Outcome from consecutive ICSI cycles in patients treated with recombinant human LH and those supplemented with urinary hCG-based LH activity during controlled ovarian stimulation in the long GnRH-agonist protocol

Clinical results were compared in a well-established, assisted reproduction program during the cross-over from highly purified (HP)-human menopausal gonadotropin (hMG) to rhFSH/rhLH. We included the last 33 patients treated with HP-hMG and the first 33 patients receiving rhFSH/rhLH for ovarian stimulation in their first intracytoplasmic sperm injection cycle. Patient baseline characteristics were almost identical in the two groups. Ovarian stimulation characteristics (days of stimulation, total amount of FSH administered using a modest initial loading dose of 150 IU/d, patients with oocyte retrieval) were similar for the two groups. However, the number of total and leading follicles and E2 serum levels on the human chorionic gonadotropin injection day were significantly higher in the rhFSH/rhLH group. The oocyte yield was significantly higher in the rhFSH/rhLH group as well as the number of metaphase II oocytes, difference almost reaching the statistical significance. The number of oocytes fertilized was also higher in patients receiving rhFSH/rhLH treatment. Implantation and clinical pregnancy rates were similar in both the study groups. It is concluded that in women undergoing controlled ovarian hyperstimulation under pituitary suppression for ART, the recombinant combined product containing FSH and LH in a fixed 2:1 ratio is more effective than HP-hMG in terms of follicle development, oocyte yield and quality, and fertilization rates.

Urinary hormone levels during the natural menstrual cycle: the effect of age

A number of studies have identified hormonal changes in women during their reproductive lifespan, many focusing upon changes in women over the age of 40 years. The present study has determined the effect of increasing age on hormone levels over three decades. Daily early morning urine samples were assayed for estrone-3-glucuronide (E3 G), pregnanediol-3-glucuronide (P3 G), testosterone-17-glucuronide (T17 G), FSH and LH. An examination of the validity of using creatinine as a volume adjuster in urine samples formed an integral part of the analysis. Volunteers were healthy women who had regular (25-35 days) cycles, were not taking oral contraceptives, hormone therapies or any other medication. Three age groups were compared: 20-29 years (n=13), 30-39 years (n=9) and 40-49 years (n=13). Statistical analyses were carried out using two-way ANOVA and post hoc t-tests. Creatinine excretion, despite revealing no cycle-related variation in any age group, showed a decline with increasing age. Creatinine output was significantly lower in the 40-49 years age group in all phases of the cycle than in the 20-29 and 30-39 groups (P<0.0001). Uncorrected levels of E3 G were significantly higher in the 30-39 years group when compared with the 40-49 age group (P<0.0001). Uncorrected P3 G output was significantly higher in women aged 20-29 years than in women aged 40-49 years (P<0.001) and levels of uncorrected T17 G were higher in the 20-29 year age group when compared with the 30-39 or 40-49 years age group (P<0.0001). The present study is consistent with previous reports that have revealed a decline in creatinine clearance with increasing age, and therefore casts into some doubt the validity of using creatinine clearance as a procedure to correct for volume fluctuations in differing age groups of women. The study also demonstrates unequivocally that age-related variations in hormone levels are not restricted to women over 40 years of age. The novel finding of highly significant differences in mean levels of T17 G between the age groups is of considerable interest. It is presently unclear whether this resulted from specifically increased ovarian and/or adrenal secretion. The possible impacts of changes in testosterone levels during the female reproductive lifespan merits further study.

Measuring endocrine profiles of women in field studies

Improved methods are needed to evaluate the effects of occupational and environmental hazards on the reproductive health of human female populations. This communication describes highly specific, sensitive, and reliable time-resolved fluorescence immunoassays for measuring luteinizing hormone (LH) and follicle-stimulating hormone (FSH), estrone 3-glucuronide (E13G), and pregnanediol 3-glucuronide (Pd3G) in urine, a fluid that is convenient and painless to collect serially from large populations. Furthermore, some of the technical issues relevant to the successful application of these measurements to field studies are discussed.

[Pubertal development after pediatric heart transplantation]

Twenty-one children and adolescents underwent orthotopic cardiac transplantation at the Hôpital Sainte-Justine between July 1984 and June 1993. Of those patients, 16 (4 girls and 12 boys) who survived more than one year after the procedure were followed prospectively for documentation of onset and progression of puberty. The immunosuppressive therapy included cyclosporine, azathioprine and prednisone. Subjects were evaluated at 6 month intervals for the study of: pubertal development according to staging by the method of Marshall and Tanner and hormonal profile (FSH, LH, testosterone, DHEAS). Despite a stagnation of pubertal signs before surgery, puberty carried on and progressed normally postoperatively. The urinary levels of gonadotropins rose to adequate levels for age. Testosterone levels in boys were related to the progression of secondary sexual characteristics. Levels of DHEAS were drastically reduced, most likely because of the supraphysiological doses of oral glucocorticoids. Our results indicate that after pediatric heart transplantation, puberty progresses normally at adolescence.

Serum and urinary levels of pituitary--gonadal hormones in insulin-dependent and non-insulin-dependent diabetic males with and without neuropathy

Diabetic neuropathies were studied in 100 insulin-dependent diabetes mellitus patients, 314 non-insulin-dependent diabetes mellitus patients with and without an objective evidence of neuropathy (age span, 15-80 years; duration of diabetes distributed over 1-33 years), and their age-matched nondiabetic controls. Serum and urinary levels of pituitary-gonadal hormones were evaluated in the diabetic subjects. There were striking results, i.e., a significantly low serum total and serum free (urinary) testosterone level (p < .0005) and a significantly high serum and urinary FSH and LH and serum prolactin level (p < .0005), specifically in the neuropathic diabetic patients, suggesting a series of pathological reactions in the smooth musculature of genital organs characterized by an increase in the interstitial thickness of seminiferous tubules, peritubular and intertubular fibrosis, and tubular sclerosis. Testicular necrosis, probably due to neuropathy, provided an additional aid to confirm these findings. A decrease in semen volume and sperm motility in the diabetic neuropathic patients further suggested the involvement of the entire smooth musculature of the reproductive tract, leading to atonia of the bladder and urethra. Such complications are purely neurogenic. The low serum and urinary testosterone levels and increased serum and urinary FSH and LH and serum prolactin levels in the diabetic men with neuropathy suggest gonadal disorder (hypogonadotropic hypogonadism), which may be due to testicular necrosis and thickening of seminiferous tubules, causing autonomic lesion.

Ovarian-pituitary hormone interactions during the perimenopause

To describe the hormone changes that occur at the onset of the perimenopause, daily urine and random blood samples were collected from 5 peri-menopausal women for 3 or 4 consecutive cycles. Estrone conjugate and pregnanediol-3-glucoronide concentrations were determined for urine samples. Circulating luteinizing hormone, follicle stimulating hormone, progesterone, estradiol and estrone concentrations were determined in serum samples. Two of the 5 women experienced irregular menstrual intervals during the study period. One of these subjects experienced a prolonged intermenstrual interval. Three other women exhibited apparently regular ovulatory menstrual cycles. The prolonged intermenstrual interval of one women exhibiting irregular menstrual intervals was associated with low urinary estrogen levels in the early follicular phase of the affected cycle, followed by increased gonadotrophin levels and increased estrogen levels that rose to exceed normal cycle concentrations by 2- or 3-fold. Increased estrogen levels were followed by declining gonadotrophin levels, minimal progesterone production, and, ultimately, vaginal bleeding. These data suggest that there are some forms of menstrual variability at the time of the perimenopause associated with lowered early follicular phase estrogen levels. Reduced negative feedback and subsequently increased gonadotrophin levels may have stimulated estrogen production which may have suppressed gonadotrophin secretion and lowered estrogen excretion, resulting in the observed oscillations between episodes of hypo- and hyperestrogenism.

