Follicular fluid treatment during the follicular versus luteal phase of the menstrual cycle: effects on corpus luteum function

Administration of charcoal-extracted porcine follicular fluid (pFF) to rhesus monkeys at the time of menses impairs the subsequent function of the corpus luteum of the menstrual cycle. The following studies were performed: 1) to characterize the luteal phase defect induced by pFF treatment at menses, and 2) to determine whether pFF treatment in the luteal phase alters corpus luteum function. Adult, female rhesus monkeys were injected sc for 3 days with pFF (10, 5, and 5 ml) beginning on day 1 (n = 5) or day 18 (n = 4) of the menstrual cycle. Femoral venous blood was collected daily throughout the treatment cycle and during the posttreatment cycle of day 18 to 20-treated monkeys. Serum LH, FSH, 17 beta-estradiol (E2), and progesterone (P) were measured by RIA. After pFF treatment on days 1-3, FSH and E2 levels in the early follicular phase were less (P less than 0.05) than those of control cycles (n = 7). Serum LH was not suppressed by pFF treatment. Moreover, the preovulatory rise in circulating E2 and the amplitude of the LH/FSH surge were similar in control and pFF-treated monkeys. Although timely midcycle gonadotropin surges occurred in four of five pFF-treated monkeys, serum P was markedly reduced (P less than 0.05) during the first half of the luteal phase. Circulating P increased to control levels during the late luteal phase before normal onset of menses 16.3 +/- 1.0 (SE) days after the LH surge. Treatment with pFF on days 18-20 of the cycle reduced the levels of circulating FSH, but serum LH, E2, P, and the length of the luteal phase remained comparable to control cycles. Moreover, the hormonal patterns and the length of the follicular and luteal phases in the posttreatment cycle indicated normal ovarian function. Thus, pFF treatment at menses results in an aberrant ovarian cycle characterized by an insufficient, rather than short, luteal phase. Whereas pFF treatment in the early follicular phase vitiates development of the dominant follicle and the related corpus luteum, similar treatment at midluteal phase does not suppress concurrent luteal function or subsequent folliculogenesis.     

Circadian variations in plasma progesterone in the luteal phase of the menstrual cycle and during pregnancy

To investigate possible variations in plasma progesterone levels during the hyperthermic phase of the menstrual cycle and during early and late pregnancy, venous blood samples were taken at 4-hour intervals during periods of 24 hours. Progestrone determinations were done by gas-liquid chromatography. No significant circadian variation in peripheral plasma progesterone concentration was determined in the 10 women studied during the hyperthermic phase of their menstrual cycles or in 14 women studied during early pregnancy. However in the 15 women studied in late pregnancy a statistically significant rise was found from 8 a.m. until 4 or 8 p.m. (p less than .001), followed by a decrease until 4 to 8 a.m. Results indicate a daily change in peripheral plasma progesterone level during the last trimester of pregnancy. The cause of this diurnal variation is not known.     

Follicular arrest during the midfollicular phase of the menstrual cycle: a gonadotropin-releasing hormone antagonist imposed follicular-follicular transition

The functional dependency of the dominant follicle on pulsatile gonadotropin inputs was evaluated by using a GnRH antagonist as a probe. Hormonal dynamics, particularly the relationship of FSH, estradiol, and inhibin, during and after the withdrawal of GnRH receptor blockade achieved by treatment with Nal-Glu GnRH antagonist (50 micrograms/kg, im) for 3 days in the midfollicular phase of the cycle (days 7-9) were ascertained. Daily blood samples were obtained for LH, FSH, estradiol (E2), progesterone, and immunoreactive inhibin (i-INH) measurements by RIA during 2 consecutive (control and treatment) cycles in 12 women. In 5 women, LH pulsatility was assessed by 10-min blood sampling for 12 h before, during, and after Nal-Glu treatment. The administration of Nal-Glu prolonged both follicular phase (14.0 +/- 0.5 vs. 19.7 +/- 0.8 days; P less than 0.0001) and total cycle length (28.1 +/- 0.5 vs. 34.1 +/- 1.2 days; P less than 0.0001). Gonadotropin suppression (50-60%) was achieved, as reflected by a marked decrease in mean LH levels (14.3 +/- 1.9 to 5.4 +/- 0.5; P less than 0.01) and LH pulse amplitude (5.5 +/- 0.7 to 2.4 +/- 0.3 IU/L; P less than 0.01) in response to Nal-Glu antagonist. The number of LH pulses was reduced (36%), but pulses remained discernible. Concentrations of FSH (10.8 +/- 1.4 to 5.9 +/- 0.4 IU/L; P less than 0.05), E2 (322.7 +/- 71.9 to 84.8 +/- 7.7 pmol/L; P less than 0.01) and i-INH (284.0 +/- 25.9 to 164.4 +/- 7.5 U/L; P less than 0.01) decreased concomitantly. Within 24-48 h of the last injection of Nal-Glu, all hormones had returned to pretreatment levels. This was followed by normal functional expression of follicular growth and maturation, as reflected by an increase in E2 and i-INH levels, timely ovulation, and normal luteal function. These findings indicate that an approximately 50% decline in gonadotropin support to the dominant follicle leads to functional arrest, but not demise, of the developing follicle(s) without triggering new folliculogenesis. The follicular apparatus retained its ability to reinitiate its original functionality once appropriate gonadotropin inputs were reinstated.     

Increased extracellular local levels of estradiol in normal breast in vivo during the luteal phase of the menstrual cycle

Estrogen exposure is a major risk factor for breast cancer. Tissue estrogen originates from the ovaries but a significant portion is also produced by enzyme activity locally in the breast itself. How these enzymes are regulated is not fully understood. The extracellular space, where the metabolic exchange and cell interactions take place, reflects the environment that surrounds the epithelium but there has been no previous study of hormone concentrations in this compartment. In the present study microdialysis was used to measure extracellular estrogen concentrations in breast tissue and abdominal subcutaneous fat in 12 healthy women in vivo. It was found that women with high plasma progesterone levels had significant increased levels of estradiol in breast tissue compared with fat tissue (breast tissue 168+/-6 pM; subcutaneous fat, 154+/-5 pM; P<0.05), whereas women with low plasma progesterone exhibited no difference. Moreover, there was a significant correlation between local breast tissue estradiol and plasma progesterone levels (r=0.709, P<0.01). There was no difference in estrone sulphate in breast and fat tissue regardless of progesterone levels. Estrone was not detectable. The results in this study suggest that progesterone may be one regulator in the local conversion of estrogen precursors into potent estradiol in normal breast tissue.     

Morphological and endocrinological studies on follicular development during the human menstrual cycle

In order to clarify the morphological dynamics of follicular development and its correlation with ovarian endocrine activity, the present studies were performed in 45 regularly menstruating women who underwent gynecological surgery. Ovarian venous blood was collected from 35 women during the follicular phase. Thirteen of these 35 women were ovariectomized. In addition, 11 pairs of ovaries were obtained from women during the luteal phase. The ovaries were sectioned serially at 2.5 micron and every 13th stained slice was examined to assess the sizes and numbers of atretic and nonatretic follicles. The follicles were divided into five stages: 0.4 less than or equal to approximately less than 1.0 mm, 1.0 less than or equal to approximately less than 2.0 mm, 2.0 less than or equal to approximately less than 4.0 mm, 4.0 less than or equal to approximately less than 6.0 mm, and 6.0 mm less than or equal to approximately in follicular diameter. Estradiol concentrations in ovarian venous plasma were low on both sides on days 1 and 3 of the cycle, whereas a clear asymmetry was found on day 5 before morphological recognition of the dominant follicle. Thereafter, estradiol increased proportionally to the growth of the dominant follicle, followed by a sudden drop when ovulation was imminent. An asymmetrical rise of progesterone occurred on day 10 and later which was sustained up to ovulation. A dominant follicle was recognized in 8 of 11 women between days 6 and 14. All dominant follicles were invariably associated with higher estradiol concentrations in the ipsilateral ovarian blood. Seven of 8 dominant follicles were on the side contralateral to the preceding corpus luteum. The mean diameters of the largest nonatretic follicles were 5.4 +/- 0.3 (SE) mm during the luteal phase as a whole and 4.7 +/- 0.7 mm during the late luteal phase. The mean diameters of the largest nonatretic follicles were not significantly different between the groups with or without the corpus luteum in the luteal phase. In terms of number and atretic rate, follicles of less than 4.0 mm in diameter did not change throughout the cycle in the presence or absence of the corpus luteum. In contrast, cyclic changes of growth and atresia occurred in the larger antral follicles.(ABSTRACT TRUNCATED AT 400 WORDS)     

