PubMed Health⌕ Search

Biomedical subjects

D L Healy

Publications and source records attributed to D L Healy.

At least 109 records · Page 6Linked to original sources
PubMed1989

Circulating immunoreactive oxytocin during the human menstrual cycle comes from the pituitary and is estradiol dependent.

The aims of this study were to 1) evaluate the relative contributions of hypothalamic and ovarian oxytocin (OT) to peripheral serum concentrations and 2) determine the relationship between serum OT and ovarian steroid concentrations. Four groups of women were studied: 1) women with spontaneous cycles (n = 4) and normal serum estradiol (E2), progesterone, LH, and FSH levels; 2) in vitro fertilization (IVF) patients (n = 8) undergoing ovarian hyperstimulation; 3) agonadal oocyte-recipient patients (n = 6) receiving replacement E2 and P therapy; and 4) postmenopausal women (n = 21). Peripheral serum samples were collected daily during a menstrual cycle from the normal and agonadal women and for 6 days before ovulation in the IVF group. Serum immunoreactive OT was measured by specific RIA after Sep-Pak extraction; the assay sensitivity was 0.6 pmol/L. Serum OT in the women with normal cycles increased during the follicular phase, reaching a peak 1 day after the LH surge, and decreased in the luteal phase [days 7, 16, and 21, 10.7 +/- 3.5 (mean +/- SE), 25.7 +/- 5.7, and 13.2 +/- 2.5 pmol/L, respectively; P less than 0.05]. Serum OT levels were higher in IVF patients before ovulation than in women with spontaneous cycles, but lower than those in the agonadal women, who had a peak value (49.1 +/- 9.6 pmol/L; P less than 0.05) on day 13 of E2/progesterone replacement therapy. Serum OT was positively correlated (r = 0.68, normal women; r = 0.91, oocyte recipients) with serum E2 values during the first part of the cycle (P less than 0.01). A similar positive correlation between serum OT and E2 was found in the postmenopausal women (r = 0.83). We conclude that serum OT before and around the time of ovulation comes mainly from the pituitary, and not from the ovary, and is E2 dependent.

Adult↗
PubMed1989

Purified FSH stimulates production of inhibin by the human ovary.

Ovarian inhibin production is stimulated by the administration of human menopausal gonadotrophins or following a rise in endogenous LH and FSH. In order to determine whether FSH specifically stimulates inhibin secretion in vivo, immunoassayable serum inhibin levels were measured following the administration of a highly purified preparation of urinary FSH free of significant contamination with LH. Ten anovulatory women underwent a protocol of induction of ovulation with purified FSH and human chorionic gonadotrophin (hCG). During the induction of ovulation, blood samples were taken for radioimmunoassay of FSH, LH, oestradiol, progesterone and inhibin. During the administration of FSH there were increases in plasma concentrations of FSH, oestradiol and inhibin (P less than 0.01) but no significant change in the concentration of LH. Oestradiol and inhibin concentrations rose in parallel and were closely correlated (tau = 0.920, n = 110, P less than 0.001). There was also a direct correlation between the measured level of FSH and inhibin (tau = 0.512, n = 110, P less than 0.05), but there was no correlation between LH and oestradiol, inhibin or FSH. Inhibin (tau- = 0.702, n = 10, P less than 0.01) and oestradiol (tau- = 0.691, n = 10, P less than 0.01) were correlated with the number of follicles seen on ovarian ultrasound. Levels of oestradiol and inhibin reached a peak on the day of hCG administration or on the following day. Inhibin levels then fell over the next 2 days in all cycles. In an ovulatory cycle resulting in conception, inhibin and oestradiol then rose in parallel with progesterone.(ABSTRACT TRUNCATED AT 250 WORDS)

Estradiol↗
PubMed1988

Anti-progesterones: background and clinical physiology.

The development of anti-progesterones has provided a probe to examine the role of progesterone both in the normal cycle and in pregnancy. The most widely used of these agents, mifepristone, appears to act both directly at the endometrial progesterone receptor, and centrally by reducing circulating gonadotrophin concentrations. In addition, ovarian steroidogenesis may be modified. The clinical application of these agents for the interruption of pregnancy will be considered in the following chapters.

