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.). Read the rest of this entry »

Defining exercise prescription in lifestyle modification programs for overweight/obese polycystic ovary syndrome women

28 11 2011

To the Editor:

We reviewed the manuscript by Nybacka et al. (1) with great interest. The authors randomized overweight/obese women with polycystic ovary syndrome (PCOS) to investigate the effects of different lifestyle modification approaches on ovarian function and endocrine/metabolic parameters. The patients were assigned to diet, exercise or diet plus exercise for 4 months, and at least 1-year after the termination of the programs were invited to participate in a follow-up visit. A total of 14, 17 and 12 women completed, respectively, the diet, exercise and diet plus exercise intervention after 4 months, and 7 of each group completed the follow-up visit. At the end of the study the authors’ conclusion was that “properly managed diet and exercise, alone or in combination, are equally effective in improving reproductive function in overweight/obese women with PCOS, despite the minor weight loss associated with exercise.” Read the rest of this entry »

Five-day anastrozole in infertility needs supplemental hCG

19 05 2011

To the Editor:

I read with great interest the article by Tredway D et al. (1), in which they concluded that “in terms of ovulation rates, 5-day anastrozole at 1,5, and 10 mg/d was less effective than CC at 50mg/d for cycle 1”. They have done a good work.

However, surprisingly, the ovulation rates for anastrozole groups were obviously low. In their Results Section, they mentioned that “most patients receiving anastrozole 1 mg/d (72.7%) and 5 mg/d (73.5%) achieved monofollicular development (one follicle ≥ 17 mm in diameter), compared with 70.4% of patients receiving CC”. We argue that monofollicular development (one follicle ≥ 17 mm in diameter) rates were similar between anastrozole and CC, why was ovulation rates difference so significant (the ovulation rates for anastrozole at 1, 5, and 10 mg/d were 30.4%, 36.8% and 35.9%, respectively, compared with 64.9% for CC at 50 mg/d)?

We believe that it is due to lack of supplemental hCG. Read the rest of this entry »