Follicle-stimulating Hormone Measurements Research Articles

Weak evidence of bright light effects on human LH and FSH

BackgroundMost mammals are seasonal breeders whose gonads grow to anticipate reproduction in the spring and summer. As day length increases, secretion increases for two gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH). This response is largely controlled by light. Light effects on gonadotropins are mediated through effects on the suprachiasmatic nucleus and responses of the circadian system. There is some evidence that seasonal breeding in humans is regulated by similar mechanisms, and that light stimulates LH secretion, but primate responses seem complex.MethodsTo gain further information on effects of bright light on LH and FSH secretion in humans, we analyzed urine samples collected in three experiments conducted for other goals. First, volunteers ages 18-30 years and 60-75 commenced an ultra-short 90-min sleep-wake cycle, during which they were exposed to 3000 lux light for 3 hours at balanced times of day, repeated for 3 days. Urine samples were assayed to explore any LH phase response curve. Second, depressed participants 60-79 years of age were treated with bright light or dim placebo light for 28 days, with measurements of urinary LH and FSH before and after treatment. Third, women of ages 20-45 years with premenstrual dysphoric disorder (PMDD) were treated to one 3-hour exposure of morning light, measuring LH and FSH in urine before and after the treatments.ResultsTwo of the three studies showed significant increases in LH after light treatment, and FSH also tended to increase, but there were no significant contrasts with parallel placebo treatments and no significant time-of-day treatment effects.ConclusionsThese results gave some support for the hypothesis that bright light may augment LH secretion. Longer-duration studies may be needed to clarify the effects of light on human LH and FSH.

Comparing Serum Follicle-Stimulating Hormone (FSH) Level with Vaginal PH in Women with Menopausal Symptoms

Despite the important implication for women's health and reproduction, very few studies have focused on vaginal PH for menopausal diagnosis. Recent studies have suggested vaginal PH as a simple, noninvasive and inexpensive method for this purpose. The aim of this study is to compare serum FSH level with vaginal PH in menopause. This is a cross-sectional, descriptive study, conducted on 103 women (aged 31-95 yrs) with menopausal symptoms who were referred to the Menopausal Clinic at Ghaem Hospital during 2006. Vaginal pH was measured using pH meter strips and serum FSH levels were measured using immunoassay methods. The data was analyzed using SPSS software (version 11.5) and results were evaluated statistically by the Chi-square and Kappa tests. p≤0.05 was considered statistically significant. According to this study, in the absence of vaginal infection, the average vaginal pH in these 103 menopausal women was 5.33±0.53. If the menopausal hallmark was considered as vaginal pH>4.5, and serum FSH as ≥20 mIU/ml, then the sensitivity of vaginal pH for menopausal diagnosis was 97%. The mean of FSH levels in this population was 80.79 mIU/ml. Vaginal pH is a simple, accurate, and cost effective tool that can be suggested as a suitable alternative to serum FSH measurement for the diagnosis of menopause.

Ovarian ablation by radiation therapy: Is it still an option for the ablation of ovarian function in endocrine responsive premenopausal breast cancer patients?

Surgical or medical ovarian ablation is likely to be the treatment of choice at the current time, radiation ablation (RA) can be still a reasonable alternative. The efficacy and toxicity of radiation therapy (RT) for ovarian function suppression in 118 premenopausal breast cancer patients were retrospectively evaluated. The median age was 39 years (range 21–52 years). RT was given with either Co-60 or 15MV photons of the linear accelerator. The median total dose was 15Gy in 4 consecutive fractions (range 5Gy single fraction–36Gy in 18 fractions over 3.5 weeks). The endpoint for treatment efficacy was menstrual status. Amenorrhea was noted in 113 of 118 patients (96%) in 6 months following RA. Five patients (4%) who had still normal menstrual functioning after 6 months of RA underwent estradiol and follicle stimulating hormone measurements and were found to have premenopausal levels. No acute Grade 3 or 4 (according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria) toxicities were noted. With a median follow-up of 24.5 months (range: 6–167), no late severe complications that could be attributable to RT were reported. RA should be considered as an option for endocrine responsive premenopausal breast cancer patients and can be easily delivered when postoperative or palliative irradiation is given.

Ovarian ablation by radiotherapy; is it still an option for the ovarian function suppression in endocrine responsive premenopausal breast cancer patients?.

