Ovarian Overstimulation Research Articles

Maternal virilization developing during a twin pregnancy; demonstration of excess ovarian androgen production associated with theca lutein cysts.

Virilization developed in a 22-year-old woman during a twin gestation. Serum testosterone levels were elevated (912 to 1394 pg per milliliter), showed no response to ACTH infusion, fell 50 per cent (691 pg per milliliter) during dexamethasone suppression, and rose threefold (1618 pg per milliliter) with human chorionic gonadotrophin. Serum androstenedione levels were normal (2035 to 2466 pg per milliliter), responded minimally to ACTH stimulation and dexamethasone suppression, but rose appreciably during human chorionic gonadotrophin stimulation. Retrograde venous catheterization showed levels of testosterone and androstenedione higher in the right ovarian vein than in the vena cava. Bilateral theca lutein cysts were found at surgery. After ovarian wedge resection, the production rate and plasma concentration of testosterone decreased and remained normal during the following five months. Ovarian overstimulation with androgen production, secondary to multiple gestation, appeared to be the cause of the virilization.

Urinary Oestrogen Excretion in the Beagle Bitch

SUMMARY Total urinary oestrogen excretion has been measured in beagle bitches during the normal oestrous cycle and in animals receiving exogenous gonadotrophins. Oestrogen levels rose during proestrus to reach a mean value of approximately 2, μg/24 hours in late proestrus and early oestrus. A significant correlation was found between urinary and plasma oestrogen levels in three bitches studied during proestrous and oestrus. The administration of pregnant mare serum gonadotrophin and human chorionic gonadotrophin was associated with a marked increase in oestrogen output suggesting that ovarian overstimulation had occurred.

Experience with induction of ovulation

One hundred and thirty-five patients diagnosed as ovulatory failure have been treated in our clinic since 1966. One hundred and eighteen of these have been treated with clomiphene citrate, or more recently, its cisisomer, and 17 patients with long-standing secondary amenorrhea or primary amenorrhea have been treated with human menopausal gonadotropins, in combination with human chorionic gonadotropins. Of the latter group, 14 of the 17 were shown to be capable of response to exogenous gonadotropins and 12 of these ovulated and 7 (50 per cent) became pregnant. The over-all ovulatory rate with clomiphene citrate or its cisisomer was 78 per cent, with a pregnancy rate of 31 per cent. The results of our present investigation with clomiphene citrate in 10 and 20 mg. dosage are presented in detail, and compared with our previous experience with clomiphene. It appears that cisclomiphene 20 mg. is as effective as clomiphene citrate 100 mg., but has the decided advantage of fewer side effects associated with its use. With the human menopausal gonadotrophins, no major complications, such as ovarian overstimulation or multiple pregnancies, were encountered, and we feel this is attributed to careful selection of patients and daily tracking of total urinary estrogens.

Ovarian overstimulation, massive ascites, and Singleton pregnancy after clomiphene

Ovarian overstimulation, massive ascites, and Singleton pregnancy after clomiphene

Ovarian Overstimulation, Massive Ascites, and Singleton Pregnancy After Clomiphene

Bilateral ovarian enlargement with massive ascites and pregnancy occurred in a patient after two courses of clomiphene citrate (Clomid) therapy. It is likely that the patient received the second course of clomiphene during early stages of pregnancy. Early pregnancy must be ruled out prior to the administration of this type of therapy.

Gonadotropin Therapy

The individual patient response to menotropins therapy was found to be extremely variable. Failure to appreciate this variability can lead to ovarian overstimulation. Overstimulation was found to be associated with abnormally high excretion levels of total estrogen. The author concluded that daily monitoring of estrogen excretion by a rapid chemical method was necessary to determine the optimum time for the administration of chorionic gonadotropin and, at the present time, provided the best method for preventing ovarian overstimulation.