Diagnostic value of urinary luteinizing hormone levels in the monitoring of precocious puberty treatment.

Objective To determine whether first-voided urinary LH (FV-ULH) - level measurement can adequately assess pubertal suppression as much as standard tests can. Subjects and methods The study group included patients with central precocious puberty and rapidly progressing early puberty who received up to 3 - 4 doses of GnRHa therapy monthly and did not have adequate hormonal suppression after GnRH stimulation (90-minute LH level > 4 IU/L). Design: All of the participants underwent an LHRH test just after admission to the study. According to the stimulated peak LH levels, the patients were divided into 2 groups and followed until the end of the first year of treatment. The concordance between FV-ULH and stimulated LH levels was assessed. Results The FV-ULH levels in patients with inadequate hormonal suppression were significantly high compared to patients with adequate hormonal suppression. FV-ULH levels were very strongly correlated with stimulated LH levels (r = 0.91). Its correlation with basal LH levels was significant (r = 0.65). However, this positive correlation was modestly weakened after the first year of treatment. The cutoff value for FV-ULH of 1.01 mIU/mL had the highest sensitivity (92.3%) and specificity (100%). Conclusion FV-ULH levels, using more reliable and sensitive assay methods, can be used to monitor the adequacy of GnRHa therapy.

Diagnostic value of urinary luteinizing hormone levels in the monitoring of precocious puberty treatment

ABSTRACT Objective To determine whether first-voided urinary LH (FV-ULH) - level measurement can adequately assess pubertal suppression as much as standard tests can. Subjects and methods The study group included patients with central precocious puberty and rapidly progressing early puberty who received up to 3 - 4 doses of GnRHa therapy monthly and did not have adequate hormonal suppression after GnRH stimulation (90-minute LH level > 4 IU/L). Design: All of the participants underwent an LHRH test just after admission to the study. According to the stimulated peak LH levels, the patients were divided into 2 groups and followed until the end of the first year of treatment. The concordance between FV-ULH and stimulated LH levels was assessed. Results The FV-ULH levels in patients with inadequate hormonal suppression were significantly high compared to patients with adequate hormonal suppression. FV-ULH levels were very strongly correlated with stimulated LH levels (r = 0.91). Its correlation with basal LH levels was significant (r = 0.65). However, this positive correlation was modestly weakened after the first year of treatment. The cutoff value for FV-ULH of 1.01 mIU/mL had the highest sensitivity (92.3%) and specificity (100%). Conclusion FV-ULH levels, using more reliable and sensitive assay methods, can be used to monitor the adequacy of GnRHa therapy.

Daily luteal serum and urinary hormone profiles in the menopause transition: Study of Women's Health Across the Nation.

OBJECTIVE: To further characterize the endocrinology of the menopause transition, we sought to determine: whether relationships between urine and serum hormones are maintained as women enter their sixth decade; whether a single luteal phase serum progesterone (P) is reflective of integrated-luteal urinary pregnanediol glucuronide (uPdg); and whether serum P, like luteal uPdg, declines as women approach their final menses (FMP). METHODS: The Study of Women's Health Across the Nation (SWAN) Daily Hormone Study's (DHS) is a community-based observational study. A subset of participants underwent a timed, luteal blood draw planned for cycle days 16 to 24 during the same month of DHS collection. Serum-luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol and P, and urine LH, FSH, estrone conjugates (E1c), and daily and integrated luteal uPdg were measured in 268 samples from 170 women. Serum/urine hormone associations were determined using Pearson's correlation and linear regression, adjusted for concurrent age, body mass index, smoking status, and race/ethnicity. RESULTS: Pearson's r ranged from 0.573 (for LH) to 0.843 (for FSH) for serum/urine correlations. Integrated luteal uPdg weakly correlated with serum P (Pearson's r = 0.26, P = 0.004) and explained 7% of the variability in serum P in adjusted linear regression (total R 0.09, P = 0.002). Serum P demonstrated a marginally significant decline with approaching FMP in adjusted analysis (P = 0.04). CONCLUSIONS: Urine and serum hormones maintain a close relationship in women into their sixth decade of life. Serum luteal P was weakly reflective of luteal Pdg excretion.

