[LH, FSH and ovarian steroids in serum during normal menstrual cycles and cycles with corpus luteum insufficiency in the human female (author's transl)]

Continuous Body Temperature Monitoring to Improve the Diagnosis of Female Infertility

Introduction Ovulatory dysfunction is a major cause of female infertility. We evaluated the use of continuous body temperature monitoring with a vaginal biosensor to improve standard diagnostic procedures for determining ovulatory dysfunction. Material and Methods This prospective interventional study was performed in a reproductive medicine department of a university hospital. The menstrual cycles of 51 women with infertility were monitored and analysed using three different strategies: sonographic and hormonal assessment (standard approach), continuous core body temperature measurement and analysis using the algorithm of OvulaRing, and lowest daily body temperature measurement monitored with a vaginal biosensor and analysed based on the body temperature curves used in natural family planning. Results Statistically significant differences were found in the temperature curves of women with luteal phase deficiency and polycystic ovary syndrome compared to women with normal menstrual cycles. The analysis of individual cyclofertilograms can be used to detect cycle phases and estimate the date of ovulation. Conclusions Continuous body temperature monitoring with a vaginal biosensor can improve the standard diagnostic procedures used to determine ovulatory dysfunction, especially if dysfunction is due to luteal phase deficiency and polycystic ovary syndrome. Analysis of the lowest daily body temperature combined with the basal body temperature measurements used in fertility awareness methods may be equieffective to continuous body temperature measurements with OvulaRing. The results of this study show that a revised diagnostic approach using fewer hormonal assessments combined with continuous body temperature monitoring can reduce the number of appointments in an infertility clinic as well as the costs.

The effect of danazol on gonadotropin secretion during the follicular phase of the menstrual cycle

The effects of danazol on pulsatile luteinizing hormone (LH) release, basal LH and follicle-stimulating hormone serum levels, gonadotropin release induced by estradiol (E2) and gonadotropin-releasing hormone were examined in five eugonadal women. Danazol administration resulted in a significant suppression of follicle-stimulating hormone serum levels. LH concentrations and LH pulse frequency appeared to be reduced, but these changes did not reach statistical significance. The pituitary response to exogenous gonadotropin-releasing hormone was not altered. The stimulatory effect of E2 on LH secretion was completely abolished in one subject, severely diminished in three subjects, and unchanged in one subject. In addition, the time course of this response was altered. Serum prolactin concentrations were lowered, whereas basal E2 and progesterone levels did not seem to be affected.

Could aspiration of the Graafian follicle cause luteal phase deficiency?

Luteal phase quality was evaluated in 32 patients wih nonstimulated cycles after laparoscopic oocyte recovery for in vitro fertilization. A luteal phase deficiency occurred in two cases (6.2%), the mean duration of the luteal phase was 13.5 +/- 1.3 days in 30 patients, and two patients developed amenorrhea of 23 and 43 days respectively after laparoscopy in spite of normal progesterone values 7 and 9 days after oocyte recovery. Six embryo transfers were performed after fertilization and regular cleavage of the obtained oocytes. No pregnancy resulted from the embryo transfers, although the patients had apparently normal luteal phases. In one patient there was a transient beta-subunit human chorionic gonadotropin (beta-hCG) elevation in serum. Luteal phase deficiency should not be main cause of a nonsuccessful embryo transfer. However, a prophylactic luteal phase support after oocyte recovery and embryo transfer in nonstimulated cycles is proposed.

Induction of ovulation with chronic intermittent (pulsatile) administration of LH-RH in women with hypothalamic and hyperprolactinemic amenorrhea

Five women with hypothalamic amenorrhea were treated with LH-RH (10-15 microg i.v. at 90 min intervals for 17-20 days). In all women this chronic intermittent LH-RH administration resulted in a normalization of serum gonadotropin levels. Four women exhibited preovulatory estradiol serum levels with subsequent LH peaks. In three women the LH peaks were followed by normal luteal phase serum progesterone levels. One woman with hyperprolactinemic amenorrhea was also treated with the same therapeutic regimen which induced ovulation as judged from normal luteal phase serum progesterone levels. The results indicate that normal pituitary-ovarian function can be established in hypothalamic amenorrhea by chronic intermittent administration of LH-RH. They also suggest that in the human female hypothalamic LH-RH function may be only permissive in that the cyclicity of endocrine events during the menstrual cycle is regulated on pituitary and ovarian levels. Hyperproactinemic amenorrhea appears to be associated with insufficient endogenous LH-RH secretion which can be substituted by exogenous chronic intermittent administration of LH-RH. Elevated prolactin levels per se do not interfere with the pituitary positive feedback mechanisms nor with the gonadotropin action on the ovarian level.