Abortifacient Agents↗
PubMed1988

Serum inhibin levels in polycystic ovary syndrome: basal levels and response to luteinizing hormone-releasing hormone agonist and exogenous gonadotropin administration.

Serum inhibin levels were measured by RIA twice weekly for 4 weeks in 5 women with the polycystic ovary syndrome (PCOS). These were compared to those in 10 women with normal menstrual cycles. Serum inhibin levels were similar in the 5 PCOS women (mean, 199; range, 126-266 U/L) and were not significantly different from those in the normal women during the early follicular phase (227; 100-485 U/L) or midfollicular phase (243; 143-412 U/L) of their cycles. Inhibin levels were higher (P less than 0.001) in the late follicular phase (408; 227-732 U/L), at midcycle (623; 367-1058 U/L), and during the midluteal phase (1245; 898-1727 U/L) in the normal women compared to those in the PCOS group. Serum inhibin levels were also measured in PCOS (n = 8) and infertile (n = 14) women after the rise and subsequent diminished gonadotropin secretion that occurred during LHRH agonist administration. In both groups, serum LH and FSH increased after initiation of LHRH agonist administration; this increase was accompanied by parallel rises in serum estradiol and inhibin before suppression (PCOS women: r = 0.71; P less than 0.001; n = 108; infertile women: r = 0.42; P less than 0.05; n = 163). All hormone levels, including inhibin, decreased during continued LHRH administration. Five PCOS women underwent ovulation induction using combined LHRH agonist and human menopausal gonadotropin administration. Serum estradiol and inhibin rose in parallel in response to exogenous gonadotropins (r = 0.92; P less than 0.001; n = 77). In conclusion, we found no evidence of a primary defect in ovarian inhibin physiology in women with PCOS in terms of either basal or gonadotropin-stimulated (exogenous or endogenous) secretion.

Adult↗
PubMed1988

Vaginal progesterone administration before ovulation induction with exogenous gonadotropins in polycystic ovarian syndrome.

We studied the value of vaginal progesterone (P4) in suppressing serum LH concentrations and restoring normal luteal phase serum LH concentrations before administration of exogenous gonadotropins in anovulatory women with the polycystic ovarian syndrome (PCOS). P4 (50 mg every 12 h) was administered by vaginal suppository to 9 women (18 cycles) for 14 days before ovulation induction with human menopausal gonadotropin (hMG) and hCG. Serum LH, FSH, estradiol, P4, and PRL levels were measured daily. A biphasic effect on LH secretion occurred during P4 administration. Peak serum LH levels occurred on day 5 (125% of basal levels; P less than 0.05) of vaginal P4 suppository use, followed by a progressive fall (P less than 0.05) to 79% of basal levels, but serum LH levels were still higher than those in normal women despite achieving physiological luteal phase P4 concentrations. Ovulation occurred in 56% of cycles after P4 and hMG/hCG treatment and in 65% of control cycles after hMG/hCG alone. In 7 women, serum LH was measured at 10-min intervals for 6 h before and after vaginal P4 administration for 10 days. LH pulse frequency decreased from 7.4 +/- 1.1 to 4.4 +/- 1.2 pulses/6 h (P less than 0.01), and LH pulse amplitude increased from 3.8 +/- 1.8 to 6.1 +/- 2.9 IU/L (P less than 0.01) after P4 administration. We conclude that vaginal P4 (50 mg every 12 h) 1) produces serum P4 concentrations within the normal range for the luteal phase of the menstrual cycle; 2) elevates serum LH, but not FSH, within 5 days; 3) decreases LH pulse frequency and increases LH pulse amplitude after 10 days, but does not normalize serum LH values; and 5) fails to improve the results of subsequent ovulation induction with exogenous gonadotropins in patients with PCOS.

Administration, Intravaginal↗
PubMed1988

Comparison of inhibin immunological and in vitro biological activities in human serum.

