Elevated Basal Follicle-stimulating Hormone Research Articles

Value of estrogen pretreatment in patients with diminished ovarian reserve and elevated FSH on a line antagonist regimen: a retrospective controlled study.

The key to enhancing the efficacy of antagonistic regimens in pregnancy is to better synchronize follicular growth during cycles of controlled ovarian stimulation (COS), especially in patients with diminished ovarian reserve (DOR). During in vitro fertilization-embryo transfer (IVF-ET) treatment, luteal phase estrogen pretreatment may enhance follicular development synchronization and yield of mature oocytes. However, the effect of estrogen pretreatment in DOR patients with elevated basal follicle-stimulating hormone (FSH) levels has not been well studied. We retrospectively analyzed the clinical data of patients with elevated basal FSH levels and DOR (401 cycles) who underwent IVF/intracytoplasmic monosperm injection (ICSI)-assisted conception. Both groups were treated with a flexible gonadotropin-releasing hormone (GnRH) antagonist regimen and were further divided into two groups according to whether they received luteal estrogen pretreatment. There were 79 patients in the estrogen pretreatment group and 322 patients in the control group. On the second day of the menstrual cycle, gonadotropin (Gn) stimulation of the ovaries was initiated. The general characteristics, clinical, biological parameters and outcomes of the two groups were compared. The basic profiles of the two groups were similar (P > 0.05). More patients in the pretreatment group showed FSH rebound after gonadotropin (Gn) initiation, resulting in a significantly higher number of Gn days and total Gn than those in the control group (P < 0.05). There was no statistically significant difference in the number of days of antagonist use, follicle output rate (FORT), number of metaphase II(MII)eggs obtained, number of Two pronuclei (2PN) fertilized, number of D3 quality embryos, blastocyst formation rate, fresh embryo clinical pregnancy rate, cumulative pregnancy rate, and non-transferable embryo rate between the two groups (P > 0.05). The use of luteal phase estrogen pretreatment in patients with elevated basal FSH combined with DOR resulted in high FSH levels after the release of negative feedback, which was detrimental to early follicular growth, did not increase the follicular output rate, may have increased the use and duration of controlled ovarian stimulation drugs, and did not increase the number of eggs gained or improve clinical outcomes.

The Effect of Elevated Basal Follicle Stimulating Hormone Levels on Assisted Reproductive Technology Cycle Outcomes

OBJECTIVE: Despite the availability of better biomarkers, basal day 3 follicle-stimulating hormone is widely available and often used as the first-line test in ovarian reserve evaluation. The aim of this study was to evaluate the outcomes of cycles with elevated (&gt;12 IU/mL) basal follicle-stimulating hormone values. STUDY DESIGN: Cycles with basal day 3 follicle-stimulating hormone values &gt;12 IU/mL were divided into four cohorts according to follicle-stimulating hormone levels: group I, follicle-stimulating hormone between 12-15 IU/m, group II between 15-20 IU/mL, group III between 20-25 IU/mL and group IV &gt;25 IU/mL. Both demographic characteristics and controlled ovarian stimulation parameters were retrospectively reviewed. RESULTS: Total antral follicle count was significantly higher in group I compared to the other three groups (p=0.001). Number of follicles ≥17 mm on human chorionic gonadotropin (hCG) day, number of retrieved oocytes, mature oocytes and fertilized oocytes were significantly higher in group I compared to the other groups (p=0.003, p=0.001, p=0.001, and p=0.001, respectively). No significant difference was found between groups regarding cancellation rates. The rate of embryo transfer per started cycle was significantly higher in group I compared to group III and group IV (p=0.001). Clinical pregnancy rates per embryo transfer were comparable among the groups.CONCLUSION: Despite the retrieval of lower quantities of oocytes, reasonable pregnancy rates could be achieved if embryo transfer was performed in cycles with follicle-stimulating hormone values over 12 IU/mL.