[Light and electronmicroscopic examinations on granulosa and theca of preovulatory and freshly ruptured follicles of human ovaries (author's transl)]

In a first paper, the structural and functional relationship of granulosa and theca of follicles during early development stages was reported. On the special question of whether and from which moment these two tissue formations are involved in the steroidbiosynthesis, our electronmicroscopic examinations have given a further insight to this. Neither the granulosa nor the theca folliculi of primordial, primary and secondary follicles show definite morphologic submicroscopic criteria of the steriodbiosynthesis. In the resting tertiary follicle, the electronmicroscopy defines the theca cells as steroidbiosynthetic active cells, whereas the granulosa cells of this stages of follicle demonstrate the morphologic characteristics of protein-synthetic active cells. Our, under physiological conditions, systematically conducted light and electronmicroscopic studies of preovulatory and freshly ruptured follicles showed remarkable structural changes in the granulosa, as well as in the theca folliculi. For the follicle granulosa cells of the preovulatory follicle, the studies could demonstrate a structural transformation process of proteinsynthetic active to steroidbiosynthetic active cells. This transformation process can be seen in the nucleus. Especially recognizable is the continuous change from rough to smooth endoplasmatic reticulum in the cytoplasm of most of the follicle granulosa cells, which apart from that, often displayed whorle-like formations. Furthermore, we noticed striking changes of the paraplasmatic structures, especially of the fat, present in various stages in the cytoplasm of the follicle granulosa cells. We also noticed large mitochondria, which showed a lot of vesicular cristae. Numerous existing Golgi-fields contained many little homogenous fat-like droplets, which were surrounded by a thin osmiophilic membrane. This recognizable transformation process of the proteinsynthetic active granulosa cells to the steroid cells is quite completed in freshly ruptured follicles, according to our examinations. Although the theca cells have already been defined submicroscopically in the resting tertiary follicle as steroidbiosynthetic active cells, we see in this cellgroup in the preovulatory, as well as in the freshly ruptured follicle a remarkable conspicuous size-increase of the mitochondria. Apart from that, there are wide areas which are solely occupied by smooth endoplasmatic reticulum, whereas other structures, for example fat, are scarely seen. As our examinations have shown, there is a close relationship between the transformation process in the granulosa and the theca of preovulatory follicles and the theca of preovulatory follicles that, the increasing concentration of progesteron in serum, which begins prior to the ovulation can be regarded as a product of the follicle granulosa cells being transformed to steroid cells.

[Histochemical and histological investigations on the human fallopian tube under different hormonal influences. I. Demonstration of ATPase with special reference to reactive ciliated cells (author's transl)]

The localization of the Mg++-activated adenosine triphosphatase (ATPase) in the human Fallopian tube has been studied by means of histochemical methods. The samples were obtained from 18 women in the age from 23--62 years. Some of them were treated by various steroid hormones. Endosalpinx ciliary ATPase-activity represents dynein and is therefore an indicator of ciliary motility. Estrogens and gestagens have a different influence on the ATPase-activity. All cilia of one ciliated cell react in the same manner and may be regarded as a reaction unit. The relation of negative to positive ciliary borders differs characteristically in the tubal isthmus, ampulls and infundibulum and coincides with commonly known phenomena of egg transport through the oviduct. Postovulatory, reaction units increase in ampulla and infundibulum compared with the proliferative phase. The oviducts of postmenopausal women possess but a scanty outfit of reaction units. Short-time treatment with estrogen in the early secretory phase results in a great number of reaction units in all tubal segments; a similar treatment in the proliferative phase diminishes the reaction units in the ampulla. Midcycle progesterone treatment activates the ciliary ATPase in the isthmus. Low doses of lynestrenol (minipill) in the proliferative phase leads to a decrease of reaction units in all tubal segments; the pattern of ciliary reaction under low doses of lynestrenol at the time of ovulation coincides with that of the proliferative phase. Treatment with a contraceptive steroid (0,05 mg ethinylestradiol and 0,25 d-norgestrel) causes a considerable activation of the ciliary ATPase in all portions of the oviduct.

Experimental studies on the positive feedback effect of progesterone, 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone on the pituitary release of LH and FSH in the human female. The estrogen priming of the progesterone feedback on pituitary gonadotropins in the eugonadal woman

Administration of progesterone eugonadal women during the midfollicular phase of the menstrual cycle failed to induce a positive feedback effect on the serum concentrations of LH and FSH. The levels of estradiol in serum decreased following the injection of progesterone without a parallel change in LH and FSH concentrations indicating a direct ovarian effect of the exogenous progesterone. In the late follicular phase of the cycle, when preovulatory levels of estradiol were present in serum, or under a ethinyl estradiol treatment progesterone was able to induce an LH discharge indicating the requirement of an estradiol priming of the positive feedback of progesterone in eugonadal women. In order to establish the time required for a sufficient estrogen priming with preovulatory levels of estradiol in serum 3 mg of estradiol-benzoate were administered i.m. 1, 12 and 24 h prior to the administration of 30 mg of microcristalline progesterone in the midfollicular phase of the menstrual cycle, when progesterone alone did not cause an LH surge. Only when estradiol-benzoate was injected 24 h prior to the progesterone administration an LH surge reproducible in time course and magnitude occurred. Administration of estradiol-benzoate alone under these conditions did not cause an LH surge within the elapse of time after the injection when the progesterone induced LH surge occurred. Thus, these experiments demonstrate that a defined estrogen priming is required for the positive feedback effect of progesterone on the gonadotropin release in eugonadal women. Furthermore, progesterone levels in serum of about only 1--2 ng/ml were required for the induction of an LH surge indicating that under physiological conditions progesterone may have an supplementory effect on the primarily estradiol induced LH midcycle peak. 17-hydroxyprogesterone administered during the mid follicular phase of the menstrual cycle and under pretreatment with ethinyl estradiol failed to induce a positive feedback effect on the serum concentrations of LH and FSH, indicating that this steroid does not play a regulatory role on the midcycle LH release in women. 20alpha-dihydroprogesterone administered under the same experimental conditions as 17-hydroxyprogesterone seems to be able to induce an LH surge in serum provided there is an adequate estrogen priming.