Hyperprolactinemia and luteal insufficiency in infertile patients with mild and minimal endometriosis

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This study found that infertile women with mild/minimal endometriosis exhibit lower estradiol, higher prolactin, and more frequent luteal insufficiency compared to fertile controls.

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The paper assessed hormonal alterations in infertile women with stage I/II endometriosis (n=20) versus fertile women without endometriosis (n=14) and fertile women with endometriosis (n=7), measuring early follicular phase serum FSH, LH, estradiol, TSH, and prolactin, then collecting three luteal phase progesterone samples and performing endometrial biopsies. Estradiol was lower in infertile patients with endometriosis than in fertile women without endometriosis, and six infertile patients with endometriosis had prolactin levels above 20 ng/ml, with no such finding in the other groups. Luteal insufficiency was more frequent in infertile women with endometriosis (78.9%) than in fertile women with (42.9%) or without endometriosis (0%), and logistic regression found only endometriosis presence and infertility associated with luteal insufficiency. The paper’s analyses were limited by small group sizes, particularly the fertile endometriosis group, and by only using specific early follicular/luteal sampling windows. This paper is centrally about endometriosis — it links mild endometriosis–associated infertility with altered prolactin secretion and increased luteal insufficiency.

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Abstract

The objective of the present paper was to assess the presence of hormonal alterations in infertile women with stage I or II endometriosis (Group III, n = 20) compared to fertile women without endometriosis (Group I, n = 14) and to fertile women with endometriosis (Group II, n = 7). Serum levels of FSH, LH, estradiol, TSH, and PRL were measured between days 1 and 5 of the early follicular phase; in the luteal phase, three serum samples were collected for progesterone measurement, and endometrial biopsies were performed. Serum estradiol levels were lower (p = 0.035) in infertile patients with endometriosis than in fertile patients without endometriosis. Six infertile patients with endometriosis presented prolactin levels above 20 ng/ml. This was not observed in the other groups. Luteal insufficiency was more frequent in infertile patients with endometriosis (78.9%) than in fertile patients with (42.9%) or without endometriosis (0%). In a multiple logistic regression analysis, only the presence of endometriosis and infertility was significantly associated with luteal insufficiency. The serum levels of LH, FSH, and TSH were not significantly different among the groups. Luteal insufficiency and altered prolactin secretion were associated with endometriosis, and could be important mechanisms causing infertility in this group of patients.
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Subscribe to RSS DOI: 10.1055/s-2001-14945 Hyperprolactinemia and Luteal Insufficiency in Infertile Patients with Mild and Minimal Endometriosis[1] Publication History Publication Date: 31 December 2001 (online) The objective of the present paper was to assess the presence of hormonal alterations in infertile women with stage I or II endometriosis (Group III, n = 20) compared to fertile women without endometriosis (Group I, n = 14) and to fertile women with endometriosis (Group II, n = 7). Serum levels of FSH, LH, estradiol, TSH, and PRL were measured between days 1 and 5 of the early follicular phase; in the luteal phase, three serum samples were collected for progesterone measurement, and endometrial biopsies were performed. Serum estradiol levels were lower (p = 0.035) in infertile patients with endometriosis than in fertile patients without endometriosis. Six infertile patients with endometriosis presented prolactin levels above 20 ng/ml. This was not observed in the other groups. Luteal insufficiency was more frequent in infertile patients with endometriosis (78.9 %) than in fertile patients with (42.9 %) or without endometriosis (0 %). In a multiple logistic regression analysis, only the presence of endometriosis and infertility was significantly associated with luteal insufficiency. The serum levels of LH, FSH, and TSH were not significantly different among the groups. Luteal insufficiency and altered prolactin secretion were associated with endometriosis, and could be important mechanisms causing infertility in this group of patients. Key words: Hormonal Alterations - Progesterone - Endometrial Biopsy - Prolactin 1 Supported by Fundo de Incentivo à Pesquisa, Hospital de Clínicas de Porto Alegre, Brazil). References - 1 Olive D L, Schwartz L B. Endometriosis. N Engl J Med. 1993; 328 1759-1767 - 2 Koninckx P R. Is mild endometriosis a disease?. Hum Reprod. 1994; 9 2202-2211 - 3 Soules M R, Malinak L R, Bury R, Poindexter A. Endometriosis and anovulation: A coexisting problem in the infertile female. Am J Obstet Gynecol. 