Human Chorionic Gonadotrophin Stimulation Test Research Articles

Late Gender Re-Assignment in 46XY 17 Beta-Hydroxysteroid Dehydrogenase (Type 3) Deficiency: A Case Report Highlighting Challenges of Diagnosis and Management

A 12-year-old child, previously raised as a female, presented with phallic enlargement at puberty. The sexual maturity ratings were Stage 2 and 4 for breast and pubic hair, respectively, with a stretched phallic length of 3.2cm. The patient re-presented at 16 years with progressive masculinisation and regression of breast buds. A pelvic ultrasound scan, magnetic resonant imaging and laparoscopic examination showed intrabdominal left testis, intracanalicular right testis, vas deferens, and bilateral pampiniform plexus with no uterus or ovaries. Histology of gonadal biopsy showed germ cell aplasia, and the karyotype was 46XY. The surgeons fixed the gonads in the scrotal sacs after biopsy. The human chorionic gonadotrophin stimulation test showed low basal and stimulated testosterone/androstenedione ratios (0.22 and 0.17, respectively) which were strongly suggestive of 17 beta-hydroxysteroid dehydrogenase-3 (17β-HSD3) deficiency. The patient was evaluated by the mental health team and after sessions of therapy, the patient requested for gender reassignment, which necessitated orthoplasty and urethroplasty. It is to be noted that 17β-HSD3 deficiency is a frequent cause of gender change at puberty.

Assessment of theca cell function: a prerequisite to androgen or luteinizing hormone supplementation in poor responders

Poor responders are a heterogeneous population, with some patients displaying a diminished ovarian reserve and others a poor ovarian reserve with preserved granulosa cell function. Androgen and LH/hCG supplementation has been advocated for poor responders, mainly those >40 years old. Although androgens synergistically act with FSH to support folliculogenesis, and ovarian androgen secretion declines with age, there is still no evidence that androgen therapy is actually effective to improve ovarian FSH sensitivity. The main reason seems to be that theca cell function has not been appropriately assessed in patients at risk of poor response. The definition of theca insufficiency is hampered by methodologic shortcomings in routine bioassays. Provocative tests for theca cells might help to identify those patients who could benefit from androgen supplementation. The lack of data regarding theca cells in these patients might contribute to explaining the absence of evidence for a positive effect of androgen therapy.

Human chorionic gonadotrophin stimulation test as a predictor of ovarian response and pregnancy in IVF cycles stimulated with GnRH agonist gonadotrophin treatment: a pilot study

Recent evidence supports a specific and broad role of androgen produced by theca cells in reproductive physiology. This pilot study evaluated the usefulness of hCG theca stimulation test in predicting ovarian response and pregnancy. Prospective cohort study including 80 infertile women treated with IVF/ICSI. On Day 3 of the menstrual cycle preceding, the first IVF/ICSI cycle a blood sample was drawn to evaluate baseline FSH, estradiol (E(2)), 17-hydroxy-progesterone, androstenedione and testosterone levels. All women then received 250 µg recombinant hCG s.c. and underwent a second blood sampling 24 h after hCG injection to measurement steroid serum levels. Percentage increment of E(2) but not its precursors was significantly higher in normo-responders and pregnancy cycles than in poor responders and non-pregnancy cycles (P = 0.03 and P = 0.02, respectively) diagnostic accuracy being 67 and 75%, respectively. The percentage increase in E(2) thus still fails in as many as 33 and 25% of patients in predicting ovarian response and pregnancy, respectively. In addition, E(2) concentrations are poorly reproducible and a wide range of variation in all serum steroids investigated-including E(2)-after hCG injection was observed. The predictive power of the hCG test is based on E(2) but not androgen response to hCG injection. This test cannot be recommended in routine clinical practice because it is too laborious for screening purposes, shows great variability in the response obtained and its overall accuracy is not better than that reported for other available markers of ovarian reserve. The use of the currently available markers, antral follicle count and anti-Müllerian hormone, is therefore recommended.

Ovarian response to the human chorionic gonadotrophin stimulation test in normal ovulatory women: the impact of regressing corpus luteum

To evaluate the impact of the regressing corpus luteum on the hormone secretion during hCG stimulation. The hCG stimulation test in the early follicular phase has been used to assess the capacity of the ovarian theca cells to secrete steroids. A prospective observational study. University hospital. The study group consisted of 11 women with confirmed ovulation in the past cycle (corpus luteum positive [CL+]) and the control group of 11 women using oral contraceptive pills (OC; no CL). An hCG test (5,000 IU IM) was performed 2 to 4 days after menstrual bleeding, and the ovarian response was measured at 0, 48, and 96 hours after injection. Changes in serum concentrations of P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, E(2), and vascular endothelial growth factor (VEGF), and in ovarian vasculature and volume (three-dimensional power Doppler ultrasonography) were measured. Secretion of P and 17-OHP increased after hCG injection in the CL group, whereas no change was observed in women on OCs (P < or = .001). Concomitant increases were observed in volume and vasculature of the ovary with a CL (P<.05), but not in the contralateral ovary or in women on OCs. The changes in volume and vasculature correlated with levels of P and 17-OHP (P<.05). The regressing corpus luteum from the past menstrual cycle reactivates and secretes steroids in response to hCG stimulation performed during the early follicular phase, which should be taken into account when comparing hormone profiles of ovulatory and anovulatory women.

