Role of GnRH agonists in managing proximal fallopian tube obstruction.
OBJECTIVE
To assess the response of proximal fallopian tube obstruction to a medically induced hypoestrogenic state after control for spasm at the uterotubal ostium.


METHODS
This was a prospective, randomized, placebo-controlled, pilot study in a tertiary care, university-affiliated infertility practice. Twenty-one infertile women with unilateral or bilateral proximal tubal obstruction previously diagnosed by standard hysterosalpingography or laparoscopic chromotubation were randomized into two groups in a 2:1 design. Group I, 14 patients (27 occluded tubes), was administered a depot preparation of the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate, 3.75 mg intramuscularly every 28 days. Group II, seven patients (11 occluded tubes), was administered a placebo. Follow-up hysterosalpingography was performed after administration of the antispasmodic glucagon within four weeks of completion of the protocol.


RESULTS
Evidence of ovarian suppression was confirmed within four weeks in group I. A trend toward higher posttherapy patency rates was noted in group I (74.7% vs. 40%). The lack of statistical significance may have been a function of sample size. Similarly, spontaneous intrauterine pregnancy rates were also higher in GnRH agonist-treated patients (35.1% vs. 16.6%, P < .05). Tubal patency rates were significantly greater in patients with documented estrogen-sensitive disorders who received the agonist (75% vs. 20%, P < .05)


CONCLUSIONS
Proximal tubal obstruction may be an estrogen-sensitive phenomenon in a subset of infertile patients. The administration of GnRH agonists may successfully overcome this state and result in enhanced conception rates.
Surrey
E S
ES
Department of Obstetrics-Gynecology, University of California, Los Angeles School of Medicine, USA.
Bishop
J A
JA
Surrey
M W
MW
D000328:Adult; D005184:Fallopian Tube Diseases / Q000150:complications / Q000188:drug therapy*; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D016729:Leuprolide / Q000627:therapeutic use*; D010053:Ovary / Q000187:drug effects / Q000502:physiology; D010865:Pilot Projects; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide