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Query: UMLS:C0003128 (anovulation)
 1,718 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The emphasis of this review is placed on the treatment of clomiphene-resistant women with polycystic ovary syndrome (PCOS) or with hypogonadotropic hypogonadism. There has been an increasing awareness of the need to avoid the consequences of multiple folliculogenesis, and this is reflected in the more widespread use of low-dose regimens for induction of ovulation, particularly in PCOS. The past 12 months have seen the first reports of the clinical applications of recombinant human follicle-stimulating hormone (FSH), and there is an intriguing suggestion that long-acting opiate agonists may have a part to play in the management of anovulation of hypothalamic origin.
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PMID:Advances in induction of ovulation. 819 52

This case report describes the first established pregnancy and birth after induction of ovulation with recombinant human follicle-stimulating hormone (FSH) in a woman suffering from chronic clomiphene-resistant anovulation due to polycystic ovary syndrome (elevated serum luteinizing hormone and testosterone concentrations together with polycystic ovaries). Starting on day 3 of a progestagen withdrawal bleeding, 75 IU of rFSH was administered i.m. daily until a single preovulatory follicle was seen upon transvaginal ultrasound examination at day 13. Ovulation was induced by a single i.m. administration of 10,000 IU of human chorionic gonadotrophin, after which a viable singleton pregnancy was revealed at a gestational age of 6 weeks. The course of pregnancy and labour was uneventful and no abnormalities were found upon a paediatric examination.
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PMID:First established pregnancy and birth after induction of ovulation with recombinant human follicle-stimulating hormone in polycystic ovary syndrome. 819 51

The following experiments were performed: (i) concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin in plasma were measured at 2, 5, 8, 10 and 15 days in female Wistar rats treated on the first day of life with 100 micrograms oestradiol benzoate or vehicle; (ii) females injected on day 1 with 100 micrograms of oestradiol benzoate or 1 mg of testosterone propionate and from day 1 to day 10 or 15 with FSH and LH were killed on day 90; (iii) females injected from day 1 to day 10 or 15 with prolactin or vehicle were killed on day 90; (iv) females injected on day 1 with oestradiol benzoate and from day 1 to day 15 with a luteinizing-hormone-releasing hormone (LHRH) agonist were killed on day 90; (v) groups of females injected on days 1, 4, 7, 10, 13 and 16 with an LHRH antagonist were killed on day 90. Onset of puberty, vaginal cycles, organ weights and hormonal plasma concentrations were measured. Females treated on the first day of life with 100 micrograms oestradiol showed inhibition of gonadotrophin secretion and stimulation of prolactin secretion during the neonatal period. Females injected on the first day of life with oestradiol benzoate or testosterone propionate showed, in adulthood, anovulation, ovarian atrophy, reduced FSH plasma concentrations, increased prolactin plasma concentrations and reduced pituitary prolactin content.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changes in pituitary secretion during the early postnatal period and anovulatory syndrome induced by neonatal oestrogen or androgen in rats. 846 3

Lactational anovulation is an important factor in determining birth spacing in women living in developing countries. Therefore, a more comprehensive understanding of the mechanisms involved in the relationships among lactation, nutrition and ovulation is important. This study was designed using the food-restricted, lactating rat to examine whether endogenous opioids might be involved in depressing gonadotropin release. Females were mated after 65 d of age and, beginning on d 42 of life, offered food in unrestricted amounts (control) or were food restricted to 50% of what the controls consumed. On d 15 of lactation, dams were injected with either naloxone hydrochloride (3 mg/kg body weight) or saline and killed 0, 15, 30 or 60 min later. Plasma was analyzed for luteinizing hormone, follicle-stimulating hormone and prolactin. Food restriction decreased plasma concentrations of luteinizing hormone and follicle-stimulating hormone (P < 0.005). Naloxone administration marginally influenced follicle stimulating hormone (P < 0.1), but not luteinizing hormone concentration regardless of diet group. The interaction among diet group, drug group and time of killing was significant for plasma prolactin concentration (P < 0.05). Food restriction lowered prolactin concentrations, but this effect was diminished with increasing time after injection of naloxone. Furthermore, the magnitude of the effect of food restriction was lessened and even reversed with treatment of naloxone. These results indicate that endogenous opioids are not the primary mechanism suppressing luteinizing hormone release in food-restricted lactating rats.
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PMID:Naloxone administration does not relieve the inhibition of gonadotropin release in food-restricted, lactating rats. 881 99

