant before permanent flood establishment. It also suggests that midseason N applied at specific growth stages is less efficiently utilised, especially when insufficient N is applied at PF.

Molecular heterogeneity of the beta-core fragment of human chorionic gonadotrophin

We have analysed the structure and composition of the beta-core fragment of human chorionic gonadotrophin (beta C-hCG) from fresh urine specimens obtained from pregnant women and compared our findings with those previously proposed by other groups using different protocols. SDS-PAGE separation of reduced beta C-hCG demonstrated two major bands with apparent molecular weights of M(r) 8900 and M(r) 7500. The molecular weight of the agalacto beta C-hCG was estimated to be M(r) 10,218 from the amino acid analysis after high-performance liquid chromatography (HPLC) separation. Moreover, HPLC separation of its reduced and S-carboxymethylated peptides resulted in three peaks, but only two of them could be sequenced and demonstrated to be the previously reported beta 6-40 (M(r) 5000) and beta 55-92 (M(r) 5300) peptides of the beta hCG subunit. The results showed that 56-78% of beta C-hCG molecules of molecular weight M(r) 12,800 were able to bind Concanavalin A (Con A). While most were lacking all the peripheral monosaccharides and terminated in mannose, some retained other sugar residues on their antennae. Direct carbohydrate analysis showed the following molar content normalized to six mannose molecules: galactose 2.8, glucosamine 5.3, galactosamine 0.3, fucose 1.7 and sialic acid 3.0. Approximately 22-44% of the beta C-hCG molecules did not bind Con A (Con A non-reactive forms), of which 88% were totally deprived of sugar units and had an apparent molecular weight of approximately M(r) 10,000, and 12% were weakly reactive to Con A and reactive to anion exchange (negatively charged forms), being incompletely trimmed of their oligosaccharide chains. Comparison of our results with those of two other groups have indicated that the differences noted among preparations are due to either the source or the methods used to purify and characterize this fragment. In addition, our results showed significant microheterogeneity on the N-linked oligosaccharide moieties with some molecules apparently having no sugar molecules. These results have implications for the origins of beta C-hCG, suggesting secretion of some molecules without sugar chains and in other cases possible metabolism of hCG in the peripheral tissues.

Involvement of leukocytes and cytokines in the ovulatory process and corpus luteum function

The role of leukocytes and cytokines in ovarian physiology is now established, although the function of each cell type and cytokine remains to be determined in detail. Current knowledge of these effects on follicle development, ovulation, luteinization and luteotrophic process and luteolysis is reviewed. It is possible that further research will help to unravel some of the clinical mysteries in ovarian function, including polycystic ovary syndrome, premature menopause, ovulatory disorders, and luteal phase defect. Furthermore, the increasing use of cytokines and their antagonists in clinical practice may have significant effects upon reproductive function.

Prostaglandin F2 alpha mediates platelet-activating factor-stimulated atrial natriuretic factor release from the isolated rat heart

Platelet-activating factor (PAF) and the prostaglandins have recently been shown to stimulate atrial natriuretic factor (ANF) secretion from the heart. As PAF also potentiates the release of cyclooxygenase products from isolated hearts, the role of these substances in PAF-induced ANF secretion was investigated. Using an isolated perfused rat heart preparation, cyclooxygenase inhibition by indomethacin or meclofenamic acid (10 microM for each) significantly attenuated the rise in ANF associated with PAF administration (2.5 nmol). Prostaglandin F2 alpha (PGF) produced an immediate and dose-dependent increase in ANF secretion, which was significant at 0.01 mumol and reached 348 +/- 66% over baseline values after a 1-mumol injection. Prostaglandin E2 (PGE) generated a much smaller 98 +/- 25% increase after a 1-mumol administration. Furthermore, PGF but not PGE was released from isolated hearts immediately after PAF administration. PGF release reached a maximum of 0.06 nmol/min g Heart-1 1 min after PAF stimulation and had returned to undetectable baseline values by 6 min. Cyclooxygenase inhibition abolished the release of PGF after PAF, in addition to attenuating (by 60-70%) the increased secretion of ANF after PAF injection. These results demonstrate very clearly that PGF is the major mediator for PAF-stimulated ANF secretion. Such an interaction may provide an alternative mechanism to atrial distension for the secretion of ANF in pathologies such as myocardial infarction, where autacoids such as PAF and the PGs are released from damaged cardiac muscle and elevated plasma levels of ANF are observed.

