Mean LH Levels Research Articles

Cytogenetic analysis and endocrine profile in patients with nonobstructive azoospermia or severe oligozoospermia

ObjectiveTo study the prevalence of chromosomal anomalies in infertile males with severe oligozoospermia or non obstructive azospermia and its correlation with clinical and endocrine profile. Patients and methodsConsecutive 30 male subjects (mean age 35.5 ± 7.1 years) with primary infertility attending at the infertility clinic, Urology department, Suez Canal University Hospital, Egypt were enrolled in the study. These patients had severe oligozoospermia (n = 9) or non obstructive azospermia (n = 21). Clinically testicular volume, scrotal Doppler ultrasound examination and endocrine evaluation (serum FSH, testosterone and prolactin) were determined. Cytogenetic analysis was performed by using the GTG (G-banded using trypsin and Giemsa) banding technique. ResultsNine patients (30%) had chromosomal abnormality. Patients with Klinefelter Syndrome and de la Chapelle male syndrome represented 26.7% (n = 8) and 3.3% (n = 1) respectively. All patients diagnosed as Klinefelter group were azoospermic, while 57.1% of normal karyotyping were azoospermic and 42.9% were severe oligozoospermic (p = 0.029). Klinefelter group had significantly lower mean testosterone level than normal karyotyping group (p = 0.016). Also, Klinefelter group had significantly higher mean FSH and LH levels than normal karyotyping group (p < 0.01). The anomaly detected was 47, XXY chromosomal constitution, found in 8 (38%) out of 21 patients with non-obstructive azoospermia. ConclusionThere is a high prevalence of chromosomal abnormalities in infertile males with non obstructive azoospermia. All patients with azoospermia and severe oligozoospermia (sperm count <5 million/ml) should undergo genetic screening. Our study indicates that even those presenting to infertility clinics can be heterogeneous in terms of karyotype and phenotype.

Temperature effect on luteinizing hormone secretion of Eurasian Skylark (Alauda arvensis) and Great Tit (Parus major) in China

BackgroundGlobal warming caused trophic mismatch has affected the breeding success, and even the survival, of some bird species. The ability of birds to accelerate their reproduction onset in the warmer spring could be critical to the survival of some species. The activation of the reproductive endocrine axis in birds is a key physiological process that determines the onset of reproduction. Could birds change the HPG axis endocrine rhythm under the temperature rising condition?MethodsUsing plasma LH level as an indicator of initiation of the reproductive endocrine and artificially controlling temperature, we compared variations in the timing of activation of the reproductive endocrine axis in response to temperature in two Chinese bird species, the Eurasian Skylark (Alauda arvensis) and the Great Tit (Parus major) at both the population and individual levels.ResultsAt the population level, temperature only significantly influenced LH level in the Eurasian Skylark, and had no significant effect on the LH levels in the Great Tit. Mean LH level of Eurasian Skylarks in the 20 °C group was higher than that of those in the 15 °C group throughout the experiment. Large individual variations in the timing of peak LH levels were observed in the high and the low temperature groups of both Eurasian Skylarks and Great Tits.ConclusionsThese results indicate that the effects of temperature differ among species. Meanwhile, there appears to be a degree of within population polymorphism in the timing of reproductive endocrine axis activation in some species. This polymorphism could provide the variation required for bird populations to cope with the possible change of their food peak under the climate warming condition.

Progestin-primed ovarian stimulation with or without clomiphene citrate supplementation in normal ovulatory women undergoing in vitro fertilization/intracytoplasmic sperm injection: A prospective randomized controlled trial.

To compare the endocrinological profiles, cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) with or without clomiphene citrate (CC) supplementation in normal ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Prospective randomized controlled study. A total of 320 infertile women undergoing IVF/ICSI. Medroxyprogesterone acetate (MPA) and human menopausal gonadotropin (hMG) were simultaneously administered on menstrual cycle day 3. The women were randomized into 2 equal groups with or without CC supplementation. The primary outcome measure was the percentage of women with profound pituitary suppression (luteinizing hormone [LH]<1.0IU/L on the trigger day). The secondary outcomes were endocrinological profiles, cycle characteristics and pregnancy outcomes. The percentage of women with profound pituitary suppression was significantly lower in the study group (hMG+MPA+CC) than in the control group (hMG+MPA) (1.9% vs 33.1%, P<.001). The mean LH level during controlled ovarian stimulation (COS) was higher in the study group than in the control group (P<.001), but none of the patients in either group exhibited a premature LH surge. The doses of Gn in the study group were significantly lower than those in the control group (1334.06±212.53IU vs 1488.28±325.08IU, P<.001). The number of oocytes retrieved was similar between the 2 groups (10.03±5.97 vs 10.34±7.52, P>.05). No significant differences were observed in either the number of viable embryos or the pregnancy outcomes between the 2 groups. Clomiphene citrate is an effective adjuvant to alleviate pituitary suppression in the PPOS protocol; however, it has no impact on clinical outcomes.