Abstract Abstract #5137 Background; Although surgical or medical ovarian ablation is likely to be the treatment of choice at the current time, radiation ablation (RA) can be still a resonable alternative. Data regarding the use of pelvic radiotherapy (RT) for ovarian ablation is very limited and in 10thSt Gallen consensus meeting, ovarian radiation was overwhelmingly rejected. In this retrospective study we evaluated the efficacy of RT for ovarian function suppression in 118 premenopausal breast cancer patients.
 Materials and Methods; 153 breast cancer patients had RA between the years 1979 and 2002 at the single center where this study was performed. 19 patients who received chemotherapy within 12 months of RA, and 16 patients who were lost to follow-up within 6 months following RA, were not included into the analyses. All patients were premenopausal and the median age at the initiation of RA was 39 years (range, 21- 52 years). 96 of 118 patients (82%) underwent RA for metastatic disease, 17 patients (14%) received RA as the systemic treatment after locoregional recurrences and 5 patients (4%) had RA as an adjuvant treatment. 97 patients (82%) received only RA as their systemic treatment, 20 patients (17%) had RA with tamoxifen and one patient (1%) had RA with aromatase inhibitors. RT was given with either Co-60 or 15 MV photons of the linear accelerator. A modified pelvic volume was irradiated with opposing anterior and posterior fields, and the dose was prescribed to midplane. The median total dose used for RA was 15Gy in 4 fractions (range 5Gy single fraction-36Gy in 18 fractions).
 Results; As the efficacy of RA, data regarding the menstrual status were collected. Amenorrhea was noted in 113 of 118 patients (96%) in 6 months following RA. 88 patients (75%) experienced amenorrhea in 2 months after pelvic RT. 5 patients (4%) who had still normal menstrual functioning after 6 months of RA had estrodiol and follicle stimulating hormone measurements. As they were found to have premenopausal levels, 3 of them received surgical and 2 of them received medical ablation. No acute Grade 3 or 4 (according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria) toxicities were noted. With a median follow-up of 24,5 months (range; 6-167 months), no late severe complications that could be attributable to RT were reported. The total RT dose (more than 15Gy) were found to be significant on the rate of ovarian ablation with Mann Whithney U-test (p=0.02).
 Conclusion: Ovarian ablation was achieved with a rate of 96% without any major acute and late toxicity using pelvic RT. It should be considered as an option for endocrine responsive premenopausal breast cancer patients and can be easily delivered when postoperative or palliative irradiation is given. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5137.

尿および糞を用いたサル類の非侵襲的ホルモン測定法とその応用―Ｆｉｅｌｄ Ｅｎｄｏｃｒｉｎｏｌｏｇｙのすすめ―

Noninvasive methods for the measurement of estrone conjugates (E1C), pregnanediol-3-glucronide (PdG), testosterone (T), follicle stimulating hormone (FSH), monkey chorionic gonadotropin (mCG) and cortisol in excreta of non-human primates were described. In the series of studies, results suggest that 1) urinary and fecal steroid metabolites accurately reflected the same ovarian or testicular events as observed in plasma steroid profiles in captive Japanese macaques, time lags associated with fecal measurements were one day after appearance in urine; 2) these noninvasive methods were applicable to wild and free-ranging animals for determining reproductive status; 3) hormonal changes during menstrual cycles and pregnancy could be analyzed by measurement of FSH, CG and steroid metabolites in the excreta in captive great apes and macaques; and 4) hormone-behavior relationships of macaques in their natural habitats and social setting could be analyzed. In these studies, we confirmed an association between maternal rejection and excreted estrogen, but not excreted progesterone, for Japanese macaques. We also reported that significantly higher levels of fecal cortisol were observed in high-ranking male Japanese macaques. 5) A reliable non- instrumented enzyme-linked immunosorbent assay for detection of early pregnancy in macaques was established.These results suggest that the noninvasive methods for monitoring characteristics of excreted hormones provide a stress-free approach to the accurate evaluation of reproductive status in primates. These methods provide the opportunities for the study of hormone-behavior interactions in not only captive but also wild and free-ranging animal species.

The Menopausal Transition—Endocrinology

The Melbourne Women's MidLife Health Project (MWMHP) and related studies have yielded valuable information regarding the endocrine changes of the menopausal transition, which are summarized in this review. To describe the endocrinology of the menopause transition. Includes changes in inhibins A and B, follicle stimulating hormone (FSH), and estradiol, cross-sectionally in regularly cycling volunteers, and longitudinally (including testosterone) in women passing through the menopause transition. Early follicular phase hormone concentrations were measured by well-characterized immunoassays in normal volunteers aged 20-50 years, and in 438 subjects initially recruited between ages 45 and 55 for a longitudinal study of the menopause transition, the MWMHP, in which annual blood samples were obtained. The data summarized here includes the first 6 years of follow-up. These volunteers also recorded menstrual cycle data and responded to detailed annual questionnaires. In regularly cycling female volunteers aged more than 40 years, it was established that inhibin B is a significant determinant of circulating FSH levels. From the MWMHP, the central endocrine event marking the onset of menstrual irregularity was shown to be a fall in follicular phase inhibin B concentrations, with a nonsignificant rise in FSH and no change in estradiol or inhibin A. Cross-sectional analysis of data from women in the early stages of the MWMHP showed a wide variation in circulating FSH levels, irrespective of menopausal status, indicating that single FSH measurements provide little useful information regarding menopausal status. Based on the prospective determination of the date of final menses (FMP), it was shown that estradiol levels begin to fall and FSH levels to rise about 2 years before FMP. At the time of FMP, FSH levels were approximately 50% of those ultimately reached postmenopausally, while estradiol had fallen by approximately 50% from reproductive age levels. Despite a major decline in sexual function, as women transited the menopause, there was no significant decline in circulating testosterone levels, the decline in sexual function being correlated with the decline in estradiol, not testosterone. Analysis of data from related studies showed that endocrinologically normal ovulatory cycles could be observed in women who had already experienced cycle irregularity, even more than 3 months of amenorrhea, and could occur close to or at the time of FMP. An extensive database on the endocrinology of the menopause transition, including both cross-sectional and longitudinal information, has been obtained.

Cycle and hormone changes during perimenopause

The menopausal transition is the stage in reproductive life commonly defined as commencing with the onset of menstrual irregularity. Classic studies of the endocrinology of the transition postulated the existence of inhibin in women to explain the observed increase in follicle-stimulating hormone (FSH) levels without a significant decrease in estradiol (E2). Descriptions were provided of cycle characteristics during the transition, emphasizing the unpredictability of the endocrine changes rather than the occurrence of an orderly and progressive decline in ovarian function. Women older than the age of 45 exhibited menstrual irregularity when the average number of primordial follicles per ovary decreased to approximately 100. Inhibin B is a major regulator of FSH secretion and a product of small antral follicles. Its levels respond to the early follicular phase increase and decrease in FSH. The age-related decrease in ovarian primordial follicle numbers, which is reflected in a decrease in the numbers of small antral follicles, leads to a decrease in inhibin B, which in turn leads to an increase in FSH, hypothesized to act as a stimulus to the maintenance of circulating E2 in the follicular phase until late in the transition. Concurrently, the concentrations of testosterone do not change significantly. Early follicular phase FSH levels in women reporting menstrual irregularity fluctuate markedly, with a more uniform increase in levels when no menses have occurred for at least 3 months. Anovulatory cycles occur at increased frequency in the last 30 months before final menses or menopause. In ovulatory cycles, FSH shows little, if any, increase, but anovulatory cycles are usually characterized by low levels of inhibin B, markedly increased levels of FSH, and low levels of E2. Thus, the heterogeneity of follicular phase FSH represents a mixture of ovulatory and anovulatory cycles. Longitudinal data indicate that both ovulatory and anovulatory cycles occur after entry into both the early and late menopausal transition and that ovulatory cycles occur even after final menses. There is no endocrine marker of menopause, which may be primarily an endometrial event. Using the hormonal concentrations in ovulatory cycles observed in women in mid-reproductive age as controls and comparing such concentrations in late reproductive age women older than 45 either continuing to cycle regularly or having entered the early or late menopausal transition, a gradual increase in follicular phase FSH and E2 and a decrease in inhibin B were observed in ovulatory cycles. Anovulatory cycles showed markedly increased FSH with low E2 and inhibin B. No specific endocrine change was characteristic of either the early or late menopausal transition, confirming the observations of previous studies regarding the unpredictability of cycle characteristics and hormone changes with the approach of menopause. Antimüllerian hormone correlates with follicle numbers and shows a large age-related decrease to reach undetectable levels at menopause. Thus, the marked decrease in follicle numbers during late reproductive age appears to predispose to erratic and unpredictable cycle characteristics, with normal ovulatory cycles continuing to occur episodically. There is no specific endocrine marker of the early or late transition, making measurements of FSH or E2 unreliable in attempting to stage an individual with regard to approaching menopause.