Gamete intra-fallopian transfer: outcome following the elective or non-elective replacement of two, three or four oocytes

The outcome of 807 gamete intra-Fallopian transfer (GIFT) cycles following the elective or non-elective transfer of two, three or four oocytes has been retrospectively studied. Electively replacing either three or two oocytes did not reduce the clinical or ongoing pregnancy rate when compared with replacing four oocytes. The incidence of high-order multiple gestation (triplet or more) was significantly reduced by replacing fewer oocytes, but the occurrence of twin pregnancy was not altered. Lower pregnancy rates were found when the number of oocytes available for replacement was limited and non-elective replacement was performed. It is suggested, therefore, that a higher number of oocytes available may allow selection of higher quality oocytes for transfer. We conclude that the overall expectation of pregnancy from the GIFT procedure is high (30-40%) and the number of oocytes replaced should be two in order to minimize the risk of high-order multiple pregnancies. It is not clear whether increasing the number of oocytes transferred will benefit subjects who failed to become pregnant previously with GIFT, but limited data suggest that transferring large numbers of oocytes to women > 40 years does not improve the expectation of pregnancy.

Beta-core fragment of human chorionic gonadotropin in cervical intraepithelial neoplasia (CIN)

A low molecular weight glycoprotein immunologically identical with the beta-core fragment of hCG (beta C-hCG) has been described in invasive tumors of the genital tract, particularly carcinoma of the cervix. A previous report has also suggested increased urinary concentrations in subjects with cervical intraepithelial neoplasia (CIN). This prospective study of 107 patients with CIN was conducted to determine concentrations of beta C-hCG in the urine compared to a reference population without CIN. All subjects underwent a cervical smear and colposcopy, with biopsy when indicated. Between 11 and 18% of patients had urinary concentrations of beta C-hCG greater than the upper limit of the reference group and these results were confirmed when corrected for urinary creatinine concentration. A substantial number of subjects (19%) also had a positive result in a C-terminal immunoassay. It is concluded that preinvasive carcinoma of the cervix may secrete hCG or beta C-hCG in the earliest stages although measurement of beta C-hCG is unlikely to prove to be a valuable diagnostic marker in CIN.

Inhibin and relaxin concentrations in early singleton, multiple, and failing pregnancy: relationship to gonadotropin and steroid profiles

OBJECTIVE

To examine the inter-relationships between inhibin, relaxin, steroid concentrations, estradiol (E2), progesterone (P), and gonadotropins in early pregnancy.

DESIGN

Hormone concentrations in plasma were measured during the luteal phase of subjects who became pregnant (n = 58) or failed to become pregnant (n = 47) after ovarian hyperstimulation for in vitro fertilization-gamete intrafallopian transfer (IVF-GIFT) (group 1). A further group of subjects became pregnant (n = 7) or failed to become pregnant (n = 8) during endocrinology tracking of a natural cycle (group 2). Blood was obtained every 3 days in the luteal phase from day 5 in group I (day 0 was oocyte recovery) and from day 0 (first increase in luteinizing hormone [LH]) in group II.

RESULTS

Progesterone and E2 were increased over nonpregnant values by day 11 (P) and day 16 (E2) in group I and by day 11 (E2 and P) in group II. Inhibin and relaxin concentrations were significantly increased by day 16 in group I (often by day 11) and by day 14 in group II pregnancy subjects. A direct relationship existed between inhibin, P, relaxin, and human chorionic gonadotropin (hCG). Subjects who had twin pregnancies demonstrated higher concentrations of all hormones and often exhibited increases earlier (by day 11 in group I) than singleton pregnancy subjects. Pregnancies that ended in miscarriages tended to have lower concentrations of P and inhibin. None of the hormones reliably discriminated between the clinical conditions of blighted ovum and of spontaneous abortion, and the predictive value of any hormone measured for miscarriage was not high.