An accurate, efficient diagnosis of disorders responsible for abnormal uterine bleeding depends on a systematic consideration of all the possible causes. Careful history and physical and pelvic examinations provide the framework for evaluation. Many adjunctive diagnostic aids can be used to evaluate women with abnormal uterine bleeding. These tests include complete blood cell count, pregnancy test, hormone levels (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, dehydroepiandrosterone sulfate), thyroid function tests, liver function tests, and coagulation profile. The need for these tests are individualized and based primarily on the patient's presentation. In women of reproductive age a complication of pregnancy should always be ruled out. Ectopic pregnancies can be life threatening. The prognosis in women with trophoblastic disease can be altered by a delay in establishing the correct diagnosis. Ultrasonographic studies, particularly transvaginal ultrasonography and hysteroscopy, have played an increasing role in the evaluation of patients with abnormal uterine bleeding over the past decade, especially for cases of intrauterine space-occupying lesions, including endometrial polyps, submucosal myomas, and retained placental fragments. Suspicion of reproductive tract malignancies is heightened in patients > 35 years old, those with a history of oligoovulation or anovulation suggestive of long-term unopposed estrogen exposure, those who are obese, and those who do not respond to first-line medical management. Diagnostic techniques available for the evaluation of these cases include endometrial biopsy, dilatation and curettage, transvaginal ultrasonography, and hysteroscopy. These procedures not only allow accurate diagnosis but may permit immediate therapeutic measures to be taken when organic causes are discovered. In summary, the key to the evaluation of abnormal uterine bleeding is a through history and physical and pelvic examinations governed by the differential diagnosis of excessive uterine bleeding and the selected use of adjunctive diagnostic tests and procedures only when absolutely necessary.
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PMID:Evaluation of patients with abnormal uterine bleeding. 882 62

A randomised clinical trial was performed to evaluate the effect of a 3-month gonadotrophin-releasing-hormone analogue (GnRH-a) in one cycle of ovulation induction with low-dose pure follicle-stimulating hormone (pFSH) in patients with polycystic ovarian syndrome (PCOS) anovulation. Twenty patients with chronic anovulation due to PCOS were randomised to ovulation induction with pFSH administered in a low-dose schedule with (10 patients) and without (10 patients) a 3-month pretreatment with GnRH-a. Ultrasound scan only monitoring of follicular growth, evaluation of plasmatic oestradiol at the day of triggering of ovulation with human chorionic gonadotrophin 5,000 IU and evaluation of plasmatic progesterone 8 days after were the main outcome measures. Ovulation occurred in 9 patients treated with pFSH and in 2 patients treated with GnRH-a plus pFSH. Five pregnancies in the pFSH group and no pregnancy in the GnRH-a group were obtained. Five cycles were stopped due to multifollicular growth in the GnRH-a group and 1 in the pFSH group. Pretreatment with a 3-month administration of a GnRH-a did not improve the ovulation rate and pregnancy rate in PCOS patient ovulation induction with low-dose pFSH.
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PMID:Ovarian stimulation with low-dose pure follicle-stimulating hormone in polycystic ovarian syndrome anovulatory patients: effect of long-term pretreatment with gonadotrophin-releasing hormone analogue. 956 44

The insulin-like growth factor binding proteins are single chain polypeptides, that can bind insulin-like growth factors, but not insulin. They can serve as autocrine or paracrine regulators of the actions of insulin-like growth factor. The human granulosa cells produce insulin-like growth factor-II but not insulin-like growth factor-I, while the human theca cells produce insulin-like growth factor-I and II. Polycystic ovarian syndrome is a disorder which is characterised by hyperandrogenism and anovulation. In polycystic ovarian syndrome there is a disorder of follicular development, with the accumulation of antral follicles within the ovary which fail to respond appropriately to endogenous follicle-stimulating hormone. Significance is given to insulin-like growth factor binding proteins, which have an inhibitory action on follicle-stimulating hormone. No differences were found in the total level of insulin-like growth factor binding proteins follicular profiles between women with polycystic ovarian syndrome and without it. Serum insulin-like growth factor binding protein-I levels are lower in polycystic ovarian syndrome with hyperinsulinaemia, probably as a consequence of insulin-mediated suppression of insulin-like growth factor binding protein-I. Consequently, serum free insulin-like growth factor-I levels are higher. This alteration may cause an excessive thecal androgen production. The alterations in the insulin-like growth factor-insulin-like growth factor binding proteins axis may be one of several mechanisms that help to sustain the steady state of anovulation and follicular dysmaturation that are characteristic of this syndrome.
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PMID:[The role of insulin-like growth-factor binding proteins in normal and polycystic ovaries]. 992 Oct 24

