Biomedical subjects
Publications and source records attributed to A M Jequier.
We describe a specific radioimmunoassay for follicle stimulating hormone (FSH) and the finding of immunoreactive FSH in human pregnancy sera. A total of 394 serum samples was taken from 204 normal pregnant women at different stages of gestation. The FSH levels remained constant throughout pregnancy and no rise was associated with the late first trimester elevation of human chorionic gonadotrophin (hCG).
The plasma sex hormone binding globulin (SHBG) capacity has been measured in 52 normal women, 11 women on various oral contraceptives containing 50 micrograms of ethinyl oestradiol and 11 women on oral contraceptives containing less than 35 micrograms of ethinyl oestradiol. The results show that women on oral contraceptives containing 50 micrograms of ethinyl oestradiol have a significantly raised SHBG capacity (p less than 0.005) whereas those patients on oral contraceptives containing 35 micrograms or less of ethinyl oestradiol have SHBG capacities which do not differ significantly from normal ovulating women (p greater than 0.05). Thus the 35 micrograms pill interferes less with bound/unbound sex steroid ratios than does the 50 micrograms pill.
The sex hormone binding globulin (SHBG) capacity was measured in 26 normal untreated postmenopausal women and 10 postmenopausal women taking different types of hormone replacement therapy. The patients on hormone replacement therapy had significantly higher levels of SHBG than postmenopausal women (p less than 0.001) and also significantly higher levels than 52 normal ovulating women studied previously (Pogmore and Jequier, 1979; p less than 0.02). This suggests that postmenopausal women on hormone therapy are being overtreated.
The profound effect of urine on sperm motility is demonstrated. Two patients with retrograde ejaculation and infertility who achieved antegrade passage of semen by ejaculation on a full bladder are described. The use of this method of management in patients with infertility due to retrograde ejaculation is discussed.
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Sixty azoospermic men were investigated by means of testicular biopsy and estimation of serum follicle stimulating hormone (FSH) levels. High FSH levels when associated with small testes indicated severe testicular damage. We suggest that these findings offer sufficient evidence to regard such patients as infertile and that further investigation is unnecessary. In men with normal FSH levels testicular biopsy is still necessary for accurate diagnosis; in practice this may often be done at the same time as epididymovasostomy.
This investigation studies the relationship between the concentrationss of prolactin and FSH in the serum during pregnancy and the puerperium. A single dose of 5 mg bromocriptine during early pregnancy induced a profound fall in the serum level of prolactin with a substantial rise 20 h later. During the initial reduction in the concentration of prolactin, no alteration was noted in the level of FSH but during the subsequent increase in the prolactin concentration, there was a significant (P less than 0.05) decrease in the concentration of FSH. During week 1 of the puerperium, the concentrations of FSH and prolactin were significantly lower in lactating women than in women who were not breast feeding, but there was no significant difference between the concentration of FSH in women who had suppressed lactation with bromocriptine and in those whose lactation was suppressed by non-hormonal methods. when the concentration of FSH was measured every 10 min during a 30 min breast feed, there was a marked but short-lived rise in the serum concentration of prolactin but no change in the level of FSH. These results suggest that an increase in the serum level of prolactin in pregnancy can have a suppressive effect on the production of FSH. Although acute suckling-induced hyperprolactinaemia in the puerperium has no such effect, the maintenance of lactation in the long term does suppress the concentration of FSH in the serum.
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A prospective study of urinary symptoms before and after total hysterectomy for a variety of gynaecological disorders has been made in 104 women. 62% were symptomatic preoperatively. Of this group 11% of the preoperatively symptomatic and 25% of the preoperatively asymptomatic either had their symptoms worsened or had symptoms appear 6 months after the operation. However, the total number of symptomatic women was reduced to 50% 6 months postoperatively. The case against total hysterectomy in the production of urinary symptoms remains to be proven.
Serum prolactin and gonadotrophin concentrations were measured by radioimmunoassay in 106 women with amenorrhoea. Prolactin was normal in those with weight related disorders, primary ovarian failure, those with a variety of systemic diseases and in those in whom amenorrhoea followed treatment with the oral contraceptive and in unexplained primary amenorrhoea. Gonadotrophin concentrations in the above patients were normal except in those with primary ovarian failure. Prolactin was elevated in eight of forty patients (20%) with functional secondary amenorrhoea and was greatly raised in all but one of the thirteen women in this series with pituitary tumours (five of whom were studied only after treatment). Only three patients in each of the last two groups had galactorrhoea. Gonadotrophin levels were normal or slightly raised in all of the hyperprolactinaemic patients apart from those studied after hypophysectomy. Four hyperprolactinaemic patients (three with pituitary tumours and one with functional amenorrhoea) who did not have galactorrhoea have been treated with bromocriptine. Prolactin secretion was reduced in all patients and, in the two with normal gonadotrophins, ovulatory menstruation was resumed. One became pregnant in the second ovulation cycle after starting treatment. We conclude that, despite the rarity of galactorrhoea, hyperprolactinaemia is common in patients with functional amenorrhoea and in those with pituitary tumours. Treatment with bromocriptine in patients with normal gonadotrophins restores ovulation when the infertility is due to prolactin excess.
Basal levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) in serum and their response to the luteinizing hormone releasing hormone (LH-RH) were measured in a group of patients with functional amenorrhoea. The results in this group were compared to those obtained in a second group of patients with secondary amenorrhoea which had followed cessation of a combined oral contraceptive. No difference either in the basal levels or in the response to LH-RH could be found. These data indicate that there is no detectable difference in pituitary gonadotrophin status between the two groups and that the two types of amenorrhoea have ghe same aetiological background.
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