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Nurs Clin North Am. 1980 Sep;15(3):511-24.

The endocrine basis of infertility in women.



In treating infertile couples an understanding of the endocrine system and its relationship to reproduction is essential. The reproductive capacity in women is regulated by the hypothalamic-pituitary-ovarian axis, a system which controls hormonal synthesis, secretion, and inhibition. Unregulated positive feedback systems produce disequilibrium which can cause hormonal imbalance predisposing the individual to possible infertility. The hypothalamus receives, processes, and acts upon various signals associated with reproductive processes. At the pituitary level, short, negative feedback loops inhibit the release of gonadotropin releasing hormone once adequate levels of pituitary hormones are reached. Hypothalamic dysfunction may be attributable to abnormalities in the amount of sequence of estrogen secretion or the inability of the hypothalamus to respond to the estrogen cue. The pituitary gland responds to levels of gonadotropin releasing hormone through inhibition or secretion of follicle stimulating hormone and luteinizing hormone. A direct outcome of pituitary gonadotropin stimulation is the rhythmicity of ovarian function. The key events in the menstrual cycle are dependent on the central role of estrogen. Ovarian failure is generally attributed to the absence of follicular tissue, which presents as some type of gonadal disgenesis. During the initial interview, the infertile couple must be informed as to the time and financial considerations and statistical outcomes of treatments and the couple's psychological status must be determined to some extent as well. Clomiphene citrate is the most widely used drug in the management of anovulatory conditions related to inadequate cycle stimulation by the pituitary gonadotropins; the usual dose os 50 mg for 5 days, increased up to 200 mg for 5 days if success is not achieved. While it does not directly stimulate ovulation, this drug starts a sequence of events that are physiologically similar to a specific phase of the normal menstrual cycle. If this is not successful the couple may be treated with human menopausal gonadotropin, or Pergonal, which brings about follicular growth and menstruation. If the couple fails to achieve pregnancy, support from health professionals is crucial in discussion adoption, child-free living, and other options.

[Indexed for MEDLINE]

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