Human Reproduction, Vol 13, 2415-2420, Copyright © 1998 by Oxford University Press
IE Messinis, S Milingos, K Zikopoulos, G Hasiotis, K Seferiadis and D Lolis
Oestradiol enhances pituitary sensitivity to gonadotrophin-releasing
hormone (GnRH) in normal women, while in women undergoing ovulation
induction the putative factor gonadotrophin surge attenuating factor
(GnSAF) attenuates the response of luteinizing hormone (LH) to GnRH. To
study the relationships between oestradiol and GnSAF during ovulation
induction, 15 normally ovulating women were investigated in an untreated
spontaneous cycle (control, first cycle), in a cycle treated with daily
i.m. injections of 225 IU urinary follicle-stimulating hormone (FSH)
(Metrodin HP, uFSH cycle) and in a cycle treated with daily s.c. injections
of 225 IU recombinant FSH (Gonal-F, rFSH cycle). Treatment with FSH started
on cycle day 2. The women during the second and third cycle were allocated
to the two treatments in an alternate way. One woman who became pregnant
during the first treatment cycle (rFSH) was excluded from the study. In all
cycles, an i.v. injection of 10 microg GnRH was given to the women (n = 14)
daily from days 2-7 as well as from the day on which the leading follicle
was 14 mm in diameter (day V) until mid-cycle (n = 7). The response of LH
to GnRH at 30 min (deltaLH), representing pituitary sensitivity, was
calculated. In the spontaneous (control) cycles, deltaLH values increased
significantly only during the late follicular phase, i.e. from day V to
mid-cycle, at which time they were correlated significantly with serum
oestradiol values (r = 0.554, P < 0.01). Initially during the early
follicular phase in the uFSH and the rFSH cycles, deltaLH values showed a
significant decline which was not related to oestradiol (increased GnSAF
bioactivity). Then, deltaLH values increased significantly on cycle day 7
and further on day v with no change thereafter up to mid- cycle. On these
two days, deltaLH values were correlated significantly with serum
oestradiol values (r = 0.587 and r = 0.652 respectively, P < 0.05).
During the pre-ovulatory period, deltaLH values in the FSH cycles were
significantly lower than in the spontaneous cycles. Significantly higher
serum FSH values were achieved during treatment with uFSH than rFSH.
However, serum values of oestradiol, immunoreactive inhibin, and deltaLH as
well as the number of follicles > or = 12 mm in diameter did not differ
significantly between the two FSH preparations. These results suggest that
in women undergoing ovulation induction with FSH, oestradiol enhances
pituitary sensitivity to GnRH, while GnSAF exerts antagonistic effects. The
rFSH used in this study (Gonal-F) was at least as effective as the uFSH
preparation (Metrodin-HP) in inducing multiple follicular maturation in
normally cycling women.
ARTICLES
Luteinizing hormone response to gonadotrophin-releasing hormone in normal women undergoing ovulation induction with urinary or recombinant follicle stimulating hormone
Department of Obstetrics and Gynaecology, University of Thessalia, Lamssa, Greece.
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