Responses of Serum Gonadotrophins to Lh-Releasing Hormone and Oestrogens in Japanese Women With Polycystic Ovaries

Abstract

In order to define the abnormality in gonadotrophin secretion in Japanese women with polycystic ovaries (PCO) who rarely show virilization and markedly enlarged ovaries, basal levels of LH and FSH, and responses of serum gonadotrophins to LH-releasing hormone (LH-RH) or oestrogens were determined by radioimmunoassay. Eleven patients with PCO diagnosed by laparotomy or laparoscopy and 30 normal women in the follicular phase were studied. The mean (± sd) basal level of LH was significantly higher in patients with PCO than in normal controls (PCO 28.6 ± 2.4 vs. normal 10.9 ± 3.0 mIU/ml), while the mean FSH level in PCO patients was not significantly different from that in the normal controls (9.7 ± 0.7 vs. 11.4 ± 2.6 mIU/ml). The mean LH/FSH ratio in PCO patients was significantly higher than that in normal controls (3.2 ± 0.9 vs. 1.0 ± 0.3). Exaggerated response of LH to LH-RH was observed in PCO patients, while the FSH response was comparable with the normal controls. Ten out of 11 patients with PCO showed LH release exceeding the basal level after bolus iv injection of 20 mg conjugated oestrogens (Premarin®), and virtually the same mean net increase in LH from the basal level was obtained in both PCO patients and normal controls. Since the abnormalities in gonadotrophin secretion in Japanese women with PCO are not different from those reported in patients with PCO in Europe and USA, it seems likely that lower incidence of markedly enlarged ovaries and virilization in Japanese patients may be caused by the difference in ovarian response to gonadotrophin.

Impaired Glucose Tolerance in Patients with Polycystic Ovary Syndrome (PCOS)

“…Both patients and normal women were closely matched with respect to age and body weight. The higher levels of androgens and LH in the patients with PCOS accord with previously reported data [3], There were no significant differences in basal levels of insulin between PCOS and control women. In normal subjects when glucose concentrations rise, insulin levels also increase, and when plasma glucose concentrations fall, insulin release is inhibited.…”

“…The mechanism underlying the association of hyper androgenism and hyperinsulinemia are of considerable interest. Androgen levels in Japanese women with PCOS are, however, relatively lower than those in patients in western countries [3]. The relationship between insulin and androgen secretion in Japanese women with PCOS is undetermined.…”

Aggravation of Inappropriate Luteinizing Hormone Secretion by Bromocriptine in Polycystic Ovary Syndrome with Elevated Serum Dehydroepiandrosterone Sulfate.

“…All of these patients were amenorrheic with ultrasonographically confirmed polycystic ovaries (Parisi et al, 1984, Orsini et al ., 1985. Hirsutism is rare in Japanese women with PCOS (Kurachi et al, 1971, Aono et al, 1977, and none of our patients were hirsutes . Hypersecretion of LH was determined either by elevated basal LH (>23 mIU/ml) or excess response to GnRH (>81 mIU/ml), as described below .…”

The number of follicles and ovarian volume in the assessment of response to clomiphene citrate treatment in polycystic ovarian syndrome

“…Clomiphene resistant cases respond better to low dose gonadotropins, human menopausal gonadotropins (HMG), purified urinary or recombinant FSH, with or without gonadotropin-releasing hormone agonists. In cases of failure of ovulation by medical therapy, cautery, dia termy, or laser vaporization by laparoscopy and destruction of ovarian tissue at multiple sites (15)(16)(17)(18)(19)(20) per ovary) should be attempted (7). Fertility may be improved at best by in uitro fertilization in intractable anovulation or failure after several treatment cycles.…”