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Baselines in Reproductive Disorders

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ClinicalTrials.gov Identifier: NCT00456274
Recruitment Status : Unknown
Verified July 2014 by Janet E. Hall, MD, Massachusetts General Hospital.
Recruitment status was:  Recruiting
First Posted : April 4, 2007
Last Update Posted : August 4, 2014
National Institutes of Health (NIH)
Information provided by (Responsible Party):
Janet E. Hall, MD, Massachusetts General Hospital

Brief Summary:

The purpose of the study is to explore the way in which gonadotropins (pituitary hormones) are released into the body. The knowledge acquired in this study will be used for the diagnosis and treatment of reproductive endocrine disorders.

We seek to investigate the baseline characteristics of the GnRH-induced gonadotropin pulsations of patients with the following diagnoses:

  • Hypothalamic Amenorrhea (HA)
  • Idiopathic hypogonadotropic hypogonadism (IHH)
  • Polycystic ovarian disease (PCOD)
  • Acquired hypogonadotropic hypogonadism (AHH)
  • Premature Ovarian Failure (POF)


This has been an extremely productive and pivotal protocol in the studies of female reproductive physiology and pathophysiology and continues to be critical for defining the neuroendocrine abnormalities in patients with reproductive disorders. In some cases, it is also helpful in the planning of subsequent therapy if so desired.

It is important to note that minors have been included in this protocol, as many patients are extremely anxious to know more about their neuroendocrine disorder. With minors who would like to know if their disorder is correctable, this protocol may be followed up with administration of pulsatile gonadotropin-releasing hormone (GnRH).

Condition or disease Intervention/treatment Phase
Amenorrhea Hypogonadotropic Hypogonadism Kallmann's Syndrome Procedure: Frequent baseline blood sampling Not Applicable

Detailed Description:

Normal reproductive cycles in women require the integrated function of the hypothalamus, pituitary and ovaries. The hypothalamic component of the reproductive system can be assessed directly in lower animal species by measurement of gonadotropin releasing hormone (GnRH) directly from pituitary portal blood and recording of multiunit activity from the median eminence of the hypothalamus, providing direct information about the physiology of GnRH secretion and the activity of the GnRH pulse generator. However, these techniques are not feasible in the human. In addition, measurement of GnRH levels in peripheral blood does not accurately reflect hypothalamic GnRH secretion. Thus, indirect methods must be used to gain insight into hypothalamic function in the human.

In the human, pulsatile luteinizing hormone (LH) secretion has been used as a mirror of hypothalamic GnRH secretion, citing comparative data from the rat, sheep, and non-human primate which indicate that pulses of LH are directly linked to antecedent pulses of GnRH. LH secretion thus provides an estimate of the underlying frequency of GnRH pulse generator activity provided that the assay is sufficiently precise, with a low coefficient of variation, and that blood sampling is frequent enough to accurately reflect the underlying frequency of episodic GnRH pulsatility. The use of pulsatile secretion of the free alpha subunit (FAS) of the gonadotropins has recently been proposed as an alternative and improved marker of GnRH secretion in the human due to a half-life of 15 minutes versus 20 to 40 minutes for LH. Despite the dual control of FAS by GnRH and thyroid releasing hormone (TRH), our studies have shown that the pulsatile component of FAS secretion is driven solely by GnRH in euthyroid subjects. Such studies have indicated:

  1. the nearly complete concordance of pulses of FAS with those of LH in normal women, and in GnRH-deficient subjects undergoing GnRH replacement;
  2. the absence of pulsatile secretion of FAS in GnRH-deficient subjects; and
  3. the abolition of pulsatile FAS secretion in concert with that of LH following administration of a GnRH antagonist in normal and postmenopausal women.

