Characteristics of natural conceptual cycles occurring in a prospective study of sex preselection: fertility awareness symptoms, hormone levels, sperm survival, and pregnancy outcome.

A prospective study of sex preselection provided the opportunity to characterize the fertile menstrual cycle. We describe from 91 natural conceptual cycles, or sub-groups thereof, cervical mucus symptoms, basal body temperature (BBT) changes, hormonal characteristics, and the outcome of pregnancy. The cervical mucus symptoms defined a potential fertile period of 10 days' average length, with the "peak" mucus symptom occurring at a mean of day 15.5 of the cycle. A fertile period of 9 to 10 days was also indicated by pregnancies resulting from single acts of intercourse between -6 and +3 days from ovulation. The BBT chart was biphasic in 73 of 76 cycles. The duration of the LH surge as observed in early morning urine samples averaged five days, with the peak occurring 1.4 days after the onset. Considerable inter-subject variability was seen in the LH excretion levels. Hormone measurements of peripheral plasma during the luteal phase showed the first detectable presence of hCG between day 7 and day 13 after conception. Progesterone concentrations in the midluteal phase exceeded 20 nmol/L and tended to be higher than in a comparison group of nonfertile cycles, whereas the estradiol concentrations were similar in fertile and nonfertile cycles. The birth sex ratio favored males when intercourse preceded ovulation/fertilization by two days or longer. While this association was statistically significant, the number of pregnancies involved is too small to conclude that the relationship is real.     

Self-examination of cervical mucus to determine the fertile period

24 women, of whom 2 each presented with primary and secondary infertility, were taught to observe their cervical mucus secretions outside the vulva. The correlation between the sensation, presence, and aspect of the mucus and the quantity of estrone and estradiol excreted in the urine were determined for each day of the cycle. The women were aged 24-39 years and had 0-7 children, with an average of 2.3. 2 women kept incomplete records and 2 had anovulatory cycles, leaving 20 in the sample. All 20 noted at least 1 day of fertile type mucus. 11 women noted 3 or fewer days which corresponded to the estrogenic peak. 4 of the women who noted more than 3 days of fertile type mucus identified 1-3 days of maximum wetness, bringing to 15 the number of favorable cases. In 4 cases the women observed fertile type mucus outside the estrogenic peak. In 14 cases the fertile type mucus was preceded by 1 or more days of thick mucus. It is hoped that this method will be of use in the treatment of infertility.     

An estrogen test to determine the times of potential fertility in women

Defined changes in the concentration of estrone glucuronide in daily samples of early morning urine have been used to locate the limits of the fertile period and the time of maximum conception probability during 118 cycles (106 menstrual, 12 conceptional) in 73 women. The peak day of urinary luteinizing hormone was used as an index of ovulation. Follicular growth was monitored daily by ultrasonography throughout 38 cycles, and the time of maximum follicular diameter was used as an alternative reference point to define the times of potential fertility according to the life spans of the gametes. With optimized algorithms and the best index of ovulation, the estrogen test delineated the limits of the fertile period in 89% of the tests (mean length, 10.8 days; range, 5 to 17 days) and the time of maximum conception probability in 82% of the cycles, with a mean time to the maximum follicular diameter of 0.42 days (range, -4 to +4 days).     

Vulvar mucus observations and the probability of pregnancy

OBJECTIVE: To assess the day-specific and cycle-specific probabilities of conception leading to clinical pregnancy, in relation to the timing of intercourse and vulvar mucus observations. METHODS: This was a retrospective cohort study of women beginning use of the Creighton Model Fertility Care System in Missouri, Nebraska, Kansas, and California. Data were abstracted from Creighton Model Fertility Care System records, including women's daily standardized vulvar observations of cervical mucus discharge, days of intercourse, and clinically evident pregnancy (conception). Established statistical models were used to estimate day-specific probabilities of conception. RESULTS: Data were analyzed from 1681 cycles with 81 conceptions from 309 normally fertile couples (initially seeking to avoid pregnancy) and from 373 cycles with 30 conceptions from 117 subfertile couples (who were initially trying to achieve pregnancy). The highest probability of pregnancy occurred on the peak day of vulvar mucus observation (.38 for normally fertile couples and.14 for subfertile couples). The probability of pregnancy was greater than.05 for normally fertile couples from 3 days before to 2 days after the peak, and for subfertile couples from 1 day before to 1 day after the peak. The cycle-specific probability of conception correlated with the quality of mucus discharge in normally fertile couples but not in subfertile couples. CONCLUSION: Standardized vulvar observations of vaginal mucus discharge identify the days with the greatest likelihood of conception from intercourse in normal fertility and subfertility and provide an indicator of the overall potential for conception in a given menstrual cycle in normal fertility.     