1976; 125 412-417 - 4 Brosens I A, Koninckx P R, Corveleyn P A. A study of plasma progesterone, oestradiol-17β, PRL and LH levels, and of the luteal phase appearance of the ovaries in patients with endometriosis and infertility. Br J Obstet Gynaecol. 1978; 85 246-250 - 5 Cheesman K L, Bem-Nun I, Chatterton R T, Cohen M R. Relationship of luteinizing hormone, pregnanediol-3-glucuronide, and estriol-16-glucuronide in urine of infertile women with endometriosis. Fertil Steril. 1982; 38 542-548 - 6 Muse K N, Wilson E A. How does mild endometriosis cause infertility?. Fertil Steril. 1982; 38 145-152 - 7 Muse K N, Wilson E A, Jawad M J. Prolactin hyperstimulation in response to thyrotropin-releasing hormone in patients with endometriosis. Fertil Steril. 1982; 38 419-422 - 8 Acién P, Lloret M, Graells M. Prolactin and its response to the luteinizing hormone-releasing hormone thyrotropin-releasing hormone test in patients with endometriosis before, during and after treatment with danazol. Fertil Steril. 1989; 51 774-780 - 9 He Y E. Prolactin secretion in patients with endometriosis and its relationship to luteal phase defect and infertility. Chung Hua Fu Chan Ko Tsa Chih. 1993; 28 14-17 - 10 The American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril. 1985; 43 351-352 - 11 Noyes R W, Hetig A T, Rock J. Dating the endometrial biobsy. Fertil Steril. 1950; 1 1-25 - 12 Jordan J, Craig K, Clifton D K, Soules M R. Luteal phase defect: the sensitivity and specificity of diagnostic methods in common clinical use. Fertil Steril. 1994; 62 54-62 - 13 Cahill D J, Wardle P G, Maile L A, Harlow C R, Hull M G. Pituitary-ovarian dysfunction as a cause for endometriosis-associated and unexplained infertility. Hum Reprod. 1995; 10 3142-3146 - 14 Tummon I S, Maclin V M, Radwanska E, Binor Z, Dmowski W P. Occult ovulatory dysfunction in women with minimal endometriosis or unexplained infertility. Fertil Steril. 1988; 50 716-720 - 15 Williams C AV, Oak M K, Elstein M. Cyclical gonadotrophin and progesterone secretion in women with minimal endometriosis. Clin Reprod Fertil. 1986; 4 259-268 - 16 Bancroft K, Williams C AV, Elstein M. Pituitary-ovarian functioning women with minimal or mild endometriosis and otherwise unexplained infertility. Clin Endocrinol. 1992; 36 177-181 - 17 Barry-Kinsella C, Sharma S C, Cottell E, Harrison R F. Mid to late luteal phase steroids in minimal stage endometriosis and unexplained infertility. Eur J Obstet Gynecol Reprod Biol. 1994; 54 113-118 - 18 Machida T, Taga M, Minaguchi H. Prolactin secretion in endometriotic patients. Eur J Obstet Gynecol Reprod Biol. 1997; 72 89-92 - 19 Matalliotakis I, Panidis D, Vlassis G, Vavilis D, Neonaki M, Koumantakis E. PRL, TSH and their response to the TRH test in patients with endometriosis before, during, and after treatment with danazol. Gynecol Obstet Invest. 1996; 42 183-186 - 20 Matorras R, Rodríguez F, Pérez C, Pijoan J I, Neyro J L, Rodríguez Escudero F J. Infertile woman with and without endometriosis: a case control study of luteal phase and other infertility conditions. Acta Obstet Gynecol Scand. 1996; 75 826-831 - 21 Asukai K, Uemura T, Minaguchi H. Occult hyperprolactinemia in infertile women. Fertil Steril. 1993; 60 423-427 - 22 Hinney B, Henze C, Kuhn W, Wuttke W. The corpus luteum insufficiency: a multifactorial disease. J Clin Endocrinol Metab. 1996; 81 565-570 - 23 Hargrove J T, Abraham G K. Abnormal luteal function in endometriosis. Fertil Steril. 1980; 34 302 - 24 Cheesman K L, Cheesman S D, Chatterton R T, Cohen M R. Alterations in progesterone metabolism and luteal function in infertile women with endometriosis. Fertil Steril. 1983; 40 590-595 - 25 Pittaway D E, Maxson W, Daniell J, Herbert C, Wentz A C. Luteal phase defects in infertility patients with endometriosis. Fertil Steril. 1983; 39 712-713 - 26 Ballach J, Vanrell J Á. Mild endometriosis and luteal function. Int J Fertil. 1985; 30 4-6 - 27 Kusuhara K. Luteal function in infertile patients with endometriosis. Am J Obstet Gynecol. 1992; 167 274-277 - 28 Moeloeck F A, Moegny E. Endometriosis and luteal phase defect. Asia Oceania J Obstet Gynaecol. 1993; 19 171-176 - 29 Garcia-Velasco J A, Arici A. Is the endometrium or oocyte/embryo affected in endometriosis?. Hum Reprod. 1999; 14 (2) 77-89 1 Supported by Fundo de Incentivo à Pesquisa, Hospital de Clínicas de Porto Alegre, Brazil). Dr. E. P. Passos Departamento de Ginecologia e Obstetrícia Hospital de Clínicas de Porto Alegre Rua Ramiro Barcelos, 2350 - 11° andar 90035-003 Porto Alegre RS - Brazil Phone: Phone:+ 55 (51) 346-7155 Fax: Fax:+ 55 (51) 346-7155 Email: E-mail:[email protected]

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Hyperprolactinemia Infertility Luteal Phase Adult Endometriosis Endometriosis Endometriosis Estradiol Estradiol Female Follicular Phase Follicular Phase Humans Hyperprolactinemia Hyperprolactinemia Hyperprolactinemia Infertility Infertility Infertility

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SciLite annotations

chemicals 3
estradiol progesterone estradiol

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