Basal follicle stimulating hormone (FSH) level as a predictor of fetal aneuploidy in patients undergoing in vitro fertilization (IVF)

Increasing maternal age promotes embryonic aneuploidy and subfecundity whereas elevated serum levels of FSH predict subfecundity, regardless of age. It is unclear, however, whether rising serum FSH levels also predict poor oocyte quality leading to embryonic aneuploidy. Therefore, the objective of this study was to determine if basal serum FSH levels predict the risk of embryonic aneuploidy in women undergoing IVF, independent of age. Historical cohort study. Seventy-six patients undergoing 97 IVF cycles of preimplantation genetic screening (PGS) with comparative genomic hybridization (CGH) were studied. Basal serum FSH levels on cycle day 3 were assessed before initiation of hormone therapy. GnRH agonist and antagonist were used in 74% and 26% of the IVF cycles, respectively. Embryonic aneuploidy was calculated as a ratio of number of aneuploid embryos per total embryos biopsied on day 3. The association between log serum FSH level and embryonic aneuploidy rate was assessed by multiple linear regression, adjusting for maternal age, total gonadotropins used and maximal serum estradiol (E2) level. Mean maternal age, log serum FSH and log maximal serum E2 were 39 ± 3.5 years, 0.8 ± 0.26 mIU/mL and 3.49 ± 0.23 pg/ml, respectively. 3348 ± 1629 IU of total gonadotropins were used. Embryonic aneuploidy increased at a rate of 0.12 per year with maternal age. There was no significant correlation between log serum FSH level and embryonic aneuploidy rate, controlling for all covariables. There was a significant positive correlation between the interactions of peak E2 levels and maternal age with aneuploidy, which was thought to be secondary to the effect of maternal age. Despite the positive correlation between embryonic aneuploidy rate and maternal age, no relationship was evident between elevated basal serum FSH levels and genetic quality of the embryo, as assessed with PGS with CGH.

