ALTERNATE-DAY GNRH THERAPY FAR OVARIAN HYPOFUNCTION INDUCED BY WEIGHT-LOSS - TREATMENT OF 6 PATIENTS WHO REMAINED AMENORRHEIC AFTER WEIGHT-GAIN

OBJECTIVE Body weight loss has an adverse effect on the pituitary-ovar ian function, and no restoration of the function occurs in 20-30% of p atients even after the recovery of body weight. In the present study, the efficacy of alternate-day GnRH therapy was investigated in six pat ients whose pituitary-ovarian function had not recovered at 15 months to 6 years after the recovery of body weight. DESIGN Synthetic GnRH (1 00 mu g) was injected intramuscularly on alternate days far a total of 12 doses. On the completion of GnRH administration the efficacy of cl omiphone-human chorionic gonadotrophin (hCG) therapy was evaluated. A GnRH loading test and evaluation of LH secretion patterns were also pe rformed to investigate the changes in hypothalamic-pituitary-ovarian f unction secondary to GnRH treatment. RESULTS All six patients ovulated in response to clomiphene-hCG therapy after 1-3 courses of GnRH treat ment. The ovulatory response to clomiphene-hCG continued during follow -up periods of 5 months to 5 years. The initial hormonal change induce d by GnRH treatment was a rise in the basal serum FSH level and a retu rn of the FSH response to GnRH loading. This was followed by an increa se in serum LH and the return of LH response to GnRH loading. In all s ix patients, pulsatile LH secretion was absent before starting GnRH tr eatment. GnRH treatment produced LH pulses in five of the six patients , although the pulse frequency was less than that in normally cycling women. A further increase in the pulse frequency was observed during c lomiphene therapy. CONCLUSIONS Alternate-day GnRH administration is ef fective in inducing responsiveness to clomiphene in patients with anov ulation secondary to weight loss.