Induction of Ovulation and Fertility in Amenorrheic Women by Pulsatile Low-Dose Gonadotropin-Releasing Hormone

Hurley, David H.; Brian, Rhonda J.; Outch, K; Stockdale, Jan; Fry, Annette; Hackman, Charles; Clarke, Iain J.; Burger, Henry

doi:10.1097/00006254-198409000-00016

Cited by 5 publications

(7 citation statements)

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“…The GnRH pulse generator is active during fetal and neonatal life 4 and then is inhibited or desynchronized by poorly defined central processes until the onset of puberty. [5][6][7] Puberty and ovulation are centrally driven processes that can be achieved by providing exogenous pulses of GnRH at a frequency of one pulse every 60 to 90 min [8][9][10] or by stimulating the dormant GnRH neuronal network with excitatory amino acids. 11 The mechanisms that modulate the activity of the GnRH neuronal network or GnRH pulse generator are largely unknown.…”

Section: Abstract: Stress; Amenorrhea; Anovulation; Hypothyroidism; Amentioning

confidence: 99%

Use of Cognitive Behavior Therapy for Functional Hypothalamic Amenorrhea

Berga

Loucks

2006

Annals of the New York Academy of Sciences

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Behaviors that chronically activate the hypothalamic-pituitary-adrenal (HPA) axis and/or suppress the hypothalamic-pituitary-thyroidal (HPT) axis disrupt the hypothalamic-pituitary-gonadal axis in women and men. Individuals with functional hypothalamic hypogonadism typically engage in a combination of behaviors that concomitantly heighten psychogenic stress and increase energy demand. Although it is not widely recognized clinically, functional forms of hypothalamic hypogonadism are more than an isolated disruption of gonadotropin-releasing hormone (GnRH) drive and reproductive compromise. Indeed, women with functional hypothalamic amenorrhea display a constellation of neuroendocrine aberrations that reflect allostatic adjustments to chronic stress. Given these considerations, we have suggested that complete neuroendocrine recovery would involve more than reproductive recovery. Hormone replacement strategies have limited benefit because they do not ameliorate allostatic endocrine adjustments, particularly the activation of the adrenal and the suppression of the thyroidal axes. Indeed, the rationale for the use of sex steroid replacement is based on the erroneous assumption that functional forms of hypothalamic hypogonadism represent only or primarily an alteration in the hypothalamic-pituitary-gonadal axis. Potential health consequences of functional hypothalamic amenorrhea, often termed stress-induced anovulation, may include an increased risk of cardiovascular disease, osteoporosis, depression, other psychiatric conditions, and dementia. Although fertility can be restored with exogenous administration of gonadotropins or pulsatile GnRH, fertility management alone will not permit recovery of the adrenal and thyroidal axes. Initiating pregnancy with exogenous means without reversing the hormonal milieu induced by chronic stress may increase the likelihood of poor obstetrical, fetal, or neonatal outcomes. In contrast, behavioral and psychological interventions that address problematic behaviors and attitudes, such as cognitive behavior therapy (CBT), have the potential to permit resumption of full ovarian function along with recovery of the adrenal, thyroidal, and other neuroendocrine aberrations. Full endocrine recovery potentially offers better individual, maternal, and child health.

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Section: Abstract: Stress; Amenorrhea; Anovulation; Hypothyroidism; Amentioning

confidence: 99%

Use of Cognitive Behavior Therapy for Functional Hypothalamic Amenorrhea

Berga

Loucks

2006

Annals of the New York Academy of Sciences

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“…Significant gonadotropin elevations have been induced by pulsatile infusions of LH-RH, peak values of the LH-RH pulses being in the nanogram range in humans [32,33] and in monkeys [34]. In monkeys, an inhibitory effect was induced by increasing the pulse frequency without changing the dosage [34].…”

Section: Discussionmentioning

confidence: 99%

“…Blood was collected in group A on days 1, 2,7,9,12,14,21,23,25,28,35, and 42 and in group B every day from day 1 to day 8 just before each Decapeptyl injection, and then on days 10,12,14,21,24,26,28,30,32,34,37,39,42,49, and 56. The samples were collected on EDTA, immediately centrifuged, and the plasma was stored at -20°C until analyzed.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Prostatic Carcinoma with D-Trp-6-LH-RH: Plasma Hormone Levels After Daily Subcutaneous Injections and Periodic Administration of Delayed-Release Preparations

et al. 1986

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The hormonal effects of a delayed-release intramuscular (IM) preparation of D-Trp-6-LH-RH (Decapeptyl microcapsules) were investigated in men aged 65-75 years. Six men with a prostatic adenoma (group A) received subcutaneously (SC) 500 p g DecapeptyUday for seven days. Seven men with a prostatic carcinoma (group B) were given the same SC treatment, but in addition received on days 8, 28, and 56 an IM injection of Decapeptyl microcapsules. During SC treatment, plasma Decapeptyl levels rose to 2-4 ng/ml. Plasma LH, FSH, and 17-hydroxy-progesterone peaked on day 2, and estradiol-17P on day 3, whereas high testosterone levels were maintained from day 2 to day 4, and then fell abruptly on day 6. In group A, hormone levels were minimal on day 12 or 14 but returned to basal on day 23. After IM injection of microcapsules on day 8, two out of seven subjects from group B exhibited the same hormonal pattern as for group A, but testosterone secretion was completely suppressed after the second IM injection. In both subjects, plasma Decapeptyl was undetectable in most samples from day 10 to day 28, but became detectable after the second injection. In five subjects from group B, plasma Decapeptyl was detectable in all plasma samples from day 10 to day 49. Testosterone levels were in the castrate range after day 24 (0.25 f 0.03 ng/ml). Mean LH level (* SEM) decreased progressively from day 14 (65 f 6 ng LER 907/ml) to day 56 (36 f 2 ng/ml). These data provide evidence for the efficacy of periodic administration of Decapeptyl microcapsules for suppressing testicular secretion.

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“…Ovulation occurs in about 90% of treatment cycles and cumulative pregnancy rates of up to 80% of patients are reported. (Leyendecker et al, 1980b;Schoemaker et al, 1981;Hurley et al, 1984;Mason et al, 1984;Menon et al, 1984;Ross et al, 1985). Multiple pregnancies are few in comparison to Pergonal (Serono Laboratories (UK) Ltd., Welwyn Garden City, Herts) and hCG treatment regimens.…”

Section: Ovulation Inductionmentioning

confidence: 99%

Gonadotrophin Releasing Hormone: From Physiology to Pharmacology

Clayton¹

1987

Clinical Endocrinology

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Induction of Ovulation and Fertility in Amenorrheic Women by Pulsatile Low-Dose Gonadotropin-Releasing Hormone

Cited by 5 publications

References 0 publications

Use of Cognitive Behavior Therapy for Functional Hypothalamic Amenorrhea

Use of Cognitive Behavior Therapy for Functional Hypothalamic Amenorrhea

Treatment of Prostatic Carcinoma with D-Trp-6-LH-RH: Plasma Hormone Levels After Daily Subcutaneous Injections and Periodic Administration of Delayed-Release Preparations

Gonadotrophin Releasing Hormone: From Physiology to Pharmacology

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