Buckler H M, Phillips S E, Cameron I T, Healy D L, Burger H G
Medical Research Centre, Prince Henry's Hospital, Melbourne, Australia.
J Clin Endocrinol Metab. 1988 Aug;67(2):300-6. doi: 10.1210/jcem-67-2-300.
We studied the value of vaginal progesterone (P4) in suppressing serum LH concentrations and restoring normal luteal phase serum LH concentrations before administration of exogenous gonadotropins in anovulatory women with the polycystic ovarian syndrome (PCOS). P4 (50 mg every 12 h) was administered by vaginal suppository to 9 women (18 cycles) for 14 days before ovulation induction with human menopausal gonadotropin (hMG) and hCG. Serum LH, FSH, estradiol, P4, and PRL levels were measured daily. A biphasic effect on LH secretion occurred during P4 administration. Peak serum LH levels occurred on day 5 (125% of basal levels; P less than 0.05) of vaginal P4 suppository use, followed by a progressive fall (P less than 0.05) to 79% of basal levels, but serum LH levels were still higher than those in normal women despite achieving physiological luteal phase P4 concentrations. Ovulation occurred in 56% of cycles after P4 and hMG/hCG treatment and in 65% of control cycles after hMG/hCG alone. In 7 women, serum LH was measured at 10-min intervals for 6 h before and after vaginal P4 administration for 10 days. LH pulse frequency decreased from 7.4 +/- 1.1 to 4.4 +/- 1.2 pulses/6 h (P less than 0.01), and LH pulse amplitude increased from 3.8 +/- 1.8 to 6.1 +/- 2.9 IU/L (P less than 0.01) after P4 administration. We conclude that vaginal P4 (50 mg every 12 h) 1) produces serum P4 concentrations within the normal range for the luteal phase of the menstrual cycle; 2) elevates serum LH, but not FSH, within 5 days; 3) decreases LH pulse frequency and increases LH pulse amplitude after 10 days, but does not normalize serum LH values; and 5) fails to improve the results of subsequent ovulation induction with exogenous gonadotropins in patients with PCOS.
我们研究了阴道用黄体酮（P4）在多囊卵巢综合征（PCOS）无排卵女性中，于给予外源性促性腺激素之前抑制血清促黄体生成素（LH）浓度以及恢复正常黄体期血清LH浓度的价值。在用人绝经期促性腺激素（hMG）和人绒毛膜促性腺激素（hCG）诱导排卵前14天，通过阴道栓剂给9名女性（18个周期）使用P4（每12小时50mg）。每天测定血清LH、促卵泡生成素（FSH）、雌二醇、P4和泌乳素（PRL）水平。在使用P4期间，LH分泌出现双相效应。阴道使用P4栓剂第5天时血清LH水平达到峰值（为基础水平的125%；P<0.05），随后逐渐下降（P<0.05）至基础水平的79%，但尽管达到了生理性黄体期P4浓度，血清LH水平仍高于正常女性。P4与hMG/hCG治疗后56%的周期发生排卵，单独使用hMG/hCG的对照周期中65%发生排卵。对7名女性，在阴道使用P4 10天前后，每隔10分钟测定血清LH 6小时。使用P4后，LH脉冲频率从7.4±1.1降至4.4±1.2次/6小时（P<0.01），LH脉冲幅度从3.8±1.8增至6.1±2.9IU/L（P<0.01）。我们得出结论，阴道用P4（每12小时50mg）1）使血清P4浓度处于月经周期黄体期的正常范围内；2）在5天内升高血清LH，但不升高FSH；3）10天后降低LH脉冲频率并增加LH脉冲幅度，但未使血清LH值恢复正常；4）未能改善PCOS患者随后使用外源性促性腺激素诱导排卵的结果。
