Eine klinische Studie zur Sterilitätstherapie bei der hyperandrogenämischen Ovarialinsuffizienz*

Abstract

The therapeutic effect of glucocorticoid therapy in infertile patients with hyperandrogenemic ovarian insufficiency was verified in a clinical study and compared with the results of other forms of therapy. Of 40 patients treated with 0.5 mg/d dexamethasone only one conceived. Of 47 patients treated with 7.5 mg/d prednisone 6 became pregnant. A combination therapy of dexamethasone and clomiphene resulted in 3 pregnancies among 20 patients; a combination of prednisone and clomiphene in 18 patients led to one pregnancy. In the majority of these patients previous treatment with clomiphene only had been unsuccessful. In the patient in whom both clomiphene and glucocorticoid therapy was unsuccessful, hMG/hCG therapy was applied. The pregnancy rate, 24% in the dexamethasone group and 36% in the prednisone group, was much higher. Plasma testosterone concentrations were not significantly suppressed under corticoid therapy. Neither at the beginning of a cycle nor at the time of ovulation were FSH and LH levels changed by the administration of corticoids. There was no significant correlation between the plasma testosterone values and the length of the cycle, the duration of the follicular phase, the duration of the rise in basal temperature or the length thereof. There was a significant correlation between testosterone and the LH/FSH quotient at the beginning of the cycle both in the spontaneous cycles and under corticoid therapy, though not under clomiphene therapy. In the control cycles there was a significant correlation between testosterone and LH; in the corticoid cycles it was not significant, and under corticoid therapy there was no correlation. A negatively significant correlation between testosterone and FSH was found in the control cycles. This correlation was not significant under glucocorticoid therapy and there was no correlation under clomiphene therapy. As testosterone concentrations increased a decrease in the percentage of biphasic cycles was observed in all groups. Regardless of the testosterone concentration, the pregnancy rate in patients showing signs of androgenization, at 22%, was higher than in patients without these symptoms. In patients who conceived under corticoid therapy there was no uniform correlation either to the pretherapeutic testosterone levels or to the degree of testosterone suppression. Neither the initial testosterone level nor the degree of its suppression is of any prognostic value for corticoid therapy. The more pronounced the clinical symptoms in hyperandrogenemic patients, the more effective a corticoid therapy will be; this applies both to signs of androgenization as well as to the degree of ovarian insufficiency.