Low Serum Follicle-stimulating Hormone Research Articles

Efficacy of Kirin pill plus vitamin CE and coenzyme Q10 in the treatment of ovarian reserve hypofunction

Purpose: To investigate the efficacy of Kirin pill plus vitamin CE and coenzyme Q10 in the treatment of diminished ovarian reserve (DOR). 
 Methods: 145 patients with ovarian reserve hypofunction hospitalized in Xiangyang Central Hospital, Xiangyang City, China from March 2019 to March 2022 were recruited and assigned randomly to receive either vitamin CE and coenzyme Q10 (control group), or vitamin CE and coenzyme Q10 plus Kirin pills (study group). The parameters/indices determined include menstrual recovery, clinical efficacy, sex hormone and serum anti-mullerian hormone (AMH) levels, changes in the number of ovarian sinus follicles, and levels of CD3+, CD4+ and CD8+ T cell. 
 Results: There were no significant differences (p > 0.05) observed among baseline data, pre-treatment sex hormones, serum AMH, ovarian antral follicle count, CD3+, CD4+, and CD8+ T cell levels. After the intervention, administration of the Kirin pill resulted in significantly lower serum follicle stimulating hormone (FSH) and FSH/luteinizing hormone (LH), elevated AMH levels, and better LH and estradiol (E2) levels in patients compared to the administration of vitamin CE and coenzyme Q10 (control group). The study group also showed superior ovarian reserve function and more ovarian basal sinus follicles than the control group (p < 0.05). 
 Conclusion: Kirin pill plus vitamin CE and coenzyme Q10 treatment regimen optimizes the ovarian reserve function of patients with DOR infertility by improving basal sex hormones, menstrual cycle and menstrual volume, AMH and ovarian basal sinus follicle count. Further clinical trials are required prior to application in clinical practice.

The predictive factors of successful sperm retrieval for men with Y chromosome AZFc microdeletion.

To identify key predictors for successful sperm retrieval in men with AZFc microdeletion. Totally, 71 infertile men with confirmed AZFc microdeletion were studied. For each patient, the endocrine profile including serum follicle stimulating hormone (FSH), luteinizing hormone, total testosterone, prolactin, and estradiol was recorded, along with intratesticular testosterone levels (ITT), age, and testicular size. The factors were further analyzed to determine the key predictors for successful sperm retrieval. Of the 71 men with AZFc microdeletion, 52 (73.2%) were classified as having non-obstructive azoospermia (NOA), 7 (9.9%) as having cryptozoospermia, and 12 (15.8%) as having severe oligoasthenoteratozoospermia. Of the 52 men with azoospermia, 47 received microdissection testicular sperm retrieval, and sperm retrieval was successful in 35 of those cases (74.5%). A significantly lower serum FSH (p = 0.03) was found in those patients from whom sperm could be successfully retrieved. The area under the receiving operating characteristic curve for FSH was determined to be 0.721. Using an FSH cutoff point of 12.95 mIU/mL, the model for predicting successful sperm retrieval was found to have 51.4% sensitivity, 83.3% specificity, 90.0% positive predictive value, and 37.0% negative predictive value. ITT levels were obtained from 7 NOA patients, the mean ITT and the mean ITT/serum testosterone ratio was 1932.8ng/ml and 567.2 in 6 men with successful sperm retrieval, whereas, in a patient with fail sperm retrieval, the levels were 2370ng/ml and 393.0. Men exhibiting AZFc microdeletion with discernible spermatogenesis from whom sperm was successfully retrieved by mTESE generally presented with relatively lower FSH levels.

Alterations of DNA methylation were associated with the rapid growth of cortisol-producing adrenocortical adenoma during pregnancy