Letters to the Editor

11 November 2009 Dear Editor, BENIGN OVARIAN TUMOUR PRESENTING AS HUGE ABDOMINAL MASS The annual incidence of ovarian neoplasms in the paediatric and adolescent population is estimated to be 2.6 cases per 100 000, with germ cell tumours being the most common ones.1 We presented a girl with a huge abdominal mass without any discomfort or pain. In this paper, we emphasised the diagnosis of serous cystadenoma in children who present with asymptomatic abdominal mass. A 12-year-old pre-menarchal girl presented with a history of increasing abdominal distension, without discomfort, pain or any other urinary and gastrointestinal symptoms (Fig. 1a). The patient's weight was 60 kg, and height was 163 cm. No pain or abdominal masses were noted upon examination. The other physical and systemic examinations were unremarkable. The first ultrasonographic examination of the abdomen was performed by a paediatrician in an effort to reveal the cause of frequent micturition, and a cyst of the left ovary was an incidental finding. Pelvic ultrasonographic examination revealed a large cystic mass (56 cm) arising from the left ovary, reaching to the level of the xiphoid. Magnetic resonance imaging showed a huge mass arising from the left ovary with no signs of organ invasion (Fig. 1b,c). Laboratory results including endocrinological tests (follicle-stimulating hormone (FSH)-immunochemiluminometric assays (ICMA) 25.08 mIU/mL, LH-ICMA 5.06 mIU/mL, oestradiol 58 pg/mL), as well as thyroid-stimulating hormone [TSH] and T4, were normal for the age and pubertal stage of the patient. The ovarian tumour marker values (alfa feto protein [AFP], beta human chorionic gonadotropin [βHCG], carcinoembryonic antigen [CEA], cancer antigen-125 [CA125] and lactate dehydrogenase [LDH]) were also normal. The cyst was surgically removed with preservation of normal ovarian tissue, and histopathology revealed a serous cystadenoma. The huge cyst was unilocular, with a thin wall and clear content. Both of the ovaries were visible by pelvic magnetic resonance imaging, and their volumes were found within normal limits (Fig. 1d). The patient was followed up regularly, and there was no evidence of recurrence 30 months after surgery. (a) The patient with minimal abdominal distension at admission. (b,c) Magnetic resonance imaging demonstrated an enormous mass occupying almost the entire abdomen. (d) Cyst was surgically removed, with preservation of normal ovarian tissue. Although there are numerous classes of epithelial ovarian cancer in adults, the histological subtypes of epithelial ovarian tumours in children include only serous and mucinous tumours.2 Benign serous cystadenomas are rare benign neoplasms in the paediatric age group.3 Although this tumour is rare, this diagnosis should be considered in 11–15-year-old girls presenting with a huge abdominal mass. Malignant transformation is possible in 5–10% of cases, in particular, the adenomatose shapes that can induce transformation into adenocarcinoma.4 However, serous cyst tumour of the ovary in our patient occurred prior to menarche, and these tumours tend to present with abdominal distension. The FSH levels were measured by new ICMA. The normal ranges were calculated by age and Tanner stage (premenopausal: 5–30 IU/L). The patient was a pre-menarchal pubertal girl at Tanner stage 4. She exhibited an elevated basal FSH level; however, the menses had not started, and the mid-follicular oestradiol levels were normal. FSH serum levels were high during spontaneous puberty and slowly normalised thereafter in our patient. The differential diagnosis of ovarian masses in pre-menarchal girls includes cysts, torsion with subsequent oedema, benign or malignant ovarian neoplasm, and, rarely, involvement of the ovary by lymphoma, leukaemia, or metastatic disease.5 Ovarian causes of cysts in adolescents include follicular and corpus luteum cysts, haemorrhagic functional cysts, endometriomas, or benign and malignant neoplasms. Disorders of the fallopian tube such as hydrosalpinx, pyosalpinx, paratubal cyst or ectopic pregnancy can mimic an ovarian cyst. Peritoneal cysts or peri-appendiceal abscesses are occasionally mistaken as adnexal pathology.6 Patients with a serous cyst might present late, and this may lead to renal insufficiency secondary to urinary outflow obstruction. A mass may also be totally asymptomatic and revealed by ultrasonography incidentally. Benign cystadenomas are the most common cysts and are effectively treated by unilateral cystectomy.7 Conservative surgery is adequate for benign lesions and early-stage ovarian tumours of borderline malignancy. Early detection of adnexal masses and surgical techniques makes it possible to remove the tumour and preserve the underlying ovary and subsequent fertility. Surgical treatment of our case was successful, and the patient adjusted well to her post-operative body image.

The predictive value for in vitro fertility delivery rates is greatly impacted by the method used to select the threshold between normal and elevated basal follicle-stimulating hormone

To evaluate the predictive accuracy of different methodologies for selecting a basal FSH threshold level that prognosticates live birth after IVF. Retrospective. Academic private practice. Eight thousand nineteen patients who had their basal FSH levels determined by the program's endocrinology laboratory. Thresholds between normal and elevated basal FSH levels were calculated by using six different methodologies. Live birth rate per initiated IVF cycle. The thresholds selected by using the manufacturer's normal range or using 95% confidence intervals of a fertile population, the infertile population, or distinct age groups within the infertile population all proved unsatisfactory. The live birth rates for patients in whom there had been a previously elevated FSH level were <or=43.7%. The efficiency curves that were created for each of the five age groups were the most useful. With appropriately selected thresholds, the predictive value of an abnormal result approaches 100%. The methodology used to select thresholds for basal FSH levels has enormous impact on the utility of the screening test. The use of anything other than clinical outcome-based methods to select the threshold greatly decreases the utility of the test and may lead to false conclusions or inaccurate patient counseling.

O-171: The predictive value of ovarian reserve screening with basal follicle stimulating hormone (FSH) levels is greatly impacted by the method used to select the threshold between normal and elevated basal FSH values

Many different methodologies have been used to select the threshold value between normal and elevated FSH levels. This study evaluates the impact of these various methodologies on the predictive value of basal FSH screening for ovarian reserve as measured by delivery rates per IVF cycle.