Biomarkers of Ovarian Reserve

The primary function of the female ovary is the production of a mature and viable oocyte capable of fertilization and subsequent embryo development and implantation. At birth, the ovary contains a finite number of oocytes available for folliculogenesis. This finite number of available oocytes is termed "the ovarian reserve". The determination of ovarian reserve is important in the assessment and treatment of infertility. As the ovary ages, the ovarian reserve will decline. Infertility affects approximately 15%-20% of reproductive aged couples. The most commonly used biomarker assay to assess ovarian reserve is the measurement of follicle stimulating hormone (FSH) on day 3 of the menstrual cycle. However, anti-müllerian hormone and inhibin-B are other biomarkers of ovarian reserve that are gaining in popularity since they provide direct determination of ovarian status, whereas day 3 FSH is an indirect measurement. This review examines the physical tools and the hormone biomarkers used to evaluate ovarian reserve.

Usefulness of FSH measurements for determining menopause in long-term users of depot medroxyprogesterone acetate over 40 years of age

Objective To assess the usefulness of follicle-stimulating hormone (FSH) measurements for determining menopause in 40–55-year-old users of depot medroxyprogesterone acetate (DMPA). Study Design FSH levels were measured in 355 blood samples from 82 amenorrheic women during an 18-month period. Blood was collected every 90 days immediately prior to DMPA administration. Results Using FSH values >35 mIU/mL as being in the post menopausal range, 32 women (39.0%) presented at least one FSH measurement in the postmenopausal range and 14 of them (43.7%) had more than one elevated FSH measurement and were considered postmenopausal. In five users (15.6%), only the last FSH measurement was within the postmenopausal range, and in 13 women (40.6%), FSH returned to normal values following one measurement that was within the postmenopausal range. Conclusions The menopausal status in DMPA users in amenorrhea should be determined based on at least two consecutive high FSH evaluations, since, as shown here, 40.6% of the women with high FSH had a low FSH in the subsequent determination. FSH measurements should be done only in women ≥50 years old because there is a greater possibility of being in postmenopause. However, we do not recommend the interruption of DMPA use prior to the quantification of FSH.

Gonadal Function in Males After Chemotherapy for Early-Stage Hodgkin's Lymphoma Treated in Four Subsequent Trials by the European Organisation for Research and Treatment of Cancer: EORTC Lymphoma Group and the Groupe d'Étude des Lymphomes de l'Adulte

To analyze fertility in male patients treated with various combinations of radiotherapy and chemotherapy, with or without alkylating agents, or with radiotherapy alone for Hodgkin's lymphoma. Follicle-stimulating hormone (FSH) levels were measured in patients with early-stage upper-diaphragmatic disease enrolled in four European Organisation for Research and Treatment of Cancer (EORTC) trials (H6-H9). Median follow-up after therapy was 32 months. Patients with FSH measurement at least 12 months after end of treatment (n = 355) were selected to assess post-treatment fertility. Patients with FSH measurement 0 to 9 months after therapy (n = 349) were selected to analyze fertility recovery; of these, patients with elevated FSH (> 10 U/L; n = 101) were followed until recovery. Factors predictive for therapy-related infertility were assessed by logistic regression. The proportion of elevated FSH was 3% and 8% in patients treated with radiotherapy only or with nonalkylating chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], epirubicin, bleomycin, vinblastine, prednisone [EBVP]); it was 60% (P < .001) after chemotherapy containing alkylating agents (mechlorethamine, vincristine, procarbazine, prednisone [MOPP], MOPP/doxorubicin, bleomycin, vinblastine [ABV], bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone [BEACOPP]). After a median time of 19 months, recovery of fertility occurred in 82% of patients treated without alkylating chemotherapy. This proportion was 30%, statistically (P < .001) lower in those treated with alkylating chemotherapy, and median time to recovery was 27 months. The post-treatment proportion of elevated FSH increased significantly (P < .001) with the dose of alkylating chemotherapy administered, and recovery was less frequent and slower after higher doses. Age more than 50 years and stage II disease also contributed to poor outcome. Fertility can be secured after nonalkylating chemotherapy for Hodgkin's lymphoma. In contrast, alkylating chemotherapy has a dismal effect, even after a limited number of cycles.