Seasonal variation in urinary and salivary reproductive hormone levels in Amazonian manatees (Trichechus inunguis).

The Amazonian manatee (Trichechus inunguis) is a threatened aquatic mammal endemic to the Amazon basin. The aim of this study was to evaluate the urinary and salivary reproductive hormone levels of captive Amazonian manatees collected during two seasons of the year. Salivary samples from four males and urinary and salivary samples from three females were collected during two seasons (March-June and September-November) over two consecutive years. Salivary testosterone in males was measured by radioimmunoassay and reproductive hormones in females (salivary progesterone and oestradiol and urinary progestogens, oestrogens and luteinising hormone) were measured by enzyme immunoassay. The data were analysed in a 2×2 factorial design, where the factors were year and season. There was no effect of year or season for salivary testosterone. All female hormones showed a seasonal effect (higher hormone levels during March-June than September-November) or an interaction between year and season (P<0.05). These results strongly indicate the existence of reproductive seasonality in Amazonian manatees; however, apparently only females exhibit reproductive quiescence during the non-breeding season. Further long-term studies are necessary to elucidate which environmental parameters are related to reproductive seasonality in T. inunguis and how this species responds physiologically to those stimuli.

[Family planning methods based on fertility awareness]. / Métodos de planificación familiar basados en el conocimiento de la fertilidad.

The desire to limit fertility is recognized both by individuals and by nations. The concept of family planning is based on the right of individuals and couples to regulate their fertility and is based in the area of health, human rights and population. Despite the changes in policies and family planning programs worldwide, there are large geographic areas that have not yet met the minimum requirements in this regard, the reasons are multiple, including economic reasons but also ideological or religious. Knowledge on the physiology of the menstrual cycle, specifically ovulation process has been further enhanced due to the advances in reproductive medicine research. The series of events around ovulation are used to detect the "fertile window", this way women will look for the possibility of postponing their pregnancy or actually start looking for it. The aim of this article is to review the current methods of family planning based on fertility awareness, from the historical methods like the core temperature determination and rhythm, to the most popular ones like the Billings ovulation method, the Sympto-thermal method and current methods like the two days, and the standard days method. There are also mentioned methods that require electronic devices or specifically computer designed ones to detect this "window of fertility". The spread and popularity of these methods is low and their knowledge among physicians, including gynecologists, is also quite scarce. The effectiveness of these methods has been difficult to quantify due to the lack of well designed, randomized studies which are affected by small populations of patients using these methods. The publications mention high effectiveness with their proper use, but not with typical use, what indicates the need for increased awareness among medical practitioners and trainers, obtaining a better use and understanding of methods and reducing these discrepancies.

Hormonal evaluation and midcycle detection of intrauterine glycodelin in women treated with levonorgestrel as in emergency contraception.

BACKGROUND: The study was conducted to assess the effects of levonorgestrel (LNG) on hormonal behavior and on the secretory pattern of intrauterine glycodelin at the midcycle of ovulatory women. STUDY DESIGN: Thirty healthy sterilized women with normal ovarian function were studied during one control untreated cycle and one LNG-treated cycle. In the treated cycle, each woman received two doses of 0.75 mg of LNG 12 h apart during the preovulatory phase approximately 2 days before the LH surge. Daily follicle development recordings were performed until follicle rupture was observed, and serum glycodelin, LH, estradiol, estrone and progesterone were measured as well. In addition, glycodelin concentrations were assayed in uterine flushing obtained on Days LH+1 and LH+12. RESULTS: LNG did not modify follicle rupture in 20 of 30 women. In spite of ovulatory progesterone and the occurrence of follicle rupture in these women, luteal phase length was significantly decreased, as well as the serum concentrations of LH, estradiol and estrone in the periovulatory phase. Glycodelin in serum and uterine flushings was significantly elevated in the periovulatory phase when compared to control cycles. CONCLUSIONS: LNG taken at the dose used in emergency contraception before the LH surge increased prematurely serum and intrauterine concentrations of glycodelin at the time of ovulation. Since there are well established glycodelin inhibitory effects upon fertilization, these results may represent an additional action of LNG in situations where the intervention did not interfere with ovulation.