BackgroundCortisol-producing adrenocortical adenoma (CPA) during pregnancy rarely occurs in clinic. Growing evidence suggests that DNA methylation plays a key role in adrenocortical adenomas. The present study aims to examine the genome-wide DNA methylation profiles and identify the differences in DNA methylation signatures of non-pregnant and pregnant patients with CPA.ResultsFour pregnant and twelve non-pregnant patients with CPA were enrolled. The pregnant patients with CPA had higher serum cortisol, Estradiol, Progesterone, and human chorionic gonadotropin concentration, while having lower serum FSH (follicle-stimulating hormone) and luteinizing hormone concentrations (P < 0.01). Compared with the non-pregnant patients, the duration is shorter, and the growth rate of the tumor is faster in pregnant patients with CPA (P < 0.05). Morphology and cell proliferation assay showed that the percentage of Ki-67 positive cells in CPA were higher in pregnant group than non-pregnant group (8.0% vs 5.5%, P < 0.05). The DNA methylation analysis showed that Genome-wide DNA methylation signature difference between pregnant and non-pregnant with CPA, that the pregnant group had more hypermethylated DMPs (67.94% vs 22.16%) and less hypomethylated DMPs (32.93% vs 77.84%). The proportion of hypermethylated DMPs was relatively high on chromosomes 1 (9.68% vs 8.67%) and X (4.99% vs 3.35%) but lower on chromosome 2(7.98% vs 12.92%). In pregnant patients with CPA, 576 hypomethylated DMPs and 1109 hypermethylated DMPs were identified in the DNA promoter region. Bioinformatics analysis indicated that the Wnt/β-Catenin pathway, Ras/MAPK Pathway and PI3K-AKT Pathway were associated with the development of CPA during pregnancy.ConclusionsGenome-wide DNA methylation profiling of CPA in non-pregnant and pregnant patients was identified in the present study. Alterations of DNA methylation were associated with the pathogenesis and exacerbation of CPA during pregnancy.

MP21-04 SUCCESSFUL SPERM RETRIEVAL FOR MEN WITH Y CHROMOSOME AZFC MICRODELETION

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP21)1 Sep 2021MP21-04 SUCCESSFUL SPERM RETRIEVAL FOR MEN WITH Y CHROMOSOME AZFC MICRODELETION I-Shen Huang, Wei-Jen Chen, and William J Huang I-Shen HuangI-Shen Huang More articles by this author , Wei-Jen ChenWei-Jen Chen More articles by this author , and William J HuangWilliam J Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002006.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Among the genetic aberrations contributing to male infertility, the deletion of the AZFc region of the Y chromosome is a common cause of spermatogenetic failure and the chances for successful surgical sperm extraction from azoospermic men with AZFc region microdeletion are relatively good. Nevertheless, it is still a challenge to procure sperm from a sizeable proportion of individuals with AZFc microdeletion, even when meticulous surgical measures are employed. The objective of this study is to identify predictive factors for successful sperm retrieval in men with AZFc microdeletion. METHODS: 76 infertile men were studied, each having Y chromosome AZFc microdeletion at some time during a 10-year period, as confirmed by multiplex polymerase chain reaction (PCR) amplification of STS (sequence tagged site). For each patient, the endocrine profile including serum follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), prolactin (PRL) and estradiol (E2) was recorded, along with intratesticular testosterone level (ITT), age and testicular size. The factors were further analyzed to determine the key predictors for successful sperm retrieval. RESULTS: Of the 76 men with AZFc microdeletion, 56 were classified as having non-obstructive azoospermia (NOA), 8 as having cryptozoospermia, and 12 as having severe oligoasthenoteratozoospermia (OAT). Of the 56 men with azoospermia, 50 received microdissection TESE (mTESE), and sperm retrieval was successful in 37 of those cases (74 %). A significantly lower serum FSH (P = 0.02) was found in those patients from whom sperm could be successfully retrieved. On the other hand, parameters such as levels of LH, TT, PRL, E2, testicular volume and age were not found to be correlated with successful sperm recovery. The area under the receiving operating characteristic (ROC) curve (AUC) for FSH was determined to be 0.721. Using an FSH cut-off point of 12.95 mIU/mL according to Youden’s index, the model for predicting successful sperm retrieval was found to have 51.4% sensitivity, 84.6% specificity, 90.5% positive predictive value (PPV) and 37.9% negative predictive value (NPV). CONCLUSIONS: Men exhibiting AZFc microdeletion with discernible spermatogenesis from whom sperm was successfully retrieved by mTESE generally presented with relatively lower FSH levels. Source of Funding: nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e347-e347 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information I-Shen Huang More articles by this author Wei-Jen Chen More articles by this author William J Huang More articles by this author Expand All Advertisement Loading ...

