Long-term GnRH analogue treatment is equivalent to laparoscopic laser diathermy in polycystic ovarian syndrome patients with severe ovarian dysfunction.
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.
Muenstermann
U
U
Department of Reproductive Medicine and Gynaecologic Endocrinology, University of Magdeburg, D-39108 Magdeburg, Germany. Ursula.Muenstermann@yahoo.com
Kleinstein
J
J
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
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