Mean versus individual hormonal profiles in the menstrual cycle.

OBJECTIVE: To evaluate hormonal profiles of normal menstrual cycles. DESIGN: Prospective, descriptive study of a case series. SETTING: University-based natural family planning center. PATIENT(S): Twenty-five natural family planning users for three or more cycles (n = 78). These women were healthy, contraception-free, parous, with regular ovulatory cycles. INTERVENTION(S): Immunoassays for estrone glucuronide, LH, and pregnanediol glucuronide were done in daily timed and measured samples of early morning urine. MAIN OUTCOME MEASURE(S): Estrone glucuronide, LH, and pregnanediol glucuronide levels were measured during the menstrual cycle. RESULT(S): All cycles showed an ovulatory pattern configuring classic hormonal mean curves. Most (77%) differed from the mean curve pattern. All had estrone glucuronide peaks, LH peaks, and pregnanediol glucuronide increases. Estrone glucuronide and LH peaks were not always clear; some lasted more than 1 day (long peak: estrone glucuronide 19%, LH 9%) or fluctuated (double peak: estrone glucuronide 4%, LH 6%; small LH peak: 19%). There were also prepeak estrone glucuronide surges, and pre- and postpeak LH surges. Pregnanediol glucuronide increased more clearly (6% fluctuated 1 day). Some women had repeated cycles with long estrone glucuronide peaks (16%) and fluctuations in LH surge (44%). CONCLUSION(S): Normal menstrual cycle hormonal profiles generally differ from mean curves, which are usually considered standard.

Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation.

OBJECTIVES: The objective of the study is to evaluate the effects of levonorgestrel transferred through breast milk on thyroid stimulating hormone (TSH) and luteinizing hormone (LH) levels in full breast-fed infants. METHODS: Forty healthy postpartum women and their male newborns were recruited for the study. Women were randomly allocated to two study groups: Group 1, IUD users and group 2, Norplant users. Blood and milk samples were collected on the day of IUD or Norplant insertion and 3 and 6 months later for TSH and levonorgestrel measurements. RESULTS: The results disclosed a significant decrease in TSH levels, and a negative relationship between LNG levels and TSH concentration in breast feeding infants at 3 months after implant insertion. The lowest TSH levels were observed at 6 months in the women from group 2. CONCLUSIONS: The overall data indicate that the LNG levels transferred to fully breast-fed infants through breast milk from Norplant users significantly modified their TSH levels.

On the mechanisms of action of short-term levonorgestrel administration in emergency contraception.

The effects of short-term administration of levonorgestrel (LNG) at different stages of the ovarian cycle on the pituitary-ovarian axis, corpus luteum function, and endometrium were investigated. Forty-five surgically sterilized women were studied during two menstrual cycles. In the second cycle, each women received two doses of 0.75 mg LNG taken 12 h apart on day 10 of the cycle (Group A), at the time of serum luteinizing hormone (LH) surge (Group B), 48 h after positive detection of urinary LH (Group C), or late follicular phase (Group D). In both cycles, transvaginal ultrasound and serum LH were performed from the detection of urinary LH until ovulation. Serum estradiol (E2) and progesterone (P(4)) were measured during the complete luteal phase. In addition, an endometrial biopsy was taken at day LH + 9. Eighty percent of participants in Group A were anovulatory, the remaining (three participants) presented significant shortness of the luteal phase with notably lower luteal P4 serum concentrations. In Groups B and C, no significant differences on either cycle length or luteal P4 and E2 serum concentrations were observed between the untreated and treated cycles. Participants in Group D had normal cycle length but significantly lower luteal P4 serum concentrations. Endometrial histology was normal in all ovulatory-treated cycles. It is suggested that interference of LNG with the mechanisms initiating the LH preovulatory surge depends on the stage of follicle development. Thus, anovulation results from disrupting the normal development and/or the hormonal activity of the growing follicle only when LNG is given preovulatory. In addition, peri- and post-ovulatory administration of LNG did not impair corpus luteum function or endometrial morphology.