Long-term treatment of central precocious puberty with an intranasal LHRH analogue: control of pituitary function by urinary gonadotropins

Daily subcutaneous doses of luteinizing hormone-releasing hormone (LHRH) analogues are a well-established therapy for gonadotropin-dependent precocious puberty. Reports on intranasally administered analogues, however, are controversial. We studied the effect of intranasal D-Ser(TBU)6-LHRH(BUS) on growth rate, skeletal maturation, and urinary gonadotropins in five girls and one boy with central precocious puberty (CPP) who had been treated for 1.4-2.3 years (mean 1.9). Because of the potential antifertility effects of LHRH analogues, testicular histology was analysed in the boy. In the five children with accelerated growth, the bone age-related velocity of height gain decreased from 10.58 +/- 2.77 to 5.82 +/- 1.8 cm/year (means +/- SD, P less than 0.01), and the ratio of change in bone age to change in chronological age fell below 1. Basal luteinizing hormone (LH), and LHRH-stimulated LH and follicle stimulating-hormone, at pubertal levels before treatment, decreased significantly in all children, normalizing in four (P less than 0.04). During therapy, pituitary function was best controlled by urinary LH, which correlated with clinical data. After 13 months of therapy, testicular histology showed degenerated Sertoli cells, and absence of B- and Ap-spermatogonia and of primary spermatocytes in the boy. We conclude that: (1) Efficient long-term suppression of central precocious puberty--including accelerated growth and skeletal maturation--can be maintained by intranasal dosage of BUS. (2) Urinary LH reflects pituitary function and proves to be a reliable guide to adjustment of the LHRH-analogue dose regimen.(ABSTRACT TRUNCATED AT 250 WORDS)

Melatonin: data consistent with a role in controlling ovarian function

FSH and LH excretion were correlated with melatonin excretion in consecutive daily urines obtained from a normal adult female (27 days), a normal 11-year-old girl (28 days), and an 8-year-old girl with idiopathic sexual precocity (30 days). Additionally pregnanediol-3-glucuronide (PG) excretion was determined in the urines of the adult female. Gonadotropin and PG excretion patterns of the adult female were those associated with a normal menstrual cycle. Excretion of melatonin, mean +/- SD, (11.3 +/- 2.7 vs 4.7 +/- 1.4 ng/h, p less than 0.005) was greater and PG (38.3 +/- 81 vs 124.2 +/- 46.7 ug/h, p less than 0.005) was less during the first 13 days as compared to the subsequent 14 days. Gonadotropin and melatonin excretions correlated positively (first 13 days FSH, r = 0.828; rs = 0.815 and LH, r = 0.816; rs = 0.905, p less than 0.005 and subsequent 14 days FSH, r = 0.607; rs = 0.685, p less than 0.025 and LH, r = 0.490, p less than 0.05; rs = 0.638, p less than 0.025). Excretion of PG and melatonin did not correlate during the first 13 days. However, during the subsequent 14 days they correlated negatively (r = -0.679, p less than 0.005; rs = -0.620, p less than 0.025). During the 28-day period the gonadotropin and melatonin excretion patterns of the 11-year-old girl showed random fluctuations and correlated positively (FSH, r = 0.669; rs = 0.631 and LH, r = 0.690; rs = 0.695, p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Further evidence for insulin hypersecretion not as an initial event but as a consequence of body growth and maturation in juvenile-onset obesity

According to our previous study, hyperinsulinism develops not before 10 years of age despite the presence of obesity but during the maturation years of 10-20. We aimed here at examining the growth-related islet B-cell change together with pituitary activity in non-familial juvenile obesity. Measurement of 24 h urine hormones was shown to be useful for evaluation of the diurnal hormones in plasma. In 56 non-obese and obese juveniles, a significantly positive correlation was found between age (6-18 years) and 24 h urine insulin and c-peptide, thus indicating that the age-related absolute value of body weight significantly affects insulin and c-peptide excretions both in non-obese and obese subjects. Consequently, urinary insulin and c-peptide excretions per kg of body weight were highly similar between obese and non-obese juveniles. However, when the lower specific gravity of fat mass compared with lean body mass and the relative shortage of circulating plasma in fat tissues are taken into consideration, it is obvious that obesity by itself specifically augments this physiologic B-cell maturation between 10 and 20 years of age. The possible interactions of growth hormone and pituitary gonadotropin in hyperinsulinism are discussed.

