A small minority of patients triggered with GnRH agonist had an inadequate response. Rescheduling of oocyte retrieval after hCG retrigger yielded similar IVF outcomes. Evaluation of trigger response based on serum LH and P concentrations is time dependent. Patient characteristics suggestive of hypothalamic hypofunction were predictive of an inadequate response to the GnRH agonist trigger.

Acute exercise may stimulate PRL secretion, which, in turn, may contribute to exercise-associated menstrual dysfunction. We compared the response of PRL secretion in sedentary women and women runners with normal and abnormal menstrual cycles. We also studied the GH response to acute exercise, as GH may bind to lactogenic receptors. Five nonrunning women, 5 eumenorrheic running women, four oligomenorrheic running women, and six amenorrheic running women were studied on 2 consecutive days. On day 1, the women cycled on a bicycle ergometer against an increasing workload until total exhaustion. Serum PRL and GH increased several-fold in response to acute exercise in all three groups of running women. On day 2, the women simulated a daily training run by enduring a designed submaximal exercise regimen. In response to submaximal exercise, no group had a significant elevation of PRL or GH. Therefore, a threshold of exercise intensity exists that must be achieved before a significant increase in PRL or GH secretion occurs in women runners; serum PRL and GH in the nonrunning group did not increase significantly even in response to acute maximal exercise. The transient elevations in PRL and GH in women runners probably do not contribute to their menstrual dysfunction unless individual hypersensitivity of the hypothalamic-pituitary-ovarian axis to such intermittent elevations is present.

Long distance women runners have a high incidence of oligoamenorrhea. In order to study the possible role of PRL in contributing to their menstrual dysfunction, we evaluated PRL secretion in eumenorrheic (n = 7) and oligomenorrheic runners (n = 9) who averaged 25-50 miles/week, as well as nonrunning women (n = 5) during the midfollicular phase of their cycles. Serum estradiol, progesterone, testosterone, FSH, LH, TSH, and T4 were similar among the three groups. The mean 24-h +/- SE PRL concentrations between the three groups: nonrunners, 12.9 +/- 0.6 ng/ml; eumenorrheic runners, 13.5 +/- 0.4 ng/ml; and oligomenorrheic runners, 15.0 +/- 0.8 ng/ml, were not significantly different. A dopamine (DA) infusion, 0.004 micrograms/kg X min, produced physiologic serum DA levels in these subjects. The nadir of serum PRL levels during DA infusion was similar in each group, which argues against an abnormality in dopaminergic tone in the runners with menstrual dysfunction. Our findings of normal 24-h PRL secretion and appropriate PRL responses to DA in women runners with menstrual dysfunction do not support a role for PRL in this disorder.

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