Contraceptive potential of a mifepristone-nomegestrol acetate sequential regimen in women.

The effectiveness of a sequential regimen consisting of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles was assessed in 10 surgically sterilized volunteers who were followed for one pretreatment and three treated cycles. Hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and an endometrial biopsy taken on day 22-25 of the third treatment cycle were used to monitor the effects of treatment. During treatment, 24 monophasic (no sustained progesterone rise above 12 nmol/l) and six biphasic cycles were recorded. Nine follicular ruptures were detected echographically in these 30 treated cycles, five of which occurred in monophasic cycles. All follicular ruptures occurred on days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were recorded. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.

PIP: This study investigated the efficacy of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles in 10 surgically sterilized volunteers. To monitor the effects of treatment, hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and endometrial biopsy were taken on day 22-25 of the third treatment cycle. About 24 monophasic and 6 biphasic cycles were recorded during treatment. About 9 follicular ruptures were echographically detected in these 30 cycles, 5 of which occurred in monophasic cycle. All follicular ruptures occurred in days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were observed. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.

Natural family planning: suitability of the CUE method for defining the time of ovulation.

The purpose of this study was to compare the CUE method for family planning with the Ovulation Detection Method for defining the fertile phase of the menstrual cycle. We evaluated 42 cycles from 10 women in Monterrey, Mexico, who were monitored by basal body temperatures, urinary LH, pelvic ultrasound, and the CUE monitor. The fertile phase of the cycle was adequately defined in all cycles using the CUE method, and in 35 cycles (83.3%) by the Ovulation Method. Using our protocol, the period of recommended abstinence with the CUE method is 9 days and with the Ovulation Method 11 days. The CUE method accurately defines the fertile phase of the menstrual cycle, thus improving the predictability of ovulation for women who use natural methods of birth control.

PIP: To evaluate the potential utility of the CUE method in natural family planning (NFP), this method was compared with a standard NFP technique, the Ovulation Method, in 39 cycles of 10 women from Monterrey, Mexico. All women had more than 2 years' experience with the Ovulation Method. In the CUE method, ovulation prediction is based on a peak in salivary electrical resistance and its confirmation by a rise in vaginal resistance as monitored by a hand-held electronic instrument attached to a specially designed sensor. The CUE method defined the fertile period of all 39 cycles adequately, while the Ovulation Method resulted in incorrect definition of the fertile phase in 4 (10%) of 39 cycles. The salivary peak predicted ovulation an average of 8 days in advance of its occurrence and the increase in vaginal readings in the periovulatory period was seen within 1 day of follicle collapse in all subjects. The duration of abstinence required by the CUE method would have averaged 9.0 +or- 1.5 days (range, 6-13 days). In contrast, the average duration of abstinence associated with the Ovulation Method was 11.0 +or- 2.9 days (range, 6-16 days). 82% of cycles monitored by the CUE method compared with only 53% of those monitored by the Ovulation Method would have required a period of abstinence of 10 days or less. The simplicity and objectivity of the CUE method, combined with its requirement for fewer days of abstinence, offer the potential for improving NFP compliance and continuation.

[Correlation between plasma progesterone and ultrasonographic detection of corpus luteum in ovulatory cycles]. / Correlacion entre progesterona plasmatica y deteccion ultrasonografica de cuerpo luteo en ciclos ovulatorios.

The ultrasound detection of corpus luteum in the midluteal phase of ovulatory cycles was associated with significantly higher levels of plasma progesterone, opposed to those patients where a corpus luteum could not be identified. The hormone level was directly proportional no the number of corpora lutea seen. However, only 33.3% o patients with no corpus luteum visible were found to have suboptimal plasma progesterone levels (< 10 ng/ml).

