Treatment of anovulatory patients by pulsatile administration of gonadotropin releasing hormone

Abstract

83 anovulatory patients refractory to clomiphene were treated with gonadotropin releasing hormone (GnRH) in pulsatile form (Zyklomat). 146 of 172 treated cycles were ovulatory. A total of 37 pregnancies occurred. The patients were classified into three groups according to the degree of severity of their cyclic disturbance and according to the results of testosterone determinations. In amenorrhoic women with normal testosterone values (group I) the authors found the highest incidence of ovulation and pregnancies. In the patients of group II the ovulation rates were high, whereas the incidence of pregnancies was low (this group comprised anovulatory oligomenorrhoea and normal testosterone values). It was found that about 30% of the anovulatory women with elevated testosterone levels (group III) were refractory to therapy, the proliferation phases being mostly considerably prolonged during the ovulatory cycles. It is concluded from the results of this study that in women with normoandrogenemic amenorrhoea the treatment of first choice should be pulsatile application of GnRH. In many hyperandrogenemic, anovulatory patients treatment with gonadotrophins should be considered as the presently more suitable method.