Reply: Managing IVF in women with consistently or variably elevated early follicular phase FSH

Abstract Background Uterine blood flow promotes endometrial development and subsequent implantation of fertilized eggs. We examined the temporal changes in uterine blood flow during natural and hormone replacement (HRT) cycles and clarified the relationship between uterine blood flow and assisted reproductive technology outcomes for vitrified-warmed embryo transfer (ET). Methods This was a retrospective cohort study. A total of 60 patients with vitrified-warmed ET were assigned to two groups according to the endometrial preparation: natural cycle (28 patients) or HRT cycle (32 patients). The uterine endometrial blood flow was evaluated using measurements of the radial artery resistance index (RA-RI) during the early follicular phase, the days of the human chorionic gonadotropin (hCG) trigger during a natural cycle or the start of progesterone administration during the HRT cycle, and the day of ET. We statistically and longitudinally measured and evaluated the RA-RI values of all individual patients. Results During natural cycles, the RA-RI on the day of ET was significantly higher than that during the early follicular phase. During HRT cycles, the RA-RI on the day of ET was also significantly increased compared to that during the early follicular phase. We validated the efficacy of the RA-RI values for predicting the possibility of pregnancy with vitrified-warmed ET. During natural cycles, the area under the receiver-operating characteristic curves (AUCs) for the early follicular phase, the day of hCG trigger, and the day of ET were 0.75 (95% confidence interval [CI], 0.57–0.93), 0.69 (95% CI, 0.49–0.88), and 0.60 (95% CI, 0.36–0.84), respectively. During HRT cycles, AUCs for the early follicular phase, the day of starting progesterone administration, and the day of ET were 0.60 (95% CI, 0.40–0.81), 0.60 (95% CI, 0.39–0.87), and 0.58 (95% CI, 0.37–0.79), respectively. Conclusions The uterine RA-RI increased at approximately the time of the implantation window compared to that of the early follicular phase during both natural and HRT cycles with vitrified-warmed ET. Our findings suggest that RA-RI during the early follicular phase might be effective and useful for deciding whether to choose the natural or HRT cycle for vitrified-warmed ET.

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Changes in hormonal concentrations after different heavy-resistance exercise protocols in women

Journal of Applied Physiology ◽

10.1152/jappl.1993.75.2.594 ◽

1993 ◽

Vol 75 (2) ◽

pp. 594-604 ◽

Cited By ~ 143

Author(s):

W. J. Kraemer ◽

S. J. Fleck ◽

J. E. Dziados ◽

E. A. Harman ◽

L. J. Marchitelli ◽

...

Keyword(s):

Menstrual Cycle ◽

Rest Period ◽

Follicular Phase ◽

Total Testosterone ◽

Factor I ◽

Rest Periods ◽

Early Follicular Phase ◽

In Series ◽

Heavy Resistance Exercise ◽

Blood Variables

Nine eumenorrheic women (age 24.11 +/- 4.28 yr) performed each of six randomly assigned heavy-resistance protocols (HREPs) on separate days during the early follicular phase of the menstrual cycle. The HREPs consisted of two series [series 1 (strength, S) and series 2 (hypertrophy, H)] of three protocols, each using identically ordered exercises controlled for load [5 vs. 10 repetitions maximum (RM)], rest period length (1 vs. 3 min), and total work (J) within each three-protocol series. Blood measures were determined pre-, mid- (after 4 of 8 exercises), and postexercise (0, 5, 15, 30, 60, 90, 120 min and 24 and 48 h). In series 1, a significant (P < 0.05) reduction in growth hormone (GH) was observed at 90 min postexercise for all three protocols. In series 2, the 10-RM protocol with 1-min rest periods (H10/1) produced significant increases above rest in GH concentrations at 0, 5, and 15 min postexercise, and the H10/1 and H5/1 protocols demonstrated significant reductions at 90 and 120 min postexercise. Cortisol demonstrated significant increases in response to the S10/3 protocol at 0 min, to the H10/1 protocol at midexercise and at 0 and 5 min postexercise, and to the H5/1 protocol at 5 and 15 min postexercise. No significant changes were observed in total insulin-like growth factor I, total testosterone, urea, or creatinine for any of the HREPs. Significant elevations in whole blood lactate and ammonia along with significant reductions in blood glucose were observed. Hormonal and metabolic blood variables measured in the early follicular phase of the menstrual cycle varied in response to different HREPs. The most dramatic increases above resting concentrations were observed with the H10/1 protocol, indicating that the more glycolytic HREPs may stimulate greater GH and cortisol increases.

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P-094. Increased dose of FSH during the early follicular phase in low responder patients does not influence treatment outcome

Human Reproduction ◽

10.1093/humrep/12.suppl_2.165 ◽

1997 ◽

Vol 12 (Suppl_2) ◽

pp. 165-165

Author(s):

S. Pellegrini ◽

F. Serra ◽

M. Mannelli ◽

S. Pratesi ◽

B. Fuzzi ◽

...

