Endometriosis, defined by the presence of viable endometrial tissue outside the uterine cavity, is a common condition affecting 2-3% of women of reproductive age. Today, a composite theory of retrograde menstruation with implantation of endometrial fragments in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted explanation. There is substantial evidence that immunological factors and angiogenesis play a decisive role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes. Furthermore, growth factors and inflammatory mediators in the peritoneal fluid, produced mainly by peritoneal macrophages, are altered in endometriosis, indicating a role for these immune cells and mediators in the pathogenesis of this disease.
R Gazvani and A Templeton
D. Mortimer and A. A. Templeton
Summary. Laparoscopic sperm recovery from the pouch of Douglas and tubal fimbriae was performed in 64 infertile couples. Spermatozoa were recovered from 16/35 couples investigated after AIH, and from 13/29 couples post coitum. The method of insemination had no effect on the result, which was positive in 45·3% of all couples, although AIH did result in significantly larger numbers of peritoneal spermatozoa. The number of peritoneal spermatozoa did not show any direct correlation with the number inseminated, but there were reductions along the tract of 5·83 (±1·14 s.d.) orders of magnitude for total sperm count, and 5·52 (±1·21 s.d.) for the number of motile spermatozoa. Only sperm motility had a significant influence on the success of sperm transport; spermatozoa were recovered from patients with sperm densities as low as 3·0 and 3·5 × 106/ml, but with 56 and 44% motile spermatozoa. No influence of cycle day within the range ±4 days of ovulation on sperm transport was found. In 45 couples, routine semen analyses were apparently completely normal, but the incidence of sperm recovery was still only 49% (22/45), suggesting that a failure of sperm transport may have been a significant causative factor in their infertility.
I. E. Messinis and A. A. Templeton
Summary. Five normally ovulating women were induced to superovulate with pulsatile 'pure' FSH (28 i.u. every 3 h by a s.c. pump), and another 5 women were given an i.m. injection of 10 mg oestradiol benzoate in the late follicular phase. Serum oestradiol concentrations in the luteal phase were similar in both groups and significantly higher than in corresponding control cycles. The luteal phase was of shorter duration in the FSH (11·2 ± 0·7 days) than in the control (13·4 ± 0·2 days) and the oestrogen-treatment cycles (13·4 ± 0·7 days) (P < 0·05, mean ± s.e.m.). FSH cycles had significantly lower early luteal serum LH (Day 1:5·3 ± 1·5 mi.u./ml) and mid-luteal serum progesterone values (35·4 ± 3·5 nmol/l) compared with the control (27·8 ± 5·8 mi.u./ml and 65·4 ± 5·7 nmol/l, respectively) and oestrogen treatment cycles (25·3 ± 8·3mi.u./ml and 59·1 ± 8·4nmol/l, respectively) (P < 0·05, mean ± s.e.m.). These results suggest that, in hyperstimulated cycles, the luteal phase can be disrupted even without follicle aspiration, and that suppression of endogenous LH secretion may be responsible.
I. E. Messinis and A. A. Templeton
Summary. This review article summarizes the evidence provided by in-vivo and in-vitro studies suggesting that the human ovary produces a nonsteroidal factor distinct from inhibin which participates in the control of gonadotrophin secretion from the pituitary.
This factor has been called gonadotrophin surge-attenuating factor (GnSAF) and is defined as attenuating the endogenous surge in luteinizing hormone (LH) in super-ovulated women by reducing the pituitary response to LH-releasing hormone. In-vivo bioactivity of GnSAF has been detected during the follicular phase of superovulated cycles; in-vitro studies have shown activity of this factor in human follicular fluid. From a physiological point of view, a hypothesis is proposed that GnSAF attenuates the amplitude of the positive effect of oestradiol on gonadotrophin secretion during the follicular phase of the human menstrual cycle and therefore plays an important role in controlling ovulation. If GnSAF is isolated, it may have several clinical applications including contraception.
Keywords: LHRH; LH; FSH; pituitary; GnSAF; man
I. E. Messinis and A. A. Templeton
Summary. The response of the pituitary to exogenous LHRH was investigated in 9 normally ovulating women during the late follicular phase of a spontaneous (control) cycle, a cycle during treatment with clomiphene and a cycle during treatment with 'pure' FSH. During clomiphene treatment, basal FSH concentrations increased significantly up to Day 6 of the cycle and then decreased progressively while basal LH values showed a continuous rise. During treatment with FSH, basal LH concentrations decreased significantly. The response of both FSH and LH to LHRH showed a significant and quantitatively similar decrease during clomiphene or FSH administration as compared to the spontaneous cycles. It is suggested that basal secretion of FSH and LH is regulated by two separate mechanisms, and that an ovarian inhibitory factor(s) attenuates the response of both FSH and LH to exogenous LHRH and possibly the endogenous LH surge in superovulated cycles.
Keywords: LHRH; LH; FSH; pituitary; ovulation; man
I. E. Messinis and A. A. Templeton
Summary. Intramuscular injections of oestradiol benzoate were given to 8 normally cyclic women in the early follicular phase of 3 different cycles. Progesterone was also injected in the second (low dose) and the third cycle (high dose). Oestradiol induced simultaneous surges of LH and FSH in all women and the onset of these surges was advanced by progesterone. Low-dose progesterone induced a significant increase in the amplitude and the duration of the LH and FSH surges, while high-dose progesterone decreased the duration significantly. In contrast to the oestrogen-only treatment cycles, when the women were treated with progesterone, basal LH and FSH concentrations were suppressed significantly not only before the onset but also after the end of the surge. The results suggest that progesterone affects the dimension of the oestradiol-induced gonadotrophin surge by exerting both a stimulatory and an inhibitory effect on pituitary gonadotrophin secretion. Supraphysiological concentrations of progesterone decreased the duration of the oestradiol-induced gonadotrophin surge significantly and this is possibly part of the mechanism which attenuates the endogenous LH surge in women superovulated for in-vitro fertilization.
Keywords: LH surge; gonadotrophins; progesterone; oestradiol; man
I. E. Messinis, A. MacTavish and A. A. Templeton
Gonadotrophin surge-attenuating factor (GnSAF) is a putative nonsteroidal ovarian factor that attenuates the luteinizing hormone (LH) surge in superovulated women. GnSAF bioactivity was studied during the luteal phase by investigating six normally ovulating women in two cycles – a spontaneous and a follicle-stimulating hormone (FSH)-treated cycle. In both cycles, the pituitary response to an acute intravenous injection (10 μg) of luteinizing-hormone-releasing hormone (LHRH) was investigated in late follicular (follicle size 16 mm), early luteal (day 5 after human chorionic gonadotrophin, hCG), midluteal (day 9 after hCG) and late luteal phase (day 12 or 13 after hCG). FSH was injected daily at the dose of 225 iu on cycle days 2, 3 and 4, and 150 iu thereafter. The increase in LH and FSH (mean ± sem) 30 min after LHRH in the spontaneous cycles decreased significantly from early to late luteal phase and remained unchanged in the FSH-treated cycles. Increases in LH and FSH 30 min after LHRH were significantly attenuated in the FSH-treated compared with the spontaneous cycles in late follicular and luteal phases. Serum oestradiol and progesterone concentrations were significantly higher in the FSH than in the spontaneous cycles only in early, but not in mid- and late luteal phase. The pattern of serum oestradiol and progesterone changes during the luteal phase did not correlate with the increases in LH and FSH 30 min after hCG both in the spontaneous and the FSH cycles. These results suggest that GnSAF bioactivity is high during the luteal phase of superovulated cycles.
P. A. Fowler, I. E. Messinis and A. A. Templeton
Summary. It has been suggested that in superovulated women the endogenous LH surge is attenuated by a non-steroidal factor, called gonadotrophin surge-attenuating factor (GnSAF), which reduces gonadotrophin secretion in response to LHRH. To determine whether human follicular fluid (hFF) from superovulated women contains GnSAF activity, the secretion of LH and FSH by cultured sheep pituitaries was studied. After charcoal extraction of steroids, hFF was treated by heparin/Sepharose chromatography, which reversibly binds inhibin. The effects of whole hFF and the bound and unbound fractions on basal and LHRH-induced gonadotrophin secretion were then assessed. Steroid-free hFF significantly reduced basal FSH, but not basal LH, secretion, and significantly attenuated the LH and FSH responses to LHRH. The bound (inhibin) fraction significantly decreased both basal and LHRH-induced FSH secretion but did not affect LH release. The unbound fraction had no effect on basal LH or FSH secretion, but significantly attenuated LHRH-induced secretion of both LH and FSH. We conclude that the unbound fraction of hFF from superovulated women contains GnSAF. It has been demonstrated that GnSAF is a non-steroidal factor and its activity is distinct from that of inhibin.
Keywords: gonadotrophins; pituitary; follicular fluid; inhibin; gonadotrophin surge-attenuating factor; man
A. A. Templeton, I. Cooper and R. W. Kelly
Summary. The PG concentrations in the semen of 23 fertile men were 73 μg PGE/ml, 267 μg 19-OH PGE/ml, 2·1 μg PGF/ml and 18·3 μg 19-OH PGF/ml. The wide ranges of concentrations found for the PGEs (2–272 μg/ml) and for the 19-OH PGEs (53–1094 μg/ml) throw some doubt on the previously established correlation between infertility and low prostaglandin concentrations.
R. W. Kelly, I. Cooper and A. A. Templeton
Summary. The prostaglandin levels have been measured in a group of men with sperm concentrations greater than 300 × 106/ml and compared with the levels in men with sperm concentrations of 50 to 150 × 106/ml. The distribution of the PG levels in all groups was highly skewed but the data could be transformed to a normal distribution by taking logarithms. Comparison of the PG levels showed a highly significant lowering of the PG levels in the polyzoospermic group when compared with either of the groups with normal sperm concentrations.