Luteal function following ovulation induction in polycystic ovary syndrome patients using exogenous gonadotrophins in combination with a gonadotrophin-releasing hormone agonist.
The luteal phase was studied in 12 polycystic ovary syndrome (PCOS) patients following ovulation induction using exogenous gonadotrophins combined with a gonadotrophin-releasing hormone agonist (GnRH-a). Human menopausal gonadotrophin (HMG) was preceded by 3 weeks of treatment with GnRH-a (buserelin; 1200 micrograms/day intra-nasally) and administered in a step-down dose regimen starting with 225 IU/day i.m. GnRH-a was withheld the day before administration of human chorionic gonadotrophin (HCG; 10,000 IU i.m.). Blood sampling and ultrasound monitoring was performed every 2-3 days until menses. The luteal phase was significantly shorter in PCOS patients as compared to eight regularly cycling controls: 8.8 (3.3-11.4) days [median(range)] versus 12.8 (8.9-15.9) days (P = 0.01). Median peak values for progesterone did not show significant differences comparing both groups: 52.3 (17.1-510.3) nmol/l versus 43.0 (31.2-71.1) nmol/l, respectively (P = 0.8). The interval between the day of the progesterone peak and return to baseline was significantly shorter in the PCOS patients than in controls: 2.5 (0.3-4.9) days versus 4.2 (3.9-10.5) days (P < 0.005). Luteinizing hormone (LH) concentrations during the luteal phase as reflected by area under the curve were significantly lower in PCOS as compared to controls: 4.4 (1.6-21.0) IU/l x days and 49.0 (27.8-79.6) IU/l x days, respectively (P < 0.001). In conclusion, patients with PCOS may suffer from insufficient luteal phases after ovulation induction using HMG/HCG in combination with a GnRH-a. The corpus luteum apparently lacks the support of endogenous LH and may be stimulated only by the pre-ovulatory injection of HCG.(ABSTRACT TRUNCATED AT 250 WORDS)
Donderwinkel
P F
PF
Department of Obstetrics and Gynaecology, Dijkzigt University Hospital, Erasmus University, Rotterdam, The Netherlands.
Schoot
D C
DC
Pache
T D
TD
de Jong
F H
FH
Hop
W C
WC
Fauser
B C
BC
D000328:Adult; D002064:Buserelin / Q000008:administration & dosage*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D008183:Luteal Phase / Q000502:physiology*; D007986:Luteinizing Hormone / Q000097:blood; D008596:Menotropins / Q000008:administration & dosage; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D012016:Reference Values
D006063:Chorionic Gonadotropin; D006062:Gonadotropins; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D002064:Buserelin