One hundred pregnancies after treatment with pulsatile luteinising hormone releasing hormone to induce ovulation.
OBJECTIVE
To review treatment with pulsatile luteinising hormone releasing hormone in infertile women who do not ovulate and are resistant to clomiphene after 100 pregnancies achieved with this treatment.


METHODS
Retrospective analysis of 146 courses of treatment over 434 cycles.


METHODS
Infertility clinic.


METHODS
118 Women whose failure to ovulate was due to idiopathic hypogonadotrophic hypogonadism (n = 39), amenorrhoea related to low weight (n = 17), organic pituitary disease (n = 15), or polycystic ovaries (n = 47).


METHODS
Dose of 15 micrograms luteinising hormone releasing hormone/pulse subcutaneously every 90 minutes given with a miniaturised pump throughout cycle monitored by ultrasound. Women with hypogonadotrophic hypogonadism had 48 courses, women with amenorrhoea related to low weight 23, women with organic pituitary disease 18, and women with polycystic ovaries 57.


METHODS
Follow up of 100 pregnancies achieved in 77 women during six years after introducing treatment. MEASUREMENTS and main results--One hundred pregnancies (seven multiple, 28 miscarriages). Cumulative rates of pregnancy were 93-100% at six months in women with idiopathic hypogonadotrophic hypogonadism, amenorrhoea related to low weight, and organic pituitary disease. In women with polycystic ovaries (cumulative rate of pregnancy 74%) adverse prognostic factors were obesity, hyperandrogenism, and high luteinising hormone concentrations, which were also associated with a high rate of early pregnancy loss.


CONCLUSIONS
Treatment with pulsatile luteinising hormone releasing hormone is safe, simple, and effective, and the preferred method of inducing ovulation in appropriately selected patients. Compared with exogenous gonadotrophin treatment there is little need for monitoring, no danger of hyperstimulation, and a low rate of multiple pregnancies.
Homburg
R
R
Cobbold Laboratories, University College, London.
Eshel
A
A
Armar
N A
NA
Tucker
M
M
Mason
P W
PW
Adams
J
J
Kilborn
J
J
Sutherland
I A
IA
Jacobs
H S
HS
D000022:Abortion, Spontaneous / Q000209:etiology; D001835:Body Weight; D005260:Female; D005498:Follicular Phase; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007986:Luteinizing Hormone / Q000097:blood; D010060:Ovulation / Q000187:drug effects*; D010900:Pituitary Diseases / Q000150:complications; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011379:Prognosis; D012189:Retrospective Studies
D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone