Hypothalamic function of secondary anovulatory women

In order to investigate the hypothalamic function of the women suffering from ovulatory defect, serial determinations of the serum gonadotropins (LH and FSH) were made over a period of 120 hrs following the intramuscular injection of estradiol benzoate (E.B.) 1 mg. Ten normal cycling women and 57 anovulatory women, excluding premature ovarian failure, were subjected to this study. The positive release of LH in serum (exceeds at least 150% of basal level) to E. B. were noted in follicular phase of the normal cycles, but not in luteal phase, and in 31 of 57 anovulatory women the release occurred between 48 to 96 hrs after the E.B. injection. The LH surge after EB. was difficult to provoke when the basal serum LH and estradiol (E2) levels were low as less than 10 mIU/ml and 50 pg/ml, respectively. Thirteen of 27 women, who showed LH surge, ovulated by Clomid. Only 3 of 17 women, who did not show LH surge to E.B., ovulated as a response to Clomid. Ten of 14 cases, who showed LH surge to E.B. but not ovulated by Clomid, revealed polycystic ovarian disease (PCO), and the responsiveness to E.B. and Clomid improved after wedge-resection of the ovaries. These results suggest that the serum E2 level is closely correlated with the ability for LH-RH production in hypothalamic "surge center" either primarily or secondarily, and that E.B. provocation test is useful to investigate the hypothalamic function of anovulatory patients and to preoperatively diagnose the PCO patients refractory to Clomid treatment.