Journal of Clinical Endocrinology & Metabolism, Vol 79, 1215-1220, Copyright © 1994 by Endocrine Society

ARTICLES

Treatment of anovulation with pulsatile gonadotropin-releasing hormone: prognostic factors and clinical results in 600 cycles

M Filicori, C Flamigni, P Dellai, G Cognigni, L Michelacci, R Arnone, M Sambataro and A Falbo
Reproductive Endocrinology Center, University of Bologna, Italy.

Pulsatile GnRH (pGnRH) was administered to 292 anovulatory patients in 600 consecutive cycles between February 1984 and February 1993. This represents the largest single pGnRH series ever reported. Patients were divided into the following groups: primary hypogonadotropic amenorrhea (PHA), 73 patients, 161 cycles; other hypogonadotropic hypogonadisms (OHH), 57 patients 107 cycles; multifollicular ovary (MFO), 39 patients 75 cycles; polycystic ovary (PCO), 85 patients 172 cycles; and other hyperandrogenic anovulations (OHA), 38 patients 85 cycles. GnRH was administered iv at a dose of 1.25-20.0 micrograms every 30-120 min; most cycles (505) were performed with a regimen of 2.5-5.0 micrograms GnRH every 60-90 min. In 228 cycles of MFO, PCO, and OHA patients, pGnRH was preceded by GnRH agonist (GnRH-A) suppression. Ovulatory rates were 75%, and pregnancy occurred in 105 cycles (pregnancy rate of 18%/treatment cycle and 23%/ovulatory cycle). Ovulatory and pregnancy rates were higher in PHA, OHH, and MFO and lower in PCO and OHA. Only 4 multiple pregnancies occurred (3.8%), none after GnRH-A suppression. The abortion rate was 30% and was highest in PCO (45%). GnRH-A pretreatment improved ovulatory rates only in PCO (from 49% to 71%; P < 0.001), whereas it had no significant effect on pregnancy and abortion rates in any group. Higher weight and insulin were associated with lower ovulatory and pregnancy rates; higher LH and testosterone were associated with lower ovulatory rates only. We conclude that 1) pGnRH is a highly effective ovulation induction method; 2) pGnRH does not cause ovarian hyperstimulation; 3) low dose pGnRH is associated with a remarkably low incidence of multiple pregnancy; 4) GnRH-A pretreatment improves pGnRH outcome in PCO and further lowers the incidence of multiple pregnancy; 5) pGnRH is associated with relatively elevated abortion rates, particularly in PCO; and 6) pGnRH is less successful in overweight patients and when high baseline LH, testosterone, and insulin levels are present.

This article has been cited by other articles:

				I. E. Messinis Ovulation induction: a mini review Hum. Reprod., October 1, 2005; 20(10): 2688 - 2697. [Abstract] [Full Text] [PDF]

				S. Burgues The effectiveness and safety of recombinant human LH to support follicular development induced by recombinant human FSH in WHO group I anovulation: evidence from a multicentre study in Spain Hum. Reprod., December 1, 2001; 16(12): 2525 - 2532. [Abstract] [Full Text] [PDF]

				S. Gill, A. E. Taylor, K. A. Martin, C. K. Welt, J. M. Adams, and J. E. Hall Specific Factors Predict the Response to Pulsatile Gonadotropin-Releasing Hormone Therapy in Polycystic Ovarian Syndrome J. Clin. Endocrinol. Metab., June 1, 2001; 86(6): 2428 - 2436. [Abstract] [Full Text] [PDF]

				M. Filicori and G. E. Cognigni Roles and Novel Regimens of Luteinizing Hormone and Follicle-Stimulating Hormone in Ovulation Induction J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1437 - 1441. [Abstract] [Full Text]

				S. B. Seminara, M. Beranova, L. M. B. Oliveira, K. A. Martin, W. F. Crowley Jr., and J. E. Hall Successful Use of Pulsatile Gonadotropin-Releasing Hormone (GnRH) for Ovulation Induction and Pregnancy in a Patient with GnRH Receptor Mutations J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 556 - 562. [Abstract] [Full Text]

				J. H. Mendelson, N. K. Mello, and S. S. Negus Effects of Luteinizing Hormone-Releasing Hormone on Plasma Cocaine Levels in Rhesus Monkeys J. Pharmacol. Exp. Ther., May 1, 1999; 289(2): 791 - 799. [Abstract] [Full Text]

				T. E. R. H. L. S. Group Recombinant Human Luteinizing Hormone (LH) to Support Recombinant Human Follicle-Stimulating Hormone (FSH)-Induced Follicular Development in LH- and FSH-Deficient Anovulatory Women: A Dose-Finding Study J. Clin. Endocrinol. Metab., May 1, 1998; 83(5): 1507 - 1514. [Abstract] [Full Text]