New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles.

Can dydrogesterone (DYG) be used as an alternative progestin in a progesterone primed ovarian stimulation (PPOS) protocol? DYG can be used as an appropriate alternative progestin in a PPOS protocol. PPOS is a new ovarian stimulation regimen based on a freeze-all strategy that uses progestin as an alternative to a GnRH analog for suppressing a premature LH surge during the follicular phase. Medroxyprogesterone acetate (MPA) has been successfully used as an adjuvant to gonadotrophin in the PPOS protocol. However, the use of MPA may lead to stronger pituitary suppression and thus may require a higher dosage of hMG and a longer duration of ovarian stimulation than that of conventional ovarian stimulation protocol. A prospective RCT including 516 patients was performed between November 2015 and November 2016. Computerized randomization was conducted to assign participants at a 1:1 ratio into two treatment groups: an hMG + DYG group (260 patients) or an hMG + MPA group (256 patients) followed by IVF or ICSI with the freeze-all strategy. One cycle per patient was included. The primary outcome of the trial was the number of oocytes retrieved. The sample size was chosen to detect a difference of two oocytes with a power of 90%. Patients under 36 years of age with normal ovarian reserve who were undergoing their first IVF/ICSI procedure due to tubal factor infertility were randomized into two groups based on the oral progestin protocol used: hMG co-treatment with DYG (hMG + DYG) or hMG co-treatment with MPA (hMG + MPA). The different progestin was simultaneously administered at the beginning of menstrual cycle 3 (MC3). Oocyte maturation was co-triggered by administration of a GnRH agonist and hCG. All viable embryos from both protocols were cryopreserved for later transfer. Only the first frozen embryo transfer (FET) cycle was included in our study. The embryological and clinical outcomes were measured. Basic characteristics, such as age, BMI and infertility duration, in both groups were comparable. There was no significant difference in the number (mean ± SD) of oocytes retrieved [10.8 ± 6.3 for the hMG + DYG group versus 11.1 ± 5.8 for the hMG + MPA group, P = 0.33] or the oocyte retrieval rate [74.3 ± 19.6% for the hMG + DYG group versus 75.0 ± 19.5% for the hMG + MPA group, P = 0.69] between the groups. The viable embryo rate per oocyte retrieved did not differ between the two groups [odds ratio (OR): 1.08, 95% CI: 0.97-1.21, P = 0.16]: 37.4% (1052/2815) for the hMG + DYG group versus 35.6% (1009/2837) for the hMG + MPA group. During the whole process of ovarian stimulation, the mean LH level in the hMG + DYG group was always higher than that in the hMG + MPA group (P < 0.001); however, no patient from either group experienced a premature LH surge. In addition, no patients experienced moderate or severe ovarian hyperstimulation syndrome during the ovarian stimulation. No significant difference was found in the clinical pregnancy rate of the first FET cycle between the two groups (OR: 0.82, 95% CI: 0.56-1.21, P = 0.33): 57.6% for the hMG + DYG group (125/217) versus 62.3% for the hMG + MPA group (132/212). The patients and physician were not blinded to the study. Further, a large proportion of patients were still pregnant at the end of the clinical trial, therefore live birth rates were not observed in the follow-up period. The dose-effectiveness of DYG administration was not addressed in the trial design. DYG, which exhibits no or only weak inhibition of ovulation in normal dosage, can serve as an hMG adjuvant during ovarian stimulation. This finding suggests the possibility of a new application of DYG: as an appropriate alternative progestin for a PPOS protocol in IVF. This work was supported by The National Nature Science Foundation of China (Grant no. 81503603), Shanghai Three-year Plan on Promoting TCM Development (Grant no. ZY3-LCPT-2-2006) and the Natural Science Foundation of Shanghai (Grant nos. 15401932700 and 15ZR1424900). None of the authors declare any conflict of interest. Chictr.org.cn: ChiCTR-IPR-15007251. Chictr.org.cn: 22 October 2015. 1 November 2015.

