HYPOGONADOTROPIC PATIENTS WITH ULTRASONOGRAPHICALLY DETECTED POLYCYSTIC OVARIES - ENDOCRINE RESPONSE TO PULSATILE GONADOTROPIN-RELEASING-HORMONE

To characterize the endocrine response during induction of ovulation i n patients with hypogonadotropic hypogonadism and ultra sound findings of polycystic ovary, we performed a retrospective analysis of 22 trea tment cycles with pulsatile gonadotropin-releasing hormone (GnRH) in s uch patients and of 17 treatment cycles in similar patients with ultra sonographically normal ovaries. Of the 21 patients studies, 11 had art ultrasound finding of polycystic ovaries and ten had ovaries that app eared normal. Serum luteinizing hormone (LH), follicle-stimulating hor mone (FSH) and estradiol levels, number of follicles of diameter > 12 mm (by ultrasound), and ovulation and conception rates were measured. Patients with hypogonadotropic hypogonadism and ultrasound-diagnosed p olycystic ovary had pretreatment endocrine status similar to those wit h normal ovaries, but had much higher baseline ovarian volume. Ovulati on induction with pulsatile GnRH induced much higher serum LH concentr ations in the former group despite similar FSH levels. This difference preceded any charge in estradiol levels. Tile former group consistent ly recruited significantly more follicles during pulsatile GnRH treatm ent. However, ovulation and conception rates were (non-significantly) higher in the latter group. In conclusion, this study characterized a subgroup of hypogonadotropic patients with ovarian morphology, volume and response to ovulation induction similar to in patients with polycy stic ovary syndrome. When treated with pulsatile GI?RH, those with pol ycystic ovary significantly hypersecreted LH before their estradiol le vel changed significantly. The primary lesion in polycystic ovary synd rome seems to be in the ovary, with pituitary hypersecretion of LH sec ondary to disturbed ovarian feedback signalling.