Corpus luteum function in subdermal levonorgestrel implant users.

PIP: Occurrence of ovulation and corpus luteum function were determined in 16 women inserted with 6 silastic rods, each containing 34 +or- 2mg levonorgestrel, for 1 year. Records of all subjects indicated minimal menstrual disturbances. Mean +or- S.E. serum progesterone levels at days M -7 to M -4 of the menstrual cycle revealed: anovulation (7 subjects) with serum progesterone levels less than 3 ng/ml, inefficient corpus luteum (7 subjects) with progesterone levels of 3-5 ng/ml, and normal ovulation (2 subjects) with progesterone levels above 5 ng/ml. Mean serum estradiol levels determined in the 3 levonorgestrel subgroups were insignificantly different from each other as well as from mean estradiol levels determined in 24 normal ovulatory control women.^ieng

Subdermal levonorgestrel implants and pituitary function.

This study was designed to report changes in circulating FSH, LH, and prolactin levels in women users of subdermal levonorgestrel implants. The subjects comprised 21 women implanted with 6 silastic rods, each containing 34 mg levonorgestrel, between days M0 and M+4 of the menstrual cycle. Blood samples were drawn prior to, 1 month and 6 months after implantation, during the early follicular phase in menstruating (n=12), and randomly in amenorrheic (n=9) subjects. No significant differences were noted between the mean values of estimated hormones at the 3 intervals of estimation in both regularly menstruating and amenorrheic groups.

Endocrine profiles in pediatric andrology. I. Thyroid-stimulating hormone response to thyrotropin-releasing hormone in normal and protein-calorie malnourished infants.

Thryotropin-releasing hormone (TRH) was intravenously administered to eight normal control infants and ten infants with kwashiorkor. Stimulation caused by TRH was measured at various time intervals. The basal total protein mean value +/- SE was 6.9 +/- 0.3 and 4.0 +/- 0.3 g/dl for the control and kwashiorkor groups, respectively. Serum total thyroxine was 7.7 +/- 0.6 and 4.8 +/- 0.8 micrograms/dl for the control and kwashiorkor groups, respectively. Serum levels of thyroid-stimulating hormone (TSH) were 3.2, 13.5, 9.0, 7.4, and 8.0 microU/ml for the controls before stimulation and 20, 60, 90, and 120 min after stimulation, respectively. The corresponding values for the infants with kwashiorkor were 5.7, 13.9, 14.9, 15.2, and 15.3 microU/ml, respectively. The delayed TSH response to TRH stimulation in the infants with kwashiorkor was attributed to disturbance in the hypothalamic-pituitary-thyroid axis.

Endocrine profiles in pediatric andrology. II. Insulin-dependent diabetic adolescents.

Seventy-five diabetic male and female children and 75 matched controls were classified according to pubertal staging. Blood samples were assayed for gonadotropins and gonadal hormones. The ultimate adult height in diabetic patients was 5 cm less than that of controls. Almost all diabetic children had a retarded bone age. Levels of serum gonadotropins and gonadal hormones did not differ markedly between diabetic and healthy children. The delay in growth and maturation was not due to hormonal failure, but probably to chronic undernutrition of body cells and failure to utilize the amino acids for protein anabolism related to relative insulin deficiency.

Effect of urinary bilharzial infection on male pubertal development and endocrine functions.

One hundred seventy-five males aged 9-20 years were selected. The subjects comprised two groups; controls and patients infected with urinary bilharziasis not associated with any other parasite. Pubertal development was assessed. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and progesterone were determined by radioimmunoassay procedure. Delay in pubertal development was evident in the normal control group as indicated by higher chronological age mean values at the various stages as compared to other world norms. Urinary bilharziasis exaggerated the delay in pubertal development as compared to that in the control group. In relation to the control group, the group with urinary bilharziasis had higher levels of serum FSH and LH, which were significant only at stages III and IV. No significant difference was noted between the two groups for serum testosterone and progesterone levels, except for the high progesterone mean value at stage V in the group with urinary bilharziasis.

Endocrine profiles in pediatric andrology. III. Human chorionic gonadotropin stimulation test in cryptorchid boys.

