Human ovarian receptors to human prolactin: implications in infertility

In the human, hyperprolactinemia may interfere with fertility. To find out whether or not prolactin (PRL) can act directly on human ovarian tissues, in vitro studies involving specific binding of human PRL to various human ovarian elements were carried out. Human PRL was isolated from amniotic fluid, and its intact monomeric iodinated isohormone B was prepared. Labeled PRL was incubated with plasma membranes of either granulosa or whole follicular homogenates. Relatively high specific binding sites were obtained. Saturation studies and Scatchard analysis showed a single class of binding sites with high binding affinity (Kd = 1.8 x 10(8) M) and a concentration of 7.9 x 10(-15) moles/mg protein. These results clearly demonstrate the existence of specific receptors to isoprolactin B in ovarian elements with binding capacity and concentration at least equal to that found in other targets for PRL. It is reasonable to assume that hyperactivation of these receptors in states of hyperprolactinemia constitutes the cause for the disturbances in ovarian functions that lead to infertility.

Non-fertility in cows with an abnormal indole metabolism and disturbed carbohydrate composition in the cervical mucus: a preliminary report

Cervical mucus samples of the cow appear to provide information on the probability of becoming pregnant. In six 'repeat breeders' a strong indole metabolism was found in the cervix. When luteal tissue was decreasing and follicles increasing, compounds were found indicating possible exfoliation of the endometrium, which in dogs is a normal process in late metoestrus. Exfoliation of the endometrium was actually demonstrated in two cows after slaughter. It can delay the onset of oestrus for several days and can disturb implantation of an embryo. The carbohydrate composition of the cervical mucus was also different from that in normal cows. Treatment with PMSG and PGF resulted only twice in the formation of glucuronic acid and sorbitol, which are seemingly necessary for the receipt of spermatozoa. A disturbed carbohydrate composition and an abnormal indole metabolism, which is easily detectable in the cervical mucus, may prevent or disturb fertilization in cows.

Proportions of nucleic acids in the uteri of ewes with clover disease and the effect of oestrogen after ovariectomy

In entire ewes, the ratio of RNA to DNA in the uterus was higher at oestrus than at dioestrus but did not differ between control and clover-affected ewes at either stage of the oestrous cycle. After ovariectomy the ratio of RNA to DNA in the uteri decreased in both control and clover-affected ewes, but the decrease was greater in the control ewes (P less than 0.01). Subsequently when ewes received a single injection of oestradiol-17 beta, a similar rise in uterine RNA/DNA ratio occurred in the two groups. However, following injection of the ewes with oestradiol-17 beta for 3 days, the ratio of uterine RNA to DNA was higher in control than in clover-affected ewes (P less than 0.05). Thus, the uteri from clover-affected ewes undergo less regression after ovariectomy and yet show less response to repeated oestrogenic stimulation that do that of control ewes. This pattern of response is consistent with the hypothesis that the permanent changes caused by phyto-oestrogens in ewes are analogous to the differentiation which normally occurs during organogenesis.

The role of salivary progesterone in studies of infertile women

Fifteen women with normal menstrual cycles, dated by accepted criteria, had salivary progesterone concentrations during the luteal phase of the cycle which were significantly higher than those in the follicular phase. Progesterone concentrations in matched samples of plasma and saliva showed excellent correlation in both normal and infertile women. Salivary progesterone profiles derived from daily sampling of 20 infertile patients not only allowed accurate assessment of ovarian dysfunction but also indicated more effectively than conventional techniques the change in hormonal status following ovulation induction therapy with clomiphene citrate or bromocriptine.

Oestrogen receptors and metabolic activity in the genital tract after ovariectomy of ewes with permanent infertility caused by exposure to phytooestrogens

Characteristics of the uterus anc cervix after ovariectomy of ewes with permanent phytooestrogen infertility (PPI) were compared with controls. Ewes with PPI had more oestrogen-binding sites in the cervix, but not in the uterus. There was no difference between the two groups of ewes in the binding affinity constant of receptors from the uterus or cervix. There were more keratinized cells in the vaginal epithelium of ewes with PPI, and the rates of protein and glycoprotein synthesis in the uterus and cervix were higher in ewes with PPI. These results offer further evidence that PPI in adult ewes is similar to the "persistent oestrus' syndrome in rodents oestrogenized neonatally.

