Intranasal treatment with luteinising hormone releasing hormone agonist in women with endometriosis.

An agonist analogue of luteinising hormone releasing hormone (buserelin) was successfully used to treat women with endometriosis. A dose of 200 micrograms administered intranasally thrice daily was found to be effective in five patients, in whom the endometriotic lesions resolved after six months'' treatment. Failure occurred in a sixth patient, who received only 400 micrograms once daily. Anovulation was induced in all subjects together with suppression of menstruation after the first month of treatment. Symptoms of abdominal pain, dysmenorrhoea, and dyspareunia were relieved during treatment, and one previously infertile patient conceived within two months of stopping treatment. No side effects were reported with this dosage, and the results suggest a new form of treatment for patients with endometriosis.     

One hundred pregnancies after treatment with pulsatile luteinising hormone releasing hormone to induce ovulation.

OBJECTIVE--To review treatment with pulsatile luteinising hormone releasing hormone in infertile women who do not ovulate and are resistant to clomiphene after 100 pregnancies achieved with this treatment. DESIGN--Retrospective analysis of 146 courses of treatment over 434 cycles. SETTING--Infertility clinic. PATIENTS--118 Women whose failure to ovulate was due to idiopathic hypogonadotrophic hypogonadism (n = 39), amenorrhoea related to low weight (n = 17), organic pituitary disease (n = 15), or polycystic ovaries (n = 47). INTERVENTIONS--Dose of 15 micrograms luteinising hormone releasing hormone/pulse subcutaneously every 90 minutes given with a miniaturised pump throughout cycle monitored by ultrasound. Women with hypogonadotrophic hypogonadism had 48 courses, women with amenorrhoea related to low weight 23, women with organic pituitary disease 18, and women with polycystic ovaries 57. END POINT--Follow up of 100 pregnancies achieved in 77 women during six years after introducing treatment. MEASUREMENTS and main results--One hundred pregnancies (seven multiple, 28 miscarriages). Cumulative rates of pregnancy were 93-100% at six months in women with idiopathic hypogonadotrophic hypogonadism, amenorrhoea related to low weight, and organic pituitary disease. In women with polycystic ovaries (cumulative rate of pregnancy 74%) adverse prognostic factors were obesity, hyperandrogenism, and high luteinising hormone concentrations, which were also associated with a high rate of early pregnancy loss. CONCLUSIONS--Treatment with pulsatile luteinising hormone releasing hormone is safe, simple, and effective, and the preferred method of inducing ovulation in appropriately selected patients. Compared with exogenous gonadotrophin treatment there is little need for monitoring, no danger of hyperstimulation, and a low rate of multiple pregnancies.     

Induction of ovulation with pulsatile luteinising hormone releasing hormone.

Ovulation was successfully induced with luteinising hormone releasing hormone in 28 women with hypothalamic amenorrhoea who had failed to respond to treatment with clomiphene. Luteinising hormone releasing hormone was administered in a pulsatile manner with miniaturised automatic infusion systems. The rate of ovarian follicular maturation, as monitored by serial pelvic ultrasonography, was similar to that observed in spontaneous cycles. Endocrine assessment by serial measurement of gonadotrophin, oestradiol, and progesterone concentrations showed hormone concentrations to be within the normal range. Intravenous treatment was required in only two patients, the remainder responding satisfactorily to subcutaneous infusion. All patients conceived within six cycles of treatment, and only one multiple pregnancy occurred.     

Long term treatment with luteinising hormone releasing hormone agonists and maintenance of serum testosterone to castration concentrations.

Serum concentrations of luteinising hormone and testosterone were measured by radioimmunoassay one, two, four, seven, and 24 hours after the subcutaneous administration of 500 micrograms of the luteinising hormone releasing hormone agonist [D-Trp6, des-Gly-NH2(10)] LHRH ethylamide or [D-Ser(TBU)6, des-Gly-NH2(10)]LHRH ethylamide in patients who had previously received daily treatment with these peptides for 0, 1, 6, 12, 18, and 24 months. No increase in the serum concentrations of luteinising hormone or testosterone were detected at any time between one and 24 months'' treatment. The data show that daily subcutaneous administration of the two luteinising hormone releasing hormone agonists used at the appropriate dose can maintain concentrations of serum androgens equivalent to those after castration during long term treatment.     

Steroid sulfates in testis tissue of prostatic cancer patients treated for six months with the gonadotropin releasing hormone agonist buserelin

In order to assess the extent of inhibition of testicular steroidogenesis during long-term treatment of prostatic cancer with GnRH agonist, we measured the intratesticular levels of 5 steroid sulfate conjugates in human testis tissue removed from patients after 6 months of intranasal treatment with buserelin. The most pronounced decreases were found in testosterone and pregnenolone sulfates, to 1.6 and 7.1%, respectively, of concentrations measured in testis tissue from primarily orchiectomized prostatic cancer patients. In contrast, clearly smaller decreases were found in three other steroid sulfates measured, those of dehydroepiandrosterone (to 26%), 17-hydroxyprogesterone (to 27%) and 5-androstene-3 beta, 17 beta-diol (to 62%). These results are in keeping with our previous analyses of unconjugated steroids in similar tissue samples, and indicate that testicular steroidogenesis per se is not totally blocked by long-term intranasal treatment with GnRH agonist. Testicular steroid sulfate conjugation may be specifically suppressed since the total concentration of these conjugates decreased more than free steroid levels in our earlier measurements.     