P278 The EEG alpha response is affected by changes in sex hormone levels in two phases of menstrual cycle

Objectives It is known that sex hormones affect the brain in women. However, there are not enough studies that explain the relationship between sex hormone fluctuations during menstrual cycle and brain waves. Our aim in this study is to show the effects of sex hormone fluctuations on the EEG alpha response in menstrual phase and follicular phase. Methods EEG recordings on resting state was performed in 11 healthy volunteer women in two different phases (menstrual and follicular). The alpha power values were analyzed by artifact-free 45 epochs lasting 2 s. Blood samples of volunteers were drawn simultaneously and estradiol, progesterone, FSH and LH were analyzed with electrochemiluminesence immunoassay method. The assessment of alpha power values and its relationship with hormone levels were performed in two phases of menstrual cycle. Results The highest difference between the mean power value in the menstrual phase (46.06) and the follicular phase (36.08) was obtained from the parietal region of the brain. At the same time, the lowest difference between the mean power value (41.06) in the menstrual phase and the follicular phase (39.37) was obtained from the occipital region of the brain. Estrodiol, progesterone, FSH, LH mean levels were 30.2 pg/ml; 0.17 ng/ml; 6.7 mIU/ml; 5.43 mIU/ml in the menstrual cycle and 123.9 pg/ml; 0.23 ng/ml; 7.3 mIU/ml; 17.12 mIU/ml in the follicular phase, respectively. Conclusion We found that increased estradiol levels in response to the elevation of LH levels in blood during follicular phase resulted in a decrease in the power of the alpha waves from the parietal region. Sex hormone fluctuations in menstrual cycle has minimal effect on the EEG alpha response in occipital region.

Polycystic ovarian syndrome in patients with schizophrenia treated with atypical anti-psychotics: A case control study

ObjectiveObjective was to compare the prevalence of probable polycystic ovarian syndrome (PCOS) in females treated with atypical anti-psychotics with normal controls.AimsTo compare the prevalence of PCOS in patients treated with atypical anti-psychotics and normal controls. To study the hormone profiles in these two groups.MethodsCases consisted of 102 reproductive age females with schizophrenia treated with atypical anti-psychotics for ≥6 months and had gained ≥10% body weight. Control group was 123 age and BMI matched females. Menstrual history, physical examination for hirsuitism, acne, androgenic alopecia, anthropometrics measures, Ultrasound abdomen and hormone analysis were done.ResultsMean age of cases = 33.17 years (SD 8.9) and controls = 33.08 years (SD 5.6). Mean BMI of cases = 25.92 (SD 5.2) and controls = 25.03 (SD 4.3). Polycystic ovarian morphology of ovaries on ultra sound scan was significantly more in cases 49 (48%) than controls 16 (13.%) (P &lt; 0.001). Probable PCOS was significantly more in atypical anti-psychotic treated females (n = 22, 21.56%) than in normal controls (n = 10, 8.13%) (P = 0.04). Atypical anti-psychotic treated patients with PCOS had significantly lower mean LH levels 6.69 mIU/L than those without PCOS 10.30 (P = 0.35). There was no significant difference in testosterone, FSH, prolactin, TSH and free T4 levels.ConclusionTreatment with atypical anti-psychotics is associated with higher prevalence of PCOS. This has not been reported previously. The hormonal profile in these patients may be different with low testosterone and LH levels.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of FSH, LH ,Testosterone , Prolactine, TSH and T4 hormones levels in different subgroups of infertile males.

Gonadotropins (FSH, LH) and testosterone are the prime regulators of germ cell development. Abnormal spermatogenesis is often associated with altered serum gonadotropins and testosterone. the potential relationship between other hormones, including thyroid hormones, and semen quality are still not completely understood. Thus in the present study an attempt has been made to report the degree of associations between thyroid hormones and semen quality. FSH, LH .T. PRL.T4 and TSH.hormones levels were estimated in 39 infertile men of whom 5 were azoospermia, 13 were oligozoospermic, 21 were with asthenzoospermia . Results showed statistically significant differences(P≤ 0.05) in the mean FSH, Testosteron (T.), PRL. And T4. Levels in all the infertile males studied when compared with the fertile controls (n=39). However, there is no significant difference in the mean levels of LH and TSH between the infertile and fertile men. Present study found that though men with abnormal semen profile had slightly higher in T4 concentrations in asthenozoospermia group as compared to those with normal semen profile. This study also show positive correlation between T4 and T. ( R2=0.408) and negative correlation between T4 and FSH was (R2=-0.515) ,T4 and LH was (R2=-0.345).