The relationship between reproductive outcome measures in DDT exposed malaria vector control workers: a cross-sectional study

BackgroundThe utility of blood reproductive endocrine biomarkers for assessing or estimating semen quality was explored.MethodsA cross-sectional study of 47 DDT exposed malaria vector control workers was performed. Tests included blood basal and post gonadotrophin releasing hormone (GnRH), lutenizing hormone (LH), follicle stimulating hormone (FSH), testosterone, sex hormone binding globulin (SHBG), estradiol (E2) and inhibin; a questionnaire (demographics and general medical history); a physical examination and semen analysis. Semen parameters were determined using either/or or both WHO or the strict Tygerberg criteria. Relationships between semen parameters and endocrine measures were adjusted for age, duration of abstinence before sampling, presence of physical abnormalities and fever in the last two months. All relationships between specific endocrine hormones were adjusted for age and basal SHBG.ResultsMultiple logistic regression showed a consistent positive relationship (prevalence odds ratio (POR) = 8.2, CI:1.4–49.2) between low basal inhibin (<100 pg/ml) and low semen count (< 40 million) and density (< 20 million/ml); consistent positive, but weaker relationships (1> POR < 2) between abnormally low semen count as well as density and baseline and post GnRH FSH; and positive relationships (POR = 37, CI:2–655) between the prevalence of high basal estradiol (> 50 pg/ml) and abnormal morphology (proportion < 5%) and low motility (proportion <50%). Most of the expected physiological relationships between specific endocrines were significant.ConclusionThe study has demonstrated that low basal inhibin, elevated basal FSH and high basal E2 can serve as markers of impaired semen quality.

Association of basal follicle stimulating hormone (FSH) levels with FSH receptor variants in subfertile women with normal menstrual cycle: implications for ovarian sensitivity to FSH

Objective: Recently a frequently occurring polymorphic variant of the FSH receptor gene has been described in which the amino acid asparagine (Asn) is replaced by serine (Ser) at position 680. The Ser variant is associated with higher FSH levels in the early follicular phase and more FSH is needed to obtain normal follicular response in ovulatory patients undergoing IVF treatment.(Perez Mayorga et al. J Clin Endocrinol Metab 85: 3365–3369, 2000). Aim of our study was to test whether this receptor variant occurs more often in regularly menstruating patients with elevated basal FSH, a condition which is associated with a higher ovarian FSH threshold (de Koning et al Hum Reprod 16 abstract book 1: 207, 2001).

Pregnancy rates with IVF remain significant despite elevated maximal basal FSH levels in younger women

Objective: Elevated cycle day 2- 3 (baseline) follicle stimulating hormone (FSH) is a recognized marker of diminished ovarian reserve (DOR) and is predictive of adverse outcome following IVF. Reproductive aging is independently associated with elevation in baseline FSH. We hypothesize that a diagnosis of DOR has different prognostic implications for younger versus older women, younger biological age mitigating the adverse association of FSH elevation and IVF outcome.

Useful Predictors of Ovarian Stimulation Response in Women Undergoing in vitro Fertilization

Eighty-seven patients undergoing in vitro fertilization were studied to evaluate the prognostic value of different tests in predicting ovarian stimulation response. We studied basal follicle-stimulating hormone (FSH) value on cycle day 3, the clomiphene citrate (CC) challenge test and serum estradiol levels on cycle day 3. Patients with elevated basal FSH levels needed more ampoules of gonadotropins for stimulation and had a higher cancellation rate because of poor response. Patients with abnormal CC challenge test results also needed more ampoules of gonadotropins, but the higher cancellation rate in this group did not reach statistical significance. The basal estradiol level did not contribute to further discrimination between groups. We conclude that basal FSH level on cycle day 3 is a useful prognosticator of ovarian stimulation response.