Report on evaluation of the azoospermic male

Report on evaluation of the azoospermic male

O-265: Determining clinically meaningful laboratory values when new measurement technologies are introduced: Relating follicle stimulating hormone (FSH) results to pregnancy

Basal and clomiphene citrate stimulated FSH levels have been useful in predicting the likelihood of success in patients undergoing in vitro fertilization (IVF). It has been shown that there is variation in FSH results when the same sera is run in different assay systems, even when using the same International Reference Preparation (IRP). The purpose of this study is to evaluate whether a new “cut-off” for FSH was required after the introduction of new laboratory technology for measurement of FSH. Retrospective evaluation of FSH values and pregnancy outcome after the initiation of new FSH laboratory technology in patients undergoing IVF. All patients who underwent ovarian suppression and gonadotropin stimulation from April 2004 through March 2006 for IVF and had measurement of FSH within the prior 3 months were included in the analysis. The highest FSH level obtained was used for evaluation. FSH measurements were initially performed with the Technicon Immuno 1 System (Bayer Corporation, Tarrytown, NY) which utilized a heterogeneous Sandwich Magnetic Separation technology with spectrometer analysis (normal follicular values 1.6-18.1 mIU/mL (IU/L))(“old FSH”). Subsequently the ADVIA Centaur Assay System (Bayer Healthcare LLC, Tarrytown, NY), which utilizes a 2-site sandwich immunoassay using direct chemiluminometric technology (normal follicular values 2.5-10.2 mIU/mL (IU/L))(“new FSH”), was introduced. Both assay systems are standardized to WHO 2nd IRP for FSH. Parallel samples were run in both assay systems prior to clinical implementation of “new FSH.” A total of 560 cycles were available for evaluation; 303 had FSH values performed using “old FSH” and 257 using “new FSH”. There were no differences in age, days of stimulation, oocyte number, number of embryos transferred or pregnancy rate between the two groups. In the “old FSH” group, the ongoing pregnancy rate was 31% in patients with an FSH ≤ 12 IU/mL and 10% in those patients with an FSH > 12 IU/mL. FSH values were ≤ 16 IU/mL in all ongoing or delivered pregnancies. In the “new FSH” group, the ongoing pregnancy rate was 35% in patients with an FSH ≤ 12 IU/mL and 9% in those patients with an FSH > 12 IU/mL. FSH values were ≤ 16 IU/mL in all ongoing or delivered pregnancies. Evaluation of results from running parallel samples found a correlation coefficient of 0.99, with the “new FSH” having an average bias of -14.2% and average difference of -1.72 IU/mL. These results confirmed previous studies demonstrating the value of FSH levels in predicting IVF success. Our expectation, based on data from running parallel samples, was that the “cut off” using “new FSH” would be lower than that with “old FSH”, though this was not the case. This reinforces the need for each center to establish their own cut off values for each assay used.

Imminent ovarian failure in childhood cancer survivors

The aim of this study was to investigate reproductive history and the prevalence of imminent ovarian failure (IOF) in female childhood cancer survivors. Reproductive history and ovarian function were evaluated by questionnaires ( n = 124) and by measurement of follicle stimulating hormone (FSH) and oestradiol ( E 2) levels ( n = 93). IOF was defined as FSH > 10 IU/l or E 2 > 0.28 nmol/l on day 3 of the menstrual cycle, or FSH > 12.4 IU/l on day 7 of the pill-free interval. IOF was demonstrated in 22.6% of the participants and correlated with age at diagnosis ( P < 0.005) and age at study ( P = 0.036). IOF correlated inversely with methotrexate ( P = 0.046). The incidence of miscarriages (22.7%) and recurrent miscarriages (7.3%) was increased. The male/female (M/F) ratio of the offspring was decreased. In conclusion, female childhood cancer survivors are at risk for IOF. If pregnant, the risk of (recurrent) miscarriages is increased. The M/F ratio in the offspring is decreased.