Histological dating of timed endometrial biopsy tissue is not related to fertility status

OBJECTIVE: To assess the ability of histological dating to discriminate between women of fertile and infertile couples. The utility of histological dating of endometrium in the evaluation of infertile couples is uncertain. DESIGN: Prospective multicenter study, with subjects randomly assigned to biopsy timing. Criterion standard for infertility was 12 months of unprotected, regular intercourse without conception and for fertility at least one live birth within 2 years. SETTING: University-based infertility practices. PATIENT(S): Volunteer subjects (847) recruited at 12 clinical sites participating in the National Institutes of Health-funded Reproductive Medicine Network. Inclusion criteria included ages 20-39 years, regular menstrual cycles, and no hormonal treatment or contraceptive use for 1 month before the study. Fertile controls were excluded if they had a history of infertility, recurrent pregnancy loss, or recent breastfeeding. INTERVENTION(S): Subjects underwent daily urinary LH testing. After detection of the LH surge, subjects were randomized to biopsy in the mid (days 21-22) or the late (days 26-27) luteal phase. Pathologists at each site estimated the cycle day based on standard criteria. For the primary analysis, an out-of-phase biopsy was defined as a greater than 2-day delay in the histological maturation of the endometrium. MAIN OUTCOME MEASURE(S): The proportion of out-of-phase biopsies in fertile and infertile women was compared using logistic regression models with age at randomization as a covariate. Comparisons were also made between fertile vs. infertile at the midluteal or late luteal phase time points. RESULT(S): Biopsies were evaluated (301 mid and 318 late; N = 619). Out-of-phase biopsy results poorly discriminated between women from fertile and infertile couples in either the midluteal (fertile: 49.4%, infertile: 43.2%) or late luteal phase (fertile: 35.3%, infertile 23.0%). Results did not substantially differ using alternative definitions of "out-of-phase" or standardized cycle day. CONCLUSION(S): Histological dating of the endometrium does not discriminate between women of fertile and infertile couples and should not be used in the routine evaluation of infertility.     

Identification and prediction of the fertile window with a new web-based medical device using a vaginal biosensor for measuring the circadian and circamensual core body temperature

Fertility awareness-based (FAB) methods represent a term that includes all family planning methods that are based on the identification of the fertile window. They are based on the woman’s observation of physiological signs of the fertile and infertile phases of the menstrual cycle. The first approach consists basically in symptothermal methods accompanied by cervical mucus measurements and clinical menstrual cycling data recording. The second most often used methods are the urinary measurement of E3G and luteinizing hormone (LH) with a personalized computer system. Hence these systems lack the efficacy of the continuous circadian and circamensual measurement of the core body temperature. Only this approach enables the accurate detection of the ovulation during the fertile window. A new medical device called OvulaRing has been developed to fill this gap. In the present study, the system and its first clinical results are presented. OvulaRing is a medical device used just like a tampon. The device is a vaginal ring of evatane that contains an integrated biosensor. This sensor measures continuously every 5?min the core body temperature throughout the entire cycle. This device allows a circadian and circamensual intravaginal exact measurement. With this system, 288 measurements are created per day. The system can detect retrospectively and predict prospectively the fertile window of the users. One hundred and fifty eight women aged between 18 and 45 years used this medical device in an open non-randomized clinical study for 15 months. A total of 470 cycles could be recorded and were able for analysis. By the same time in a subgroup of patients, hormonal assessments of LH, follicle-stimulating hormone, estradiol and progesterone as well as vaginal ultrasound were performed in parallel between the 9th and the 36th day of the cycle. The validation error due to software errors was 0.89% for the retrospective analysis; that means that the accuracy for the detection of the ovulation was 99.11%. Accuracy of 88.8% for a window of 3 days before ovulation, the day of ovulation and the 3 days after ovulation was achieved for the prospective analysis. In the subgroup of woman with recorded pregnancies, it could be shown that after 3.79 months of use (median) pregnancies were observed. In 67.72% in up to 3 months, in 16.36% between 3 and 6 months of use, in 7.27% between 7 and 9 months, in 5.45% between 10 and 12 months and in 1.82% between 13 and 15 months of use of the system. With this new web-based system, a precise determination of the fertile window even in women with ultralong cycles (>35 days) could be detected independently of their personal live circumstances. Exact determination of the fertile window is herewith possible so that OvulaRing represents an evolution in the FAB method for the cycle diagnosis of women with regular, irregular or anovulatory menstrual cycles.     

