Chapter 41: Hypothalamic-Pituitary-Ovarian Dysfunction

Hilgers TW

Reproductive Endocrinology · Luteal Phase

Chapter 41: Hypothalamic-Pituitary-Ovarian Dysfunction

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 541-560, 2004

RRM Academy Synopsis

Faulty brain-to-ovary signals may underlie many infertility cases

A 2004 textbook chapter proposes that faulty hormone signals from the brain to the ovary may be linked to many cases of infertility. The author reviews the science and shares one clinic's hormone tests in infertile women.

Key Findings

Infertile women with regular cycles had lower progesterone after the Peak Day than women with normal ovulation by ultrasound. In that comparison, estradiol around ovulation also peaked slightly lower.
Women with endometriosis and infertility had lower beta-endorphin levels than women of normal fertility, in the first days of the cycle and in the mid-luteal phase.
After a GnRH challenge test, women with limited mucus cycles had a higher LH:FSH ratio than women with higher mucus cycle scores. The LH difference alone was not statistically significant.
One cited study of women with endometriosis found fewer LH receptors in ovarian follicles. Another found fewer estrogen receptors in the cervix of women with poor cervical mucus and regular cycles.
The author calls a receptor deficiency syndrome very reasonable to suspect and says the data do not show which change comes first.

RRM Context

Restorative reproductive medicine treats infertility as a sign to investigate. The chapter ties signs a woman can chart to hormone patterns. One example is the mucus cycle score from the Creighton Model FertilityCare System (CrMS). NaProTECHNOLOGY clinicians use charting to guide evaluation.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter reviews the physiology of the hypothalamic-pituitary-ovarian axis, including the GnRH pulse generator, gonadotropin secretion, the activin-inhibin-follistatin system, beta-endorphin and steroid hormone receptors. Pope Paul VI Institute data presented in the chapter show a marked decrease in post-Peak progesterone in infertile women with regular cycles compared with controls who had normal ovulation patterns by ultrasound. In GnRH challenge tests on day 5 of the cycle, LH:FSH ratios were significantly higher in women with limited mucus cycles than in women with higher mucus cycle scores. Hilgers closes by proposing a receptor deficiency syndrome, citing evidence of estrogen receptor dysfunction in the endocervix of women with poor mucus and infertility and LH receptor dysfunction in the ovaries of women with endometriosis.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Infertility › Luteal Phase Defect › Progesterone Replacement

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 41: Hypothalamic-Pituitary-Ovarian Dysfunction

Faulty brain-to-ovary signals may underlie many infertility cases

Key Findings

RRM Context

Abstract

Topics

By this author

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