Keyword(s):

Treatment Outcome ◽

Follicular Phase ◽

Early Follicular Phase ◽

Low Responder

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PITUITARY GONADOTROPHIN SECRETION DURING THE FIRST WEEKS OF PREGNANCY

Acta Endocrinologica ◽

10.1530/acta.0.0850177 ◽

1977 ◽

Vol 85 (1) ◽

pp. 177-188 ◽

Cited By ~ 12

Author(s):

Sten Jeppsson ◽

Gunnar Rannevik ◽

Jan I. Thorell

Keyword(s):

Longitudinal Study ◽

Pregnant Women ◽

Luteal Phase ◽

Elevated Level ◽

Normal Limit ◽

Follicular Phase ◽

Gonadotrophin Secretion ◽

Early Follicular Phase ◽

Basal Plasma ◽

Pituitary Secretion

ABSTRACT A longitudinal study of basal plasma LH and FSH and their responses to 25 μg LRH iv as well as basal levels of oestradiol, progesterone, prolactin and HCG was performed every week in 3 women, pregnant after heterologous insemination, from conception until the 6th week of gestation. A comparative study was carried out in 7 women in cycles in which no conception occurred after insemination. All hormones were assayed with radioimmunoassay. LH was measured with a specific assay for native LH, which did not cross-react with HCG. A decrease in basal levels of LH and FSH as well as decreasing responses to LRH was found during the first 2 weeks of gestation. These changes did not differ from what was observed during the luteal phase in the non-conception cycles. One week later the basal FSH levels and the FSH response in the pregnant women showed a further decrease, while in the non-pregnant women, now reaching the early follicular phase, a rise in FSH basal levels occurred. The basal levels of LH and the LH response, however, did not differ from that found in the nonpregnant women at this time. FSH basal levels remained below the lower normal limit in eumenorrhoic women from the 3rd week of gestation. By this time the FSH response was almost completely inhibited. The LH basal levels, however, remained above the lower normal limit in eumenorrhoic women, but the LH response to LRH progressively decreased and was completely inhibited by the 5th week of gestation. In the non-conception cycles the LH response varied with the levels of oestradiol in plasma. This was not found in the pregnant women as the decrease in gonadotrophin response occurred while oestradiol remained at mid-cycle levels during the first 4 weeks of gestation. Rather it seems that the increasing and continuously elevated level of progesterone, in the presence of appropriate levels of oestradiol, might be the main go nadal steroid responsible for the diminishing pituitary secretion. The contribution of HCG to the further decrease in gonadotrophin secretion after the 2nd week of pregnancy cannot be answered by the present studies. Prolactin remained at non-pregnant levels until the 6th week of gestation, and appeared to have no influence on the secretion of gonadotrophins during early pregnancy.

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Menopause Transition: Annual Changes in Serum Hormonal Patterns over the Menstrual Cycle in Women during a Nine-Year Period Prior to Menopause

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2003-030824 ◽

2004 ◽

Vol 89 (6) ◽

pp. 2763-2769 ◽

Cited By ~ 98

Author(s):

Britt-Marie Landgren ◽

Aila Collins ◽

Giorgy Csemiczky ◽

Henry G. Burger ◽

Lyrissa Baksheev ◽

...

Keyword(s):

Follicular Phase ◽

Serum Progesterone ◽

Menstrual Cycles ◽

Prolonged Length ◽

Healthy Women ◽

Early Follicular Phase ◽

Serum Hormone ◽

Menopause Transition ◽

Collection Period ◽

Number Of Cycles

Abstract To examine the hormonal characteristics of menstrual cycles in healthy women approaching menopause, serum hormone profiles were investigated annually in this longitudinal study of 13 healthy women between 4 and 9 yr before menopause and the year of the menopause. Serum FSH, LH, estradiol, progesterone, total inhibin, inhibins A and B, and prolactin were determined in blood samples collected annually three times weekly for 4 wk beginning with the onset of menses. Menstrual bleeding diaries covering this 4- to 9-yr period were also collected allowing the prospective identification of the final menstrual period. A change in serum hormone patterns was observed in cycles approaching menopause, exemplified by an increasing number of cycles of prolonged length with a prolonged follicular phase resulting in a failure to detect a luteal phase rise in serum progesterone within the 4-wk collection period. These prolonged cycles (designated B cycles based on a previous work) were analyzed separately and compared with the remaining ovulatory (D) cycles. No B cycles were identified in any women earlier than 27 cycles from menopause. The proportion of B cycles increased as menopause approached, reaching 62% in the last 10 cycles. The proportion of D cycles decreased accordingly. The B cycles during the initial 4-wk collection period were characterized by elevated FSH, LH, FSH/inhibin A and FSH/inhibin B ratios, and longer duration, although cycle length/subject was not significantly different presumably due to the small number of B cycles. The D cycles showed no changes in hormonal profiles over the 4- to 9-yr time period. These data indicate that there is a time-related change in the character of menstrual cycles as menopause approaches, with an increasing proportion of cycles observed with prolonged follicular phases that may either be delayed ovulatory cycles or anovulatory cycles. The increase in the proportion of B cycles with elevated early follicular phase FSH levels and low inhibin/FSH ratios toward menopause provides a basis for the apparent early increase in serum FSH and decrease in serum inhibins observed previously in studies of the menopause transition based on sampling confined to the follicular phase only. The data amplify and clarify current concepts of the endocrine basis of the menopause transition.

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