Oestrogen receptors beta genotype in infertile Egyptian men with nonobstructive azoospermia.

In a prospective study, the polymorphism of oestrogen receptor β gene was investigated in nonobstructive azoospermia patients. Ninety infertile patients with nonobstructive azoospermia diagnosed after two semen analysis, 2weeks apart and negative testicular sperm extraction during intracytoplasmic sperm injection, and 60 fertile men as controls were enrolled in the study. Semen analysis, hormonal profile and allele-specific PCR reaction were performed to detect variants of the RsaI polymorphism of the oestrogen receptor β gene for all patients and controls. The mean patient's age was significantly lower than the mean age of the controls (P<0.05). There was a significant increase in the mean serum levels of FSH, LH, free testosterone and E2 and significant decrease in total testosterone in patients than controls (P<0.05). In the patients, the frequency of the homozygous GG, heterozygous AG and homozygous AA genotype was 83.3%, 14.3% and 3.3% respectively, whereas their frequencies in the controls were 95%, 5% and 0% respectively (odds ratio 3.8). There is no significant correlation between ERß polymorphisms and patient's age or pituitary and sex hormones (P>0.05). Our findings suggested that in Egyptian population, genetic mutation in ERß is associated with the risk of nonobstructive azoospermia.

Effects of estradiol benzoate injection to intact and castrated male rabbits on LH, FSH, testeosterone and prostate tissues

Objective: This study was conducted to investigate the effects of estradiol benzoate injection to intact and castrated male rabbits on LH, FSH, testosterone and prostate tissue. Materials and methods: A total of 72 mature male rabbits were used in this study. The rabbits were randomly divided into two groups (36 intact and 36 castrated) and each group was further divided into four sub-groups. The rabbits of each subgroup were injected estradiol benzoate dosed at 0, 40, 80 and 120 µgm/rabbit, through intramuscular (IM) route, on each alternative day over a period of 30 days. The levels of LH, FSH, and testosterone were measured in serum samples. Prostate tissue samples were taken from each sub-groups, histological examination was done. Results: The mean serum levels of LH and FSH were not affected by injection of estradiol benzoate in all intact and castrated rabbits sub-groups (P>0.05). However, the results of testosterone levels were showed insignificant increase in all intact and castrated male rabbits sub-groups, except the intact male rabbit sub-group that received estradiol benzoate at 120 µg/rabbit (P

여성의 혈중 남성호르몬 수치와 성기능 장애의 상관관계 연구

Introduction and Aim. Sex hormones might induce significant changes in sexual desire, arousal, orgasm, and satisfaction. Decreased sexual desire and sexual dysfunctions in females have been associated with low levels of androgen. This study was to explore the relationship of sex hormones and sex hormone-binding globulin (SHBG) with female sexual dysfunction. Materials and Methods. Seventy-four women with sexual dysfunction were taken their medical history, personal history and physical examination. A self-reporting questionnaire on sexual problems and satisfaction was administered to them. Also levels of total, free, and bio-available testosterone, LH, FSH, estradiol, DHEAS and SHBG were measured, and free androgen index were calculated. Using Wilcoxon rank-sum test, the hormone levels of the sexual dysfunction groups were compared to those of control group. Nine patients were treated by testogel®. Results. The mean levels of LH, FSH, DHEA and DHEAS were lower in women with lack of sexual desire. The levels of DHEA was lower in the arousal disorder group (p&lt;.05) and lower in the orgasmic disorder group (p&lt;.01) than the control group. Sexual pain disorder groups showed lower estradiol level (p&lt;.05). Among the nine patients receiving testosterone replacement therapy by using testogel®, 4 patients reported that symptoms were improved subjectively, the other 4 patients had not significant change, and the remaining 1 patient stopped the therapy due to side effect. Conclusion. The findings supported the concept that sex hormones significantly affect sexual response in women with sexual dysfunction. An androgenic hormone profile was associated with lack of libido, orgasmic disorder, and estrogen with pain disorder.

Studying the Effect of LeutiniZing Hormone and Follicular Stimulating Hormone on Poly Cystic Ovary Syndrome in Married and in Non-married Women

Polycystic ovary syndrome (PCOS) is a common disorder in female during reproductive age. The aim of this study was to find out the correlation between LH, FSH hormone and LH: FSH ratio and polycystic ovary syndrome .The present study included 50 patients of polycystic ovary syndrome (25 married in age group ranged between 20-45 years and 25 unmarried women with age ranged between 15-18years) and a control group comprising of 30 women (15 married &amp; 15 unmarried) in the same age. Blood samples were aspirated from individual from 2nd – 5th day menstrual cycle (early follicular phase) for those of normal cycle while for patients with Polycystic ovary syndrome blood sample were collected regardless to the duration of the cycle to measure FSH, LH, and LH:FSH ratio by using ELISA methods The results of this study showed the mean levels of LH and LH/FSH ratio significantly elevated in PCOS groups compared with normal groups in both married and unmarried women. We suggested that changes in the LH level and LH: FSH ratio has a role in polycystic ovarian syndrome.

Comparative study of gonadotropin levels and clinical presentation in surgical and natural menopause

Introduction: Menopause means complete stoppage of menses for last one year due to failure of follicular activities of the ovaries. This can be determined by the various hormones secreted by ovary such as LH and FSH. As these hormones are responsible for normal maintenance of basic ovarian function in reproductive life; there occurs considerable alteration in their levels in menopause. Aims and Objectives :- 1] To study and compare ovarian function by determining levels of LH and FSH in Surgical and Natural menopause. 2] To study and compare ovarian function in Surgical and Natural menopause. Brief Methodology: - Case study: - 50 women with surgical menopause between 45 – 50 years of age. Control study: - 50 women with natural menopause between 45 – 50 years of age. Material & Methodolgy :- Fasting serum samples of all women with surgical and natural menopause were analysed for LH and FSH on Immulite 1000 chemiluminiscence based analyser in special investigation lab. Summary of the Results :- Mean levels of LH and FSH were higher in surgical menopausal women as compared to natural menopausal women. Women in surgical menopause suffered from more vasomotor symptoms and cognitive decline as compared to women in natural menopause group.

Effect of systemic inflammation on level of ferritin seminal in chronic renal male patient undergoing hemodialysis.

BackgroundMost hemodialysis patients present with chronic systemic inflammation characterized by the elevation of serum C-reactive protein (CRP) levels and/or the production of proinflammatory interleukins by the immune system in response to the hemodialysis process. Plasma ferritin(PF) is one of the parameters used to correct anemia. An PF level of >500 ng/mL is not recommended for correction of anemia because of the uncertainty of whether these levels are elevated because of anemia or a mere reaction to inflammation. we aimed to study the effects of inflammation on seminal ferritin (SF) levels and hypothesized that SF is not affected because of the testicular immune privilege.MethodsA prospective prevalence study was conducted at the Department of Hemodialysis of the University Hospital of Brasília (HuB) between June 2010 and July 2011. The sample included 60 chronic renal patients undergoing hemodialysis and 20 control subjects from the health promotion general outpatient clinic. All participants were males aged 18–60 years. Inflammation was assessed through serum CRP levels, and the testicular condition was determined by measuring sex hormone levels. In the patient group, inflammation was considered to be present when CRP was >5 mg/L (n = 27) and absent when CRP was ≤5 mg/L (n = 33). Control group (n = 20) CRP was ≤1 mg/L. Blood and semen were collected via arm venoclysis and after voluntary masturbation, respectively. CRP was measured by turbidimetry; PF, SF, and sex hormone levels by immunochemoluminescence. Statistical significance was set at p < 0.05.ResultsThere was no significant difference in mean SF levels among patients with inflammation (295.34 ± 145.39 ng/mL), those without inflammation (324.42 ± 145.51 mg/mL), and controls (335.70 ± 075.90 ng/mL; p = 0.49). There was no correlation between mean SF and PF levels in the patients with and without inflammation). All participants were eugonadal with mean serum FSH, LH, and testosterone levels of 3.76 ± 2.17 mUI/mL, 7.00 ± 3.53 mUI/mL, and 454.18 ± 173.08 ng/dL, respectively.ConclusionSystemic inflammation did not significantly alter SF levels in eugonadal hemodialysis patients.

