EXPLORING THE RECOVERY PHASE AFTER TREATMENT WITH A GONADOTROPIN-RELEASING HORMONE-AGONIST FOR OVULATION INDUCTION IN POLYCYSTIC-OVARY-SYNDROME - 3 PILOT TRIALS

Objective: Guided by the favorable results of pulsatile gonadotrophin- releasing hormone (GnRH) in the recovery phase after GnRH agonist (GnR H-a) in PCOS, two hypotheses concerning the recovery phase were tested : (1) The resistance to clomiphene citrate will be broken in the recov ery phase. (2) Stimulation with (i) a fixed dose of follicle stimulati ng hormone (FSH) or (ii) with the GnRH-a itself is equally effective i n inducing ovulation as pulsatile GnRH. Design: After discontinuation of a 17-21 days GnRH-a treatment, ovulation induction was attempted wi th clomiphene citrate (CC) or with a fixed dose of FSH or with GnRH-a itself in three separate pilot trials. A previously reported group of 12 patients, treated with pulsatile GnRH in the recovery phase served as control. Patients: Three groups of six patients having PCOS. The gr oup treated with CC was a selected CC-resistant group. Results: No CC- treated patient ovulated. After FSH stimulation two patients ovulated, and one patient ovulated on stimulation with a low dose of the GnRH-a . Endocrine observations in the recovery phase showed an early rise of FSH as compared to the rise of LH and androgens. Conclusion: This stu dy could not demonstrate any effect of the recovery phase with respect to facilitation of follicular growth in PCOS. Both tested hypotheses were rejected: (1) The resistance to CC appeared not to be broken by t he GnRH-a treatment and (2) subsequent stimulation with FSH or with th e GnRH-a itself were not as effective as stimulation with pulsatile Gn RH. An extensive further study of the mentioned modalities did not see m feasible.