Induction of S-phase entry by a gonadotropin releasing hormone agonist (buserelin) in the frog,Rana esculenta,primary spermatogonia

In the testis of the frog, Rana esculenta, mitotic activity of primary spermatogonia is regulated by gonadotropins and synergistically by testosterone. In addition GnRH-like material directly stimulates gonadal activity. Intact animals were treated with a GnRH agonist (GnRHa, buserelin, Hoechst) and/or a GnRH antagonist giving injections intraperitoneally on alternate days for 15 days. Moreover, testes were treated in vitro for 24 hr with GnRHa. ³H-thymidine and colchicine were used to assess the labelling and the mitotic index (LI and MI) of primary spermatogonia. Both LI and MI were increased by the treatment with GnRHa but the rate of cells measured by LI was significantly higher than that of cells measured by MI. Therefore, our results confirm the role of GnRH-like material as local regulator of the testicular activity in vertebrates and show its involvement in promoting the G1-S transition of spermatogonial cell cycle in the frog, Rana esculenta.     

Gonadotropin releasing hormone agonist treatment for central precocious puberty

Several methodological problems complicate the evaluation of final statural height (FH) benefit after treatment with gonadotropin releasing hormone (GnRH) agonists for central precocious puberty (CPP). Since no controlled study has been performed, we have to rely on indirect methods, comparison with predicted height or with historical controls. FH of 58 girls, uniformly treated with triptorelin slow release formulation (triptorelin-SR, Decapeptyl((R))) for CPP were compared with predicted height before treatment and with FH of an historical group of patients not treated with GnRH agonist. The comparison with predicted height revealed an improvement of 4.8 +/- 5.8 cm; comparison with the historical control group showed a mean improvement of 8.3 cm. The post-treatment growth spurt (DeltaFH - height at the end of treatment) was a strong predictor of FH in multivariate analysis. The data suggest that continuing treatment beyond the age of 11 in girls does not improve and could actually decrease FH.     

Trial of support treatment with human chorionic gonadotrophin in the luteal phase after treatment with buserelin and human menopausal gonadotrophin in women taking part in an in vitro fertilisation programme.

OBJECTIVE--To evaluate the effect of support with human chorionic gonadotrophin in the luteal phase in women taking part in an in vitro fertilisation programme after buserelin and human menopausal gonadotrophin were used to hyperstimulate their ovaries. DESIGN--Controlled group comparison. SETTING--Outpatient department of a private hospital. PATIENTS--115 Women with indications for in vitro fertilisation, all of whom had at least one embryo transferred. INTERVENTIONS--After suppression of the pituitary with buserelin the ovaries of all the women were stimulated with human menopausal gonadotrophin on day 4 of the luteal phase. Human chorionic gonadotrophin (10,000 IU) was given to induce ovulation, and oocytes were recovered 34 hours later. Embryos were transferred 46 to 48 hours after insemination. Women who had received the 10,000 IU of human chorionic gonadotrophin on a date that was an uneven number (n = 61) were allocated to receive support doses of 2500 IU human chorionic gonadotrophin three and six days after that date. The remaining 54 women did not receive hormonal support. END POINT--Determination of the rates of pregnancy. MEASUREMENTS and main results--Support with human chorionic gonadotrophin did not significantly alter the progesterone or oestradiol concentrations in the early or mid-luteal phase. The mean (range) progesterone concentrations in the late luteal phase in women who did not become pregnant were, however, significantly higher in those who received support (16(9-110) nmol/l nu 8(4-46) nmol/l), and the luteal phase was significantly longer in this group (14 days nu 12 days). The rate of pregnancy was significantly higher in the women who received support than in those who did not (25/61 nu 8/54). CONCLUSIONS--When buserelin and human menopausal gonadotrophin are used to hyperstimulate ovaries support with human chorionic gonadotrophin in the luteal phase has a beneficial effect on in vitro fertilisation.     

Effect of active immunisation of ewes against synthetic luteinising hormone releasing hormone.