Biochemical Study of Gonad Hormones in Sera of Iraqi Patients with Thyroid Disorder

The objective of this study was to evaluate the alteration in levels of gonado trophins hormones i.e.,Leutizing (LH),Follicular(FSH) in sera of patients with thyroid disorders and molecular binding study of (LH ,FSH) with their antibodies The study was conducted at the specialized center for endocrinology and diabetes from January / 2009 to March / 2010.Two hundreds and twenty three Iraqi subjects, 109 patients with thyroid disorders at age range between (40-50) years and 114 healthy individuals as control group were included in this study.The majority of patients were female with hyperthyroidism and (49.54 % ) were at age range between(40 - 50) years. The levels of hormones(LH,FSH.tri iodothyronine(T3).thyroxine(T4), thyroid stimulating hormoneTSH) were measured by using Enzyme Linked Flourscent Assay( ELFA, while residual studies used Immuno Raido Metric Assay(IRMA) method only.It was found that production of TSH was increased with about (15-20) fold in hyperthyroidism over that in control.Sixty percent of patients with hyperthyroidism were underweight BMI?20.0 (kg/m2) while (44.5%) of patients with hypothyroidism were overweight BMI( 25.0-29.9)kg/m2 . The mean level of LH and FSH had increased significantly (p

Biochemical Study of Gonad Hormones in Sera of Iraqi Patients with Thyroid Disorder

The objective of this study was to evaluate the alteration in levels of gonado trophins hormones i.e.,Leutizing (LH),Follicular(FSH) in sera of patients with thyroid disorders and molecular binding study of (LH ,FSH) with their antibodies The study was conducted at the specialized center for endocrinology and diabetes from January / 2009 to March / 2010.Two hundreds and twenty three Iraqi subjects, 109 patients with thyroid disorders at age range between (40-50) years and 114 healthy individuals as control group were included in this study.The majority of patients were female with hyperthyroidism and (49.54 % ) were at age range between(40 - 50) years. The levels of hormones(LH,FSH.tri iodothyronine(T3).thyroxine(T4), thyroid stimulating hormoneTSH) were measured by using Enzyme Linked Flourscent Assay( ELFA, while residual studies used Immuno Raido Metric Assay(IRMA) method only.It was found that production of TSH was increased with about (15-20) fold in hyperthyroidism over that in control.Sixty percent of patients with hyperthyroidism were underweight BMI?20.0 (kg/m2) while (44.5%) of patients with hypothyroidism were overweight BMI( 25.0-29.9)kg/m2 . The mean level of LH and FSH had increased significantly (p

Effect of royal jelly in ovo injection on embryonic growth, hatchability, and gonadotropin levels of pullet breeder chicks

The objectives of this study were to compare the following: (1) hatchability, (2) chicks' body and internal organs weights, and (3) plasma gonadotropin levels of hatchlings after in ovo administration of royal jelly (RJ) on Day 7 of incubation. Fertile eggs (n = 270) were injected into the air sac or yolk sac with 0.5 mL normal saline solution consisting of four formulations (normal saline solution with antibiotics, ultrafiltrate RJ, pure RJ, and RJ with antibiotics). The eggs were randomly divided into nine groups of 30 eggs each: (i) C: the control eggs received no injection, (ii) ASA: air sac–injected eggs received normal saline solution with antibiotics, (iii) ARJ: air sac–injected eggs received pure RJ, (iv) ARJA: air sac–injected eggs received RJ with antibiotics, (v) ARJF: air sac–injected eggs received RJ ultrafiltrate solution, (vi) YSA: yolk sac–injected eggs received normal saline solution with antibiotics, and (vii) YRJ: yolk sac–injected eggs received pure RJ, (viii) YRJA: yolk sac–injected eggs received RJ with antibiotics, and (ix) YRJF: yolk sac–injected eggs received ultrafiltrate RJ solution. Hatchability rate was lower in ARJ (46.7%), ARJA (43.3%), ARJF (43.3%), and YRJF (46.7%) groups than in the control (80.0%; P < 0.05). Hatchability rate in ASA (70.0%), YSA (66.7%), YRJ (66.7%), and YRJA (63.3%) groups were comparable to the control (P > 0.05). In ovo injection of RJ and or RJ with antibiotics in both sacs increased chicks’ body weight (CWT), heart weight (HWT), and liver weight (LWT) and FSH and LH levels compared with control (P < 0.05). CWT in YRJ (37.02 g), YRJA (37.03 g), ARJ (36.82 g), and ARJA (36.89 g) groups were higher than control (34.9 g; P < 0.05). Similarly, HWT significantly increased in YRJ (0.22 g), YRJA (0.21 g), ARJ (0.20 g), and ARJA (0.20 g) in comparison to control (0.18 g; P < 0.05). In addition, LWT were higher in YRJ (0.83 g), YRJA (0.82g), ARJ (0.81g), and ARJA (0.81g) than control (0.72 g; P < 0.05). Six hours post-hatch, the mean plasma FSH and LH levels in ARJ (1.13 and 2.80 mIu/mL), YRJ (1.32 and 3.36 mIu/mL), ARJA (1.23 and 2.95 mIu/mL), and YRJA (1.31 and 3.28 mIu/mL) groups were higher than in the control (0.56 and 1.48 mIu/mL, P < 0.05). We concluded that in ovo administration of RJ or RJ with antibiotics might be an effective method to increase CWT, chicks' internal organs weights, and LH and FSH secretion rate without deleterious effect on hatchability. However, further research should be conducted to determine the putative endocrine disruptive effects of RJ and its byproducts.