Is FSH Useful for Identifying Reproductive Stage

Although follicle-stimulating hormone (FSH) levels are commonly used to distinguish among women in premenopausal, transitional, and postmenopausal stages, a few small longitudinal studies cast doubt on whether these tests reliably predict reproductive stages. To examine the usefulness of FSH measurements, investigators used data from 576 healthy women …

The association of hysterectomy and menopause: a prospective cohort study

To determine whether or not hysterectomy leads to an earlier onset of the menopause. A prospective cohort study. Gynaecology service of large urban hospital. Premenopausal women with and without hysterectomy. Multivariate survival analysis techniques were used to adjust for differences in initial follicle stimulating hormone (FSH) levels, body mass index, smoking and unilateral oophorectomy between the groups. FSH levels were measured for five years following hysterectomy and compared with the comparison group. Menopause was defined as a single FSH measurement of at least 40 IU/L. Two hundred and fifty-seven women undergoing hysterectomy were compared with 259 women who had not undergone a hysterectomy. Fifty-three women (20.6%) in the hysterectomy group and 19 women (7.3%) in the comparison group reached menopause over the five years of the study. Women in the hysterectomy group with a pre-operative FSH <10 IU/L reached menopause 3.7 years (95% CI 1.5-6.0 years) earlier than women in the comparison group independent of BMI, smoking and unilateral oophorectomy. Twenty-eight women in the hysterectomy group had unilateral oophorectomy and 10 (35.7%) of these women reached menopause over the five years of follow up. Women in the hysterectomy group with unilateral oophorectomy reached menopause 4.4 years (95% CI 0.6, 7.9 years) earlier than women with both ovaries in the hysterectomy group independent of baseline FSH, BMI and smoking. Hysterectomy is associated with an earlier onset of menopause. Hysterectomy with unilateral oophorectomy is associated with an even earlier onset of the menopause in this study.

Oestradiol and FSH in gestational trophoblastic disease: a prospective analysis of their predictive value

To determine whether oestradiol or follicle-stimulating hormone (FSH) measured prior to treatment could improve the predictive value of the risk score used to determine treatment in cases of persistent gestational trophoblastic disease (GTD). Prospective observational study. Tertiary referral centre for GTD. All women referred to Weston Park Hospital, Sheffield, with GTD between 1st January 1996 and 31st December 2000. Blood was taken prior to the initiation of treatment to measure oestradiol and FSH. The results were analysed with respect to the time taken for the beta-hCG to return to normal. Time taken to reach a normal beta-hCG. Data on 118 women were collected. Three women died of GTD during follow up. Using Cox's proportional hazards regression analysis, division of the risk scores into high and low risk groups (</=7, >7) demonstrated a significant difference with regard to the length of time taken to reach a normal beta-hCG level (hazard ratio 0.32; 95% CI: 0.18, 0.57) comparing high risk relative to low risk. However, addition of neither oestradiol nor FSH to the Cox regression analysis produced a significant hazard ratio (Ln oestradiol, 0.95; FSH 0.99). Division of the patients' risk scores into three groups of low (0-4), intermediate (5-7) and high (>7) risk groups produced similar results. The measurement of neither oestradiol nor FSH appears to improve the prediction of outcome in persistent GTD when added to the risk score.

Serum luteinizing hormone, follicle-stimulating hormone and oestradiol pattern in women undergoing pituitary suppression with different gonadotrophin-releasing hormone analogue protocols for assisted reproduction

Gonadotrophin-releasing hormone analogues (GnRH-a) are used widely in controlled ovarian stimulation (COS) cycles for assisted reproduction. At present, there is great debate about the influence of exogenous hormone activity on the hypothalamus–pituitary axis following pituitary desensitization. The objective of this comparative study was to investigate the pattern of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol in women undergoing ovarian stimulation with different GnRH-a preparations. We retrospectively analysed 201 women, aged between 27 and 43 years, who were referred consecutively to our infertility clinic between January 2002 and January 2003. All women had no endocrinopathies or occult ovarian failure as assessed by day-3 hormone profile. Women were enrolled in one of the following COS protocols: depot triptorelin long protocol (n = 38), buserelin long protocol (n = 101) or buserelin short protocol (n = 62). Recombinant FSH was used to induce ovulation. Treatment was monitored by transvaginal ultrasound scan and serum measurement of FSH, LH and oestradiol. Among the women initially included, 30 had cancelled cycles due to poor ovarian response. Serum LH levels were significantly higher in the short-protocol group compared with the long-protocol groups (p < 0.001). The number of follicles, oocyte yield, number of grade-I embryos and fertilization rate were significantly lower in the short-protocol group than in the long-protocol groups. These findings showed that LH concentrations are significantly higher in women undergoing reversible medical hypophysectomy with a GnRH-a short protocol than in women treated with a long protocol. The hypothesis of an LH ceiling is confirmed.