Clinicohormonal Parameters as a Primary Step to Differentiate Normosmic Idiopathic Hypogonadotropic Hypogonadism and Kallmann Syndrome in a Tertiary Care Hospital in Eastern India

Introduction: Idiopathic hypogonadotropic hypogonadism is a rare gonadal dysgenesis in which puberty does not take place naturally. It occurs due to insufficient pulsatile secretion of Gonadotrophin-Releasing Hormone (GnRH) and the resulting Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH) deficiency leads to absence of or delayed sexual maturation. Kallmann syndrome is an uncommon genetic disorder characterised by hypogonadotropic hypogonadism associated with anosmia or hyposmia. When anosmia is absent, the same is referred as normosmic Idiopathic Hypogonadotropic hypogonadism (nIHH). Aim: To find out the significant differences between Kallmann syndrome and nIHH based on clinical features and biochemical assessment as a primary measure to initiate the treatment early. Materials and Methods: This hospital based cross-sectional observational cohort study was conducted in Department of Endocrinology, Nilratan Sircar Medical College and Hospital, Kolkata, India. The study was done on 55 cases of IHH presenting to the department with delayed secondary sexual characteristics. Results: Out of these 55 cases, 45 (81.8%) were of nIHH and only 10 (18.2%) cases were of Kallmann Syndrome. It was found that both the conditions show male predominance. Smell abnormalities were present only in Kallmann group. The level of serum testosterone was significantly higher (p&lt;0.05) in nIHH subjects (mean-35.59 ng/dL) than patients with Kallmann Syndrome (mean-14.90 ng/dL). Patients with Kallmann syndrome showed significantly reduced pubic and axillary hair development and absence of gonadal development. Conclusion: Absence of puberty with anosmia/hyposmia with low serum FSH and LH, drastically reduced serum testosterone, are factors that point towards the diagnosis of Kallmann syndrome even in absence of genetic study, which is helpful for initiation of hormone replacement therapy for treatment.

Menopoz Tipi ve Süresinin Postmenopozal Kadınlarda Pre-Diyabet ve Diyabet Gelişimine Etkisi

Aim: The onset of menopause is an important factor determining quality of life in females. The aim of this study was to evaluate the effect of natural or surgical menopause, the duration of the menopausal period, and serum gonadotropin levels on the development of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) in postmenopausal women. Material and Methods: This retrospective study included 140 postmenopausal women with pre-DM, 148 postmenopausal women with DM and 265 healthy postmenopausal women. The groups were compared in respect of menopause type, the duration of the menopausal period, and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) levels. Statistical evaluations were made. Results: There was found to be no significant effect of natural or surgical menopause on the development of pre-DM or DM (p=0.393). Increased duration of menopause was mostly seen in women with DM and the difference was statistically significant compared to the controls (p=0.019). Serum decreased FSH and LH levels and increased E2 level were observed in the DM group and the difference was significant compared to the control group (respectively, p=0.001, p=0.001 and p=0.012). Conclusion: The onset of natural or surgical menopause does not affect the development of pre-DM and DM. Women with DM have a longer menopausal period. Women with pre-DM and DM have lower serum FSH and LH levels and higher serum E2 levels. This can be explained in part by adiposity and insulin resistance.

FSH promotes fat accumulation by activating PPARγ signaling in surgically castrated, but not immunocastrated, male pigs

Follicle-stimulating hormone (FSH) was recently implicated as a novel regulator of fat accumulation. Surgical castration causes high FSH concentrations and increases fat accumulation, whereas immunocastration results in low FSH concentrations and less fat in immunocastrated boars versus barrows. However, detailed information regarding the role of FSH in regulation of fat accumulation in male pigs is unclear. First, expression of FSH receptor was confirmed (real-time quantitative PCR) in subcutaneous and visceral adipose tissues (SAT and VAT, respectively) of boars. Then, surgical castration (high FSH model) was compared to immunocastration (low FSH model) to investigate potential roles of FSH in adipogenesis and fat accumulation. High FSH concentrations after surgical castration activated PPARγ signaling by upregulating expression of CREB (P < 0.05), and then recruited an array of PPARγ target adipogenic genes, including transcription factor (C/EBPα), long-chain fatty acid uptake (LPL), fatty acid de novo synthesis (FASN, ACACA) and lipid droplet formation (PLIN1) in both SAT and VAT, promoting fat accumulation in barrows. In contrast, much lower serum FSH concentrations in immunocastrates attenuated (P < 0.05) expressions of PPARγ and PPARγ target genes in both SAT and VAT, resulting in less fat accumulation in immunocastrated boars versus barrows. We concluded that the substantially elevated FSH concentrations in barrows promoted fat accumulation by activating the PPARγ signaling pathway in adipose tissues, whereas immunocastrates accumulated less fat due to low FSH.