A comparison of serum inhibin levels in men and women was undertaken using a sensitive sheep pituitary cell in vitro bioassay and a newly developed heterologous RIA. The RIA was based on an antiserum raised to bovine 31K inhibin using [125I]31K inhibin as tracer. Bovine inhibin alpha- and beta-subunits, bovine activin-A, transforming growth factor-beta, and Mullerian inhibitory substance did not cross-react in the RIA. In both assays, dilutions of serum gave response lines parallel to that of the partially purified human follicular fluid inhibin preparation used as standard. Negligible levels of both bio (B)- and immuno (I) activities were found in serum from women with premature ovarian failure or castrated men. In ovulation-induced cycles, serum B inhibin levels increased progressively from the early to the late follicular phase and remained at the late follicular phase level during the early and midluteal phases. Serum I inhibin levels also rose during the follicular phase, but declined during the early luteal phase before increasing again in the midluteal phase. As a consequence, inhibin B:I ratios varied during the treatment cycle, with high ratios in early follicular (2.86) and early luteal (2.25) phases and a low ratio in the midluteal phase (1.09). Similar changes in serum B:I ratios also occurred during the midcycle and midluteal phases of normal cycles. The B:I ratio was lower (0.35) in normal men. We conclude that the largely similar pattern of inhibin biological and immunological activities in serum obtained during a variety of physiological conditions support the validity of the RIA procedure, and the B:I ratio of serum inhibin varies during the follicular and luteal phases of the cycle and is low in men. Potential reasons for these changes in B:I ratio include the presence of interfering substances in either the bioassay or the RIA, the presence of inhibin isoforms, and/or modulation of secreted forms by sex steroids.

Adult↗
PubMed1988

Occult ovarian failure: a syndrome of infertility, regular menses, and elevated follicle-stimulating hormone concentrations.

Ten women with infertility, regular menses, and elevated plasma FSH concentrations after a failed in vitro fertilization attempt were studied throughout a spontaneous menstrual cycle. Plasma estradiol, progesterone, inhibin, LH, and FSH concentrations were measured by RIA on days 1, 8, 15, and 22 and compared with the ovarian steroid and gonadotropin profiles obtained from seven endocrine-normal women. The elevated FSH concentrations in the hypergonadotropic group were not associated with significant changes in E2 and P4, but an increase in LH concentrations was found on days 1, 8, and 22 (medians of 18 and 4, 17 and 6, and 7 and less than 3 U/L for the hypergonadotropic and normal groups, respectively; P less than 0.01). Their plasma inhibin concentrations [213, 242, 747, and 561 U/L (median values on days 1-7, 8-14, 15-21, and 22-28)] were normal. Autoantibodies to adrenal, thyroid, or ovary were present in five (50%) women, and antiovarian antibodies were present in 4. Two women gave a family history of thyroid disease, and one woman was hypothyroid. Repeat assessment 3-6 months revealed persistently elevated FSH concentrations in five (63%) of eight women; the other three had normal ovarian steroid and gonadotropin concentrations. The triad of infertility, regular menses, and elevated plasma FSH concentrations describes a group of women with occult ovarian failure, a condition of compensated granulosa cell function, which may be an early stage of premature ovarian failure. These women with occult ovarian failure had an impaired response to ovarian hyperstimulation and may be at increased risk of developing polyglandular autoimmunity.

Adult↗
PubMed1987

Predictive value of plasma human chorionic gonadotrophin beta subunit in diagnosing ectopic pregnancy after in vitro fertilisation and embryo transfer.

