Luteinizing hormone surge in normally ovulating women

21 01 2013

To the Editor:

After reading the article “Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women” (1), now including concurrent ultrasound data I would like to confirm once more hormonal findings published in Fertility and Sterility more than a decade ago (2). Unnoticed, Park et al. also described these LH patterns in your journal in 2007 (3).

I have reanalyzed the data published originally (2), according to the methods specified in the studies by Direito et al. and Park et al. (1, 3), and shown data from all three studies in Tables 1 and 2. The sum (25%) of what was first described as two peaks and a small peak (2) would be comparable herein to a double peak. Park et al. found a luteinizing hormone (LH) surge of rapid onset (within 1 day) in 42.9% of patients, and of gradual onset (in 2 to 6 days) in 57.1%, or 25.6% and 74.4% in 2 to 10 days, respectively. Overall, although in some cases there seemed to be a tendency, after analyzing three or more cycles from each woman, I did not clearly find repetition of the same type of LH profile within the same woman reported by Direito et al. Relating LH and Pregnanediol Glucuronide (PDG) profiles, a novel finding is that cases with double- and multiple-peaked LH surges associated significantly with transient rises in PDG before the definite rise (P<0.001, Chi test; PDG rise according to Park et al.).

Characteristics of cycles and LH surges

Table 1: Characteristics of cycles and LH surges (click inside table to enlarge)

Table 2:  Configuration of the LH surge (click inside table to enlarge)

Table 2: Configuration of the LH surge (click inside table to enlarge)

These three studies (1, 2, 3) have close results and show that LH surges in ovulatory pattern cycles are extremely variable in configuration, amplitude, and duration. All results were found in healthy, contraceptive-free, regularly cycling women and with proven fertility in my study (2). What has usually been considered a normal standard for the LH surge is only a mean profile. The serial ultrasound and hormonal findings described in the study by Direito et al. (1) give further insight into the spontaneous ovulation process, which needs further research.

María Elena Alliende, M.D., M.Sc.
Las Condes, Region Metropolitana, Chile

References

1. Direito A, Bailly S, Mariani A, Ecochard R. Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women. Fertil Steril 2012; 99:279-85.e3.

2. Alliende ME. Mean versus individual hormonal profiles in the menstrual cycle. Fertil Steril 2002; 78: 90-5.

3. Park SJ, Goldsmith LT, Skurnick JH, Wojtczuk A, Weiss G. Characteristics of the urinary luteinizing hormone surge in young ovulatory women. Fertil Steril 2007; 88: 684-90.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2013.01.122

The authors respond:

We thank Dr. Alliende for her interest in our recent article “Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women” (1).

In her letter, Dr. Alliende reanalyzes her previously published data (2) according to the methods used by Park et al. (3) and by our team, producing comparable results, and thus enhancing the generalizability of our work on the hormonal characteristics of the normal menstrual cycle to other populations.

In her letter Dr. Alliende did not find, contrary to our study, that luteinizing hormone (LH) surge characteristics remained consistent within subjects. This difference can be explained by our larger cohort, which may have allowed us to reach statistical significance, or to patient characteristics.

Finally Dr. Alliende reports evidence that double- and multiple-peaked LH surges associated significantly with transient rises in PDG before the definite rise. This interesting finding deserves to be confirmed by further investigation.
All this discussion emphasizes that more research will be required to fully understand the complex relationship between hormonal variability and the ovulatory process.

Ana Direito, M.D.
Service de Biostatistique, Hospices Civils de Lyon, Lyon, France

References

1. Direito A, Bailly S, Mariani A, Ecochard R. Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women. Fertil Steril 2012; 99:279-85.e3.

2. Alliende ME. Mean versus individual hormonal profiles in the menstrual cycle. Fertil Steril 2002;78:90-5.

3. Park SJ, Goldsmith LT, Skurnick JH, Wojtczuk A, Weiss G. Characteristics of the urinary luteinizing hormone surge in young ovulatory women. Fertil Steril 2007;88:684-90.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2013.01.123

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