1901 DEFINING THE UTILITY OF A CLINICAL CARE PATHWAY FOR CLOMIPHENE CITRATE USE IN MEN WITH HYPOGONADISM

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131901 DEFINING THE UTILITY OF A CLINICAL CARE PATHWAY FOR CLOMIPHENE CITRATE USE IN MEN WITH HYPOGONADISM Clarisse R. Mazzola, Darren J. Katz, and John P. Mulhall Clarisse R. MazzolaClarisse R. Mazzola New York City, NY More articles by this author , Darren J. KatzDarren J. Katz New York City, NY More articles by this author , and John P. MulhallJohn P. Mulhall New York City, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2320AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clomiphene citrate (CC) is an effective treatment for men with hypogonadism (HG). For fear of tachyphylaxis, many clinicians commence CC at low dose and some dose every other day rather than daily. This analysis was undertaken to define if up-titrating dose in men failing to respond to low dose CC is an effective therapeutic approach. METHODS Men with a diagnosis of HG (defined by having 2 separate early morning total T (TT) levels <300 ng/dl) opting for CC therapy constituted the study population. Demographic, comorbidity data, physical and laboratory characteristics were recorded. All patients were started on CC 25 every other day (QOD) and were up-titrated to 50mgs QOD and then eventually 50 mgs daily (QD) if the original dose strategy failed. Laboratory testing was conducted 4 weeks after commencement, 4 weeks after a dose change and every six months thereafter. Response was defined as an increase of ≥200 ng/dl in TT and a TT level ≥400 ng/dl at ≥6 months after commencing CC. ANOVA was conducted comparing TT and LH levels among the three dosing groups. Multivariable analysis was performed on patients failing to respond to CC25 QOD to define predictors of successful response to higher doses. Parameters included in the multivariable model were: patient age, mean testicular volume, varicocele presence, baseline TT, free T and LH levels. RESULTS 112 patients were included with a mean age = 45±19 years. Mean pre-treatment testicular volume = 16±8 mls. Mean baseline T and LH levels were 222±98 ng/dl and 3.8±1.6 (0.1-5.8) IU/ml. On CC25 QOD, 71/112 (63%) patients met the responder definition (TT = 467±190 ng/dl, LH = 12.4±3.6). Of the 41 who were up-titrated to C50 QOD, 32% (13) met the responder definition (TT = 414±212 ng/dl, LH = 8.2±5.2). Of the 28 moving to CC50 QD, 18% (5) met responder definition (TT = 366±166 ng/dl, LH = 7.0±1.6; ANOVA p=0.033 for TT, p=0.025 for LH). On multivariable analysis, the only factors predictive of response to up-titrating CC were: pre-treatment LH level (r=0.51, p<0.01) and pre-treatment LH level ≤6 IU/ml (RR 2.1, p<0.01). CONCLUSIONS These data confirm that about two thirds of men with HG meet a robust responder definition using CC25mgs QOD. Up-titrating permitted 44% of patients not responding to CC25 QOD to meet the responder definition. We believe these data support starting CC at low dose and up-titrating when appropriate giving patients realistic expectations when the latter is necessary. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e779 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clarisse R. Mazzola New York City, NY More articles by this author Darren J. Katz New York City, NY More articles by this author John P. Mulhall New York City, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of the prostaglandin synthase-2 inhibitor celecoxib on ovulation and luteal events in women