Effect of progestogen on glycogen metabolism in the endometrium of infertile patients during the menstrual cycle

The glycogen content and glycogen synthetase and glycogen phosphorylase levels were studied in endometrial samples obtained from 19 normal and 37 infertile patients during the menstrual cycle before and after administration of progestogen. Each of the above groups received the progestogen Lyndiol (lynestrenol, 5.0 mg, and mestranol, 0.15 mg) daily for 7 days during the follicular phase of the menstrual cycle. In both groups an increase in the endometrial glycogen deposition and an increase in glycogen synthetase enzyme levels were seen. When the administration of progestogen was started on day 7 after ovulation, during the luteal phase, the glycogen content of endometrial tissue from infertile patients increased significantly; no change was found in endometrial samples from normal patients. No difference was found in the serum progesterone levels of normal and infertile patients in the midsecretory phase of menstrual cycle, and Lyndiol reduced the serum level of progesterone to approximately that found during the follicular phase in untreated normal women. These studies suggest that the proliferative endometrium of infertile patients may be less stimulated by ovarian estrogen than is normal endometrium, whereas endometrial tissue obtained from both groups during the luteal phase responded similarly to progesterone in glycogen synthesis and storage.

Glycogen metabolism of the human endometrium

The glycogen concentration and the activities of glycogen synthetase and phosphorylase were assayed in endometrial tissue obtained during curettage. Tissues were obtained during different phases of the menstrual cycle from women investigated because of menometrorrhagia or sterility. The glycogen concentration was less than 2 mg/g wet wt in specimens from days 1-15 and increased 10-fold during the early secretory phase. The total activities of glycogen synthetase and phosphorylase were increased 1.5- and 2-fold, respectively, during the secretory phase compared to those during the first half of the cycle. The activities of the active forms (a form) of these enzymes did not show significant changes during the menstrual cycle. The largest difference between the proliferative and secretory phases was in the activity of glycogen synthetase phosphatase, which was virtually inactive in tissues obtained on days 1-15 and increased almost 20-fold during the secretory part of the cycle. In tissues obtained from cases of sterility, the activities of glycogen synthetase and phosphorylase were significantly reduced only during the early secretory phase. Glycogen concentration throughout the menstrual cycle and enzyme activities during the midsecretory and premenstrual phase were similar in cases of sterility and other pathologies.

Breast examination does not elevate serum prolactin

Serum prolactin and cortisol levels were measured in 24 patients entering the Royal Victoria Hospital infertility center both before and after a thorough physical examination that included a pelvic examination and a search for galactorrhea in both breasts. There was no significant change in the levels of prolactin or cortisol in the group as a whole in those with normal prolactin values and those with high basal prolactin values (P less than 0.05). The possible role of stress in the mediation of occasional elevation of basal prolactin values is discussed in relation to the serum cortisol levels.

[Adrenal hyperandrogenism due to enzyme disturbance of late onset (author's transl)]

In the context of hyperandrogenism, the group of hyperandrogenism due to disturbances in hormon-synthesis of late onset is worthy of being considered separately, not by virtue of its prevalence but by the fact that its course may be one of isolate hirsutism (3 cases out of 11 in this study), or even sterility. The diagnosis may be of varying difficulty, because of the incomplete nature of the block. Eleven cases are reported, ten due to a partial deficit in 21 hydroxydation, and one due to a deficit in 11 hydroxydation. The presence of cortisone precursors is often more significant in stimulation tests. Estimation of blood testosterone levels may give somewhat high results in certain cases, but it must be emphasized that it may be diminished dexamethasone and the estimateion of delta 4 androstenedione is of value. In difficult cases, the diagnosis of a minor or incomplete disturbance is based upon a combination of biological, statistical and dynamic arguments. However this diagnosis is important since cortisone at low inhibitory doses are effective, in particular against menstrual disorders, sometimes making it possible to rapidly correct sterility.

Changes in oestradiol-17beta binding in the hypothalami and pituitary glands of persistently infertile ewes previously exposed to oestrogenic subterranean clover: evidence of alterations to oestradiol receptors

The binding of [3H]oestradiol-17beta to the hypothalamus and pituitary gland of clover-affected permanently infertile and control ovariectomized ewes was compared in vivo and in vitro. When [3H]oestradiol-17beta was infused into the carotid artery (10 ng/min), the total homogenate and the nuclear and protamine-precipitable cytosol fractions of hypothalami and pituitary glands from clover-affected ewes bound significantly more[3H]oestradiol than those of the controls. Cytoplasmic oestradiol-17beta receptors from the pituitary glands of clover-affected ewes showed a significantly lower apparent association constant and a higher number of binding sites/mg protein in vitro. It is suggested that the hypothalami and pituitary glands of ewes made permanently infertile by oestrogenic clover are less sensitive to feedback regulation of oestradiol-17beta at physiological levels.