Are elevated FSH concentrations in the pre-conceptional period a risk factor for Down's syndrome pregnancies?

Recent publications have reported a relation between a decreased ovarian reserve and Down's syndrome pregnancies. Using the data of a case-control study into risk factors for a Down's syndrome pregnancy, we estimated the usefulness of pre-conceptional basal follicle stimulating hormone (FSH) screening (detection rate, false positive rate, positive and negative likelihood ratio, as well as the loss rate of unaffected pregnancies) to identify Down's syndrome pregnancies. The optimal detection rate of pre-conceptional basal FSH screening for Down's syndrome pregnancies was 14%, corresponding to a false positive rate of 5% and a positive likelihood ratio of 2.8. Incorporation of basal FSH screening into the regimen of first trimester serum screening followed by nuchal translucency measurement would increase the detection rate from 85 to 87%. However, basal FSH screening alone or in combination with other screening methods would cause an unacceptably high loss rate of unaffected pregnancies compared with current screening protocols, indicating that routine pre-conception basal FSH screening would not be useful to identify women at risk for a Down's syndrome pregnancy. However, when elevated basal FSH concentrations are diagnosed during subfertility evaluation, an elevated risk for a Down's syndrome pregnancy could be discussed with women who become pregnant.

Long-term effects of allogeneic bone marrow transplantation (BMT) on pituitary, gonad, thyroid and adrenal function in adults.

To evaluate the late-effects of allogeneic bone marrow transplantation (BMT) on endocrine function 20 adults (10 females, 10 males) with hematological malignancies were studied after a mean of 3.2 years (range 1.0-10.0) following BMT. The mean age of patients at the time of BMT was 39 years. Dynamic tests of the hypothalamic-pituitary axis included growth hormone releasing hormone (GHRH), gonadotropin releasing hormone (GnRH) and thyrotropin releasing hormone (TRH) stimulations with measurements of serum growth hormone (GH), follicle stimulating hormone (FSH), luteinizing hormone (LH), thyrotropin (TSH) and prolactin (PRL) responses. Adrenal function was assessed with the adrenocorticotropin (ACTH) test. Five patients (25%) had a subnormal GH response to GHRH stimulation, but all had a normal serum insulin-like growth factor I (IGF-I) value. There was an inverse nonlinear relationship between the body mass index (BMI; kg/m2) and GH response but no relation between the GH response and total body irradiation (TBI), intrathecal treatment or occurrence of graft-versus-host disease. In females, serum FSH and LH basal levels and responses to GnRH, in spite of oestrogen substitution therapy in 9/10 patients, indicated ovarian failure and early menopause. Most responses to GnRH were delayed. All males had elevated serum basal FSH levels indicating damage in seminiferous tubulus and infertility. Serum basal LH was elevated only in four males but testosterone values were all within normal limits. However, the mean free androgen index (FAI) was in the low normal range, and two subjects had abnormally low FAI. Serum free thyroxine (fT4) levels were normal in all but one, but an exaggerated TSH response to TRH occurred in seven patients (35%). Four of them had received TBI and one total nodal irradiation suggesting radiation-induced damage to the thyroid gland. In 19 of the 20 patients, adrenal function judged with ACTH test was normal. We conclude that functional impairments of the hypothalamus-pituitary-gonad/thyroid axis are common while disturbances in GH, adrenal and prolactin occur less often in patients after intensive treatment and BMT. Typically, the target organ is more commonly affected than the hypothalamus-pituitary axis. In spite of normal serum testosterone and LH values, serum FAI may reveal androgen deficiency.

