TREATMENT OF ANOVULATION WITH PULSATILE GONADOTROPIN-RELEASING-HORMONE - PROGNOSTIC FACTORS AND CLINICAL-RESULTS IN 600 CYCLES

Pulsatile GnRH (pGnRH) was administered to 292 anovulatory patients in 600 consecutive cycles between February 1984 and February 1993. This represents the largest single pGnRH series ever reported. Patients wer e divided into the following groups: primary hypogonadotropic amenorrh ea (PHA), 73 patients 161 cycles; other hypogonadotropic hypogonadisms (OHH), 57 patients 107 cycles; multifollicular ovary (MFO), 39 patien ts 75 cycles; polycystic ovary (PCO), 85 patients 172 cycles; and othe r hyperandrogenic anovulations (OHA), 38 patients 85 cycles. GnRH was administered iv at a dose of 1.25-20.0 mu g every 30-120 min; most cyc les (505) were performed with a regimen of 2.5-5.0 mu g GnRH every 60- 90 min. In 228 cycles of MFO, PCO, and OHA patients, pGnRH was precede d by GnRH agonist (GnRH-A) suppression. Ovulatory rates were 75%, and pregnancy occurred in 105 cycles (pregnancy rate of 18%/treatment cycl e and 23%/ovulatory cycle). Ovulatory and pregnancy rates were higher in PHA, OHH, and MFO and lower in PCO and OHA. Only 4 multiple pregnan cies occurred (3.8%), none after GnRH-A suppression. The abortion rate was 30% and was highest in PCO (45%). GnRH-A pretreatment improved ov ulatory rates only in PCO (from 49% to 71%; P < 0.001), whereas it had no significant effect on pregnancy and abortion rates in any group. H igher weight and insulin were associated with lower ovulatory and preg nancy rates; higher LH and testosterone were associated with lower ovu latory rates only. We conclude that 1) pGnRH is a highly effective ovu lation induction method; 2) pGnRH does not cause ovarian hyper stimula tion; 3) low dose pGnRH is associated with a remarkably low incidence of multiple pregnancy; 4) GnRH-A pretreatment improves pGnRH outcome i n PCO and further lowers the incidence of multiple pregnancy; 5) pGnRH is associated with relatively elevated abortion rates, particularly i n PCO; and 6) pGnRH is less successful in overweight patients and when high baseline LH, testosterone, and insulin levels are present.