Oscar A. Kletzky

Ten-year follow-up of patients with secondary amenorrhea and normal prolactin.

A group of 46 patients with secondary amenorrhea without galactorrhea or hyperprolactinemia were studied retrospectively after being clinically categorized into four groups with the use of progesterone-induced uterine bleeding and measurement of serum gonadotropins and prolactin levels. The ability to have regular spontaneous menstrual cycles and to conceive was assessed after a follow-up period of 10 years. Patients who had been classified as having hypothalamic pituitary failure (hypoestrogenic amenorrhea) with low levels of circulating estradiol had a greater rate of recovery of spontaneous ovulation and menses when compared with patients who had been classified as having only hypothalamic pituitary dysfunction (euestrogenic amenorrhea). The patients with diagnosis of hyperandrogenic chronic anovulation or polycystic ovary syndrome generally required clomiphene citrate for induction of ovulation and almost all the patients with premature ovarian failure (hypergonadotropic amenorrhea) remained estrogen-deficient and unable to ovulate. Hyperprolactinemia or an identifiable pituitary adenoma has not developed in any of the patients to date.

Early Detection of Pregnancy with Transvaginal Ultrasound

The gestational age and the serum human chorionic gonadotropin (hCG) at which an intrauterine pregnancy can be detected using transvaginal ultrasonography (TVU) is not known. In this study, ten pregnant women were serially scanned with TVU from the time of initial positive pregnancy test, to determine when an intrauterine sac greater than 2 mm, fetal pole greater than 2 mm, and fetal heart motion could be detected. A gestational sac was seen 34.8 +/- 2.2 days from the last menstrual period (LMP), at which time the hCG was 1398 +/- 155 mIU/ml of the International Reference Preparations (IRP) or 914 +/- 106 mIU/ml of the Second International Standard (second IS). A fetal pole was seen 40.3 +/- 3.4 days from the LMP when the hCG was 5113 +/- 298 mIU/ml of the IRP or 3783 +/- 683 mIU/ml of the second IS. Fetal heart motion was detected 46.9 +/- 6.0 days from the LMP when the hCG was 17,208 +/- 3772 mIU/ml of the IRP or 13178 +/- 2898 mIU/ml of the second IS. From these results, it can be concluded that transvaginal ultrasonography can detect an intrauterine gestation earlier than what has been previously reported with transabdominal ultrasonography.

Seminal prolactin concentration and sperm reproductive capacity**Presented in part at the Thirty-First Annual Meeting of the Pacific Coast Fertility Society, October 12 to 16, 1983, Rancho Mirage, California.

Prolactin (PRL) levels in the seminal plasma were determined in 63 men, all partners from infertile marriages. For comparison of seminal PRL concentration and semen quality, a sperm concentration and motility were studied in all men. Also, for determination of the fertilizing capacity of the semen, a zona-free hamster ovum penetration test was done in 49 men, while 14 men were studied by determination of the fertilization of human oocytes in vitro. Significantly higher levels of semen PRL were found in those individuals with low sperm concentration and motility as well as in those individuals that showed an abnormal hamster ovum penetration test. This suggests that high seminal PRL levels have a negative impact on sperm functional capacity.