Literature data have demonstrated that the chronic use of metoclopramide (MCP), a dopamine antagonist, causes increased gonadotropin secretion in patients with hypothalamic amenorrhea but without triggering ovulation. It has also been observed that women with hypothalamic amenorrhea respond poorly to ovulation induction with clomiphene citrate (CC). On this basis, the objective of the present study was to determine the effect of MCP on the response to CC in patients with hypothalamic amenorrhea in order to evaluate the validity of the simultaneous use of these drugs as ovulation inducers in this type of chronic anovulation. Twenty-two patients with amenorrhea of hypothalamic origin were submitted to a randomized double blind study in which one tablet of 5 mg MCP or placebo was administered every 8 hours for 2 months. After the 30th day of medication (MCP or placebo), CC, 100 mg orally, was additionally administered to both groups for 5 days. Blood samples were collected on days 1, 15 and 30 during the first month of the study and on days 7, 14 and 21 after the last CC tablet during the second month, for later measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol and progesterone by radioimmunoassay. The group that received MCP showed a significant increase in LH and FSH during the first month of the study, as well as a slighter increase in estradiol. Prolactin increased only during the second stage of treatment. No significant increases in gonadotropins, prolactin or estradiol occurred in the placebo group. In the group treated with MCP, 40% of the patients ovulated after CC, with menstruation occurring in 60% of them. In the placebo group, 33.3% of the women ovulated after CC and 44.4% menstruated at the end of the study. We conclude that MCP increases the circulating levels of LH, FSH, estradiol and prolactin in patients with hypothalamic amenorrhea and low estrogen levels, supporting the hypothesis that an increase in hypothalamic dopaminergic tonus occurs in these patients. On the other hand, the combination of MCP and CC does not improve the rate of ovulation compared to placebo.
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PMID:Induction of ovulation with clomiphene citrate in combination with metoclopramide in patients with amenorrhea of hypothalamic origin. 1045 5

Polycystic ovarian disease (PCOD) is characterized by anovulation, eventually high luteinizing hormone (LH) levels, with increased LH pulse frequency, and hyperandrogenism. As the aetiology of the disease is still unknown, gonadotrophin-releasing hormone (GnRH) antagonists, competitive inhibitors of GnRH for its receptor, are interesting tools in order to study and treat the role of increased LH levels and pulse frequency in this disease. Their administration provokes a rapid decrease in bioactive and immunoactive LH followed by a slower decrease in follicle-stimulating hormone (FSH). In patients with PCOD, the suppression of gonadotrophin secretion eradicates the symptoms of the disease as long as the treatment lasts. Several authors have suggested that increased plasma LH levels have deleterious effects on the fertility of women with PCOD. Indeed, fewer spontaneous pregnancies with more miscarriages are observed when plasma LH levels are high. Assisted reproduction techniques such as in vitro fertilization (IVF) have provided other clues to the role of the LH secretory pattern in women with PCOD. The number of oocytes retrieved, the fertilization rate and the cleavage rate are lower in PCOD patients undergoing IVF and this is inversely correlated with FSH:LH ratio. These abnormalities are corrected when endogenous secretion of LH is suppressed. On the other hand, implantation and pregnancy rates after IVF are similar to those observed in control women. New GnRH antagonists are devoid of side effects and suppress LH secretion within a few hours without a flare-up effect. This action lasts for 10-100 hours. When GnRH antagonists are associated with i.v. pulsatile GnRH, this combination both suppresses the effect of endogenous GnRH and because of the competition for GnRH receptors restores a normal frequency of LH secretion. We have studied two women with PCOD, administering first 10 mg s.c. every 72 hours for 7 days of the GnRH antagonist Nal-Glu, then adding on top i.v. pulsatile GnRH: 10 micrograms/pulse every 90 minutes for 15 days. We thus succeeded in normalizing LH secretion pattern and observed a significant decline in testosterone levels. We failed to induce appropriate ovarian response and ovulation. In conclusion, the combination of GnRH antagonist and GnRH pulsatile treatment can re-establish normal LH secretory pattern in patients with PCOD. The failure to induce ovulation with this regimen suggests the existence of an inherent ovarian defect in women with PCOD.
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PMID:The use of gonadotrophin-releasing hormone antagonists in polycystic ovarian disease. 1062 71

It has been known for many years that administration of androgens or estrogens at critical periods of development in mammals causes severe long-term effects on the endocrine/genital systems. The environmental pollutant p-tert-octylphenol (OP) possesses a weak but clear estrogen agonist activity in in vitro and in vivo studies. In the present study, effects of neonatal exposure to OP on the reproductive tract of female rats were investigated. Newborn female pups were injected with 100 mg/kg OP subcutaneously within 24 h after birth. Administration was repeated every other day until postnatal day 15 (total of eight doses). Before weaning, serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) remained at low levels during OP exposure, although the serum FSH peak and the high LH level were obvious in the controls. Histologically, inhibition of uterine gland genesis was apparent. The day of vaginal opening was about 4 days earlier in OP-treated animals than in controls. Persistent estrus was consistently observed in OP-treated animals. Atrophic and polycystic ovaries without corpora lutea showed anovulation. In the endometrium, cell-proliferative activity and cell-death were increased and decreased, respectively, and expression of estrogen receptor alpha mRNA was apparent by in situ hybridization. Unexpectedly, endometrial hyperplasias appeared at 8 weeks of age. After ovariectomy, vaginal smears immediately became of castration type and the uterus was atrophied. These results suggested that neonatal exposure to a high dose of OP alters developmental hormonal secretion presumably due to a hypothalamo-pituitary-ovarian disorder, with accelerated vaginal opening, subsequent persistent estrus, and uterine endometrial hyperplasia. The changes in the uterus and vagina are ovary-dependent.
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PMID:Irreversible effects of neonatal exposure to p-tert-octylphenol on the reproductive tract in female rats. 1086 Aug 70


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