Effects of an antiprogesterone (RU486) on the hypothalamic-hypophyseal-ovarian-endometrial axis during the luteal phase of the menstrual cycle

The impact of the antiprogesterone RU486 [17 beta-hydroxy-11 beta-(4-dimethylaminophenyl) 17 alpha-(1-propynyl)estra- 4,9-dien-3-one] on the hypothalamic-pituitary-ovarian-endometrial axis was examined in normal cycling women during the mid (MLP)- and late (LLP) luteal phases. During the MLP, 10 women received 3 mg/kg RU486 for 3 days. During the LLP, a single dose of 600 mg RU486 was administered to 4 women, and in another 4 women a single dose of 3 mg/kg was given during corpus luteum rescue by hCG. Longitudinal studies with daily and frequent blood samples (every 10 min for 10 h) were conducted during 3 consecutive cycles (control-treatment-recovery). During the MLP, RU486-induced uterine bleeding occurred in all 10 women 36-72 h after the first dose. No histological evidence of endometrial breakdown was found in endometrial biopsies taken 12-24 h before the onset of bleeding. Significant decreases in LH secretion (P less than 0.001) and LH pulse amplitude (P less than 0.006) and blunted pituitary responses to GnRH (P less than 0.01) were evident by the last treatment day, but LH pulse frequency did not change. Complete luteolysis occurred in 2 of the 10 women. Incomplete luteolysis occurred in 8 women and was associated with an initial decline of serum estradiol (P less than 0.001), but not progesterone levels, followed by rebound increases (P less than 0.001) in LH, estradiol, and progesterone levels 3 days later, which may have reversed the luteolytic processes and prolonged corpus luteum function. Spontaneous luteolysis ensued 3-5 days later with the onset of second episodes of uterine bleeding. For serum FSH, an early rise occurred during the luteal phase in advance of the onset of the second episodes of uterine bleeding. This rise may have resulted in early follicle recruitment and accounted for the shorter duration of the follicular phase during recovery cycles. During the LLP, the single RU486 dose resulted in significant decreases in LH pulse amplitude (P less than 0.03), frequency (P less than 0.05), and secretion (not significant) within 12 h. The recovery cycle was entirely normal. Corpus luteum rescue with incremental doses of hCG did not prevent uterine bleeding after RU486 treatment. These findings indicate that RU486 operates at multiple sites and implies that progesterone is important in the control of luteal function. Further, our data provide a basis for exploring the potential use of RU486 as a once a month birth control agent.     