A study was conducted aimed at establishing a range of plasma concentrations of the beta subunit of human chorionic gonadotrophin that might predict ectopic pregnancy after in vitro fertilisation and embryo transfer. From May 1984 to February 1986, 161 consecutive pregnancies at the Monash University in vitro fertilisation unit were analysed by determining plasma beta human chorionic gonadotrophin concentrations between two and 10 weeks after oocyte collection. Eighty eight ongoing singleton pregnancies, 25 multiple pregnancies, 27 first trimester spontaneous abortions, 12 anembryonic pregnancies, and nine ectopic pregnancies resulted from these conception cycles. When compared with values for ongoing singleton pregnancies two weeks after oocyte collection plasma beta human chorionic gonadotrophin concentrations in ectopic pregnancies were significantly lower (p less than 0.05; Wilcoxon rank sum test). Two weeks after oocyte collection all plasma beta human chorionic gonadotrophin concentrations in the set of ectopic pregnancies were below 30.6 IU/l, which corresponded to the lower quartile (25th percentile) of beta human chorionic gonadotrophin concentrations in ongoing singleton pregnancies. The beta human chorionic gonadotrophin concentration corresponding to the lower quartile of ongoing singleton pregnancies at each week of gestation was used to derive the predictive value of various statistics in detecting ectopic pregnancy in patients after in vitro fertilisation. The sensitivity, specificity, predictive value of a positive result, predictive value of a negative result, and efficiency of a single plasma beta human chorionic gonadotrophin concentration in predicting ectopic pregnancy were 100%, 68.1%, 16.7%, 100%, and 70%, respectively, two weeks after oocyte collection. These results suggest that a single determination of the plasma beta human chorionic gonadotrophin concentration beginning 14 days after oocyte collection is clinically useful in predicting the outcome of pregnancy achieved by in vitro fertilisation. Ectopic pregnancy after in vitro fertilisation is more likely when beta human chorionic gonadotrophin concentration is below the lower quartile of values in ongoing singleton pregnancies achieved by the technique.

Chorionic Gonadotropin↗
PubMed1987

The progesterone antagonist RU 486. A potential new contraceptive agent.

Since progesterone supports endometrial nidation of the fertilized ovum, a progesterone antagonist would theoretically block this process and thus have contraceptive potential. We have explored the ability of RU 486, a newly developed competitive progesterone antagonist, to function as a contraceptive agent. A single oral dose of 10 mg per kilogram of body weight given in the midluteal phase consistently induced menses within 72 hours in women with normal cycles and no risk of pregnancy. Bleeding was not prevented by administration of human chorionic gonadotropin in the midluteal phase. This suggested that giving a single dose of RU 486 late in the menstrual cycle might be an effective contraceptive strategy. This concept was tested in monkeys. When given to rhesus females on day 25 of the cycle, a single intramuscular dose of RU 486 (5 mg per kilogram) prevented pregnancy. The vehicle-treated control animals had a 28 percent pregnancy rate (P less than 0.05 by chi-square analysis). No side effects were noted in women or monkeys. These data suggest that a progesterone antagonist such as RU 486 has the potential to be an effective, safe, and convenient contraceptive agent. Further work will be necessary to assess the safety of long-term monthly administration and to define the optimal dose and time of administration in women.

Adult↗
PubMed1987

Lupus anticoagulant in women with multiple spontaneous miscarriage.

A link between the presence of the lupus anticoagulant (LA) and recurrent spontaneous miscarriage exists; however, the incidence of the LA in patients with unexplained recurrent miscarriage is unknown. We have therefore investigated the incidence of the LA in women with recurrent miscarriage but without evidence of systemic lupus erythematosus or other syndromes known to predispose towards spontaneous abortion. Plasma from 29 such women was obtained and tested in the activated partial thromboplastin time (APTT), testing for correction with normal plasma if prolonged and in the dilute simplastin time test (DSTT), again mixing with normal plasma if prolonged. Using a prolongation in either/or both tests which was not corrected by mixing with normal plasma as criteria for the presence of the LA, 14 (48%) patients showed evidence for the presence of the LA. Substitution of platelet-rich plasma for phospholipid and plasma in the APTT corrected the prolonged clotting time in every patient (9/29) in which it was prolonged, further substantiating the presence of the LA. We suggest that the presence of the LA should be investigated in any patient with unexplained recurrent miscarriage.

Abortion, Habitual↗
PubMed1987

Progesterone in vitro stimulates secretion of a specific protein by ovine epithelial endometrial cells.

