USE OF LUTEINIZING-HORMONE-RELEASING HORMONE AGONISTS IN POLYCYSTIC-OVARY-SYNDROME

Luteinizing hormone releasing hormone (LHRH) agonists have been used i n conjunction with gonadotrophins, and occasionally with pulsatile LHR H, for ovulation induction in women with clomiphene-citrate-resistant polycystic ovary syndrome (PCOS) and also for superovulation for in vi tro fertilization (IVF) and gamete intrafallopian transfer in women wi th PCOS. In IVF, LHRH agonists given by the 'long protocol' before gon adotrophins are commenced have consistently shown higher pregnancy rat es and higher live birth rates. Although the optimal time to commence LHRH agonist is not clearly determined, commencement in the early foll icular phase possibly with pre-treatment with the combined oral contra ceptive pill would avoid the risk of inadvertent administration during early pregnancy. The role of LHRH agonists in ovulation induction is less clear cut, although there may be some advantages in patients with refractory PCOS. The role of LHRH agonists in ovarian hyperstimulatio n syndrome and recurrent miscarriage is also discussed.