Suppression of the hypothalamus-pituitary somatotrope axis in men with spinal cord injuries

Thirty-two men with spinal cord injury (SCI) were studied for evaluation of the hypothalamus-pituitary somatotrope axis, using growth hormone-(GH)-releasing hormone (GHRH) and insulin-induced hypoglycemia. Twenty-six age-matched normal male volunteers served as controls. Six SCI subjects (18.7%) had elevated basal follicle-stimulating hormone (FSH) levels, eight (25.0%) had hyperprolactinemia, and 11 (34.4%) had reduced serum insulin-like growth factor-1 (IGF-1) levels. Twenty SCI subjects (62.5%) had reduced and/or delayed GH responses to GHRH, and eight (25.8%) had reduced GH response to insulin-induced hypoglycemia. Seven of eight hyperprolactinemic SCI subjects showed reduced GH response to GHRH and/or insulin-induced hypoglycemia. These findings are consistent with the notion that SCI subjects have a reduced central dopaminergic tone.

The Significance of Elevated Basal Follicle-Stimulating Hormone in Regularly Menstruating Infertile Women

Ebbiary, N. A. Ahmed; Lenton, E. A.; Salt, C.; Ward, A. M.; Cooke, I. O. Author Information

Inhibition of luteinizing hormone, follicle-stimulating hormone and sex-steroid levels in men and women with a potent antagonist analog of luteinizing hormone-releasing hormone, Cetrorelix (SB-75)

Cetrorelix (SB-75; [Ac-D-Nal(2)1, D-Phe(4Cl)2, D-Pal(3)3, D-Cit6, D-Ala10] luteinizing hormone-releasing hormone (LHRH)) is a new highly potent antagonist analog of LHRH containing the D-ureidoalkyl amino acid D-citrulline at position 6 and is free of allergenic effects. This study shows the inhibition of LH and follicle-stimulating hormone (FSH) release in normal men, postmenopausal women and patients with gonadal dysgenesis, using different doses and i.m., s.c. and i.v. routes of administration of SB-75. The mean serum levels of LH and FSH in normal men who received one single dose of 300 micrograms of SB-75 sc started to decline rapidly 1 h after its administration; the LH suppression was sustained for 14 h and that of FSH up to 24 h or longer as the samples were obtained only up to this time. The nadir for LH was reached at 14 h and that for FSH at 24 h or later after administration of the antagonist (p < 0.05). Serum levels of total and free testosterone decreased after the first hour and this inhibition was maintained for up to 14 h. The nadir for total testosterone was at 6 h and that for free testosterone was at 8 h (p < 0.001), corresponding to 56% and 60% of inhibition, respectively. In postmenopausal women, inhibition of the elevated basal serum LH and FSH levels occurred after a single injection of the antagonist analog SB-75 in doses of 75, 150, 300, 600 and 1200 micrograms using im, sc and iv routes of administration.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of different cumulative doses of chemotherapy on testicular function. Results in 75 patients treated for Hodgkin's disease during childhood or adolescence

Testicular function was evaluated in 75 boys after treatment for Hodgkin's disease with involved-field or extended-field irradiation and stage-dependent chemotherapy (vincristine, prednisone, procarbazine, Adriamycin [doxorubicin], and cyclophosphamide [OPPA/COPP]). Although pubertal development and testosterone levels were normal in all patients, 18 of 75 (24.0%) had elevated basal and 65/74 (87.8%) elevated stimulated luteinizing hormone (LH) levels, demonstrating chemotherapy-induced Leydig cell damage. In addition, there was a 40.5% and 53.4% incidence of elevated basal and stimulated FSH values, respectively, indicating severe impairment of spermatogenesis as confirmed by azoospermia in four patients. Testicular dysfunction was observed in patients treated before as well as during puberty. The incidence of elevated basal follicle stimulating hormone (FSH) and LH values was significantly higher in patients who had received higher cumulative doses of chemotherapy, i.e., 28.9% and 13.2% with two OPPA, 45.5% and 36.4% with two OPPA/two COPP, and 62.5% and 43.8% with two OPPA/four to six COPP, respectively. Chemotherapy for Hodgkin's disease causes a high and apparently dose-related incidence of testicular dysfunction in prepubertal as well as in pubertal boys affecting Leydig cell function as well as spermatogenesis. Circumstantial evidence indicates that procarbazine is the major gonadotoxic agent involved.

