SPONTANEOUS FOLLICULAR AND LUTEAL FUNCTION IN INFERTILE WOMEN WITH OLIGOMENORRHEA - ROLE OF LUTEINIZING-HORMONE

OBJECTIVE There is a paucity of longitudinal endocrine studies of infe rtile patients with oligomenorrhoea. We have assessed the frequency an d quality of spontaneous follicular development and luteal function in patients with oligomenorrhoea and infertility (PCOS), and have relate d the observed criteria to circulating LH activity. DESIGN Prospective detailed investigations in a cohort of unselected patients.PATIENTS I nfertile women with oligomenorrhoea (PCOS, n = 131) presenting to the infertility clinic at the Royal Infirmary, Glasgow. MEASUREMENTS Patie nts were monitored with frequent plasma oestradiol (E(2)) concentratio n assessments over a minimum period of 3 weeks, starting more than 2 w eeks after a menstrual bleed. When follicular maturation was identifie d the patient provided daily blood samples through to her ensuing mens trual bleed, and EP, progesterone, total testosterone, FSH and LH were assessed in these samples. Luteal phase progesterone profiles were as sessed between the days LH surge +2 and LH surge +6 by means of a prog esterone index. RESULTS Forty-eight per cent of the patients showed ev idence of follicular development. The oestradiol profiles in the patie nts showing follicular growth were normal, but the progesterone curve was sub-normal in the early luteal phase, due to a high proportion of deficient luteal phases. The mean LH concentrations were elevated in t he whole group, but no difference was observed between the mean LH val ues for those patients showing spontaneous follicular development and those who did not, and the incidence of ovulation was similar in the n ormal LH and elevated LH groups. Similarly, no relation was establishe d between LH and the quantitative assessment of luteal phase progester one profiles (progesterone index), and the distribution of progesteron e indices was similar in the normal LH and elevated LH groups. Testost erone concentrations were positively correlated with LH (p = 0.008) bu t not with the incidence of spontaneous follicular growth. There was n o significant difference in the incidence of spontaneous ovulation bet ween the patients with elevated or normal mean follicular phase testos terone concentrations. CONCLUSION The data indicate that both LH and t estosterone secretion in PCOS were closely linked, but that neither wa s directly linked to the incidence or inhibition of spontaneous follic ular development in PCOS, or to the disturbance in luteal phase proges terone profiles.