Normal Production of Human Chorionic Gonadotropin in Perimenopausal and Menopausal Women and After Oophorectomy

Abstract

Low-level hCG production in woman in physiologic perimenopause, in menopause, or in women with prior bilateral oophorectomy is a normal biologic and biochemical phenomenon. Management protocols in all fields need to be changed to accept pituitary hCG as normal and recognize the clinical maneuvers that will secure the diagnosis. Understanding this physiology will avoid needless delays in necessary therapies such as organ transplant procedures and will limit the misadventure of prescribing unnecessary cancer treatments.

Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

“…Pituitary hCG is physiologically produced with increasing menopausal production of luteinizing hormone, owing to the decreased production of estrogen and the suppression of progesterone [86, 87]. To distinguish this phenomenon from hCG secondary to trophoblastic disease, women can be treated with estrogen, which would suppress pituitary hCG but would not alter GTN produced hCG.…”

Efficacy, efficiency and effectiveness of gonadotropin therapy for infertility treatment

“…[9][10][11]13,17,18 Production of different isoforms is controlled by a combination of steroidal feedback and gonadotropinreleasing hormone (GnRH). 10,19 The higher the estradiol levels, the lower the FSH sialylation, as shown in Table 1. 3,20 Therefore, the pattern of circulating FSH during the menstrual cycle is dynamic with respect not only to its quantity (concentration) but also to isoform distribution (quality).…”

“…3 Human menopausal gonadotropin preparations have both FSH and LH activity, but the latter is primarily derived from the hCG component present in postmenopausal urine and concentrated during purification. 2,18,19 Sometimes, hCG is added to achieve the desired amount of LH-like biological activity. 2 In 1999, purified hMG gonadotropins were introduced, allowing its subcutaneous (SC) administration.…”

Gonadotropin in Assisted Reproduction: An Evolution Perspective

“…FSH and LH are synthesized and secreted by gonadotrophs of the anterior pituitary gland under stimulation of pulsatile secretion of gonadotropinreleasing hormone (GnRH) from the hypothalamus [12]. Human chorionic gonadotropin is synthesized during pregnancy by syncytiotrophoblast cells and also by the pituitary in perimenopause and menopause women [13,14].…”

“…The first hMG preparation was registered in Italy in 1950, but clinical trials only started 10 years later [3]. hMG preparations have both FSH and LH activity, but the latter is primarily derived from the hCG component present in postmenopausal urine and concentrated during purification [2,13,14]. Sometimes hCG is added to achieve the desired amount of LH-like biological activity [2].…”