Enzyme activities and protein and carbohydrate concentrations in cervical secretions at dioestrus in normal ewes and ewes with permanent phytooestrogenic infertility

Cervical secretions of clover-affected and control ewes in the luteal phase of the ovarian cycle were obtained by flushing the anterior vagina. The flushings were analysed for proteins, carbohydrates and enzyme activities, and were found to be similar to the secretions of the normal ovine uterus. There was significantly more protein, carbohydrate and acid-soluble glycoprotein but less alkaline phosphatase, N-acetylglycosidases (EC 3.2.1.30 and 3.2.1.53) and ribonuclease I in the vaginal flushings of clover-affected ewes. The observed changes were not due to more inflammation in the cervix of clover-affected ewes as there were fewer bacteria, leukocytes and epithelial cells and no elevation of lysozomal enzyme activities in their flushings. It is suggested that the cervix of the clover-affected ewe behaves as though under a stronger than normal oestrogenic stimulation during dioestrus.

Steroidogenesis in preovulatory follicles of patients given human menopausal and chorionic gonadotrophins as judged by the radioimmunoassay of steroids in follicular fluid

The administration of human menopausal gonadotrophin (HMG) followed by human chorionic gonadotrophin (HCG) stimulated the development of various numbers of follicles in patients treated for infertility. Graafian follicles from these patients were aspirated 32-33 h after the injection of HCG and the levels of steroids in the follicular fluid and matching serum samples were measured by radioimmunoassay. The follicles could not be grouped into two distinct clusters as found in patients given HCG during the menstrual cycle but a broad classification of follicles into four groups was indicated from the dendrogram. Two of the groups were similar to the ovulatory and non-ovulatory groups found previously, whereas the other two groups of follicles were more intermediate in nature. The use of a discriminant analysis showed that these two groups had clearly been stimulated by the HMG and HCG, although they were not yet fully ovulatory. Our data indicate that the number of developing follicles is considerably increased by treatment with HMG and HCG but there is asynchrony in follicular development because the pattern of steroid synthesis differs in many follicles. The effects of this asynchronous development on oocyte maturation and disorders of the luteal phase are discussed.

[Etiopathogenetic and clinical notes on the syndrome of the micropolycystic hyperandrogenic ovary and matrimonial sterility]

The nosological, clinical, aetiopathogenetic and therapeutic aspects of hyperandrogenic micropolycystic ovary are examined with particular reference to matrimonial sterility. There is not doubt about the existence of a syndrome substantially characterized, clinically, by menstrual trouble, inability to procreate, more or less evident signs of hyperandrogenism and a tendency to obesity and, morphologically, by ovarian micropolycystic alterations of typical pathognomonic aspect: the marked production of androgens on the part of the female gonad possibly accompanied by peripheral alterations interfering with their metabolism. The syndrome is not too frequent and, in personal experience, occurs in less than 1% of the series. The main therapeutic approach remains cuneiform resection of the ovary. Still in personal experience, 21.2% of cases treated led to pregnancy but not more than eight-ten months after operation. The effect would therefore appear to be transitory and the operation is decisively rejected where unmarried women are involved.

Endocrine studies during the refeeding of young women with nutritional amenorrhea and infertility

Serial endocrine studies were performed during the refeeding of a group of nine young women who presented with amenorrhea associated with injudicious dieting. No significant psychopathology was disclosed by the Lanyon Psychological Screening Inventory in any of the patients, six of whom were single and three married and infertile. The mean weight before refeeding was 81.6% of the normal for height. The mean initial serum follicle-stimulating hormone concentration was within the limits of normal for young women of reproductive age, but the serum luteinizing hormone (LH) concentration and the vaginal maturation score were low. As weight was regained, the serum LH concentration increased (the pooled r for LH versus percent normal weight = 0.85) and the vaginal maturation score rose (the pooled r for vaginal maturation score versus percent normal weight = 0.93). When a mean weight of 96.6% of normal was reached after a mean of 5.3 (range, 2 to 11) months of refeeding, spontaneous menses occurred. The initial cycle was ovulatory in two instances and anovulatory in five, as determined by basal body temperature patterns, plasma progesterone concentrations, and endometrial biopsies. With continued weight gain, menstruation became regular and the three married patients conceived.

Inadequate cervical mucus--a cause of "idiopathic" infertility

The purpose of this study was to investigate and treat a group of patients referred for "idiopathic" infertility in whom no apparent cause for infertility, apart from inadequate cervical mucus, was found. Hormone investigations revealed that these patients could be divided into two groups: those with low sex steroid profiles despite apparent ovulation, and a second group with normal sex steroid profiles. All patients were treated with ovulation-inducing agents in an attempt to produce "controlled" ovarian hyperstimulation and an improved cervical mucus. Four of six patients conceived. The rationale behind the use of ovulation-inducing agents in this situation is discussed.