Effects of FSH on serum immunoreactive inhibin levels in the luteal phase of the menstrual cycle

OBJECTIVE  FSHcauses a dose-related increase in circulating immunoreactive inhibin (INH) in the follicular phase of the menstrual cycle, while LH is the major stimulus to INH secretion by the corpus luteum. The present study was undertaken to assess whether FSH can also stimulate INH production during the luteal phase.
DESIGN  Normal volunteers were treated with a single injection of LH-free FSH (Metrodin, 150 units) or saline as control, during the early, mid- or late luteal phase of the cycle, with subsequent hormone measurements.
PATIENTS  The 21 volunteers were aged 19–29. Seven subjects given FSH and 8 controls were studied in the early luteal phase, 1–4 days post ovulation. Eight FSH treated subjects and 10 controls were studied in the mid-luteal phase, 5–9 days post ovulation, and 6 each, respectively, were studied in the late luteal phase.
MEASUREMENTS  Oestradiol (E₂), progesterone (P), and INH were measured by previously described radioimmunoassays.
RESULTS  In both the early and mid-luteal phases, FSH caused a significant rise in INH (early, from 778 to 922 U/l, mid-luteal 1553 to 2090 U/l) and E₂ (early 371 to 545 pmol/l, mid-luteal 528 to 636) while there was no significant change in P. No significant changes occurred in the saline treated subjects. In the late luteal phase FSH prevented the significant fall in INH seen in the controls, whilst there was no effect on E₂ or P.
CONCLUSIONS  It was concluded that both FSH and LH are capable of modulating inhibin production during the luteal phase of the menstrual cycle. FSH may exert its actions on the corpus luteum or alternatively on developing follicles. The present study cannot clearly distinguish between these possibilities.     

Hormone changes during the menstrual cycle in abetalipoproteinemia: reduced luteal phase progesterone in a patient with homozygous hypobetalipoproteinemia.

Progesterone synthesis by the human corpus luteum requires a source of cholesterol, which can be derived from both local synthesis and uptake of low density lipoproteins (LDL). When the corpus luteum is maintained in organ culture, progesterone synthesis is primarily dependent on LDL and the rate of progesterone production during growth in a LDL-free media is suboptimal. An in vivo situation analogous to that of corpus luteum grown in LDL-depleted media exists naturally in patients with abetalipoproteinemia. To determine whether a complete deficiency of plasma LDL affects serum concentrations of progesterone (particularly during the luteal phase) or those of other hormones, we have measured the serum concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, estrone, and progesterone during the menstrual cycle in a patient with phenotypic abetalipoproteinemia (on the basis of homozygous hypobetalipoproteinemia). Our results show a normal cyclical pattern with midcycle increases in the concentrations of luteinizing and follicle-stimulating hormones, prolactin, and estrogens but a distinctly subnormal increase in the luteal phase concentrations of progesterone. These results suggest that, in patients with phenotypic abetalipoproteinemia, the absence of LDL leads to an impairment in the maximal rates of production of progesterone by the corpus luteum.     

Plasma lipid and lipoprotein levels during the follicular and luteal phases of the menstrual cycle

Estrogen levels are higher during the luteal compared with the follicular phase of the menstrual cycle. It was hypothesized that the luteal compared with the follicular phase has a lipid and lipoprotein profile associated with decreased coronary heart disease (CHD) risk. This was tested using well-defined data from healthy, well-characterized premenopausal Caucasian women under very controlled metabolic conditions. The percent differences in lipid, lipoprotein, and sex hormone levels between the follicular and luteal phases were estimated using generalized estimating equations after adjusting for age, body mass index, calendar time, and season. The low-density lipoprotein cholesterol (LDL-C) level was 6.2% lower (P = 0.015), and the total cholesterol/high-density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C ratios were 5.1% (P = 0.0006) and 8.4% (P = 0.002) lower, respectively, during the luteal phase. Levels of estradiol and other estrogens were significantly higher (by>100% each; P < 0.0001 in all cases) in the luteal phase. These findings support the study hypothesis. Fluctuations in levels of LDL-C and the total cholesterol/HDL-C and LDL-C/HDL-C ratios between menstrual cycle phases need to be considered in the screening and medical monitoring of premenopausal women, especially those with borderline levels. Although small, such fluctuations may prove to be clinically significant in the long run. Studies involving premenopausal women need to more clearly define and validate menstrual cycle phase in the design and interpretation of study results.     