Assessment of bull fertility using a mucus penetration test and a human chorionic gonadotrophin stimulation test

The relative predictive abilities of an in vitro mucus penetration test and a human chorionic gonadotrophin (hCG) stimulation test were compared for assessing bull fertility. Cervical mucus was collected from 22 Holstein cows and then stored in liquid nitrogen. Semen was collected from 13 Holstein bulls and evaluated for standard semen parameters. The mucus penetration test was performed with fresh ejaculates, and the results were expressed as the distance traveled by the vanguard spermatozoa during incubation at 38°C for 10 min. Increases in plasma testosterone levels were determined by a ratio of testosterone concentration before and after hCG injection. Sperm motility and mucus penetration were significantly correlated with the conception rate. However, no significant correlation was confirmed between the increased plasma testosterone levels and conception rate. The results indicate that the mucus penetration test is an effective method for predicting the fertility of bulls.

Evaluation of the testosterone response to hCG and the identification of a presumed anorchid dog

ABSTRACTA two‐year‐old dog was presented with no scrotal testes. There was no history of castration but at laparotomy no testes were found. To confirm that the dog was truly anorchid a human chorionic gonadotrophin stimulation test was performed. This was then validated in normal entire and castrated dogs.

Effects of gonadotrophin-induced elevation of serum testosterone upon somatomedin C levels and serum thymidine activity in children.

3H-thymidine uptake into lectin-activated human lymphocytes allows to measure a growth-stimulating activity of serum, the thymidine activity (TA), which is GH dependent in vivo and related to somatomedins (Sm). In this work, it is shown: that addition of human chorionic gonadotrophin (HCG) or testosterone in vitro does not increase the 3H-thymidine uptake into lymphocytes; that the gonadotrophin-induced elevation of testosterone in children is accompanied by a significant increase of TA and, at a lesser degree, of Sm C; that these two increases are significantly correlated, and that the age-related variation of TA and Sm C after HCG stimulation test are not parallel.

An evaluation of the HCG stimulation test in the investigation of male infertility.

Of 159 patients being investigated at the infertility clinic during 1978, 31 agreed to undergo than human chorionic gonadotrophin (HCG) stimulation test. Twenty-one of these patients exhibited varying degrees of oligozoospermia and their response to HCG, measured by a rise in serum testosterone, was not significantly different from that of the remaining patients who had normal sperm counts. Endocrine function of the testes appears to be unaltered even in patients with severely impaired tubular function. It is concluded that assessment of Leydig cell function is of no value in the routine investigation of male fertility.

HCG stimulation test in children with abnormal sexual development.

Plasma testosterone was estimated by radioimmunoassay in 60 children with disorders of sexual development before and after stimulation with human chorionic gonadotrophin (HCG). In 21 children the testosterone levels after 3 and 5 daily injections of 1000 units HCG were compared and good correlation was found between the paired results (r =0-93), suggesting that the 5-day HCG test has no advantage over the 3-day test. In 7 boys with apparently normal genital development the increments in plasma testosterone ranged from 2-0 to 8-5 nmol/1 after 3 injections of HCG. 10 boys with anorchia showed little response to HCG stimulation, but in patients with other disorders, such as micropenis (10), cryptorchidism (8), hermaphroditism (3), male pseudohermaphroditism (13), hypospadias (3), and sex chromosome anomalies (6), there was considerable variation in the plasma testosterone level after HCG. In 2 boys with suspected anorchia the results suggested that testes were present and this was confirmed at operation.

Gonadotrophin test of the functional capacity of Leydig cells in normal and hypogonadal boys.

SUMMARYA human chorionic gonadotrophin stimulation test of prepubertal testes was studied at two different dosage levels. Three doses of 500 i.u. or 1500 i.u. were administered intramuscularly at 2‐day intervals, and the plasma testosterone concentration was measured with a competitive protein‐binding technique before the stimulation and 24 hr after the last dose.The test was carried out with the smaller dose in fourteen and with the larger dose in eighteen boys with two clinically normal testes. Ten boys with male pseudo‐hermaphroditism, four with bilateral cryptorchidism, two with the Prader‐Labhart‐Willi syndrome, and one with Noonan's syndrome were also tested.The results, as evaluated in conjunction with the information available in the literature, indicate that appropriate stimulation is obtained with three doses of 1500 i.u. given at 2‐day intervals. Giving the testes enough time to respond is as important as the dose of gonadotrophin. Measurement of the basal concentration of testosterone is of little value. No virilization was observed after this stimulation. The clinical value of the test was clearly indicated by the results obtained in the pathological series.