Alternative indications for pulsatile gonadotropin-releasing hormone therapy in infertile women.

Three groups of women with different types of ovulatory dysfunction who had failed to conceive on conventional therapy were treated with pulsatile gonadotropin-releasing hormone (GnRH). Group A consisted of nine patients with luteal phase defect; group B included four patients with apparently normal menstrual cycles but disordered folliculogenesis seen by serial ultrasound examinations; and group C consisted of eight patients who exhibited anovulation or irregular ovulation. GnRH was administered subcutaneously or intravenously in dosages varying from 5 micrograms to 20 micrograms, with pulse frequency of 2 to 3 hours in 53 cycles. Forty-one cycles were ovulatory. Four pregnancies resulted, one ending in miscarriage at 12 weeks' gestation. Our results indicate that GnRH may be used as an alternative to the prevalent therapeutic methods for ovulatory dysfunction. Only those women who had anovulation and abnormal basal levels of serum luteinizing hormone were resistant to GnRH therapy.

Intrauterine insemination: the University of Minnesota experience.

Forty-five patients initiated intrauterine insemination between October 1981 and August 1983. Indications for insemination included poor semen (count less than 20 X 10(6)/ml and/or motility less than 40%), poor cervical mucus, presence of sperm antibodies, unexplained poor postcoital tests, or various combinations of the above. During this time period, 374 inseminations were performed in 163 cycles and resulted in eight pregnancies in the 45 patients receiving artificial insemination by homologous donor, for an overall pregnancy rate of 17.4%. The fact that five of the pregnancies occurred in the first insemination cycle and two in the second cycle was felt to indicate a cause-and-effect relationship. A trial of intrauterine insemination in selected patients would appear to be warranted.

Vaginal agenesis in association with gonadal dysgenesis.

Two cases of gonadal dysgenesis and congenital absence of the vagina are presented. One of the 2 patients studied had a normal female karyotype, an absent vagina, and a uterus represented by 2 thin fibrous bands ending just beneath the urinary bladder in the midline. The other patient had features of Turner syndrome, a 45,X chromosomal complement, and an absent vagina with infantile uterus and fallopian tubes. As gonadal anomalies may coexist in patients with congenital absence of the vagina, laparoscopic evaluation of such patients may be of diagnostic value.

Combined use of clomiphene and intranasal luteinizing hormone-releasing hormone for induction of ovulation in chronically anovulatory women.

Combined therapy with clomiphene and intranasal luteinizing hormone-releasing hormone (LHRH) was used to induce ovulation in eight chronically anovulatory patients under treatment for infertility. Clomiphene, 100 mg daily, was given from the 5th to the 9th day of the cycle. Synthetic LHRH was administered intranasally in different dosages from day 11 to day 14, in an attempt to induce late follicular development and ovulation. Five of the eight patients ovulated, and three conceived. The success achieved with combined clomiphene and intranasal LHRH administration suggests a therapeutic potential in the management of anovulatory infertility.

PIP: Combined therapy with clomiphene and intranasal (LHRH) luteinizing hormone-releasing hormone was used to induce ovulation in 8 chronically anovulatory patients under treatment for infertility. Clomiphene, 100 mg daily, was given from the 5th-9th day of the cycle. Synthetic LHRH was administered intranasally in different dosages from days 11-14 in an attempt to induce late follicular development and ovulation. 5 of 8 patients ovulated and 3 conceived. The success achieved with combined clomiphene and intranasal LHRH administration suggests a therapeutic potential in the management of anovulatory infertility.

XY gonadal dysgenesis in three siblings.

Three tall, phenotypic female siblings with XY gonadal dysgenesis were found to have short fourth metacarpal bones (bilateral in two and unilateral in the other). Clitoromegaly was observed in the two older siblings, without hirsutism. Bilateral streak gonads were found in all three. A gonadoblastoma was present in the left streak gonad of the youngest, and an adenomatoid tumor in the left streak gonad of the oldest, who was diabetic. Determination of androgens from peripheral and gonadal venous plasma revealed androgen secretion by the streak gonads. On the basis of clinical findings, familial tendency, and androgen secretion from the streak gonads in these patients, it is proposed that the XY gonadal dysgenesis represents a severe form of male pseudohermaphroditism.

Prolactinomas: surgical therapy, indications and results.

This study indicates that transsphenoidal microsurgical removal of prolactinomas is highly effective for producing significant normalization of preoperative prolactin levels, resumption of menses, and the recovery of fertility in patients with microadenomas. Minimal morbidity and no mortality were encountered in this series. Surgical treatment in patients with microadenomas is comparable to bromocriptine therapy for achieving normalization of prolactin levels and fertility. In patients with macroadenomas, bromocriptine is more effective than surgery. This drug can also be used for achieving fertility when prolactin levels fail to normalize and resumption of menses does not occur following surgery. Radiation therapy should be reserved postoperatively for those patients who have macroadenomas with suprasellar or parasellar extension.

Myasthenia gravis, premature menopause, and thyroid autoimmunity.

Two case reports of patients with myasthenia gravis, premature menopause at ages 18 and 29 years, and evidence of thyroid and ovarian autoimmunity are presented. Both patients had elevated gonadotropins, sex steroid values in the menopausal range, and ovaries without follicular activity. An autoimmune etiology is suggested because of the high titers of antithyroid and antiovarian antibodies.