At the start of the breeding season 13 intact and four ovariectomised ewes were immunised against LH-RH which was rendered immunogenic by conjugation to bovine serum albumin using carbodiimide. The immunogen was emulsified with Freund's complete adjuvant prior to multi-site intradermal injection into a shaved area on the back of each animal. All the ewes were boosted using an identical procedure six and twelve weeks later. LH-RH antibody titres were monitored from weekly blood samples. Oestrous cycles were shown to stop in all but one of the intact ewes after anti-LH-RH titres had developed, but before the seasonal anoestrus. Laparoscopy of the ewes at this time showed that the ovaries and uteri were in various stages of regression. Plasma gonadotrophin levels of ovariectomised ewes fell significantly after immunisation and in intact immunised ewes ovariectomy failed to result in any increase in plasma gonadotrophins. Injection of 150μg synthetic Lh-RH or 6μg of an immunologically distinct analogue of LH-RH failed to induce LH or FSH responses approaching those previously demonstrated with identical doses in non-immunised anoestrous ewes. These results suggest that immunisation against LH-RH could provide an alternative to ovariectomy for the suppression of unwanted oestrous symptoms and ovulation but that reversal of the effects of immunisation might be difficult to achieve routinely.     

Advanced carcinoma of the prostate: treatment with a gonadotrophin releasing hormone agonist.

Ten patients with advanced progressive adenocarcinoma of the prostate were treated with a long acting analogue of gonadotrophin releasing hormone. Eight of these patients responded to treatment in terms of pain relief and clinical regression of tumour. Serum gonadotrophin and testosterone concentrations were significantly suppressed by the end of the second week of treatment, testosterone concentrations being comparable with those achieved by castration. The two patients who failed to respond had both relapsed previously when receiving conventional treatment, and neither showed any endocrine response to the analogue. Superagonists of gonadotrophin releasing hormone may be the treatment of choice in adenocarcinoma of the prostate, but further trials are required to establish long term safety and efficacy.     

Serum bioactive and immunoreactive follicle stimulating hormone during chronic treatment with gonadotropin releasing hormone agonist in elderly men.

Chronic administration of GnRH agonists "down regulates" the pituitary and decreases LH and FSH serum levels. Changes in the bioactivity of FSH have not been adequately assessed under such treatment, for lack of a proper test. We examined serum changes under GnRH agonist treatment among 12 healthy elderly men suffering only from benign prostatic hypertrophy, for up to one year, using a modification of a granulosa cell bioassay for the determination of FSH bioactivity. While radioimmunoassay-FSH decreased, we noticed a significant increase in the bioactivity of this hormone. The clinical importance of this increase is discussed.     

Calcium elevation in sheep cumulus-oocyte complexes after luteinising hormone stimulation

We investigated Ca²⁺ levels in intact cumulus-oocyte complexes (COCs) on exposure to peak levels of luteinising hormone (LH). Specific preparations were used where cumulus corona cells were loaded with a membrane-permeant Ca²⁺-sensitive dye (FLUO-3AM), whereas the oocyte was injected directly with the nonpermeant form of the dye (FLUO-3). After exposure to LH, cumulus and corona radiata cells showed distinct rises in intracellular Ca²⁺ in 50–200 sec. The pattern of Ca²⁺ response varied in the different cells both for the duration of the transients and for their persistence. Interestingly, Ca²⁺ elevations were recorded in all the layers of the cumulus mass, including the innermost layer of corona cells, demonstrating the wide diffusion of LH receptors. Following the Ca²⁺ raise in somatic cells, an intracellular Ca²⁺ elevation also was recorded within the oocyte with a delay of 100–300 sec. The elevation started at the cortex of the oocyte and then spread all over the ooplasm. The addition of verapamil or manganese chloride did not prevent LH-induced Ca²⁺ elevation in the COC, whereas mechanical uncoupling of cumulus cells from the oocyte prevented any Ca²⁺ response within the oocyte. The results indicate that cumulus-corona cells are capable of transducing LH message by rising intracellular Ca²⁺ and show that this signal is rapidly transferred into the oocyte through gap junctions. This may result from the direct diffusion of Ca²⁺ or its putative releaser IP3 from cumulus cells to the oocyte. Mol. Reprod. Dev. 50:361–369, 1998. © 1998 Wiley-Liss, Inc.     

The ability of prolactin to change the sensitivity of the pituitary of the lactating rat to luteinising hormone releasing hormonein vitro

The ability of prolactin to influence the responsiveness of the lactating rat pituitary to luteinising hormone releasing hormone has been examinedin vitro. The pituitary responsivenessin vivo to luteinising hormone releasing hormone decreased as a function of increase in the lactational stimulus. Prolactin inhibited the spontaneousin vitro release of luteinising hormone and follicle stimulating hormone to a small extent, from the pituitary of lactating rats with the suckling stimulus. However, it significantly inhibited the release of these two hormones from luteinising hormone releasing hormone-stimulated pituitaries. The responsiveness of pituitaries of rats deprived of their litter 24 h earlier, to luteinising hormone releasing hormone was also inhibited by prolactin, although minimal. It was concluded that prolactin could be influencing the functioning of the pituitary of the lactating rat by (a) partially suppressing the spontaneous release of gonadotropin and (b) inhibiting the responsiveness of the pituitary to luteinising hormone releasing hormone.