Serum testosterone (T) concentration and urinary 17-ketosteroid (17-KS) excretion were measured under basal conditions and after stimulation with human chorionic gonadotropin (hCG) in 36 prepubertal males (10 normal children and 26 cryptorchid patients). As a function of hCG stimulation, the increase in serum T level was evident in both groups, although the magnitude of the rise was higher in the control group than in cryptorchid boys. No significant differences in serum T or urinary 17-KS were observed between patients with unilateral and bilateral undescended testis, either before or after hCG stimulation. In spite of the wide individual variations in testicular response in all subjects, the test is valuable in assessing Leydig-cell function and in prognosis for virilization at puberty.

Corpus luteum function in medicated and non-medicated IUD users.

PIP: Serum estradiol and progesterone were determined by radioimmunoassay procedures at premenstrual days M-7 and M-6 in 30 nonlactating women: 1) control non-IUD users (n=10), 2) Lippes loop users (n=10), and 3) copper T 200 users (n=10). Results indicated ovulatory and normal corpus luteum pattern in the 3 groups. Comparable evaluation was performed at premenstrual days M-4 and M-2 in 30 lactating women: 1) control lactating (n=10), 2) copper T 200 users (n=10), and 3) Progestasert TM system users (n=10). Results indicated anovulatory figures in progesterone-releasing device users, and while about 40% of lactating controls and copper T 200 users showed evidence of ovulation, the rest were nonovulatory.^ieng

FSH, LH, E2, progesterone, and testosterone in peripheral blood, spermatic vein, and semen of subfertile men with varicocele.

Peripheral blood (PB), spermatic vein (Sp. V.), and semen samples were collected from 31 subfertile men with varicocele. Levels of FSH, LH, estradiol, progesterone, and testosterone were determined in the three biological fluid compartments using RIA. Remarkable increases in both testosterone and estradiol in the spermatic vein samples, as compared to either peripheral blood or semen, were evident. Correlation coefficient indicated significant positive correlation between PB FSH and each of PB LH, Sp. V. FSH, and Sp. V. LH. Significant positive correlation existed between PB LH and each of Sp. V. FSH, LH, and testosterone. Significant positive correlations were found between PB testosterone and each of Sp. V. testosterone and semen testosterone, as well as between PB estradiol and each of Sp. V. FSH and progesterone. Significant positive correlations between Sp. V. FSH and Sp. V. testicular progesterone was significantly correlated with seminal estradiol.

Subdermal levonorgestrel implants: serum androgens.

Serum levels of androstenedione, dihydrotestosterone, and testosterone were determined by radioimmunoassay procedures in 25 female volunteers using subdermal levonorgestrel implants as a contraceptive. Mean serum androstenedione levels were increased after 1 and 6 months in comparison with preimplantation levels, the increase being significant only after 1 month. This could be attributed to increased production from the adrenal or ovaries and/or changes in clearance rate. Testosterone levels showed approximately 24% increase above basal values after 6 months' use of levonorgestrel implants, which was attributed to concomitant increases in androstenedione levels. The implication of these results is discussed.

Serum cortisol in women users of subdermal levonorgestrel implants.

The aim of this study was to reveal changes in serum cortisol levels in users of subdermal levonorgestrel implants (Norplant). The study was undertaken on 18 regularly menstruating females subdermally implanted with 6 silastic rods, each containing 34 +or- 2 mg levonorgestrel, between days M0-M+4 of the menstrual cycle. Venous blood samples were collected between 10:00 and 11:00 a.m. under basal conditions, before and 1, 6, and 12 months after implantation. Sera were analyzed for cortisol by radioimmunoassay procedures. Mean +or- S.E.M. cortisol levels were 15.94 +or- 1.23, 10.20 +or- 0.84, 11.21 +or- 1.14, and 11.14 +or- 1.05 mcg prior to and 1, 6, and 12 months after implantation, respectively. All postimplantation values were significantly lower in comparison to basal levels. However, results obtained fell within the normal range of serum cortisol, with no subjects reporting symptoms of adrenocortical insufficiency.

Clinical and hormonal studies of subfertile males with varicocele.

To evaluate the hormonal factor in subfertile males with varicocele, FSH, LH, estradiol (E2), and testosterone (T) were assayed both from cubital and spermatic veins. The hormonal profile of patients showed no significant differences from the normal control group. Blood hormonal levels of E2 and T in the testicular veins were much higher than those in the cubital veins while FSH and LH levels showed no significant difference. FSH, LH, and testosterone blood levels in cubital and spermatic veins were statistically correlated. A preoperative hormonal study would be helpful in excluding cases in which varicocele is not the underlying cause of infertility.