Effect of follicle stimulating hormone or human chorionic gonadotrophin treatment on the production of gonadotrophin surge attenuating factor (GnSAF) during the luteal phase of the human menstrual cycle

OBJECTIVE Although there is much in-vivo evidence for the existence of a gonadotrophin surge attenuating factor (GnSAF), its source and identity remain unknown. We have studied the control of GnSAF production by FSH and hCG during the luteal phase of the cycle. DESIGN Normally cycling women were investigated in three cycle. Starting on day 5 after the midcycle LH peak, the women received i.m. injections of placebo (1st cycle control), hCG at a dose of 750 IU per day (2nd cycle) and FSH at a dose of 225 IU per day (3rd cycle) for five consecutive days. The response of LH to a single i.v. dose of 10 μg GnRH (GnSAF bioactivity) was investigated several times during the experimental period. PATIENTS Six normally ovulating women with long-standing unexplained infertility were studied. The women were used as their own controls during the cycle treated with placebo. MEASUREMENTS Pituitary response to GnRH was calculated as the net increase in LH at 30 minutes (ΔLH) above the basal value. RESULTS Serum concentrations of FSH and hCG increased significantly during the second and 3rd cycles respectively. Compared with the control cycles, ΔLH was significantly attenuated as early as 12 hours from the onset of FSH injections. In contrast, basal concentrations of oestradiol (E₂) and immunoreactive inhibin started to increase 48 hours after the first injection of FSH, while progesterone values remained similar to those in the controls. During treatment with hCG, no attenuation was seen in ΔLH values, while those of E₂, progesterone and inhibin showed a significant increase. CONCLUSIONS These results demonstrate that during the luteal phase of the human menstrual cycle, FSH, but not LH, stimulates the production of gonadotrophin surge attenuating factor. It is suggested that the source of gonadotrophin surge attenuating factor at that stage of the cycle is a cohort of small follicles rather than the corpus luteum.     

The source of inhibin secretion during the human menstrual cycle

The source of inhibin secretion during the human menstrual cycle was investigated in two ways. The concentration of inhibin was compared in samples obtained from the ovarian and peripheral veins of 41 women undergoing hysterectomy. In 13 of the women, the corpus luteum was enucleated at operation and the peripheral concentration of inhibin measured at intervals for 24 h. Inhibin was assayed by a heterologous RIA using an antiserum raised against 31 kilodalton bovine inhibin. The concentrations of estradiol and progesterone in the peripheral and ovarian veins were similar to those previously reported. During the early follicular phase, the geometric mean inhibin concentrations were found to be significantly higher in both the right and left ovarian veins than the peripheral vein (180.4 and 157.7 vs. 78.7 U/L: P less than 0.02) but no difference was found in the late follicular phase between the vein draining the dominant ovary and the contralateral ovarian vein (231.1 vs. 193.4 U/L: NS). The inhibin concentrations in the veins draining the ovary bearing a corpus luteum were, however, significantly higher than those in the contralateral ovarian veins during the mid (409.1 vs. 203.6 U/L: P less than 0.02) and late (287.1 vs. 153.2 U/L: P less than 0.01) luteal phases. After enucleation of the corpus luteum, the inhibin concentration fell from the level seen before lutectomy (134.4 U/L) to 80.0 U/L at 24 h (P less than 0.01). This study demonstrates conclusively that the human corpus luteum secretes inhibin. No increase in inhibin secretion was seen from the dominant follicle in the late follicular phase. This casts doubt on the hypothesis that the selective suppression of FSH during the follicular phase is due to inhibin from the dominant follicle.     

