A randomized controlled study comparing the endocrine effects of pulsatileintravenous gonadotropin-releasing hormone after gonadotropin-releasing hormone agonist pretreatment versus clomiphene citrate in patients with polycystic ovary syndrome

Objective: To compare the endocrine changes in the follicular phase in infe rtile patients with polycystic ovary syndrome (PCOS) treated with either pu lsatile IV GnRH after GnRH-agonist (GnRH-a) downregulation or clomiphene ci trate (CC). Design: Subgroup analysis within a randomized, controlled, multicenter stud y. Setting: Women referred to the Infertility Clinic, Catharina Hospital Eindh oven, The Netherlands. Patient(s): Twenty-eight infertile patients with PCOS. Intervention(s): Pat ients were randomly assigned to pulsatile IV GnRH (10-20 mu g/90 min) after GnRH-a down-regulation or CC (50-150 mg; cycle days 3-7). Patients were mo nitored on alternate days with ovarian sonography and serum concentrations of E-2, LH, and FSH. Serum P and songraphy confirmed ovulation. Main Outcome Measure(s): Serum concentrations of E-2, LH, and FSH were asse ssed before treatment was started and after each ovarian sonography. Result(s): In ovulatory cycles, no statistically significant differences we re observed during the follicular phase comparing serum concentrations of E -2, LH, and FSH between the treatments. However, a significant increase in LH occurred in the GnRH group. Conclusion(s): No significant endocrine differences were observed between G nRH and CC treatment. However, there was a significant increase in the seru m LH concentration during the follicular phase in the GnRH group. Increment s of LH in the GnRH group may be due to recovery of endogenous LH secretion . (C) 2000 by American Society for Reproductive Medicine.