138 research outputs found
Interference with follicle stimulating hormone regulation of human ovarian function
This review summarizes observations on the background and potential
clinical significance of interference with follicle stimulating hormone
(FSH) regulation of human ovarian function. This interference may occur at
the level of the pituitary by the secretion of FSH isoforms with reduced
or absent bioactivity. In addition, interference with FSH may occur in the
circulation, or within the ovarian follicular compartment. Although the
full range of its significance remains to be elucidated, there are
distinct indications that these mechanisms may be involved in normal
ovarian physiology, as well as in abnormal response of the ovary to
stimulation by endogenous FSH or by exogenously-administered gonadotrophin
preparations. Moreover, recent advances in the determination of the
structure-function relationship of FSH and FSH-receptor interaction, in
combination with new developments in recombinant DNA technology, will
allow the production of modified FSH- or FSH receptor-like molecules with
altered bioactivity. The availability of FSH agonists and antagonists in
the near future should provide a challenge for clinicians to improve
treatment outcome and to find new indications for the use of these
compounds
Is there a future for ovulation induction in the current era of assisted reproduction?
The clinical use of medical induction of ovulation in normogonadotrophic
anovulatory women (WHO II), including polycystic ovary syndrome, is
increasingly questioned. However, we believe that this treatment modality
still represents a highly effective means of fertility treatment in women
with low pregnancy chances without intervention. A conventional treatment
algorithm involving clomiphene citrate (CC) followed by FSH induction of
ovulation may result in a 71% cumulative singleton live birth rate. In
attempts to improve treatment outcome further and reduce complication
rates, new compounds such as insulin-sensitizing agents or aromatase
inhibitors are currently used increasingly. Approaches such as patient
selection for different treatment modalities on the basis of initial
screening characteristics and alternative protocols for FSH ovulation
induction may also be proposed to render treatment algorithms more patient
tailored and therefore improve overall outcomes. More research is needed
in this area, rather than referring these patients to assisted
reproduction prematurely. This may lead to a more individually tailored
approach for ovulation induction in a given patient, resulting in a
further improvement of the balance between chances for success versus
complications
Zorg rondom de voortplanting: luxe geneeskunde?
Rede uitgesproken bij de aanvaarding van het ambt van bijzonder hoogleraar in de gynaecologische endocrinologie aan de Erasmus Universiteit Rotterdam op donderdag 29 januari 199
Urinary follicle-stimulating hormone for normogonadotropic clomiphene-resistant anovulatory infertility: prospective, randomized comparison between low dose step-up and step-down dose regimens
A low dose step-up and step-down regimen for induction of ovulation using
urinary FSH was compared in a prospective randomized fashion in 37
normogonadotropic clomiphene-resistant oligo- or amenorrheic infertile
women. The objectives was to assess potential differences in duration of
treatment, ovarian stimulation (serum FSH levels), and response [serum
estradiol (E2) levels and number and size of follicles]. Monitoring (blood
sampling and transvaginal sonography) took place on the day of initiation
of treatment, the first day of ovarian response as assessed by ultrasound
(i.e. the first day a follicle > or = 10 mm could be recognized), the day
of hCG administration to induce ovulation, and 3 days thereafter. The
median duration of treatment in the low dose step-up group was 18 (range,
7-41) days compared to 9 (range, 4-16) days in the step-down group (P =
0.003), and the total numbers of ampules administered were 20 (range,
7-69) and 14 (range, 7-33), respectively (P = NS). Serum FSH levels from
the first day of sonographic ovarian response until the administration of
hCG were constant (median increase, 2%/day) in patients receiving the low
dose step-up protocol, but showed a decrease (median, 5%/day) in step-down
cycles (P < 0.001). Monofollicular growth, defined as not more than one
follicle 16 mm or larger on the day of hCG administration, was observed in
56% of low dose step-up and 88% of step-down cycles (P = 0.04). The
percentage of patients with normal range periovulatory E2 serum levels
(500-1500 pmol/L) was 33% in the low dose step-up group vs. 71% in the
step-down group (P = 0.03). We conclude that a step-down protocol for
gonadotropin induction of ovulation exhibits a more physiological, late
follicular phase FSH serum profile than a low dose step-up protocol. This
results in a shorter duration of treatment, a greater number of
monofollicular cycles, and more cycles with periovulatory E2 levels within
the normal range in the step-down protocol
The follicle-stimulating hormone (FSH) threshold/window concept examined by different interventions with exogenous FSH during the follicular phase of the normal menstrual cycle: duration, rather than magnitude, of FSH increase affects follicle development
According to the threshold concept, FSH concentrations need to surpass a
distinct level to stimulate ovarian follicle growth. The window concept
stresses the significance of a limited duration of elevated FSH levels
above the threshold for single dominant follicle selection. The aim of
this study was to investigate effects on follicle growth of increased FSH
levels, differing in duration and magnitude of elevation, durin
Management of infertility in a patient presenting with ovarian dysfunction and McCune-Albright syndrome
Persistent autonomous ovarian dysfunction in McCune-Albright syndrome
(MAS) patients is associated with the development of multiple dominant
follicles, premature luteinization, cyst formation, and anovulatory
infertility. Due to the mosaic distribution of the mutation, ovaries may
be unequally affected. In the current patient, the least affected ovary
became quiescent upon GnRH agonist-induced gonadotropin suppression.
