GNRH ANALOG ADMINISTRATION IN PATIENTS WITH POLYCYSTIC OVARIAN DISEASE

Objective: To evaluate the hormonal response to the short protocol of gonadotropin-releasing hormone (GnRH) analog (GnRHa) in patients with polycystic ovarian disease (PCOD). Methods: We enrolled 35 patients (2 0 infertile) with ultrasonographic and hormonal PCOD characteristics. GnRHa Suprefact was applied subcutaneously at a daily dose of 0.9 ml f or 9 consecutive days starting on the 10th-15th day after induced or s pontaneous bleeding. Blood sampling for follicle-stimulating hormone ( FSH), luteinizing hormone (LH), testosterone (T), estradiol (E(2)), es trone (E(1)) and dehydroepiandrosterone sulfate (DHEA-S) was performed before the treatment and on days 3 and 4 of GnRHa administration. Stu dent's t-test was used for the analysis of differences between various mean values. All statistical analyses were performed by the computeri zed statistical package CSS-Statistica. Results: Pretreatment hormonal levels (FSH 5.68 +/- 1.86 IU/I, LH 14.16 +/- 1.72 IU/I, E(2) 0.29 +/- 0.20 nmol/l, E(1) 0.35 +/- 0.17 nmol/l, T 3.52 +/- 1.40 nmol/l, DHEA- S 7.15 +/- 2.89 mu mol/l) barely differed on day 3 of GnRHa administra tion, except for the rise in LH (17.14 +/- 10.97 IU/I), which was stil l not significant. On day 9 of GnRHa application, significant suppress ion of FSH (3.16 +/- 1.55 IU/1) and LH (8.05 +/- 5.00 IU/I) was regist ered compared with pretreatment levels, without changes in the FSH:LH ratio, and in other parameters studied. Although there were no changes in ultrasound characteristics on day 9 of GnRHa administration compar ed with basal findings, bleeding occurred 14-18 days after the last Gn RHa dose in 32 patients. There were three pregnancies out of 20 infert ile patients in the treated cycles. Conclusion: Significant suppressio n of FSH and LH in PCOD patients does not interfere with ovarian stero id production, which is probably maintained due to higher follicular s ensitivity to normal FSH and LH levels. Alternatively it may be the co nsequence of the unaltered FSH:LH ratio in spite of GnRHa-suppressed a bsolute values. However the recommencement of menstrual bleeding and 1 5% of pregnancies in the investigated infertile patients suggest the o ccurrence of certain temporary intraovarian events, which probably con tinue after the cessation of GnRHa administration.