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Two glycoproteins (LM-hCG and HM-hCG) with gonadotropic activity were purified from the chorionic tissue of patients with hydatidiform mole with low and high urinary human chorionic gonadotropin levels and were compared to each other. The immunologic, biologic, and physicochemical properties of the two preparations were very similar. Also, the quantities of LM-hCG and HM-hCG recovered from molar tissue from the two types of patients were similar. However, the molar tissue from patients who excreted high levels of human chorionic gonadotropin immunoreactivity also contained other molecular forms with apparent human chorionic gonadotropin immunoreactivity tissues from patients who excreted low levels did not. These latter molecular forms may account for the differences in the levels of human chorionic gonadotropin immunoreactivity excreted by the two types of patients.

Estrogen levels are a useful indicator to use in predicting of ovarian hyperstimulation syndrome (OHSS) which is one of the side effects of HMG-HCG therapy. However, the quantitative assay of estrogens entails cumbersome time-consuming procedures. The present study represents our attempt to establish criteria for predicting the occurrence of OHSS by the use of ultrasonography (USG), a diagnostic procedure that can be performed quickly and conveniently. The subjects were 40 anovulatory women (79 cycles) receiving HMG-HCG therapy. Each patient had USG performed at the time of switching to HCG in a regimen of sequentially administered gonadotropins and was measured for maximum follicular diameter (FD) and total of vertical follicular area (FA) to correlate measurements of these parameters with simultaneously determined serum estradiol (E2) levels. A study was also made of relationships of FD and FA with ovulation and OHSS. The results are summarized as follows: No distinct correlation was observed between FD and E2 (r = 0.3794). It should be noted, however, that the therapy was successful in inducing ovulation in those cases in which the patient was switched to HCG from HMG when FD was 18mm or above. There was a significant correlation between FA and E2 (r = 0.8113, p less than 0.001). FA was thus proven to well reflect E2 levels and hence to be a parameter of the predictive value for OHSS. All but one (with moderate OHSS) of 26 cases showing evidence of OHSS had FA values of more than 6.0cm2, while those developing severe OHSS invariably.(ABSTRACT TRUNCATED AT 250 WORDS)

A study was conducted to define biochemical characteristics of human chorionic gonadotropin (hCG) in total hydatidiform mole patients with low serum and urinary hCG levels and to inquire into the reason for its low immunological hCG level by comparing with the hCG of molar patients with a high hCG level. Both hCGs purified from chorionic tissue of molar patients with low and high hCG levels have essentially identical physicochemical, immunological and biological properties. They have low levels of biological activity and practically identical amino acid and carbohydrate compositions. It appears that moles of patients with high levels as well as those with low levels of immunoreactivity produce this purified form of hCG. Extracts of molar tissue from patients with high levels of hCG immunoreactivity also contained other substances with apparent immunoreactivity which can be found in small amounts in tissue extracts from patients who excreted low levels of hCG immunoreactivity. In contrast, extracts of molar tissue and urine from patients with low hCG levels contained hCG-like substances which cannot be detected with the ordinary commercial hCG immunoassay kits. These differences may account for the different levels excreted by these two types of patients.