Serum-prolactin levels in lactating women using the Progestasert system.

PIP: This study investigates possible changes in serum-prolactin levels in lactating women using the Progestasert system as compared with women fitted with a copper T device and lactating mothers not using any contraceptive method. 46 females (28-35 years of age, parity 1-6) were divided into 2 major groups: 1) 26 menstruating and lactating women (further subdivided into a) control group of 11 normally menstruating women without any contraception; b) 9 Cu T 200 users; and c) 6 Progestasert users); 2) amenorrheic and lactating mothers subdivided into 8 Progestasert users, and 12 Cu T 200 users. No significant differences in the premenstrual and menstrual mean prolactin values were observed in any of the groups. With the onset of menses, a uniform rise in prolactin levels was observed in 3 groups, but was significant only in the Progestasert group. Serum prolactin levels in lactating and amenorrhiec mothers 2 months after delivery showed no significant changes when Cu T 200 and Progestasert IUD users were compared. Further research on this subject should include a matched group of lactating and amenorrheic mothers.^ieng

Corpus luteum function in lactating women using the Progestasert system.

PIP: Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (P) were determined in lactating and menstruating women, 6-8 months after delivery. The subjects were categorized into 3 groups: non-IUD users, copper T-200 (Cu T 200) users, and Progestasert system users. Both types of IUDs were inserted immediately postpartum. When the values of each hormone determined at days M -4 and M -3 were averaged for each subject, remarkable decreases in the grand mean values of FSH, LH, and P were evident in Progestasert users. However, a significant difference was noted between the non-IUD and Progestasert groups for LH only. Considering serum P level as the index of corpus luteum function, the incidence of ovulation, corpus luteum insufficiency and anovulation was 50%, 17%, and 33%, respectively, in the Cu T 200 group; and 17, 33, and 50%, respectively, in the Progestasert group. Similar hormonal determinations were carried out 2 months postpartum in 2 groups of amenorrheic and lactating females fitted with Cu T 200 or Progestasert IUDs immediately after delivery. Results revealed 100% anovulation in the Progestasert group, whereas in the Cu T 200 amenorrheic group, 19, 9, and 72% were ovulating, poor corpus luteum, and anovulating, respectively. These data provide evidence that the Progestasert IUD exerts systemic depressive effect on the hypothalamic-pituitary-ovarian axis in lactating women.^ieng

Serum cortisol level in lactating women using the Progestasert system.

PIP: Premenstrual and menstrual serum-cortisol levels were determined in 3 groups of lactating and menstruating females 6 months after delivery: 1) control not using any contraception (n=11); 2) Progestasert group (n=6); and 3) Copper T 200 group (n=9). All IUDs were inserted immediately postpartum. Another group of women, the amenorrheic and lactating mothers were divided into: 1) Progestasert users (n=8), and Cu T users (n=12). Blood samples were collected from all groups and subjected to cortisol estimation using a competitive protein binding assay according to the method of Baum et al. Comparison of the data obtained revealed decreased levels in both IUD groups as compared to the normal controls at the onset of menstruation. However, the difference was significant only between the non-IUD and Cu T 200 groups. No significant differences between the groups were observed at day M (menstruation)-3. Serum cortisol levels were significantly raised in the control group with the onset of menses, which could be explained on the basis of stress. No significant differences were observed between the two groups of amenorrheic and lactating mothers. It was concluded that the Progestasert IUD system has no effect on cortisol levels in postpartum lactating women.^ieng

Thyroid function in lactating women using the Progestasert system.