Marijuana smoking and markers of testicular function among men from a fertility centre.

Is marijuana smoking associated with semen quality, sperm DNA integrity or serum concentrations of reproductive hormones among subfertile men? Men who had ever smoked marijuana had higher sperm concentration and count and lower serum FSH concentrations than men who had never smoked marijuana; no differences were observed between current and past marijuana smokers. Studies of marijuana abuse in humans and animal models of exposure to marijuana suggest that marijuana smoking adversely impacts spermatogenesis. Data is less clear for moderate consumption levels and multiple studies have found higher serum testosterone concentrations among marijuana consumers. This longitudinal study included 662 subfertile men enroled at the Massachusetts General Hospital Fertility Center between 2000 and 2017. The men provided a total of 1143 semen samples; 317 men also provided blood samples in which we measured reproductive hormones. Use of marijuana and other drugs was self-reported at baseline. Standard protocols were followed for measuring semen quality, sex hormones and DNA integrity. We used linear mixed effect models with a random intercept to evaluate the associations of self-reported marijuana smoking at enrolment with semen parameters from subsequently collected samples, and linear regression models for sperm DNA integrity and serum reproductive hormones, while adjusting for confounders including smoking and cocaine use. Men who had ever smoked marijuana (N = 365) had significantly higher sperm concentration (62.7 (95% confidence interval: 56.0, 70.3) million/mL) than men who had never smoked marijuana (N = 297) (45.4 (38.6, 53.3) million/mL) after adjusting for potential confounders (P = 0.0003). There were no significant differences in sperm concentration between current (N = 74) (59.5 (47.3, 74.8) million/mL) and past marijuana smokers (N = 291) (63.5 (56.1, 72.0) million/mL; P = 0.60). A similar pattern was observed for total sperm count. Furthermore, the adjusted prevalence of sperm concentration and total sperm motility below WHO reference values among marijuana smokers was less than half that of never marijuana smokers. Marijuana smokers had significantly lower follicle stimulating hormone (FSH) concentrations than never marijuana smokers (-16% (-27%, -4%)) and there were no significant differences between current and past marijuana smokers (P = 0.53). Marijuana smoking was not associated with other semen parameters, with markers of sperm DNA integrity or with reproductive hormones other than FSH. Chance findings cannot be excluded due to the multiple comparisons. Our results may not be generalisable to men from the general population. Marijuana smoking was self-reported and there may be misclassification of the exposure. These findings are not consistent with a deleterious effect of marijuana on testicular function. Whether these findings are reflective of the previously described role of the endocannabinoid system in spermatogenesis or a spurious association requires confirmation in further studies. The project was funded by grants R01ES009718 and P30ES000002 from the National Institute of Environmental Health Sciences (NIEHS). None of the authors has any conflicts of interest to declare. N/A.

Case Report: Testicular failure possibly associated with chronic use of methylphenidate.

Methylphenidate is a commonly prescribed treatment for attention deficit hyperactivity disorder (ADHD). However, little is known about its adverse effects on the male reproductive system. We report a 20-year-old male patient whose chief complaint was of delayed puberty. He spoke in a high-pitched voice and complained of lack of body hair, impaired libido, inadequate erectile function, chronic fatigue, and low energy. He had been treated with methylphenidate as an infant and had continued treatment for 17 years. On examination, the patient was lean and visibly lacked facial or body hair. He further explained that he had never been able to grow underarm or facial hair and that he was often mistakenly considered a young teenager rather than a 20-year-old. The patient's genitalia were categorized as Tanner Stage 2. Laboratory studies confirmed low serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels. The patient was given exogenous testosterone supplementation with pellets and human chorionic gonadotropin to maintain testicular size. After 4 months his symptoms improved and he demonstrated signs of puberty. Our goal is to further elucidate the possible impact of methylphenidate on the male reproductive system.