[Clinico-echographic study of the ovulatory phase, spontaneous and induced, conceptional and non conceptional cycles]. / Estudio clínico-ecográfico de la fase ovulatoria, ciclos espontáneos e inducidos, concepcionales y no concepcionales.

We present the results obtained on 110 menstrual cycles of 87 patients; echography study of ovulation, immunologic LH determination, basal body register card and serial cervical mucus score, since -6 to 0 day. Echography study determined follicular diameter, endometrial bulk and the presence of liquid in the cul-de-sac. We considered only those patients in whom the disappearance of the follicle was observed 24 hours before; being this fact, the indicator of ovulation, related to all other variables. These patients presented spontaneous (47.3%), epimestrol (28.2%) or clomiphene induced (24.5%) cycles, and they turned out to be pregnant or not in that cycle, (34.6%, 25.8% and 37.0% respectively). It was 36 (32.7%) pregnant women in all the The three follicular diameter curves for pregnant cycles, were similar being the preovulatory follicular range 21.5 mm for spontaneous cycles, 18.9 mm for epimestrol induced cycles and 20.7 mm for clomiphene induced cycles. Conceptional range was from 15 to 22 mms, 15 to 22 mm, and 14 to 27 mms, respectively. We didn't observe free fluid in cul-de-sac in 5 pregnant cycles (13.9%). Most of positive LH, are about -2 and -1 (21% and 50%, respectively). There were one pregnant patient and 2 no pregnant patient with repetitive, negative LH. In 50% of patients who became pregnant, the Nadir was on -1 day. In spontaneous conceptional group, bad cervical score was not observed. The good cervical score period is longer on conceptional group than in those with epimestrol. On conceptional group, dissociation between best score day and the day of ovulations was not observed, fact that we observed in non-conceptional group.

Estudio clínico-ecográfico de la fase ovulatoria, ciclos espontáneos e inducidos, concepcionales y no concepcionales / Clinico-ecographic study of the ovulatory phase, spontaneous and induced cycles, conceptional and non conceptional

Se presentan los resultados de 110 ciclos menstruales de 87 pacientes que fueron estudiadas con seguimiento ecográfico de la ovulación, determinación inmunológica de LH, curva de temperatura basal y estudio seriado del score cervical, desde el día -6 al día 0; el seguimiento ecográfico comprendió la determinación del diámetro folicular, el grosor endometrial y la presencia de líquido libre en el fondo del saco de Douglas. Se consideran sólo aquellas pacientes en que la última observación del folículo fue hecha hasta 24 horas de su desaparición, siendo éste el hecho que indica la ovulación, relacionándose las demás veriables con ello. Estas pacientes presentan ciclos espontáneos (47,3%), inducidos con epimestrol (28,2%) o clomifeno (24,5%) y resultaron embarazadas o no en este ciclo, 34,6%; 25,8% y 37,0% respectivamente. Fueron 36 casos con embarazo (32,7%). Las tres curvas de diámetro folicular para ciclos con embarazo resultaron notablemente similares, siendo el tamaño folicular preovulatorio de 21,5 mm. para ciclos espontáneos, 18,9 mm para ciclos inducidos con epimetrol y 20,7 mm para ciclos inducidos con clomifeno. El rango en los ciclos concepcionales fue de 15 a 27 mm, 15 a 22 mm y 14 a 27 mm, respectivamente. En 5 ciclos con embarazo (13,9%) no se observó líquido libre en el Douglas. La mayoría de los LH (+) se agrupan en los días -2 y -1 (21% y 50% respectivamente). Hubo una paciente que se embarazó y 2 que no se embarazaron que tuvieron LH iterativamente negativa. En el 50% de las pacientes que se embarazaron el Nadir térmico fue el día -1. En el grupo espontáneo concepcional no se observaron malos scores cervicales. El período de buen score es más largo en los grupos concepcionales espontáneos y con epimestrol. En el grupo de ciclos con embarazo no se observó disociación entre el día del mejor score y la ovulación, hecho que sí se observa en los ciclos no concepcionales