[Value of the assay of urinary gonadotropins in pediatric endocrinology]

An assay for urinary gonadotropins (UG) performed after acetone extraction is presented. This dosage was performed either on a sample of the 24 assay urine, or on the fractionated 12 hr/12 hr urines (night/day) in normal children whose ages ranged from 2 to 20 years and in children presenting with various endocrine diseases (on about 2,000 urine samples). Normal values were established according to sex and stage of puberty. In boys, the lack of overlap between values of LH (UI/24 hr) observed in stage I (prepubescent, 9-13 yrs) and those observed in stage II represents an obvious biological marker of the onset of puberty. The night/day ratio of LH also increases close to puberty, reflecting the onset of the well-known night secretion of LH, at the time of the first stages of puberty. In girls, the preferential increase in FSH is the best criterion for the onset of puberty. In children with endocrine diseases, assay for UG/24 hr is a valuable parameter of the gonadotropic function allowing 1. to separate delayed puberty from hypogonadotropic hypogonadism; 2. to confirm a diagnosis of precocious puberty and 3. to control a treatment with LHRH analogous.

Gonadotropin excretion during puberty in malnourished children

p6nadotropins were measured by radioimmunoassay of urine samples from 285 privileged Nairobi adolescents and from 238 rural peripubertal Kenyan boys and girls who had had moderate malnutrition during childhood. Gonadotropins were reduced at all ages in the rural adolescents, but pubertal stage-matched comparisons showed no differences between children of the two study areas in middle or late phases of sexual maturity. These results document the pattern of gonadotropin changes in an environment of reduced caloric intake and confirm the presumed hypothalamic-pituitary origin of the delayed adolescence that occurs under such circumstances.

Reproductive capacity of rhesus monkeys following bilateral ovarian x-irradiation

The effect of ovarian X-irradiation of the rhesus monkey upon menstrual cycle length, duration of menstrual bleeding, excretion of gonadotrophin in the urine, concentration of gonadotrophin in the pituitary gland, ovarian histology, and breeding performance was investigated. Doses below 4000 R had no significant effect upon the above criteria. By contrast, doses of 4000 to 7000 R rapidly induced amenorrhoea in most animals, but unexpectedly these animals did not excrete greater than normal amounts of gonadotrophin. The pituitary content of gonadotrophin in cyclic and non-cyclic animals was not significantly different. Some births occurred in the animals which had been X-irradiated.

On the role of dopamine in the pathophysiology of anorexia nervosa

Based on a review of the pathophysiology of the major symptoms of anorexia nervosa, it was suggested that increased activity of dopamine at central dopamine receptors plays a role in the pathophysiology of this disorder. Although dopamine receptor site hypersensitivity, or synthesis, of a false transmitter could account for this, a defect in negative feedback control mechanisms is more consistent with the known characteristics of anorexia nervosa. The possible role of pure dopamine antagonists in symptomatic treatment and of dopamine agonists in reversing this disorder was discussed.

Neuroendocrine effects of haloperidol therapy in chronic schizophrenia

The neuroendocrine effects of haloperidol therapy have been examined in 62 male chronic schizophrenic patients, aged 16-62 years. The duration of the disease varied between 2 and 29 years. The patients were divided into 48 hebephrenics with onset of the disease at puberty, or immediately after puberty, and 14 paranoids with onset of the disease in adulthood. They received 6 mg i.m.p.d. of haloperidol, for 30 days, up to a total dose of 180 mg. The following hormonal variables were examined before therapy and at 10-20 and 30 days of treatment: total urinary gonadotropins, serum FSH and LH, GH response to insulin stimulation, ACTH reserve (Metyrapone test), total urinary 17-ketosteroids and 17-hydroxycorticoids before and after an ACTH stimulation test, serum testosterone, insulin response to glucose load, plasma thyroxine before and after a TSH stimulation test. The basic hormonal values revealed decreased secretion of total gonadotropins, FSH, LH, ACTH and testosterone, and increased insulin secretion. The haloperidol therapy seemed to stimulate the secretion of FSH, LH, total gonadotropins, ACTH and testosterone, up to normal or low-normal levels. No modifications were observed in the other hormonal variables. The significance of these results is discussed.

Monthly gonadotropin cycles in premenarcheal girls

Patterns of nocturnal excretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were investigated in 11 girls. Autoregressive digital filtering of low- and high-frequency variations was used to make patterns more apparent. Coincident FSH and LH surges, separated by an interval of 20 to 40 days, were seen in specimens from three of six postmenarcheal girls and three to five premenarcheal girls. This suggests that cyclic hypothalamic-pituitary-ovarian interactions occur before menarche.