Molecular cloning and sequence analysis of follicle-stimulating hormone beta polypeptide precursor cDNA from the bovine pituitary gland

Follicle-stimulating hormone (FSH) plays an essential role in mammalian spermatogenesis and follicular development. In a previous study, we demonstrated that some bulls carry numerous linked mutations in the FSH beta-subunit (FSHB) gene, and that these bulls have poor-quality semen, low fertility, and slightly lower serum FSH concentration compared to those without such mutations. Here, we identified the different FSHB mRNA transcripts in such individuals and analyzed the evolutionary pattern of the FSHB open reading frame (ORF) in different species. Two different lengths of FSHB mRNA transcripts corresponding to two different polyadenylation sites in the 3'-UTR were detected in wild-type bull pituitary glands, and four different mRNA transcripts resulting from the different polyadenylation sites and linked mutations were identified in mutation-bearing bull pituitaries. All transcripts had almost the same putative FSHB precursor molecule. When the ORF sequences of wild-type and mutation-bearing genes were compared with those of other tetrapod species, the leopard frog had the lowest level of homology (57.8 and 58.1%) and the buffalo had the highest level (95.9 and 96.7%), respectively. These results indicated that the bovine FSHB gene transcribes at least two classes of mRNA in the wild-type and four classes of mRNA in the mutation-bearing individuals, which provides a new insight into the bovine FSHB evolutionary pattern. In addition, these findings lay a foundation for further study of gene expression regulation and the effects of mutations on male fertility traits in cattle.

Kisspeptin/Gpr54‐Independent Gonadotrophin‐Releasing Hormone Activity in Kiss1 and Gpr54 Mutant Mice

The kisspeptin/Gpr54 signalling pathway plays a critical role in reproduction by stimulating the secretion of gonadotrophin-releasing hormone (GnRH), yet mice carrying mutations in Kiss1 (which encodes kisspeptin) or Gpr54 exhibit partial sexual maturation. For example, a proportion of female Kiss1(-/-) and Gpr54(-/-) mice exhibit vaginal oestrus, and some male Kiss1(-/-) and Gpr54(-/-) mice exhibit spermatogenesis. To characterise this partial sexual maturation, we examined the vaginal cytology of female Kiss1(-/-) and Gpr54(-/-) mice over time. Almost all mutant mice eventually enter oestrus, and then spontaneously transition from oestrus to dioestrus and back to oestrus again. These transitions are not associated with ovulation, and the frequency of these transitions increases with age. The oestrus exhibited by female Kiss1(-/-) and Gpr54(-/-) mice was disrupted by the administration of the competitive GnRH antagonist acyline, which also resulted in lower uterine weights and, in Kiss1(-/-) mice, lower serum follicle-stimulating hormone (FSH) and luteinising hormone (LH) concentrations. Similarly, male Kiss1(-/-) and Gpr54(-/-) mice treated with acyline had smaller testicular sizes and an absence of mature sperm. In addition to examining intact Kiss1(-/-) and Gpr54(-/-) mice, we also assessed the effects of acyline on gonadotrophin concentrations in gonadectomised mice. Gonadectomy resulted in a significant increase in serum FSH concentrations in male Gpr54(-/-) and Kiss1(-/-) mice. Acyline administration to gonadectomised Kiss1(-/-) and Gpr54(-/-) male mice lowered serum FSH and LH concentrations significantly. By contrast to males, gonadectomy did not result in significant gonadotrophin changes in female Kiss1(-/-) and Gpr54(-/-) mice, but acyline administration was followed by a decrease in LH concentrations. These results demonstrate that, although kisspeptin signalling is critical for the high levels of GnRH activity required for normal sexual maturation and for ovulation, Kiss1(-/-) and Gpr54(-/-) mice retain some degree of GnRH activity. This GnRH activity is sufficient to produce significant effects on vaginal cytology and uterine weights in female mice and on spermatogenesis and testicular weights in male mice.

