Induction of ovulation with various regimens of luteinizing hormone-releasing hormone administration.

Abstract

Studies have shown that porcine luteinizing hormone-releasing (LH-RH) as well as synthetic decapeptide induces a significant pituitary synthesis and release of both LH and follicle stimulating hormone (FSH) in the human after intravenous intramuscular (im) or subcutaneous administration. The present study treated 10 women between 21 and 42 years of age for 15 cycles with various doses and schedules of porcine and synthetic LH-RH. 5 different regimens of LH-RH administration were tested. Induction of ovulation with regimens of LH-RH failed in 3 patients with Stein-Leventhals syndrome and in 1 patient with galactorrhea-amenorrhea without demonstrable pituitary tumor. Previous clomiphene therapy had induced ovulation in all of these patients. These patients were treated with regimens A and B consisting of repeated daily im injections of synthetic LH-RH. The use of regimens D and E in selected patients with Stein-Leventhals syndrome and galactorrhea-amenorrhea with postive gestagen-withdrawal bleeding tests induced ovulatory cycles in all patients and even pregnancy in 1. These regimens consisted of daily consecutive im injections of synthetic LH-RH associated with clomiphene or chlomiphene citrate. Regimens D and E however were unable to induce ovulation in patients with hypothalamic amenorrhea or galactorrhea in whom ovulatory cycles had previously been induced by sequential human menopausic gonadotrophin/human chorionic gonadotrophin. These 3 patients presented evidence of hypoestrogenism and did not respond to a gestagen-withdrawal bleeding test. Differences in responses appear to depend on the presence or absence of clinical hypoestrogenism. Although more investigations are necessary it may be concluded that in some cases of primary or secondary amenorrhea and sterility some regimens of LH-RH administration have shown potential.