title: Long-term GnRH analogue treatment is equivalent to laparoscopic laser diathermy in polycystic ovarian syndrome patients with severe ovarian dysfunction.
abstract: This prospective, randomized study included 18 polycystic ovarian syndrome (PCOS) patients with severe ovarian dysfunction, who were evaluated by standard clomiphene and FSH stimulation. In this group of patients, a 6 month down-regulation with gonadotrophin-releasing hormone (GnRH) analogues gave outcomes similar to laparoscopic ovarian laser diathermy with respect to stimulatory outcome and pregnancy rate. Clomiphene stimulation with 50 mg of clomiphene/day and FSH stimulation in a low-dose, step-up protocol with purified FSH did not result in oligofollicular development; thus patients were divided into two subgroups: one subgroup received laparoscopic laser drilling and the other received 6 months of therapy with GnRH analogues plus add-back therapy after diagnostic laparoscopy. Subsequently, three cycles of low-dose, step-up stimulation with recombinant FSH were started. In both groups, approximately 30% of cycles still remained anovulatory. In the down-regulated subgroup, this mainly happened in the first cycle. In each group, ovulation was achieved in 14 cycles, intrauterine insemination was performed, and five pregnancies were obtained. This resulted in a pregnancy rate of 36% per ovulatory cycle in both groups. Overall, 50% of the formerly unreactive patients in both groups overcame childlessness. In achieving this, long-term treatment with GnRH analogues was as successful as laparoscopic laser diathermy.
authors.affiliation: Department of Reproductive Medicine and Gynaecologic Endocrinology, University of Magdeburg, D-39108 Magdeburg, Germany. Ursula.Muenstermann@yahoo.com
authors.forename: U
authors.initials: U
authors.lastname: Muenstermann
authors.forename: J
authors.initials: J
authors.lastname: Kleinstein
mesh_terms: D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use; D017373:Cyproterone Acetate / Q000627:therapeutic use; D004338:Drug Combinations; D004564:Electrocoagulation; D004997:Ethinyl Estradiol / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D010535:Laparoscopy; D007834:Lasers; D016729:Leuprolide / Q000627:therapeutic use; D010053:Ovary / Q000601:surgery; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D006063:Chorionic Gonadotropin; D004338:Drug Combinations; D005300:Fertility Agents, Female; D011994:Recombinant Proteins; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; C032640:Cyproterone acetate, ethinyl estradiol drug combination; D005640:Follicle Stimulating Hormone; D016729:Leuprolide