Increased Prevalance of the −211 T Allele of Follicle Stimulating Hormone (FSH) β Subunit Promoter Polymorphism and Lower Serum FSH in Infertile Men

The human FSHB promoter polymorphism (rs10835638; -211 G/T) has been associated with serum FSH in a cohort of young Estonian men. The minor allele carriers had reduced serum FSH (15.7% in GT heterozygotes; 40% in TT homozygotes) compared with GG homozygotes. Because FSH is essential for normal spermatogenesis and fertility, we speculated that abnormalities in FSH action could contribute to male infertility. We sought to study whether genetically inherited constitutively reduced FSH levels may affect male reproduction and replicate the association between rs10835638 and serum FSH among infertile male patients. Genotyping of rs10835638 in a cohort of infertile men (n = 1029; Andrology Center of the Tartu University Clinics, Estonia), including idiopathic infertility cases (IIFC; n = 750). Patients included male partners (sperm concentration <20 x 10(6)/ml) of infertile couples failing to conceive a child for 12 months or longer. A significant excess of TT homozygotes (1.1 vs. 2.4%) as well as GT heterozygotes (22.4 vs. 25.1%) was detected among infertile men compared with the young male cohort (chi(2) test, P < 0.05). The T allele of rs10835638 was associated with reduced serum FSH (analysis of covariance; full cohort: P = 1.20 x 10(-6), F = 13.8; IIFC: P = 7.70 x 10(-7), F = 14.3) as well as with low FSH to LH ratio (full cohort: P = 1.52 x 10(-11), F = 25.6; IIFC: P = 3.25 x 10(-9), F = 20.4). The median serum FSH levels differed between the GG and TT carriers by 48.5%. All IIFC with TT genotype exhibited low (<1.8) FSH to LH ratio. In perspective, this genetic marker may have clinical significance in molecular diagnostics of male reproductive success and a potential to identify positive responders to FSH treatment.

Predictors of improved seminal characteristics by varicocele repair

The aim of this study was to investigate predictors of the improvement of semen characteristics after low ligation for patients with varicoceles. The records of 97 oligozoospermic patients who underwent microsurgical left or bilateral inguinal varicocele repair were retrospectively evaluated. We assessed factors that could be predictors of the improvement of semen characteristics using logistic regression analysis. We evaluated age, testicular volume, varicocele grade, serum follicle-stimulating hormone (FSH), luteinising hormone, testosterone, sperm concentration and motility before low ligation. Among the 97 patients, sperm concentration improved from 6.4 +/- 5.8 to 24.2 +/- 35.1 million ml(-1) and sperm motility increased from 32.8 +/- 24.9% to 41.0 +/- 14.6% in 55 patients (57%). In logistic regression analysis, pre-operative serum FSH and testosterone concentration were predictors of sperm concentration improvement. Varicocele repair improved sperm concentration and motility. Low serum FSH and high testosterone are significant factors predicting the improvement of semen characteristics before low ligation.

A Case of Delayed Onset Central Hypothyroidism Secondary to Sheehan Syndrome

Hypothyroidism is one of the most common sequelae of Sheehan syndrome. Patients affected by this condition usually present with symptoms within weeks to months, but may present several years after postpartum hemorrhage. Rarely, the duration to onset of disease beyond 30 years has been reported in the literature. A 78-year-old woman presented with the complaint of fatigue for 2 months. Her physical examination was unremarkable. She was diagnosed with depression and started on fluoxetine. She returned to the clinic 3 weeks later with no improvement in her symptoms. Laboratory work revealed a normal thyroid stimulating hormone with a low free T4 and a low total T4. Additional investigations showed low serum follicle stimulating hormone, luteinizing hormone, and cortisol levels. Adrenocorticotropic hormone stimulation test was normal. A magnetic resonance imaging of the brain revealed a partially empty sella. On further questioning, the patient revealed that at the age of 27, after the delivery of her last child, she remained amenorrhic and failed to lactate. She recalled having excessive bleeding that required multiple blood transfusions. Based on her clinical presentation and history, she was diagnosed with delayed onset central hypothyroidism secondary to Sheehan syndrome and started on thyroid hormone supplement. As illustrated above, Sheehan syndrome can present several years postpartum. Appropriate history taking and relevant diagnostic workup is necessary to diagnose the condition.

