An Assessment of Urinary and Plasma Steroid Estimations for Monitoring Treatment of Anovulation With Gonadotrophins

Abstract

Summary Total urinary oestrogens (UE), plasma oestradiol‐17β (PE2), plasma progesterone and urinary pregnanediol values were estimated during 28 cycles of treatment with human menopausal gonadotrophins (HMG) and human chorionic gonadotrophin (HCG) in seven patients with primary or secondary amenorrhoea who complained of infertility. Ovulation occurred in 23 courses of treatment and three patients became pregnant. PE2 estimations gave a more accurate day to day assessment of the response of patients to treatment than UE values. Monitoring of treatment with PE2 values should reduce any tendency to overstimulation with HMG and allow more accurate timing of the first HCG injection which is critical for a successful ovulatory response. The first HCG dose is an effective stimulus to ovulation when administered on the day of the UE peak which is the day after the PE2 peak. The first HCG dose appeared to be an ineffective stimulus to ovulation if given subsequent to this time or more than two days after the last HMG stimulation.

Pituitary‐ovarian Function in Normal Women During the Menopausal Transition

“…This approximation has been proved adequate to follow the changes in oestrogen and pregnanediol excretion which accompany ovulation (Metcalf, 1976), and to distinguish postmenopausal from premenopausal gonadotrophin levels (Metcalf & Livesey, 1979). The parallelism shown to exist between the oestrogens and pregnanediol in urine on the one hand and between oestradiol and progesterone in plasma on the other (Black et al, 1974;Moghissi et al, 1972), and that between gonadotrophins in urine and in plasma (Metcalf & Livesey, 1979) means that measurements made on urine may be used to monitor changes in the plasma levels of these hormones. A menstrual cycle was termed 'ovulatory' if in the 10 days precedingmenstruation the 24 h pregnanediol output was 3 5 pmol on a single occasion, or if in the same period the total excreted on 2 days, 1 week apart, was 2 7 pmol.…”

Growth rates of ovarian follicles during natural menstrual cycles, oral contraception cycles, and ovarian stimulation cycles

“…Early documentation of ovarian follicular development was based on histologic evaluation of ovaries postmortem or after ovariectomy (1,2). Urinary, and later, serum estrogen (E) concentrations were also used indirectly to infer ovarian status by assessing the endocrine products indicative of ovarian function (3)(4)(5)(6)(7)(8).…”

Ultrasonic assessment of subsequent unexplained infertility after ovulation induction

“…Hyperstimulation (McArdle & Sacks 1980) was apparent in one-third (7 of 21) of cycles in which induction of ovulation with unexplained fertility was studied. In the past hyperstimulation has been designated as mild, moderate or severe (Schenker & Weinstein 1978) and risks have been assessed on the basis of oestrogen determinations (Brown & Beischer 1972;Black et al 1974). This biochemical index permits the differentiation of cycles that are markedly overstimulated from those that appear to have a normal amount of hormone production (Karam et al 1973;Schenker & Weinstein 1978).…”

“…Historically, follicular growth has been monitored by the daily determination of oestrogen in urine (Brown & Beischer 1972) or in serum (Black et al 1974); more recently, it has been followed by ultrasonography (Hackeloer et al 1979;Robertson et al 1979;Ylostalo et al 1979;Queenan et al 1980;Renaud et al 1980;Smith et a/. 1980;Hill et al 1982).…”