Cultured ovine epithelial endometrial cells from oestrogen-treated ovariectomized ewes were treated in vitro with combinations of oestradiol-17 beta (E), progesterone (P) and the P-receptor antagonist RU486 (each 10(-6) to 10(-9) M), in the presence of [35S]methionine. Neither DNA content of dishes nor total protein were increased in treatment compared with control dishes. Incorporation of [35S] into secreted protein was lower from cells treated in vitro with P or E + P (10(-9) M) than from those treated with E (10(-9) M, P less than 0.01). Incorporation of [35S] into cellular protein was decreased by P (10(-9) M, P less than 0.025). SDS-PAGE analysis of secreted proteins enabled measurement of levels of a 46K protein which is secreted maximally following E + P administration in vivo. In vitro, P either alone or with E (each 10(-7) M) increased the abundance of the 46K protein in cell secretions by a factor of 1.5 +/- 0.1 (N = 9) or 1.8 +/- 0.3 (N = 10) respectively (P less than 0.01) compared with controls. The administration of E (10(-7) M) or either or both steroids at 10(-9) M, was without effect. RU486 alone (10(-6) to 10(-8) M) was also without effect but in the presence of E + P or P, blocked the increase in the 46K protein, suggesting this effect is mediated via binding of P to its receptor.

Animals↗
PubMed1987

Circulating immunoactive inhibin in the luteal phase and early gestation of women undergoing ovulation induction.

Serum inhibin was measured by radioimmunoassay in 19 women undergoing ovulation induction within an in vitro fertilization program. In 16 nonpregnant subjects, inhibin rose during the luteal phase to reach a peak (2.5 U/ml) 6 days after oocyte retrieval; it then fell to undetectable levels by day 14 (less than 0.37 U/ml). Serum inhibin was significantly correlated (P less than 0.001) with both serum progesterone and estradiol concentrations and inversely correlated with serum follicle-stimulating hormone (FSH) (P less than 0.001). In the pregnant group (n = 3), inhibin levels reached an initial peak (3.7 U/ml) on day 6, then declined to a nadir (1.5 U/ml) on day 8 after oocyte retrieval and subsequently rose to 3.4 U/ml on day 14. These data suggest (1) an inverse relationship between inhibin and FSH, which is in support of the inhibin hypothesis; (2) that the human corpus luteum secretes inhibin; and (3) a trophoblastic/placental origin of inhibin during gestation.

Estradiol↗
PubMed1987

Contributions of in vitro fertilization to knowledge of the reproductive endocrinology of the menstrual cycle.

The administration of ovarian stimulants to endocrine-normal women in IVF programmes gives the clinical endocrinologist an opportunity to modify natural folliculogenesis. Use of antioestrogens and/or gonadotrophins at the correct time has demonstrated that follicular atresia can be prevented and that multiple pregnancy-potent haploid ova can be obtained. Scrutiny of spontaneous menstrual cycles in patients who show unsatisfactory IVF responses has identified two new syndromes, premature follicle selection and occult ovarian failure, in these patients. The incidence of these disorders in fertile women is still unclear. Early results suggest that endocrine manipulations may overcome premature follicle selection and induce codominant folliculogenesis. Inhibin is a recently characterized ovarian protein which is increased in peripheral blood during IVF treatment. Results from IVF cycles suggest that plasma inhibin may be a new index of follicular function. Other potential indices of ovarian function, such as the luteal protein relaxin, may also develop from the application of basic research to IVF and advance knowledge of the human ovarian and menstrual cycles.

Estradiol↗
PubMed1987

The maternal ovary is not the source of circulating inhibin levels during human pregnancy.

The concentration of immunoreactive inhibin in serum was measured in three pregnant women with premature ovarian failure involved in a donor oocyte in-vitro fertilization programme. Inhibin was not detectable in peripheral serum prior to conception but rose within 2-4 weeks of embryo transfer, whereafter levels rose gradually during pregnancy (less than 20 weeks 1.22 U/ml (0.85-1.76) versus greater than 20 weeks 2.28 U/ml (1.42-3.67), P less than 0.01; geometric mean +/- 67% confidence interval) and were similar to those observed in 24 normal pregnant women. hCG rose in parallel with inhibin during early gestation, but declined after 3 months. FSH levels were elevated before conception and were suppressed during pregnancy. In conclusion (i) immunoreactive inhibin is detectable from early gestation in women with no endogenous ovarian function indicating that the maternal ovary does not contribute significantly to inhibin secretion during pregnancy; (ii) the trophoblast is the likely source of inhibin during pregnancy; (iii) the regulation of hCG and inhibin secretion differs throughout gestation; and (iv) inhibin may have a role in FSH regulation during pregnancy and/or a local role within the feto-placental unit.

Chorionic Gonadotropin↗