[Hypophyseal gonadotropin secretion in sexual precocity with McCune-Albright's syndrome]

In three young girls with isosexual precocity and fibrous dysplasia of bones, plasma gonadotropins (LH and FSH) response to releasing hormone (LH-RH) has been much under the mean response in true female precocious puberty. These data and those previously reported in the literature suggest that MacCune-Albright's syndrome correlates to an hypothalamo-pituitary dysfunction rather than to a true prematurity.

Adrenal and ovarian vein androgen levels and laparoscopic findings in hirsute women

Hirsute women pose a diagnostic dilemma when urinary 17-ketosteroid and serum testosterone levels are normal. To locate the site of androgen excess in 19 hirsute women, blood samples were collested from the left ovarian and adrenal veins via a catheter insertedinto the right femoral vein. Laparoscopy and bilateral ovarian biopsies were also preformed in 18 of the 19 patients studied. Nine women had elevated 17ketosteroid (fivepatients) and/or antecubital serum testosterone (five patients) levels. Fourteen womanhad elevated testosterone concentrations distributed as follows: ovarian vein (six), adrenal vein (one), adrenal and ovarian veins (seven). Androstenedione was elevated in theovarian vein (seven) and both adrenal and ovarian veins (11) in 18 patients. Laparoscopic examinations revealed that less than 50 per cent of the enlarged ovaries could be detected by pelvic examination. Histologic studies suggested that these patients comprised two groups: a group (six patients) who appeared to ovulate and a group (12 patients) who lacked evidence of ovulation.

Sexual precocity associated with a hypothalamic tumour. Effects of sex hormone therapy

A case of sexual precocity of unusually early onset and associated with a hypothalamic tumour is described. The effects of ethinyl oestradiol and medroxyprogesterone acetate treatment have been monitored by plasma testosterone, FSH, and LH estimations. The results suggested a partial suppression of the tumour's influence, the mechanism of which is discussed.

Urinary gonadotrophins in the Sertoli-Cell-only syndrome

In order to study the hypophyseal-testicular axis in males with complete absence of germinal epithelium, the urinary total hypophyseal gonadotrophins (HG), urinary follicle stimulating hormone (FSH) and urinary luteinizing hormone (LH) were measured by specific bioassays in 12 males with classical Sertoli-cell-only syndrome and compared with HG, FSH, and LH in normal and castrated men. HG and FSH were significantly higher than HG and FSH in normal men (P smaller than 0.0025, P smaller than 0.0005, respectively), but significantly lower than in castrated men (P less than 0.001, P less than 0.01, respectively). LH was not different from LH of normal men, but significantly lower than in castrated men (P less than 0.0005). All patients had normal excretion of androgen metabolites (androsterone plus aetiocholanolone) but a dexamethasone suppression test, performed in 8 subjects, revealed that in 2 cases of testicular origin, the values were below the normal range. The excretion of oestrogens was within the normal range. The presented data support the concept that the germinal epithelium produces a substance capable of inhibiting FSH secretion from the hypophyses, the Sertoli cell itself, however, having a basal production of this inhibitor. The finding of low excretion of testicular androgen metabolites in some of the patients and normal urinary LH, indicates that disturbances in the LH-testosterone feedback mechanism in such patients may occur and that the previous concept of isolated defects of spermatogenesis in all such patients was erroneous.

Urinary gonadotrophins following castration of men

The excretion of total hypophyseal gonadotrophins (HG), follicle stimulating hormone (FSH) and luteinizing hormone (LH) was studied in 13 castrated men aged 23 to 56 years, mean 38.8 years. All the men were castrated for legal reasons. The time from castration to the investigation varied from 4 weeks to 24 years. Four of the subjects were studied from the time before surgery until 4 weeks after castration. The mean excretion of HG, FSH and LH was statistically significantly higher than that of normal men of the same age i. e. by 8, 9 and 3 times higher respectively. The FSH/LH ratio was in the mean 2.8. Following orchiectomy FSH rose more rapidly and to a higher level than LH. The maximal level of FSH was reached within 1–2 weeks after castration in contrast to LH which did not consistently reach the maximal level within 4 weeks. This difference in FSH and LH levels after castration supports the concept that FSH and LH are regulated independently in man.