Current Experience with a Standardized Method of Human Menopausal Gonadotropin/Human Chorionic Gonadotropin Administration

Abstract

The purpose of the study is to report on the treatment of 26 infertile women with ovulatory disorders, all of whom previously had been unsuccessfully treated with clomiphene and human chorionic gonadotropin (hCG), with a standardized human menopausal gonadotropin (hMG)/hCG regimen: three to eight ampules of hMG (Pergonal) on days 1, 3, and 5, and 10,000 IU of hCG on day 8. Serum estrogen levels were measured by radioimmunoassay on days 1, 3, 5, and 8, and progesterone by radioimmunoassay on day 15. Thirteen cycles were inadequately stimulated (estrogen level below 300 pg/ml). hCG injections were withheld to avoid hyperstimulation syndrome in four treatment cycles (cystic ovarian enlargement and estrogen levels over 2000 pg/ml). Twenty-two cycles in twenty-six patients were judged to be adequately stimulated. Eight pregnancies occurred. All conception cycles were characterized by an estrogen level over 300 pg/ml and a good postcoital test (PCT) on day 8, and by a progesterone level over 20 ng/ml on day 15. Of 18 patients who did not conceive, 10 had poor PCTs and 2 patients had a history of tubal surgery. The mean dose of Pergonal in conception cycles was 14.7 ampules (almost identical dosages were used in under- and overstimulated cycles, illustrating response variability). The described regimen was an effective scheme of inducing ovulation in 96% of patients. A good PCT was a favorable prognostic sign (50% of patients with adequately stimulated ovulation and good postcoital findings conceived).