Gonadotropin-releasing hormone for infertility in women with primary hypothalamic amenorrhea. Toward a more-interventional approach.
OBJECTIVE
To assess the effectiveness of a protocol of pulsatile gonadotropin releasing-hormone (GnRH) in treating infertility in women with primary hypothalamic amenorrhea.


METHODS
Retrospective analysis of 44 cycles treated at an infertility center. Twenty-four patients with primary hypothalamic amenorrhea were treated intravenously with pulsatile GnRH using 5 micrograms per bolus every 90 minutes. Ultrasound monitoring and cervical assessment by Insler's scoring system allowed timed injection of human chorionic gonadotropin (hCG) and intrauterine insemination if needed. Luteal support was provided with hCG.


RESULTS
The ovulation rate was 95% with the 5-microgram dose. A single follicle was produced in 91% of cycles. The overall pregnancy rate per ovulatory cycle was 45%, and the pregnancy rate per patient was 83%. In patients treated previously with exogenous gonadotropins, poor results were observed. Only one case of mild overstimulation was reported.


CONCLUSIONS
Pulsatile GnRH is an effective and safe method of treating infertility in women with primary hypothalamic amenorrhea, thus simulating normal ovulation; however, more-interventional management, including the qualitative estrogenic response, may lead to optimal results and increase the pregnancy rate.
Kesrouani
A
A
Department of Obstetrics and Gynecology, Hotel Dieu de France University Hospital, Paris, France. akesrouani@yahoo.fr
Abdallah
M A
MA
Attieh
E
E
Abboud
J
J
Atallah
D
D
Makhoul
C
C
D000328:Adult; D000568:Amenorrhea / Q000209:etiology*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications*; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D010062:Ovulation Induction; D010507:Periodicity; D011247:Pregnancy; D012189:Retrospective Studies
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone