204 Carl A. Gemzell 



excretion of estrogen an amount of 6.6 mg. A 10-day treatment in the same 

 woman yielded ovaries with a diameter of approximately 5 cm and a urinary 

 estrogen excretion of only 4.0 mg. 



Figure 6 shows the efTect of human pituitary FSH in an amcnorrheic 

 woman with proliferative endometrial activity indicating some ovarian 

 function. 



Following the administration of FSH a modest increase in ovarian size 

 and estrogen excretion occurred. On the 6th day of treatment an ovulation 

 took place, as indicated by the rise in pregnanediol excretion, the drop in 

 estrogen excretion and the secretory reaction of the endometrium. The day 

 after the last injection of FSH the patient underwent surgery and the ovaries 

 were polycystic, enlarged and a single corpus luteum was found in one of 

 them. An ovarian resection was performed and by histological examination 

 the corpus luteum was found to be 4 days old (Fig. 7). 



The low excretion of estrogen and pregnanediol found in this case was 

 probably due to the fact that only one follicle matured and developed into 

 a corpus luteum. 



The effect of human pituitary FSH in an amenorrheic woman with 

 secondary amenorrhea and proliferative endometrium is shown in Fig. 8. 



As in the previous case, FSH alone caused an ovulation on the 6th day of 

 treatment as indicated by the increased excretion of pregnanediol and the 

 secretory reaction of the endometrium. Twenty-four hours after the last 

 injection of FSH a single dose of HCG was administered intravenously. 

 The urine was collected in 8-hr samples immediately following the injection. 

 The HCG injection caused even during the first 8-hr period a very marked 

 increase in the urinary excretion of estrogen; the excretion of pregnanediol, 

 in marked contrast, was unaffected. 



Of 50 amenorrheic women treated with HCG alone only 2 ovulated. 

 The effect of HCG and FSH in one of these is shown in Fig. 9. 



Following treatment with HCG an ovulation took place as indicated by 

 the rise in pregnanediol excretion and a fresh corpus luteum observed by 

 culdoscopy. When this patient, who had proliferative endometrium, was 

 treated with FSH alone a polycystic enlargement of the ovaries and a marked 

 increase in the urinary excretion of estrogen occurred, but there was no indica- 

 tion of ovulation. 



The second amenorrheic woman, who ovulated following treatment with 

 HCG, reacted in a similar way on the administration of FSH. 



In five other amenorrheic women, repeated ovulations were induced 

 at certain periods of time. Two became pregnant, each on the second 

 attempt. 



Figure 10 shows the successful result in a 29-year-old woman who had a 

 secondary amenorrhea of about 7 years' duration and who had been married 

 for 6 years. 