Estudio comparativo de métodos para la predicción y el diagnóstico de la ovulación / Comparative study of methods for the prediction and diagnosis of ovulation

Cuarenta y una mujeres fueron evaluadas durante 79 ciclos menstruales mediante mediciones de temperatura basal, cambios en el moco cervical, niveles de LH urinario y de diámetro folicular por ecografías. La temperatura basal corporal descendió en 35/79 ciclos (44%) antes de la ovulación y subío entre 3 a 4 décimas de grado depués de la ovulación en todos los casos. El moco cevical experimentó cambios que no permitieron precisar ni predecir el día de la ovulación. La observación del crecimiento y de la rotura folicular por ecografía permitió precisar el día de la ovulación, pero no predecirlo. La medición de LH urinario por Higonavis permitió predecir la ovulación entre 0 y 2 días antes que ocurriera en 70/79 (89%) ciclos

Qual o valor dos constituintes da saliva para predizer ovulaçäo? / What the value of saliva constituents to predict ovulation?

Foram relatados diferenças na concentraçäo de alguns constituintes da saliva (esteroides, eletrólitos, glicose e enzimas) que ocorrem durante o ciclo menstrual e que talvez poderiam ser usados para predizer a ovulaçäo. Nos medimos estradiol, progesterona, glicose, sódio, potássio e cálcio em amostras da mistura salivar colhidas diariamente durante todo o ciclo menstrual. O dia da ovulaçäo foi determinado por ultra-sonografia e medidas de LH em urina. O perfil de estradiol e progesterona em saliva refletiu aquele classicamente encontrado em sangue. Os níveis dos eletrólitos em saliva näo mostraram padräo ciclíco definido mesmo após a correçäo da taxa de produçäo da saliva. Foram observadas alteraçöes cíclicas na concentraçäo de glicose em saliva, sendo que os valores máximos (picos) foram encontrados no dia ou no dia após a aovulaçäo, ou seja, durante o período periovulatório. Pequenos picos foram observados durante as fases folicular e lútea sem, entretanto, mostrarem um padräo reprodutivel. Estas alteraçöes foram melhor vistas nas amostras de jejum. Amostras sem o jejum tiveram concentraçöes altas de glicose o que tornou difícil a identificaçäo dos picos. Este estudo confirma o valor da medida dos esteróides em saliva, mas entretanto, sugere que medidas de glicose e eletrólitos em saliva têm, provavelmente, pouco valor como teste preditivo para ovulaçäo

Gonadotropin excretion during puberty in malnourished children.

p6nadotropins were measured by radioimmunoassay of urine samples from 285 privileged Nairobi adolescents and from 238 rural peripubertal Kenyan boys and girls who had had moderate malnutrition during childhood. Gonadotropins were reduced at all ages in the rural adolescents, but pubertal stage-matched comparisons showed no differences between children of the two study areas in middle or late phases of sexual maturity. These results document the pattern of gonadotropin changes in an environment of reduced caloric intake and confirm the presumed hypothalamic-pituitary origin of the delayed adolescence that occurs under such circumstances.

[Simplified immunology for the diagnosis of pregnancy]. / Estudio de una inmunología simplificada para el diagnóstico del embarazo.

PIP: 110 urine specimens were used to compare and evaluate 3 different pregnancy tests. The Zondek hyperemic reaction, which has been used for years, was done, and, in addition, the Planotest immunologic reaction using reagents in suspension, and a new test, called Planosec by the authors, which used lyophilized, or freeze-dried, reagents. Results were identical for the 3 tests in 98 cases, giving 60 positive and 38 negative tests. The advantages of the Planosec test over the other 2 is that it does not require refrigeration of reagents, does not require experience, it can be done in about 3 minutes, it avoids all risk of bacterial contamination of reagents, and, in case of necessity, can be used at home.^ieng