Report on evaluation of the azoospermic male

Report on evaluation of the azoospermic male

精索静脈瘤根治術後の精液改善予測因子

To determine pretreatment parameters which predict improvements following varicocele repaire in semen quality. We retrospectively evaluated a total of 139 infertile patients who underwent varicocelectomy from February 1995 to March 2000. A logistic regression analysis was performed to identify parameters associated with improvements in semen quality. Parameters evaluated included varicocele grade, age, testicular volume, serum testosterone, liteinizing hormone (LH), follicle-stimulating hormone (FSH), preoperative sperm density and sperm motility. Of 139 patients 71 (51.0%) improved sperm concentration and 59 (42.4%) improved sperm motility postoperatively. Overall, median sperm density significantly increased from 10 x 10(6)/ml preoperatively to 30 x 10(6)/ml postoperatively. Sperm motility also significantly increased 33% to 45%. In logistic regression analysis, varicocele grade (odds ratio [OR] = 5.7; 95% confidential interval [CI : 1.9-17), FSH level ([OR] = 0.76; [CI]: 0.60-0.96) and sperm motility ([OR] = 1.03; [CI]: 1.0-1.1) were independent predictive factors for improvement in sperm concentration. Varicocelectomy improves sperm concentration and motility. Our data suggest that patients with grade 3 varicocele, low serum FSH level and high sperm motility are more likely to benefit from varicocele repair in sperm concentration.

Ovulation inducation and pregnancy despite estrogen deficiency and extremely high gonadotropins by lowering follicle stimulating hormone with ethinyl estradiol and using progesterone support in the luteal phase

Background: Spontaneous ovulations in women with hypergonadotropic hypogonadism are rare. Some cases of ovulation induction on a more consistent basis with treatment with ethinyl estradiol without gonadotropins have been reported. Objective: To determine if it is possible to induce ovulation and possibly achieve a pregnancy in a woman in premature ovarian failure who has had several serum follicle stimulating hormone (FSH) levels over 100 mIU/mL including one that was 164 mIU/mL by merely using ethinyl estradiol without gonadotropins. Materials and Methods: A 25 year old woman presented with oligomenorrhea over 2 years leading to amenorrhea with estrogen deficiency as manifested not only by serum estradiol <20 pg/mL but failure to have menses following progesterone withdrawal. Ethinyl estradiol 20–40 micrograms was used to lower serum FSH. Monitoring of follicle maturation was performed using sonography to determine follicle size and serum estradiol. Progesterone vaginal suppositories 200mg twice daily was used following demonstration of oocyte release from the follicle. No gonadotropins or clomiphene citrate was used. Results: Follicle maturation (as defined by a serum estradiol >200pg/mL and a dominant follicle >17 mm) and ovulation was achieved in 6 of 10 treatment cycles. A clinical pregnancy occurred in the ninth treatment cycle and an ongoing pregnancy past the first trimester wash achieved in cycle 10. In these 6 ovulatory cycles at least 1 (and usually 1) follicle of at least 18mm diameter was attained with the serum estradiol level >200 pg/mL. Conclusions: Despite small ovaries, amenorrhea, failure to have withdrawal menses following progesterone, absence of antral follicles on initial ultrasound and consistent extremely high serum FSH levels, ovulation and pregnancy was found to be possible by merely lowering the serum FSH. Possibly, the lowering of the FSH allows restoration of previous down-regulated FSH receptors allowing resumption of response to endogenous gonadotropins. This patient had been given an extremely poor prognosis by several previous consulting reproductive endocrinologists who would only treat her if she considered donor oocytes which was against her religious beliefs.

Acquired hypogonadotropic hypogonadism presenting as decreased seminal volume

A 32-year-old man with decreased ejaculatory volume was found to have acquired hypogonadotropic hypogonadism. Initial evaluation demonstrated castrate levels of testosterone with low serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Semen analysis revealed a volume of 0.35 cc and severe oligospermia. Administration of gonadotropin-releasing hormone (GnRH) did not effect an increase in LH or FSH, indicating a pituitary defect. Magnetic resonance imaging revealed a partially empty sella turcica. Treatment with human chorionic gonadotropin (hCG) alone resulted in normalization of testosterone levels, sperm concentration, and semen volume, as well as the successful conception and delivery of a healthy baby girl. The findings from this case demonstrate the importance of considering low serum testosterone levels in the evaluation of low semen volume, as well as the role of hCG alone as an infertility treatment for acquired hypogonadotropic hypogonadism.

