Polycystic ovaries and levels of gonadotrophins and androgens in recurrent miscarriage: prospective study in 50 women
Polycystic ovaries and levels of gonadotrophins and androgens in recurrent miscarriage: prospective study in 50 women
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DOI：
10.1111/j.1471-0528.1994.tb13131.x
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发表时间：
1994-03
期刊：
影响因子：
--
通讯作者：
A. J. Leigh;A. Peattie
中科院分区：
文献类型：
--
作者：
A. J. Leigh;A. Peattie
Sir, We were most pleased to see the article by Tulppala et al. (April 100,1993), and consider it an interesting contribution to the everexpanding body of knowledge on the polycystic ovarian syndrome (PCOS). This paper has, however, prompted us to make two comments which are applicable not only to this article but also in the more general context of reproductive endocrinology. Firstly, in the paper by Tulppala et al., and in publications of others reporting observations on the interrelationship between polycystic ovaries and miscarriage (Sagle et al. 1988; Regan et al. 1990), scant attention has been paid to qualitative as well as quantitative measurements of gonadotrophin activity. Research literature (Wilson et al. 1990; Tsatsoulis et al. 1991) has disclosed the significance of the distributional composition of gonadotrophin glycoforms in conjunction with other elements (Adashi et al. 1990) in determining ultimate function at the ovary. In diagnostic and predictive terms, therefore, a single quantitative estimation of gonadotrophin values is of restricted value, since it may bear limited relation to actual hormone efficacy, or, indeed to secretory dynamics. This is of particular relevance in PCOS in which the ratio of LH bioto immuno-reactivity (B:I) may be significantly elevated with respect to that of women with normal ovarian morphology and function (Lobo el al. 1983). In addition, attention has been drawn to the potential pitfalls of reaching conclusions based on endocrine measurements from single blood samples (Veldhuis & Johnson 1990a, b), particularly with respect to the gonadotrophin hormones where pulse frequency and amplitude and glycoform circulatory half-lives are of such importance in signal transduction and perception. Our second comment pertains to the omission in the methodology section of this paper to state exactly how blood samples were collected. One of the problems we are having to surmount at the Robert Barnes Laboratories of St George’s Hospital Medical School is the implementation of a policy designed to protect staff against infection from patient blood samples. We refer to the vacutainer method of blood collection. Vacutainers are available exclusively in glass, and this has a prejudicial effect on gonadotrophin studies since LH-a glycopeptide hormone-sticks to glass. Samples collected and rapidly processed (within five to ten minutes) do not appear to suffer any deleterious effect, but samples left longer before processing are affected by a reduction in quantitative LH. To our knowledge, it is presently unknown whether certain glycoforms preferentially react with glass, giving rise to the potential for qualitative misrepresentation, or whether this is a general property of the glycoforms. We particularly wish to draw the attention of obstetricians and gynaecologists to this point, since qualitative and quantitative gonadotrophin levels are of such importance in diagnosis and in terms of evaluating response to patient management.
