Luteal phase deficiency: ultrasonic and biochemical insights into pathogenesis

Article Abstract:

Defects in the secretion of pituitary and ovarian hormones can cause infertility. During the luteal phase of the menstrual cycle, the ovary is stimulated by luteinizing hormone (LH) secreted from the pituitary gland to form a corpus luteum from an ruptured egg follicle (ovulation). After ovulation the corpus luteum secretes progesterone, the hormone responsible for preparing the lining of the uterus for embryo implantation. Later, if pregnancy occurs, the secretion of progesterone is taken over by the placenta. When the progesterone levels increase, the pituitary stops releasing LH as part of a negative feedback system. Since progesterone is essential in achieving and maintaining pregnancy, defects in the luteal phase can prevent pregnancy. In fact, luteal dysfunction is not uncommon in women with unexplained infertility. The physiology of ovarian functioning can be assessed by measuring hormones in the blood and performing serial ultrasound evaluations of the ovaries. To help understand the role of luteal phase deficiencies, hormone patterns were measured in the blood, and ovarian egg follicle size was measured by ultrasound in 175 women with unexplained infertility. The results were compared to information obtained from 43 women in the normal population. Progesterone increased abnormally (termed poor progesterone surge or PPS) in 51 infertile women (29.1 percent). Luteal cysts, an abnormal formation caused by the failure of the follicle to infill and disappear, formed in 23 infertile women (45.1 percent) but in none of the normal women. In 18 out of 23 cases the shrinking of the follicle did not follow the peak LH level, indicating that the follicles failed to ovulate. Accompanying the poor progesterone surge cycles, there was a high concentration of the follicle stimulating hormone (FSH) and a low concentration of estrogen. This suggests that PPS occurs after the abnormal follicle formation and not at the time the corpus luteum is developed. It is concluded that PPS is common in menstruating women with unexplained infertility. Ultrasound and hormone measurements can accurately assess ovarian functioning. Infertility can be caused by a defect in the development of an egg follicle, which can affect the quality of the egg, prevent the release of an egg from the ovary or promote an unfavorable uterine lining. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Development and progression, Progesterone, Luteal phase defects

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The diagnosis of polycystic ovaries in subfertile women

Article Abstract:

Polycystic ovary syndrome (PCOS) is a disorder caused by an endocrine disturbance resulting in a hormone imbalance. Overstimulation of the ovaries produces many small, underdeveloped egg follicles, resulting in ovary enlargement. PCOS causes abnormal menstruation, abnormal ovulation, and infertility. Some women are obese and have excess hair growth. The free androgen index (FAI) is used to assess the amount of free testosterone, a hormone that produces male characteristics. Diagnosis of PCOS can be made by laparoscopy, a procedure used to visualize internal structures. A tube affixed with a microscope was inserted into a small opening in the abdomen to visualize the ovaries of 206 infertile women. The results of laparoscopy were compared with individual FAI test results. PCOS was diagnosed by laparoscopy in 33 percent of the women. Only 15 percent of these women were obese, had excess hair, and did not menstruate. If a diagnosis was made based on symptoms alone, 85 percent of the cases would have been missed. Luteinizing hormone (LH, a hormone released in the brain to stimulate the ovaries) and testosterone levels, along with FAI were highest in the women with polycystic ovaries. In women with polycystic ovaries, excess hair was strongly associated with a high FAI index. Women with polycystic ovaries and regular menstrual cycles did not have any other cause for infertility. Women with polycystic ovaries had higher LH and FAI levels than normal ovulating women. Laparoscopic confirmation of polycystic ovaries was supported by hormonal evidence to positively diagnose PCO. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis

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The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body-weight

Article Abstract:

Stein-Leventhal syndrome, polycystic ovarian syndrome (PCOS), is characterized by abnormal menses, anovulation resulting in infertility, multiple ovarian cysts and hair growth. Obesity is also present in many women. Complications of pregnancy in women with PCOS are preeclampsia (high blood pressure, edema and protein in the urine) and diabetes. Infertility is improved with either surgery, drug therapy or electrocautery. Women with PCOS have an increased incidence of miscarriage, fetal malformations and multiple pregnancy which may be the result of treatment methods or the increased risk associated with body weight. The effect of electrocautery on fetal outcome was studied with emphasis on maternal body weight. In 89 PCOS patients who conceived after electrocautery, 62 women completed pregnancies beyond 31 weeks. In the obese women preeclampsia occurred in 12.9 percent and gestational diabetes was present in 3.8 percent. Major fetal malformations appeared in one percent of these pregnancies and 3.8 percent showed minor defects. The rate of early miscarriage was 15 percent and 10.3 percent for late miscarriage. The complications of preeclampsia and diabetes were found to be related to body weight and not to treatment with electrocautery or to PCOS. Researchers also concluded that electrocautery was not responsible for miscarriage, malformations or multiple pregnancy.

Care and treatment, Usage, Complications and side effects, Diseases, Obesity, Cautery

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