PRETREATMENT FOLLICLE-STIMULATING HORMONE: A PROGNOSTIC SERUM MARKER OF SPERMATOGENESIS STATUS IN PATIENTS TREATED FOR GERM CELL CANCER

Purpose We evaluate the use of pretreatment follicle-stimulating hormone (FSH) in patients with germ cell tumors as a prognostic serum marker of spermatogenesis after standard treatment. Additionally, Leydig cell function was investigated by estimation of luteinizing hormone (LH) and testosterone (T), and calculation of the T/LH ratio. Materials and Methods Serum FSH, LH and T were determined radioimmunologically associated with semen analyses in 20 patients with seminoma (pathological stages IA to IIB) after unilateral orchiectomy before and up to 24 months after infradiaphragmatic radiotherapy. Additionally, hormone analyses were performed in 18 patients with nonseminomatous germ cell tumor (pathological stages IIA to C) before and up to 36 months after standard cisplatin based chemotherapy. Results Seminoma patients undergoing radiotherapy were divided into 2 groups consisting of 12 patients with normal pretreatment serum FSH and 8 with elevated FSH reflecting spermatogenesis deficits even before treatment. Six months after irradiation a significant increase in FSH (p <0.01) associated with a decrease in sperm density was observed in both groups and 24 months after radiotherapy patients with initially normal FSH had significantly lower serum FSH (p <0.01) associated with higher sperm density than those with initially elevated FSH (p <0.01), indicating less impairment of Sertoli cell function. Comparable results were observed in chemotherapy treated germ cell tumor patients with initially normal (11) and elevated serum FSH (7), respectively, and 36 months after chemotherapy patients with initially normal FSH had significantly lower FSH concentrations than those with initially elevated FSH (p <0.01). Compensated impairment of Leydig cell function reflected by a subnormal T/LH ratio was evident before chemotherapy in 16.7% of patients increasing up to 41.2% 36 months after therapy. In contrast, 24 months after radiotherapy only 25% of seminoma patients showed a subnormal ratio reflecting less damage to the Leydig cells caused by irradiation. Conclusions Pretreatment FSH is a prognostic serum marker of spermatogenesis status of germ cell tumor patients receiving standard radiotherapy or chemotherapy. In contrast to seminoma patients after radiotherapy, impairment of Leydig cell function was evident in germ cell tumor patients after cisplatin based chemotherapy.

Inappropriately low levels of gonadotrophins in amenorrhoeic women with alcoholic and non-alcoholic cirrhosis

We investigated a group of 111 amenorrhoeic females with associated liver disease. These comprised alcoholic cirrhotics (N = 38), non-alcoholic cirrhotics (N = 12), non-cirrhotic alcoholics (N = 21) and those suffering from other chronic liver diseases (N = 40) admitted to our medical department from 1986 to 1991. The serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), oestradiol, testosterone, sex hormone binding globulin (SHBG) and prolactin were measured. Serum LH was decreased below the normal range in 50% of patients with alcoholic cirrhosis and in 42% of patients with non-alcoholic cirrhosis. One third of non-cirrhotic alcoholics also had decreased LH, in contrast to only 8% of patients with other chronic liver diseases (p < 0.01). A close correlation was found between LH and FSH when all patients were pooled (r = 0.91, p < 0.001). A gonadotrophin-releasing hormone (GnRH) injection elicited a clear LH and FSH response in 11 out of 14 patients with cirrhosis, indicating that the hypothalamus rather than the pituitary is the site of disturbance in gonadotrophin secretion. Serum SHBG was within normal limits and similar in all four groups. In nine females with alcoholic cirrhosis who abstained for 3 months, serum SHBG increased significantly from 39 +/- 18 to 70 +/- 25 nmol/l (p < 0.001), while LH increased in five of nine females and was unchanged in four. In conclusion, half of the amenorrhoeic females with alcoholic as well as non-alcoholic cirrhosis had inappropriately low serum LH and FSH levels, indicating dysfunction of the hypothalamo-pituitary axis.(ABSTRACT TRUNCATED AT 250 WORDS)