Effectiveness and safety of pulsatile GnRH pump therapy on female patients with IHH

Abstract

To investigate the therapeutic effect of pulsatile GnRH (gonadorelin) pump on female patients with idiopathic hypogonadotropic hypogonadism (IHH). In this retrospective study, five female IHH patients were recruited. Patients were treated with pulsatile gonadorelin (10 µg per 90 min) via a pump for at least 12 weeks. Serum gonadotropins and sex steroid levels were measured, and menses were recorded. After one-week treatment, luteinizing hormone (LH) level increased from (2.2 ± 2.0) U/L to (5.4 ± 2.5) U/L (P=0.028), follicle-stimulating hormone(FSH) level increased from (3.7 ± 2.7) U/L to(6.3 ± 1.0) U/L (P=0.162), and estradiol (E2) level increased from (58 ± 13) pmol/L to (260 ± 97) pmol/L (P=0.011). Menstrual bleeding was observed in 4 patients after starting treatment for 35-55 days and two natural pregnancies were reported. No menstrual bleeding was reported in another patient. The frequency of pulsatile GnRH had to be adjusted according to endogenous GnRH secretion during the follicular phase of normal women and regular menses were induced. Pulsatile GnRH is effective in treating female IHH. A constant frequency of pulsatile GnRH is suitable for most of IHH patients. However, for those who failed to produce regular menses, adjusting pulsatile frequency to imitate the physiological rhythm of GnRH may be an alternative option.