Abstract
BackgroundPulsatile GnRH therapy is the gold standard treatment for ovulation induction in women having functional hypothalamic amenorrhea (FHA). The use of pulsatile GnRH therapy in FHA patients with polycystic ovarian morphology (PCOM), called “FHA-PCOM”, has been little studied in the literature and results remain contradictory. The aim of this study was to compare the outcomes of pulsatile GnRH therapy for ovulation induction between FHA and “FHA-PCOM” patients in order to search for an eventual impact of PCOM.MethodsRetrospective study from August 2002 to June 2015, including 27 patients with FHA and 40 “FHA-PCOM” patients (85 and 104 initiated cycles, respectively) treated by pulsatile GnRH therapy for induction ovulation.ResultsThe two groups were similar except for markers of PCOM (follicle number per ovary, serum Anti-Müllerian Hormone level and ovarian area), which were significantly higher in patients with “FHA-PCOM”. There was no significant difference between the groups concerning the ovarian response: with equivalent doses of GnRH, both groups had similar ovulation (80.8 vs 77.7 %, NS) and excessive response rates (12.5 vs 10.6 %, NS). There was no significant difference in on-going pregnancy rates (26.9 vs 20 % per initiated cycle, NS), as well as in miscarriage, multiple pregnancy or biochemical pregnancy rates.ConclusionPulsatile GnRH seems to be a successful and safe method for ovulation induction in “FHA-PCOM” patients. If results were confirmed by prospective studies, GnRH therapy could therefore become a first-line treatment for this specific population, just as it is for women with FHA without PCOM.
Highlights
Pulsatile gonadotropin-releasing hormone (GnRH) therapy is the gold standard treatment for ovulation induction in women having functional hypothalamic amenorrhea (FHA)
There was no significant difference between FHA and “FHA-polycystic ovarian morphology (PCOM)” for biochemical pregnancy, miscarriage and multiple pregnancy rates
This study demonstrates that the presence of PCOM in patients with FHA does not influence the management of the pulsatile GnRH therapy, nor the ovarian response to the treatment and the pregnancy rates
Summary
Pulsatile GnRH therapy is the gold standard treatment for ovulation induction in women having functional hypothalamic amenorrhea (FHA). The use of pulsatile GnRH therapy in FHA patients with polycystic ovarian morphology (PCOM), called “FHA-PCOM”, has been little studied in the literature and results remain contradictory. The aim of this study was to compare the outcomes of pulsatile GnRH therapy for ovulation induction between FHA and “FHA-PCOM” patients in order to search for an eventual impact of PCOM. FHA is due to a chronic energy deprivation, mostly caused by significant weight loss, severe food restriction and/or excessive exercise. This negative energy balance leads to a reduced frequency of the gonadotropin-releasing hormone (GnRH) pulses, which is responsible for gonadotropin insufficiency and results in anovulation and hypoestrogenism [2]. Neither the meta-analysis from the Dumont et al Reproductive Biology and Endocrinology (2016) 14:24
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