PIP: This study determines the thyroid hormone levels, in serum and milk, of 46 healthy lactating women fitted with the Progestasert system immediately postpartum. The ages of the women ranged from 28 to 35 years, parity from 3 to 6. They were divided into 2 groups: 1) menstruating and lactating women, and 2) amenorrheic and lactating mothers. The 1st group was subdivided into: 1) non-IUD users (n=11); 2) Cu T 200 users (n=9); and 3) Progestasert users (n=6). The 2nd group was subdivided into: 1) Cu T 200 users (n=12), and 2) Progestasert users (n=8). Blood and milk samples were collected and analyzed for T4 (serum thyroxine) and T3 (triiodothyronine) using radioimmunoassay techniques. The T4/T3 ratio was calculated for each sample from the 2 parameters. In the menstruating group, the T4 level was lower in the Progestasert group than in either of the other 2 groups, although the difference was statistically significant (pO.05) only when compared with the non-IUD group. There were no significant changes observed between the mean values of the 3 groups for T3 or T4/T3 ratio, although there is a trend for decreased levels in T3 in the IUD users (Cu T 200 and Progestasert). In the amenorrheic group, no statistically significant differences were observed between the Cu T 200 and Progestasert users in any of the 3 thryoid parameters. The findings do not support the alleged contributing role of lactation to decreased serum T4 levels in Progetasert users as it is known that the hypothalamic releasing factor for thyrotropin also releases prolactin. It is possible that the absorbed progesterone on breast tissue enhances T4 transfer from serum to milk. Further comparative studies will determine the validity of these results in nonlactating women as well as the mechanism involved in the decreased serum level and increased thyroid hormone level in milk in users of medicated IUDs.^ieng

Endocrine profile of semen in subfertile males with varicocele.

The semen levels of FSH, LH, estradiol, progesterone, and testosterone were estimated in normal fertile males and in patients with oligozoospermia and varicocele. The only significant difference between the mean values of the two groups was noted for semen LH. Patients with oligozoospermia and varicocele had lower level than the normal fertile males. As a function of prostatic infection, no significant difference was obtained.

Effect of mode of insertion of IUDs on the occurrence of complications.

PIP: The attempt was made to verify whether the mode of insertion of IUDs bears any relations to the subsequent occurrence of complications such as bleeding, pain, and expulsion. The study subjects were 70 women, randomly selected from the Family Planning Clinic of Cairo University Hospitals. Subjects' age ranged from 25-35 years, parity 4-5, with last labor more than 6 months previous. The women were non-lactating, with regular menstrual patterns, and all belonged to the same socioeconomic class. Participants were divided into 7 groups according to the mode of insertion in each group. Insertion was performed on the 5th day of menstruation. The mode of insertion depended basically on the part inside the uterine cavity to which the tip of the device in the inserter was directed before being released: anterior insertion; anterior reversed insertion; posterior insertion; posterior reversed insertion; tip of the loop placed away from the lateral borders; tip touching the lateral border; and the device placed in the middle of the uterine cavity ignoring the direction of its tip in relation to the walls and lateral borders of the uterus. All subjects were followed up and checked for event rates monthly for a 2-year period. The event rates calculated per year of use in each group of different modes of insertion were as follows: 0.3; 0.3; 0.3; 0.2; 0.4; 0.2; and 0.3, per 100 women for the consecutive groups, respectively. No difference was noted between the blind insertion group (group 7) and the other groups. In sum, the incidence of observed complications were not related or restricted to a particular mode of insertion.^ieng

Serum cortisol level in lactating women using Progestasert system.

PIP: This study is designed to reveal any possible change in serum cortisol levels of lactating mothers, both menstruating and amenorrheic, fitted with a progestasert intrauterine system immediately postpartum. The subjects of the study were 46 lactating females, in the 28-35 age group and of parity from 1 to 6. The women were classified into 2 groups: 1) menstruating and lactating females (n-26), with restored menstruation for at least 3 successive cycles prior to the study. These women were classified into a control group of 11 normally menstruating mothers not using any type of contraception, 9 mothers fitted with Cu T-200 IUDs, and 6 mothers fitted with a progestasert IUD. Both devices were inserted immediately postpartum. The 2nd group comprised amenorrheic and lactating mothers, delivered 2 months prior to the study, and classified as Progestasert users (n-8) and Cu T-200 users (n=12). Comparison of serum cortisol levels in the various categories revealed decreased levels in both IUD groups as compared to normal controls, at the onset of menstruation. However, a significant difference was only obtained between the non-IUD and Cu T-200 groups. Otherwise, no significant differences between the groups were ovbserved at day M-3. Serum cortisol levels were significantly raised in the control groups with the onset of menses which could be explained on the basis of menstrual stress. Serum cortisol levels were also determined in 2 groups of lactating amenorrheic mothers, 2 months after delivery, fitted with Progestasert and Cu T-200 IUDs. Results indicate non significant difference between the 2 groups. Based on these findings, it is concluded that the progestasert intrauterine system has no effect on cortisol levels of postpartum lactating women.^ieng