We have proposed that abnormalities in the pulsatile secretion of GnRH underlie many reproductive abnormalities and that these may explain the clinical variability, which exists even within a given diagnostic category. In this protocol, we have sought to define the specific neuroendocrine profile in patients with amenorrhea or oligomenorrhea. In some patients, the results of these studies can then correlated with clinical outcomes of ovulation induction protocols and with genotype information. We have examined the spectrum of abnormal patterns of LH (and by inference GnRH) secretion in women with secondary hypogonadotropic hypogonadism. In 73 studies in 50 women, it has been determined that the most common neurosecretory defect is low frequency/low amplitude followed by normal frequency/normal amplitude, apulsatile, and low amplitude/normal frequency. Of patients studied on several occasions, 75% demonstrated at least 2 different patterns of LH secretion and 33% reverted at least once to a normal pattern of secretion. Study of the baseline patterns of LH secretion in patients with acquired GnRH deficiency/acquired hypothalamic hypogonadism (AHH) indicates that this group of patients has either an apulsatile pattern or a pattern of low amplitude LH pulses in comparison with normal women in the early follicular phase (matched for ovarian steroid levels). In these patients, the specific LH pattern does not predict response to pulsatile GnRH used for ovulation induction. FAS is apulsatile in the majority of patients with primary amenorrhea and absent LH pulses providing further support for the hypothesis that the pulsatile component of FAS secretion is primarily driven by GnRH in euthyroid patients despite the dual control of FAS by GnRH and TRH. As in men with presumed GnRH deficiency, occasional patients with absent LH pulses will have FAS pulses. These interesting patients are being further evaluated with respect to their pattern of TSH secretion and the bioactivity of their LH.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Baselines in Reproductive Disorders
Study Start Date : September 1999
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : September 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
1 Procedure: Frequent baseline blood sampling
3 ml of blood sampled every 10 minutes for a total of 8-12 hours

Primary Outcome Measures :
  1. Number of luteinizing hormone (LH) and FAS (free alpha subunit) pulses [ Time Frame: 8-12 hours ]

Secondary Outcome Measures :
  1. Amplitude of LH and FAS pulses [ Time Frame: 8-12 hours ]
  2. Inter-pulse interval for LH and FAS pulses [ Time Frame: 8-12 hours ]

Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years to 45 Years   (Child, Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Healthy women between the ages of 16-45 years
  • Negative pregnancy test
  • On no gonadal steroid preparations for at least 3 months, with the exception of the idiopathic hypogonadotropic hypogonadism (IHH) group, they should be off gonadal steroid for at least 4 weeks

The following test will be performed if they had not been done in the last 2 months

  • Normal blood count
  • Normal thyroid function test

Exclusion Criteria:

  • Hemoglobin levels less than 11 gm/dL
  • Positive pregnancy test
  • Abnormal thyroid function
  • Abnormal MRI (IHH)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00456274

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Contact: Natalie Shaw, MD 617-726-1895 nshaw@partners.org

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United States, Massachusetts
Massachusetts General Hospital Recruiting
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
National Institutes of Health (NIH)
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Principal Investigator: Janet E Hall, M.D. Massachusetts General Hospital
Additional Information:
Filicori M, Flamigni C, Crowley WF, Jr. The critical role of blood sampling frequency in the estimation of episodic luteinizing hormone secretion in normal women. In: Crowley Jr WF, Hofler JG (eds) The Episodic Secretion of Hormones. New York: Churchill Livingston.5-13, 1987.
Crowley WF, Taylor AE, Martin KA, Whitcomb RW, Finkelstein JS, Hall JE. 1994 Use of the free alpha subunit (FAS) of glycoprotein secreting hormones as a surrogate marker of GnRH secretion in the human. In: Glycoprotein Hormones: Structure, Function and Clinical Implications. JW Lusbader, LD Puett, R Ruddon (eds), Serono Symposia, UAS pp. 253-63.

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Responsible Party: Janet E. Hall, MD, Associate Physician, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT00456274    
Other Study ID Numbers: 1999P-003770
First Posted: April 4, 2007    Key Record Dates
Last Update Posted: August 4, 2014
Last Verified: July 2014
Keywords provided by Janet E. Hall, MD, Massachusetts General Hospital:
Hypothalamic Amenorrhea
Idiopathic hypogonadotropic hypogonadism
Acquired hypogonadotropic hypogonadism
Kallmann's Syndrome
Gonadotropin Releasing Hormone
Additional relevant MeSH terms:
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Kallmann Syndrome
Pathologic Processes
Gonadal Disorders
Endocrine System Diseases
Menstruation Disturbances
Disorder of Sex Development, 46,XY
Disorders of Sex Development
Urogenital Abnormalities
Congenital Abnormalities
Genetic Diseases, Inborn