Studies on Reproductive Endocrinology in Non-human Primates: Application of Non-invasive Methods

A practical method for the quantitative measurement of estrone conjugates (E1C), pregnanediol-3-glucronide (PdG), follicle stimulating hormone (FSH), and monkey chorionic gonadotropin (mCG) in the excreta of non-human primates were described. In the series of studies, results suggest that 1) urinary and fecal steroid metabolites accurately reflected the same ovarian or testicular events as observed in plasma steroid profiles in captive Japanese macaques, time lags associated with fecal measurements were one day after appearance in urine; 2) these noninvasive methods were applicable to wild and free-ranging macaques for determining reproductive status; 3) hormonal changes during menstrual cycles and pregnancy could be analyzed by measurement of FSH, CG and steroid metabolites in the excreta in captive great apes and macaques; and 4) hormone-behavior relationships of macaques in their natural habitats and social setting could be analyzed. In macaques, between maternal rejection and excreted estrogen, but not excreted progesterone were associated, moreover, in male study, significantly higher levels of fecal cortisol were observed in high-ranking males. In addition, reliable noninstrumented enzyme-linked immunosorbent assay (NELISA) for detection of early pregnancy in macaques was established. These results suggest that the noninvasive characteristic of excreted hormone monitoring provide a stress-free approach to the accurate evaluation of reproductive status in primates.

Urinary steroids, FSH and CG measurements for monitoring the ovarian cycle and pregnancy in the chimpanzee.

Non-invasive methods for monitoring reproductive status of chimpanzee based on the measurement of urinary steroids and gonadotropins were examined. A typical pre-ovulatory urinary estrone conjugate (E1C) surge and post-ovulatory increase in pregnandiol glucuronide (PdG) were seen during the menstrual cycle. Urinary follicle stimulating hormone (FSH) showed two peaks over the infertile menstrual cycle. The earliest changes indicating pregnancy were a coincident rise in E1C and chorionic gonadotropin (CG) levels and a concomitant fall in FSH levels. Urinary PdG levels showed a prolonged rise. Urinary E1C in the pregnant chimpanzee was higher than during the menstrual cycle and increased with advancing gestation, with maximum levels occurring near term. In the case of stillbirth, E1C and CG levels from mid- through late-pregnancy were low and the prepartum progressive increase in E1C was not shown. The data presented here are of great practical value in captive breeding management of chimpanzees.

Isolated follicle-stimulating hormone (FSH) deficiency in a young man with normal virilization who did not have mutations in the FSHβ gene

ObjectiveTo determine the cause of isolated FSH deficiency in a young infertile man. DesignCase report. SettingClinical and genetic studies in an academic research environment. Patient(s)A 19-year-old man with normal virilization, azoospermia, and isolated FSH deficiency. Intervention(s)Pituitary and gonadal functions were evaluated at baseline and after repeated GnRH stimulation. FSH was tested with both immunological and biological methods. The FSHβ gene was sequenced in the patient and in a series of 50 controls. Main outcome measure(s)Clinical, endocrine, and genetic characterization of an infertile patient with isolated FSH deficiency. Result(s)LH and T secretions were normal. No interference in FSH measurement was detected, and serum FSH concentrations were very low and completely unresponsive to repeated GnRH stimulation. No circulating FSH-like bioactivity was detected by means of rat Sertoli cell bioassay. Other pituitary functions were unaffected, and no lesions were seen at pituitary nuclear magnetic resonance (NMR). Inhibin B and activin levels were normal, but a progressive decrease of activin concentrations was seen during GnRH stimulation. The coding sequence of the FSHβ gene was normal, but the patient was homozygous for a novel G/T substitution in the promoter region within a P response element. This substitution was present in heterozygosity in eight out of 50 controls and in homozygosity in one man with normal FSH levels. Conclusion(s)We report an infertile male with isolated FSH deficiency but no evidence of mutations in the FSHβ gene. The G/T substitution in the FSHβ promoter represents a novel silent polymorphism, indicating that other defects in factors involved in FSH-specific expression should be taken into account.