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PubMed1998

Ovarian reserve tests in infertility practice and normal fertile women.

The decline in fecundity with the age of the woman is mainly attributed to the loss of follicles from the ovary and a decrease in oocyte quality. Evaluation of the aging status of the ovary in an individual woman has been hampered by a lack of knowledge with regard to the relative contribution of these two factors. Most if not all so called ovarian reserve tests (ORT) reflect indirectly the remaining follicle pool in the ovary. Direct a priori assessment of oocyte quality is not possible to date. In this section the predictive value of several ovarian reserve tests for the outcome of fertility treatment is listed and commented. In addition, the study of several of the ORTs in normal, fertile women is described. From the data presented dynamic testing of the ovarian function by the clomiphene citrate and GnRH agonist stimulation test, as well as static testing by the use of ultrasound based antral follicle counts seem to offer the highest clinical value. Studies performing direct comparison of these tests are needed, as well as analysis of the way these tests should direct decision making in infertility diagnosis and treatment.

Aging↗
PubMed1991

[Current possibilities in reproduction medicine. 1. Diagnosis].

The methods employed by assisted conception, presuppose a rational diagnostic evaluation. The endocrine work-up concentrates on demonstrating adequate ovulation. Today, apart from vaginal ultrasonography, this largely means LH determination in the urine in the middle of the cycle, together with progesterone measurements in the luteal phase. Recording the basal body temperature can offer no more than an orientation. The clarification of tubal patency is ideally served by laparoscopy with pertubation. With the aid of new sonographically visible contrast media, tubal flow can also be investigated using sonography. For the male work-up, classical evaluation of the ejaculate has declined in importance. As a means of establishing a fertility prognosis, forward progression, lateral movements of the head of the sperm, and functional sperm analysis (hamster oocyte penetration test) would appear most suitable.

Fallopian Tube Patency Tests↗
PubMed1988

Endocrine function after bone marrow transplantation without the use of preparative total body irradiation.

Ten children who underwent allogeneic (n = 5) or autologous (n = 5) bone marrow transplantation (BMT) for chronic myelogenous leukaemia (n = 2), acute lymphoblastic leukaemia (n = 1), acute myelogenous leukaemia (n = 2), severe aplastic anaemia (n = 2), malignant histiocytosis (n = 1), neuroblastoma (n = 1) and teratoma (n = 1) were assessed for endocrinological function. Transplant preparative regimens consisted of high-dose cyclophosphamide, high-dose cyclophosphamide in combination with high-dose busulphan, high-dose melphalan as well as BACT (BCNU, cytarabine, cyclophosphamide and 6-thioguanine) chemotherapy. None of the patients received total body irradiation (TBI). Median survival following BMT was 37 months (range 7-115). Growth hormone deficiency was present in only one patient; none of the patients had abnormal thyroid or adrenocortical function. This is in contrast to previous reports in which growth hormone deficiency and abnormal thyroid and adrenocortical function occurred in a much higher percentage of patients after BMT conditioned with TBI.

Adolescent↗
PubMed1991

[Diagnosis and treatment of juvenile uterine hemorrhage].

The authors demonstrate the usefulness of supplementary methods of investigation (echography and hysteroscopy) for the diagnosis and treatment of juvenile uterine bleedings. Hemorrhages developing at the onset of puberty are not associated with noticeable shifts in the hormonal status. Dysfunction of the hypophyseo-ovarian system is detectable at the end of this period; therefore the authors suggest a specific therapeutic approach to such patients. Blood coagulation disorders were revealed in 21.7% of the patients.

Adolescent↗
PubMed1998

Human chorionic gonadotropin stimulation to assess for ovarian hyperandrogenism.

STUDY OBJECTIVE: To determine whether human chorionic gonadotropin (hCG) stimulation elicits an exaggerated 17-hydroxyprogesterone (17-OHP) response in patients with functional ovarian hyperandrogenism. METHODS: In this clinical study, healthy volunteers and hyperandrogenic patients in an outpatient General Clinical Research Center (GCRC) setting were studied. Five adolescent girls with functional ovarian hyperandrogenism were studied. Six healthy women with regular menstrual cycles volunteered for this study. Steroid hormone responses to hCG stimulation were measured before and 30, 240, and 300 minutes after hCG injection. Congenital adrenal hyperplasia was excluded through ACTH stimulation testing and molecular genetic analysis. MAIN OUTCOME MEASURE: 17-OHP responses. RESULTS: Mean basal 17-OHP concentrations were greater in the hyperandrogenic patients, 110.4+/-41.2 ng/dL versus 61.8+/-28.6 ng/dL. After hCG stimulation, 17-hydroxyprogesterone concentrations significantly increased in the patients and were unchanged in the healthy controls. CONCLUSION: hCG stimulation elicited greater 17-hydroxyprogesterone responses in adolescent girls with functional ovarian hyperandrogenism compared with healthy controls. hCG stimulation may be helpful to confirm ovarian hyperandrogenism.

17-alpha-Hydroxyprogesterone↗
PubMed2003

Dynamic evaluation of ovarian reserve and abnormal androgen excess in women.

The evaluation of the ovarian reserve is an important area of clinical investigation that gives information on endowment and functional activity of remaining follicles within the ovary, thus concerning the female reproductive potential. In neonatal and pediatric age, an ovarian failure is commonly due to disorders of sexual differentiation. In adults, the basal and dynamic tests that predict the ovarian reserve are particularly useful in women undergoing assisted reproductive programs. Transvaginal ultrasound study of ovarian folliculogenesis performed simultaneously with the evaluation of cervical score, FSH, LH and estradiol plasma levels, evidentiates follicular rupture and ovulation, indicating also the optimum timing of hCG administration. Basal day 3 FSH, 17-beta-estradiol and inhibin B plasma levels give information on the ovarian potential. Clomiphene citrate challenge test (CCCT) and GnRH agonist stimulation test (GAST) have clinical utility as indicators of ovarian reserve but their accuracy does not allow to be predictive in terms of number-per-unit tissue of the remaining follicle within the ovary. In the present paper the strategies to study hyperandrogenism and polycystic ovarian syndrome, a common cause of ovarian reserve reduction and subfertility, are also reviewed. The abnormal androgen excess in women can be referred to the ovary, the adrenal glands, or the peripheral conversion of androgen precursors. Dynamic tests may be useful for determining the amount of androgens rising from each of these sites helping the therapeutic strategies.

Adolescent↗