198 Carl A. Gemzell 



none with secretory reaction. Of 10 women with proHferative endometrial 

 activity before the treatment 7 showed secretory reaction. However, 11 

 women out of 40 did not show any response to the administration of human 

 pituitary FSH. Eight of these 11 women were operated upon and subsequent 

 examination at operation revealed very hypoplastic ovaries entirely lacking 

 germinative tissue. The 1 1 women who did not respond to human pituitary 

 FSH had a pathologically elevated urinary excretion of gonadotropin while 

 all the women who responded to human pituitary FSH had a low or normal 

 gonadotropin excretion. 



Figure 1 shows the effect of human pituitary FSH on the urinary excretion 

 of estrogen and pregnanediol and on the endometrium of one of the 1 1 

 women in whom surgical exploration revealed ovaries without germinative 

 tissue. 



It follows from Fig. 1 that human pituitary FSH had no effect on the 

 steroid excretion and the endometrium. Thus, it may be tentatively postulated 

 that in order to obtain an effect with human pituitary FSH the ovaries must 

 have germinative tissue (11). 



Figure 2 shows the effect of human pituitary FSH and human chorionic 

 gonadotropin (HCG) on a hypopituitary dwarf with primary amenorrhea 

 and marked hypogonadism. Her endometrium was atrophic before the 

 treatment. 



FSH alone increased the urinary excretion of estrogen. The first increase 

 was noticed in the urine on the 5th day of the treatment but already on the 

 2nd day the patient complained about tension in her breasts and an increase 

 in vaginal discharge. After the last injection of FSH the urinary excretion of 

 estrogen decreased. Pelvic examination revealed that the ovaries were 

 enlarged, with diameters of about 6 cm. When HCG was administered 8 days 

 after the last injection of FSH an ovulation took place probably within 24 hr 

 as indicated by the rise in pregnanediol excretion and the secretory reaction 

 of the endometrium. 



Figure 3 shows the effect of FSH and HCG on a 24-year-old woman with 

 secondary amenorrhea and atrophic endometrium. 



HCG alone had no effect. After administration of FSH the urinary 

 excretion of estrogen rose to very high levels, the size of the ovaries increased 

 and the endometrium changed from atrophic to proliferative. When HCG 

 was administered 24 hr after the last injection of FSH an ovulation occurred 

 within 48 hr, as indicated by the rise in pregnanediol excretion, drop in 

 urinary estrogen excretion and the secretory reaction of the endometrium. 

 Figure 4 shows a similar effect in a 31 -year-old woman with atrophic 

 endometrium. 



A very strong effect of human pituitary FSH was found in a 25-year-old 

 woman with underdeveloped secondary sex characteristics, secondary 

 amenorrhea and an atrophic endometrium (Fig. 5). 