Ovarian function following chemotherapy for childhood brain tumours

Pubertal development, basal gonadotrophin, and oestradiol levels were assessed in 21 girls who had received neuroaxis irradiation for a brain tumour followed by adjuvant chemotherapy with carmustine (BCNU) or lomustine (CCNU) and procarbazine. Thirteen received chemotherapy before the age of 11 years. Ten remained prepubertal at their last assessment, nine of whom showed biochemical evidence of primary ovarian failure. The remaining three were pubertal or adult, and although basal follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels were normal, all had shown abnormalities of gonadotrophin secretion previously. Eight girls received chemotherapy after 11 years of age. Only three girls exhibited an elevated basal FSH level or exaggerated FSH response to GnRH. Elevated basal FSH values had been noted previously in two of the other five girls. All girls entered or progressed through puberty spontaneously. Seven experienced menarche at an appropriate age. However in four, gonadotrophin levels, which had been elevated, were now within the normal range. In two, menses had continued throughout with normal midfollicular oestradiol levels, whilst the other two developed secondary amenorrhoea associated with radiation-induced gonadotrophin deficiency. The majority of girls showed evidence of primary ovarian dysfunction. This did not prejudice pubertal development or the timing of menarche. Ovarian function may return to normal in the years after treatment, indicating a potential for fertility.

Pituitary-gonadal function in men with alcoholic cirrhosis of the liver.

Fourteen adult males with alcoholic cirrhosis were studied. Gonadotrophin responses to luteinizing hormone-releasing hormone (LRH) and testosterone (T) responses to human chorionic gonadotrophin (HCG) were determined and basal 17 beta oestradiol (E2) levels were measured in each case. The mean basal luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, and the mean LH and FSH responses to LRH were not significantly different from a group of age-matched male controls. However, the five men with testicular atrophy all had an elevated basal FSH level and an exaggerated FSH response to LRH. The mean serum T of the cirrhotic men was significantly lower than that of the controls (P less than 0.05), while the mean E2 level was not significantly different. However, the mean E2 level in the eight patients with gynaecomastia was significantly higher than in those without gynaecomastic (P less than 0.05). All patients had a T response to HCG, including those 5 with low basal T levels. A significant negative correlation was found between the maximum rise in T after HCG (delta T) and the maximum LH response to LRH (delta LH), suggesting a mediating effect of T reserve on the LH response to LRH. These findings tend to exclude a suppressive effect of alcohol on the pituitary gland as a cause for the hypogonadism found in men with alcoholic cirrhosis. Furthermore, the evidence of some testicular T reserve despite low basal T levels, and the presence of normal basal LH levels, suggests that the low T production is not primarily due to leydig cell dysfunction.

The diagnostic significance of LH-releasing hormone test in patients with amenorrhea

Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) following intravenous injection of 100 μg of synthetic LH-releasing hormone (LH-RH) in 10 normal women in the follicular phase and in 80 amenorrheic women were determined by radioimmunoassay. The low or normal basal levels of LH and FSH with good response to LH-RH were observed in patients with galactorrhea, secondary amenorrhea responding to progestin with bleeding, and in some of the patients with anorexia nervosa. Low resting levels with little or no increase of LH and FSH following LH-RH were experienced in patients with Sheehan's syndrome, postoperative patients with chromophobe pituitary adenoma, and in some of the patients with amenorrhea responding to progestin plus estrogen with bleeding. Elevated basal LH and FSH levels with further increase following LH-RH were seen in patients with Turner's syndrome and in some of the patients with amenorrhea responding to progestin plus estrogen with bleeding. The three typical patterns stated above may indicate that the cause of anovulation lies in the hypothalamus, pituitary, or ovaries. It is concluded that the LH-RH test is useful in clarifying the pathophysiology of anovulatory conditions.