Endocrine aspects of anovulation

Reproductive and endocrine function in patients with Hodgkin's disease: effects of oophoropexy and irradiation

Reproductive and endocrine function was investigated in 22 women with Hodgkin's disease who had bilateral mid-line oophoropexies performed at staging laparotomy. The operation was followed in 12 cases by "inverted Y" pelvic lymph node irradiation and in 4 cases by para-aortic lymph node irradiation. Pregnancies occurred after the operation in 4 of the 6 patients subsequently found not to require irradiation below the diaphragm. In the other 2 patients in this group the menstrual history was unaffected and normal gonadotrophin concentrations indicated intact ovarian function. In the group receiving para-aortic irradiation, in whom the ovarian irradiation dose was was small (about 150 rad to each ovary) menstrual function and gonadotrophin concentrations were normal at the time of review and one patient has subsequently become pregnant. In the group receiving inverted Y irradiation, in whom the ovaries were shielded from the radiation beam by a rectangular lead block, the ovarian dose was much higher (lowest dose 600 rad, highest dose 3500 rad). Nine of the 12 have persisting amenorrhoea with elevated levels of both gonadotrophins. One patient has since become pregnant and one patient has resumed menstrual cycles and has normal basal gonadotrophin concentrations. One patient who has resumed menstrual cycles has a monotrophic elevation of basal serum FSH concentrations. We conclude that bilateral mid-line oophoropexy does not impair ovarian function or gamete transport and should be performed at diagnositc laparotomy in women of child bearing age with Hodgkin's disease, even when it is uncertain whether pelvic node irradiation will be necessary. The results in the patients who received inverted Y irradiation indicate that the technique of pelvic shielding and ovarian transposition used were only partially successful in preserving fertility. Alternative techniques for preserving ovarian function are discussed.

Incidence and significance of hyperprolactinaemia in women with amenorrhea

Serum prolactin and gonadotrophin concentrations were measured by radioimmunoassay in 106 women with amenorrhoea. Prolactin was normal in those with weight related disorders, primary ovarian failure, those with a variety of systemic diseases and in those in whom amenorrhoea followed treatment with the oral contraceptive and in unexplained primary amenorrhoea. Gonadotrophin concentrations in the above patients were normal except in those with primary ovarian failure. Prolactin was elevated in eight of forty patients (20%) with functional secondary amenorrhoea and was greatly raised in all but one of the thirteen women in this series with pituitary tumours (five of whom were studied only after treatment). Only three patients in each of the last two groups had galactorrhoea. Gonadotrophin levels were normal or slightly raised in all of the hyperprolactinaemic patients apart from those studied after hypophysectomy. Four hyperprolactinaemic patients (three with pituitary tumours and one with functional amenorrhoea) who did not have galactorrhoea have been treated with bromocriptine. Prolactin secretion was reduced in all patients and, in the two with normal gonadotrophins, ovulatory menstruation was resumed. One became pregnant in the second ovulation cycle after starting treatment. We conclude that, despite the rarity of galactorrhoea, hyperprolactinaemia is common in patients with functional amenorrhoea and in those with pituitary tumours. Treatment with bromocriptine in patients with normal gonadotrophins restores ovulation when the infertility is due to prolactin excess.