Normoovulatory cycles were restored after subsequent removal of the
affected right ovary, and a pregnancy was established within 3 months. A
healthy unaffected girl was born at term after an uneventful pregnancy.
The placental tissue was normal, and the mutation was not detected in the
placenta, umbilical cord structures, or umbilical cord blood. GnRH analog
administration may help to identify those MAS patients who might benefit
from unilateral ovariectomy. Because a healthy baby was born, evidence is
provided suggesting that MAS is not passed on to the children from the
parents
Low levels of follicle-stimulating hormone receptor-activation inhibitors in serum and follicular fluid from normal controls and anovulatory patients with or without polycystic ovary syndrome
In patients with normogonadotropic anovulation, either with or without
polycystic ovary syndrome (PCOS), factors interfering with FSH action may
be involved in arrested follicle development. The aim of this study is to
assess whether factors inhibiting FSH receptor activation are elevated in
serum or follicular fluid from anovulatory patients, as compared with
regularly cycling women. For this purpose, a Chinese hamster ovary cell
line, stably transfected with the human FSH receptor, has been applied.
FSH-stimulated cAMP secretion in culture medium was measured in the
presence of serum or follicular fluid. Chinese hamster ovary cells were
stimulated with a fixed concentration of FSH (3 or 6 mIU/mL) to mimic FSH
levels in serum or follicular fluid. Samples were added in concentrations
ranging from 3-90% vol/vol to approach protein concentrations occurring in
serum or follicular fluid. In the presence of 10% vol/vol serum from
regularly cycling women (n = 8), FSH-stimulated cAMP production was
inhibited to 42 +/- 2% (mean +/- SEM of 2 experiments, each performed in
duplicate) of cAMP production in the absence of serum, whereas a similar
cAMP level (up to 38 +/- 4% of the serum-free level) was observed at
higher concentrations of serum (30-90% vol/vol). The inhibition of
FSH-stimulated cAMP production in the presence of serum samples from
normogonadotropic anovulatory patients, without (n = 13) or with (n = 16)
PCOS, was similar to controls. Follicular fluid samples (n = 57) obtained
during the follicular phase in 25 regularly cycling women and follicular
fluid samples (n = 25) from 5 PCOS patients were tested in a slightly
modified assay system. In the presence of 10 or 30% (vol/vol) follicular
fluid, FSH-stimulated cAMP levels were decreased to 68 +/- 2% and 55 +/-
2% (mean +/- SEM of a single experiment in triplicate) of the cAMP levels
in the absence of follicular fluid, respectively. There was no correlation
between the degree of cAMP inhibition and follicle size, steroid content
(androstenedione or estradiol concentrations), or menstrual cycle phase.
Furthermore, no differences in inhibition were found, comparing PCOS
follicles with size- and steroid content-matched follicles obtained during
the normal follicular phase. It is concluded that inhibition of FSH
receptor activation by proteins present in serum or follicular fluid is
constant (60 and 40%, respectively) and independent from the developmental
stage of the follicle, either during the normal follicular phase or in
patients with normogonadotropic anovulation. Inhibition of FSH recepto
Child development and quality of parenting in lesbian families: no psychosocial indications for a-priori withholding of infertility treatment. A systematic review
Among fertility centres, much discussion focuses on whether to withhold
infertility treatment from special patient groups (lesbians, prospective
single parent(s), prospective parent(s) of relatively advanced age, or
with severe diseases) because it is assumed that this is in the best
interest of the child. The present study aimed to establish whether there
is any empirical evidence for this assumption. A literature search was
made in PubMed/Medline and PsycINFO to identify studies that had assessed
psychological outcomes of children and quality of parenting after
infertility treatment. Eight studies met the following inclusion criteria:
published in an English-language peer-reviewed journal between 1978 and
2002, and focused on psychosocial child development and quality of
parenting after infer
- …