CONCLUSIONS

The trend of inhibin and relaxin concentrations closely parallels rises in P during early pregnancy. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are suppressed very early in pregnancy. The suppression of LH and FSH in hyperstimulated cycles is more governed by E2 than inhibin in stimulated cycles. Some subjects destined to miscarry exhibit abnormal endocrine changes very early in the luteal phase.

Effects of cytokines on prostaglandin production and steroidogenesis of incubated preovulatory follicles of the rat

Cytokines, leukocyte-derived peptide regulators of inflammation and other lympho-hematopoietic processes, have been implicated in ovarian physiology on the basis of findings of cytokines in follicular fluids and the presence of leukocytes in ovarian tissue. During the dramatic tissue remodelling at ovulation, several inflammatory mediators play pivotal roles in the occurrence of follicular rupture, but no data exist regarding the involvement of cytokines in this process. In the present study we have examined the effects of three different lymphocyte- and macrophage-derived cytokines--tumor necrosis factor alpha (TNF alpha), interleukin-1 beta (IL-1 beta), and interleukin-2 (IL-2)--on the production of ovulatory mediators such as prostaglandins and progesterone in the preovulatory follicle of the eCG/hCG-primed immature rat. Preovulatory follicles were incubated in the presence of human recombinant cytokines for up to 24 h, and the concentrations of prostaglandins and steroids in the incubation medium were measured by RIAs. TNF alpha and IL-1 beta stimulated production of prostaglandin E and prostaglandin F2 alpha in a dose-dependent manner during a 24-h incubation. Synthesis of prostacyclin was also stimulated by TNF alpha and IL-1 beta, as indicated by high levels of its stable metabolite 6-keto-prostaglandin F1 alpha. Time-course studies showed that a major portion of the prostaglandins were produced between 12 and 24 h. IL-2 was without effect on these parameters. TNF alpha and IL-1 beta also dose-dependently increased the production of progesterone and this was not inhibited by indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Ovulatory effect of interleukin-1 beta on the perfused rat ovary

The involvement of cytokines derived from ovarian and hematopoietic cells have been suggested in the cyclic events of the ovary. In the present study the effects of two cytokines, interleukin-1 beta (IL-1 beta) and IL-2, on ovulation, steroidogenesis, and prostaglandin (PG) production were explored in rat ovaries perfused in vitro. Ovaries of equine CG (20 IU)-primed immature rats were perfused in a recirculating system for 20 h, and samples were taken for analysis of progesterone, estradiol, prostaglandin E (PGE), and PGF2 alpha. The number of ovulations was estimated by counting the number of oocytes released into the ovarian bursae. Unstimulated ovaries did not ovulate, whereas the addition of LH (100 ng/ml) resulted in 3.4 +/- 0.6 ovulations/treated ovary. The addition of human recombinant IL-1 beta (4 ng/ml) induced ovulation (1.6 +/- 0.4) and increased the LH-induced ovulation rate 3-fold (9.8 +/- 0.5). The addition of human recombinant IL-2 (40 ng/ml) did not induce ovulation and did not affect the LH-induced ovulation rate. Ovarian release of progesterone and PGF2 alpha was increased by IL-1 beta, but estradiol and PGE release was not affected. IL-2 did not affect steroidogenesis or PG release. To elucidate whether the IL-1 beta-stimulated ovarian synthesis of PGF2 alpha was crucial for the ovulatory effect of IL-1 beta, experiments were performed in the presence of indomethacin (5 micrograms/ml), an inhibitor of PG synthesis. Indomethacin (5 micrograms/ml) inhibited LH-induced ovulation almost completely (one ovulation in one of the five treated ovaries), but did not affect the IL-1 beta-induced ovulation rate (1.4 +/- 0.2). The number of ovulations in the group treated with LH and IL-1 beta was significantly reduced (3.2 +/- 0.6) in the presence of indomethacin. These data demonstrate that IL-1 beta induces ovulation in the rat ovary, and this effect may be partly mediated by the increased production of the ovulatory mediator progesterone.