Cervical mucus secretions on the day of intercourse: an accurate marker of highly fertile days

OBJECTIVE: To provide estimates of the probabilities of conception according to vulvar mucus observations classified by the woman on the day of intercourse. STUDY DESIGN: Prospective cohort study of 193 outwardly healthy Italian women using the Billings Ovulation Method. Outcome measures include 161 conception cycles and 2594 non-conception cycles with daily records of the type of mucus and the occurrences of sexual intercourse. RESULTS: The probability of conception ranged from 0.003 for days with no noticeable secretions to 0.29 for days with most fertile-type mucus detected by the woman. The probability of most fertile type mucus by day of the menstrual cycle increased from values <20% outside of days 10-17 to a peak of 59% on day 13. CONCLUSION: Regardless of the timing of intercourse in the menstrual cycle, the probability of conception is essentially 0 on days with no secretions. This probability increases dramatically to near 30% on days with most fertile-type mucus, an association that accurately predicts both the timing of the fertile interval and the day-specific conception probabilities across the menstrual cycle.     

Dating sonographic endometrial images in the normal ovulatory cycle

Pelvic sonograms were obtained from 5 fertile volunteers and 150 infertile patients with normal ovulatory cycles, using real-time ultrasound. The existence of a linear cavity echo (C), thick hypoechoic layer (H) and increased echogenicity (E) were chosen as the parameters of sonographic endometrial images to be studied for dating the ovulatory cycle. In 109 serial sonograms from the fertile volunteers, H was observed from 3 days before ovulation (day -3) to ovulation day (day 0). E was observed from day +1 to day +8, and C, from day -10 to day +3. Studies on 189 sonograms from the infertile patients revealed a similar pattern for these parameters. We tested the accuracy of sonographic images of the endometrium, using sonograms from five patients who underwent hysterectomy. The measurements of endometrial thickness, in vivo, and in vitro, showed little difference. Sonographic endometrial images are considered indicative of histological changes, under the influence of estradiol and progesterone. Therefore, observation of the combined quantitative changes in C, H and E facilitates dating of the sonographic endometrial images in a normal ovulatory cycle.     

Effects of the antiprogesterone RU486 in the early follicular phase of the menstrual cycle

To investigate the role of progesterone (P) in the early follicular phase, the antiprogesterone effect of RU486 was examined in five normally cycling women monitored by daily hormonal levels during three consecutive cycles (control, treatment, and recovery). In addition, luteinizing hormone (LH) pulse characteristics were assessed by frequent blood sampling (10 minutes for 10 hours) on day 3 of the control and the corresponding day of treatment cycles. Administration of RU486 (3 mg/kg, orally) for the first 3 days of the menstrual cycle did not significantly alter the length of the follicular phase (13.4 +/- 1.7 to 15.2 +/- 1.3 days), the LH surge, or the luteal phase length (12.2 +/- 0.5 to 12.6 +/- 0.7 days). The intermenstrual length of the treatment cycle (29.8 +/- 1.9 days) did not differ from the control (27.6 +/- 1.8 days) or recovery cycles (29.6 +/- 2.5 days). Integrated secretion of P and estradiol (E2) did not vary during the luteal phase of the control, treatment, or recovery cycles. During RU486 treatment, LH pulse frequency, pulse amplitude, and mean LH were not altered. Whereas mean E2 levels were significantly decreased from 150.5 +/- 15.1 to 110.1 +/- 7.0 pmol/L, follicle-stimulating hormone, P, adrenocorticotropin hormone, and cortisol were not significantly altered. Thus, in spite of the transient decrement in E2 secretion during RU486 treatment, the integrity of the ovulatory menstrual cycle was maintained. We conclude that administration of the antiprogesterone RU486 at the dose used during the first 3 days of the follicular phase does not perturb menstrual cyclicity.     

Diagnosis of fertility with a personal hormonal evaluation test

BACKGROUND: To evaluate the efficacy of the urinary test "Persona" in the recognition of the fertile period comparing hormonal assay and monitoring the follicular growth by ultrasonography. METHODS: Twenty women have used "Persona" for 13 cycles (200 cycles). This device evaluates changes in E-3-G and LH concentrations and estimates the fertile days which are displayed by a red light. Inclusion criteria were: age 22-45, regular menstrual cycles (23-35 days), absence of the polycystic ovary syndrome. The participants underwent vaginal ultrasonography in several days (one of the first 7 "green days", the first "red day", the ovulation day "O", and the first "green day" after ovulation) and determination of blood concentration of LH, in the ovulation day, and progesterone, in the 21st day of cycle. RESULTS: Vaginal ultrasonography was in agreement with predictions of "Persona" in 96% in the first "green days", in 94% in the first "red day", in 95,8% in the ovulation day and in 97,5% in the first "green day" after ovulation. All participants with ultrasonographic evidence of ovulation had a concentration of LH included in 13-71 mUI/ml range and of progesterone included in 12-50 ng/ml range. CONCLUSIONS: These results suggest that the "Persona" test is effective in the recognition of the fertile period, but a correct maintenance of the microcomputer is important for the best reliability of method. The method seems to be a wellcome alternative for couples who want to use natural family planning.     

Efficacy of the new TwoDay Method of family planning

OBJECTIVE: To test the efficacy of the TwoDay Method, a new fertility awareness-based method of family planning that provides women with simple instructions to identify the days each cycle when they are most likely to become pregnant. Users avoid unprotected intercourse on days when cervical secretions are present on that day or on the day before, to prevent pregnancy. DESIGN: Prospective, nonrandomized, multicenter study. SETTING: Five culturally diverse sites in Guatemala, Peru, and the Philippines. PATIENT(S): Four hundred fifty women, aged 18-39 years, wishing to use a fertility awareness-based method to prevent or delay pregnancy. INTERVENTION(S): Study participants were followed for up to 13 cycles of method use. MAIN OUTCOME MEASURE(S): Life table pregnancy rate. RESULT(S): The first-year pregnancy rate was 3.5 (pregnancies per 100 women/years) with correct use of the method (pregnancies and cycles with no intercourse on identified fertile days), 6.3 with use of a backup method on the fertile days, and 13.7 including all cycles and all pregnancies in the analysis. CONCLUSION(S): The TwoDay Method offers a valuable addition to the services that reproductive health and other programs can offer. Its efficacy compares well with that of other coitus-dependent family-planning methods; it is easy to teach, learn, and use; and it can address the need of women for simple, accurate instructions for identifying their fertile days.     

Normal variation in the length of the luteal phase of the menstrual cycle: identification of the short luteal phase

Normal probability plots were used to assess the homogeneity of a population of 327 luteal phases from apparently ovulatory menstrual cycles. The length of the luteal phase was defined as the interval (in days) following but not including, the luteinizing hormone peak, up to and including the day before onset of menstruation. A small sub-set of the population consisted of cycles with abnormally short luteal phases but the majority of the data followed a normal frequency distribution which gave a mean (+/- SD) for normal luteal phase length of 14.13 (+/- 1.41) days. It was estimated that all cycles with a luteal phase less than or equal to 9 days were abnormal, and that 74%, 22% and 2% respectively of cycles with luteal phases of 10, 11 and 12 days were also abnormal. The total incidence of short luteal phases defined as above was 5.2%.     

Incidence of the luteinized unruptured follicle syndrome in fertile women and in women with endometriosis

One-hundred normal fertile women with normal luteal phase and 118 women with endometriosis underwent luteal phase laparoscopy before day 22. The luteal phase was ascertained by the presence of secretory endometrium and serum progesterone levels higher than 3 ng/ml. The ovaries were carefully inspected for the presence or absence of an ovulation ostium. The percentage of ostii that was observed in fertile women (91%) was similar to that observed in women with mild endometriosis (85%). However, in women with moderate and severe endometriosis, significantly less ostii were noted, respectively 72 and 51%. It is therefore argued that the absence of an ovulation ostium (so-called luteinized unrupted follicle syndrome, LUF) is more frequent in women with moderate and severe endometriosis and may contribute to infertility in this group of women.     

Estimation of the follicle-stimulating hormone (FSH) threshold for initiating the final stages of follicular development in women with elevated FSH levels in the early follicular phase

OBJECTIVE: To test the hypothesis that the follicle-stimulating hormone (FSH) threshold in patients with elevated FSH levels in the early follicular phase (EFP) is higher than in controls. DESIGN: Pilot study. SETTING: Academic hospital. PATIENT(S): Six patients with elevated EFP FSH (>10 IU/L) and 13 controls. INTERVENTION(S): Treatment with a GnRH agonist in the midluteal phase before IV administration of recombinant FSH was started in an ultra-low-dose step-up protocol. The FSH threshold was determined by the mean of FSH levels of the above threshold value and the below threshold value. MAIN OUTCOME MEASURE(S): Follicle-stimulating hormone threshold, FSH screening value, E(2), number of follicles. RESULT(S): The FSH threshold in the elevated EFP FSH group was 6.75 IU/L and was significantly higher than the FSH threshold of the controls (4.65 IU/L). The FSH screening value on day 3 was 12.0 IU/L in the patient group and 5.0 IU/L in the controls. Estradiol was significantly lower on the day that the largest follicle was 18 mm in the elevated EFP FSH group compared with controls (277 vs. 491 pmol/L, respectively). On the day of hCG administration, the number of smaller (10-13 mm) follicles was equal but the number of larger (>14 mm) follicles was higher in the control group compared with the elevated FSH group. In the control group, the basal FSH levels correlated highly with the FSH threshold levels (r = 0.8), but in the patients with elevated EFP FSH this correlation was absent. CONCLUSION(S): In normal women, basal FSH day 3 values represent the ovarian threshold for FSH. In women with elevated day 3 FSH, the FSH threshold is higher but not as high as basal FSH values. We postulate that the FSH threshold in patients with elevated EFP FSH is higher because of intraovarian factors. Basal FSH overshoots the threshold, probably because of the limited feedback by the ovary.     

New approaches to fertility awareness-based methods: incorporating the Standard Days and TwoDay Methods into practice

Helping clients select and use appropriate family planning methods is a basic component of midwifery care. Many women prefer nonhormonal, nondevice methods, and may be interested in methods that involve understanding their natural fertility. Two new fertility awareness-based methods, the Standard Days Method and the TwoDay Method, meet the need for effective, easy-to-provide, easy-to-use approaches. The Standard Days Method is appropriate for women with most menstrual cycles between 26 and 32 days long. Women using this method are taught to avoid unprotected intercourse on potentially fertile days 8 through 19 of their cycles to prevent pregnancy. They use CycleBeads, a color-coded string of beads representing the menstrual cycle, to monitor their cycle days and cycle lengths. The Standard Days Method is more than 95% effective with correct use. The TwoDay Method is based on the presence or absence of cervical secretions to identify fertile days. To use this method, women are taught to note everyday whether they have secretions. If they had secretions on the current day or the previous day, they consider themselves fertile. The TwoDay Method is 96% effective with correct use. Both methods fit well into midwifery practice.     

The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment

BACKGROUND: Comparing stress levels in women entering IVF treatment with those of fertile controls as well as relating these levels to the outcome of IVF. METHODS: State anxiety and personality profiles as well as stress hormones were studied in 22 normally menstruating women entering IVF treatment for tubal infertility. Their personality profiles as well as state anxiety scores measured before entering IVF treatment were related to the outcome of treatment. Twenty-two fertile women served as controls. Stress markers were serum prolactin and cortisol. These were estimated by radioimmunoassay. The psychological evaluation included the Karolinska Scales of Personality (KSP) and state anxiety as measured by the STAI questionnaire. Basal FSH on cycle day 3 and E2 and P4 AUC during the luteal phase were evaluated as hormonal predictors for the outcome of IVF treatment. RESULTS: Comparison of the personality profiles of the two groups, showed that infertile women had significantly higher scores of suspicion (p>0.05), guilt (p>0.05), and hostility (p>0.01), but lower somatic anxiety (0.05) and indirect aggression (0.05) than fertile controls. The infertile women also had significantly higher levels of prolactin and cortisol throughout the menstrual cycle. Serum cortisol, prolactin and FSH levels on cycle day 3 did not differ between the women who conceived after IVF treatment and those who did not conceive. However, significant differences were found in E2 and P4 AUC (p>0.01) in the luteal phase between those women who became pregnant and those who failed. There was a trend (p<0.06) toward higher state anxiety levels among the women who did not succeed in becoming pregnant after IVF treatment. CONCLUSIONS: The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.     

Administration of luteinizing hormone-releasing hormone analogs delays ovulation without affecting the luteal function in rhesus monkeys

Regularly cycling rhesus monkeys received, from days 1 to 6 of the menstrual cycle (1) the potent luteinizing hormone-releasing hormone (LH-RH) agonist D-Trp6-LH-RH, 20 micrograms/day; (2) the potent LH-RH antagonist [N-Ac-D-Trp1,3,D-p-Cl-Phe2,D-Phe6-D-Ala10]-LH-RH, 1 mg/day; or (3) vehicle. Whereas control animals showed normal menstrual cycles, as determined by dates of ovulation, length of luteal phases, and hormonal profiles, animals treated with either analog of LH-RH exhibited disruption of the cycles. In animals from both groups, delayed ovulation was observed (LH-RH agonist, 22, 23, 17, 19, and 20 days of the cycle; LH-RH antagonist, 22, 22, 24, and 10 days of the cycle, and one animal remained anovulatory for 65 days). Monkeys treated with either LH-RH analog showed normal luteal phase lengths (15, 15, 16, 14, and 15 days, and 15, 16, 16, and 13 days, respectively) and serum progesterone concentrations. The results of this study suggest that, in the rhesus monkey, the administration of LH-RH analogs during the early follicular phase induces a temporary cessation of folliculogenesis demonstrated by a delay of ovulation, with subsequent normal luteal function.     

Glycodelin in endometrial flushing fluid and endometrial biopsies from infertile and fertile women

Objective

To investigate in the natural cycle just before IVF, whether glycodelin levels in endometrial flushing fluid obtained days LH + 1 and LH + 7 can be used in predicting pregnancy in the following IVF cycle, and whether there are differences in women with tubal factor infertility compared to women with unexplained infertility and fertile controls.

Study design

A prospective observational multicentre study of 21 fertile and 75 infertile women (25 showed abnormal tubes with no signs of hydrosalpinges, 18 had uni- or bi-lateral hydrosalpinges, 17 were salpingectomised because of hydrosalpinges, and 15 women had unexplained infertility). Endometrial flushing at days LH + 1 and LH + 7, endometrial biopsy, and blood sampling at day LH + 7 were performed before down-regulation for IVF. Glycodelin levels in endometrial flushing fluids (EFF), biopsies, and plasma samples were related to tubal pathology, endometrial dating and IVF outcome. Furthermore, total protein concentration was measured in EFF to investigate the influence of normal endometrial maturation on protein concentrations from days LH + 1 and LH + 7.

Results

At day LH + 1, EFF glycodelin levels were higher in infertile women with abnormal tubes compared to fertile women, particularly in women conceiving after the following IVF. For women with unexplained infertility, a higher level at day LH + 1 was present only in women not conceiving after the following IVF. ROC curve analysis showed that at day LH + 1 EFF glycodelin levels had no predictive value for IVF outcome. At day LH + 7, glycodelin levels in endometrial flushing fluids and biopsies depended on endometrial dating.

Conclusions

At day LH + 1, glycodelin concentration is increased in endometrial flushing fluid from infertile women with abnormal tubes compared to fertile controls without being a valuable predictor of subsequent pregnancy. At day LH + 7 the glycodelin level depends on endometrial dating.     

Evaluation of brain-derived neurotrophic factor in menstrual blood and its identification in human endometrium

The presence of high-affinity brain-derived neurotrophic factor receptor Trk B in mouse and in human fetal oocytes, together with the presence of neurotrophins in human follicular fluid suggests a paracrine role for brain-derived neurotrophic factor (BDNF) in female biology. This study aims to evaluate if BDNF is present and quantitatively determined in human menstrual blood and endometrium. Twenty-one women were studied and subdivided in two groups: A, 11 fertile women (27?±?2 days cycle length) and B, 10 anovulatory women and/or women with inadequate luteal phase (36?±?2 days cycle length). In fertile women menstrual BDNF levels was higher than plasma (679.3?±?92.2 vs 301.9?±?46.7 pg/ml p <0.001). Similarly, in Group B, BDNF in menstrual blood was higher than plasma (386.1?±?85.2 vs 166.8?±?24.1 pg/ml p?<?0.001). Moreover, both menstrual and plasma BDNF concentrations in Group A were significantly higher respect to Group B (679.3?±?92.2 vs 386.1?±?85.2 pg/ml p?<?0.001; 301.9?±?46.7 vs 166.8?±?24.1 pg/ml p?<?0.001). Immunohistochemistry evidence of BDNF in endometrium, during follicular and luteal phase, was also shown. The detection of BDNF in the human menstrual blood and endometrium further supports the role of this neurotrophin in female reproductive function.