BackgroundOvarian prostaglandins are critical in normal ovulation processes; thus, their inhibition may provide contraceptive benefits. This study was performed to determine the effect of the cyclooxygenase-2 (COX2) inhibitor celecoxib on ovulation and luteal events in women. Study DesignThe study had a randomized, double-blind, crossover design. Ovulatory, reproductive-aged women underwent ovarian ultrasound and serum hormone monitoring during four menstrual cycles (control cycle, treatment cycle 1, washout cycle, treatment cycle 2). Subjects received study drug (oral celecoxib 400 mg or placebo) either (a) once daily starting on cycle day 8 and continuing until follicle rupture or the onset of next menses if follicle rupture did not occur [pre-luteinizing hormone (LH) surge dosing] or (b) once daily beginning with the LH surge and continuing for 6 days (post-LH surge dosing). Subjects were randomly assigned to one of the above treatment schemes and received the other in the subsequent treatment cycle. The main outcomes were evidence of ovulatory and luteal dysfunction as determined by inhibited/delayed follicle rupture and reduced luteal progesterone synthesis or lifespan, respectively. ResultsA total of 20 women enrolled and completed the study (Group 1=10, Group 2=10), with similar demographics between groups. Nineteen subjects exhibited normal ovulation in the control cycle (one had a blunted LH peak). In comparison to control cycles, treatment cycles resulted in a significant increase in ovulatory dysfunction [pre-LH treatment: 30% (6/20), p=.04; post-LH treatment: 25% (5/20), p=.04]. Mean peak progesterone, estradiol, and LH levels and luteal phase length did not differ significantly between control and either treatment cycle. ConclusionsAlthough treatment with celecoxib before or after the LH surge increases the rate of ovulatory dysfunction, most women ovulate normally. Thus, this selective COX2 inhibitor appears to be of limited usefulness as a potential emergency contraceptive.

Influence of hormonal control on LH pulsatility and secretion in women with classical congenital adrenal hyperplasia

Women with classical congenital adrenal hyperplasia (CAH) exhibit reduced fertility due to several factors including anovulation. This has been attributed to a disturbed gonadotropic axis as in polycystic ovary syndrome (PCOS), but there is no precise evaluation. Our aim was to evaluate the gonadotropic axis and LH pulsatility patterns and to determine factor(s) that could account for the potential abnormality of LH pulsatility. Case/control study. Sixteen CAH women (11 with the salt-wasting form and five with the simple virilizing form), aged from 18 to 40 years, and 16 age-matched women, with regular menstrual cycles (28 ± 3 days), were included. LH pulse patterns over 6 h were determined in patients and controls. No differences were observed between patients and controls in terms of mean LH levels, LH pulse amplitude, or LH frequency. In CAH patients, LH pulsatility patterns were heterogeneous, leading us to perform a clustering analysis of LH data, resulting in a two-cluster partition. Patients in cluster 1 had similar LH pulsatility patterns to the controls. Patients in cluster 2 had: lower LH pulse amplitude and frequency and presented menstrual cycle disturbances more frequently; higher 17-OH progesterone, testosterone, progesterone, and androstenedione levels; and lower FSH levels. LH pulsatility may be normal in CAH women well controlled by hormonal treatment. Undertreatment is responsible for hypogonadotropic hypogonadism, with low LH pulse levels and frequency, but not PCOS. Suppression of progesterone and androgen concentrations during the follicular phase of the menstrual cycle should be a major objective in these patients.

The impact of serum FSH and estradiol on postmenopausal osteoporosis related to time since menopause

Aim: To determine the impact on osteopenia/osteoporosis of serum follicle-stimulating hormone (FSH), estradiol levels and time since menopause in a group of Turkish postmenopausal women. Methods: Four hundred and thirty-three healthy postmenopausal women seen at the Marmara University Menopause Outpatient Clinic were enrolled for this prospective cohort study. The women were allocated to one of three groups according to the bone mineral density (BMD) of the lumbar vertebrae and total hip, as measured by dual energy X-ray absorptiometry (DEXA). Serum FSH, estradiol levels, age and time since menopause were compared between the groups. Results: The mean serum FSH, LH, estradiol and testosterone levels for women with normal, osteopenic and osteoporotic BMD at lumbar vertrebra L1-L4 and total hip were comparable. Time since menopause had a stronger predictive value for low BMD (osteopenia or osteoporosis) in the lumbar and hip areas than did serum FSH or estradiol levels. Conclusions: Our study showed that neither FSH nor E2 has a strong impact on postmenopausal BMD. However it appears that time since menopause has a weak non-significant association with postmenopausal osteopenia and osteoporosis.