Stress and the menstrual cycle: short- and long-term response to a five-day endotoxin challenge during the luteal phase in the rhesus monkey

Previously, we reported that in the rhesus monkey a 5-day inflammatory-like stress during the early-mid follicular phase acutely stimulates the hypothalamic-pituitary-adrenal axis and exerts effects on the hypothalamic-pituitary-gonadal axis, delays folliculogenesis and in some animals decreases luteal function in the post-treatment cycle. Because the endocrine environment at the time of the stress may influence the response to the stress, we now investigate the acute and long-term responses to a similar stress challenge during the luteal phase of the menstrual cycle, at a time of progesterone dominance. Nine monkeys with normal cycles were injected with endotoxin (lipopolysaccharide; LPS, 150 microg i.v.) twice a day for 5 days starting on days 4-8 after the LH peak. Blood samples were taken at hour 3 and hour 8 after each morning LPS injection to monitor the acute gonadotropin and cortisol responses. To verify cyclicity, menses were checked every day, and daily blood samples were taken for estradiol and progesterone measurement. Two control cycles, the LPS treatment cycle, and two post-treatment cycles were documented. Endotoxin activated the adrenal axis: mean (+/-SE) cortisol secretion was significantly increased at hour 3 after the first morning LPS injection (74.1 +/- 4.9 vs. 24.1 +/- 1.8 microg/dL in the control; P < 0.05) and remained elevated at hour 8. This response decreased progressively with time: on day 5 of LPS treatment, the cortisol level was still significantly higher than control at hour 3 (38.5 +/- 5.0 microg/dL; P < 0.05) but had returned to the control concentration by hour 8 (days 3-5 of LPS). Mean integrated progesterone through the luteal phase of the LPS treatment cycle was significantly decreased (33.5 +/- 3.3 ng/ml vs. 48.9 +/- 3.7 and 54.0 +/- 4.9 in the two control cycles; P < 0.05), but luteal phase length remained unchanged. When compared with control levels on the same day of the luteal phase, about one third of LH and FSH values were lower than one SD below mean control levels. LPS administration had no effect on the two post-treatment cycles, except that integrated luteal progesterone in 3 out of 9 monkeys was still reduced in post-treatment cycle 1. There were no differences in follicular phase length and preovulatory estradiol peaks between control cycles and post-treatment cycles. When compared with our previous study, the results illustrate specific responses to stress at different phases of the menstrual cycle and support the notion that a moderate short-term inflammatory-like stress episode has the potential to subtly alter critical aspects of cyclicity.     

Characterization of the levels of messenger ribonucleic acid that encode for luteinizing hormone receptor during the luteal phase of the primate menstrual cycle.

The present study was designed to characterize the expression of LH receptor messenger RNA (mRNA) in the primate corpus luteum throughout the luteal phase of the menstrual cycle. We obtained corpora lutea from cynomolgus monkeys at defined stages of the luteal phase. LH receptor mRNA was demonstrated in monkey ovarian sections by in situ hybridization with a 35S-labeled antisense RNA probe derived from rat LH receptor complimentary DNA. The hybridization signals were confined to thecal layers of antral follicles and corpus luteum. Using the same LH receptor cDNA, the pattern of expression of mRNA encoding for LH receptor during the luteal phase was determined by Northern blot analysis. Four species of mRNA migrating at 1.0, 4.0, 7.5, and 8.0 kilobase (kb) were identified; the 4.0 kb size mRNA species was more abundant than the other three species. Quantitative analysis of the 4.0 kb band of mRNA throughout the luteal phase by densitometry revealed that the levels of LH receptor mRNA were low during the early luteal phase (days 3-5 of the luteal phase). A progressive increase in the message levels was observed from the early luteal phase to the end of the luteal phase. By days 11-12, there was a significant increase in the message levels (less than 0.05) which further increased during the late luteal phase (days 13-15). After menstruation, the levels became undetectable. In contrast, mRNA levels for 3 beta-hydroxysteroid dehydrogenase, a key enzyme involved in luteal steroidogenesis, were high shortly after ovulation and declined throughout the remainder of the luteal phase. These results indicate that after ovulation and luteinization, the expression of mRNAs that encode for specialized luteal cell proteins is differentially regulated.