title: Does polycystic ovarian morphology influence the response to treatment with pulsatile GnRH in functional hypothalamic amenorrhea?
abstract: BACKGROUND
  Pulsatile GnRH therapy is the gold standard treatment for ovulation induction in women having functional hypothalamic amenorrhea (FHA). The use of pulsatile GnRH therapy in FHA patients with polycystic ovarian morphology (PCOM), called "FHA-PCOM", has been little studied in the literature and results remain contradictory. The aim of this study was to compare the outcomes of pulsatile GnRH therapy for ovulation induction between FHA and "FHA-PCOM" patients in order to search for an eventual impact of PCOM.
  
  
  METHODS
  Retrospective study from August 2002 to June 2015, including 27 patients with FHA and 40 "FHA-PCOM" patients (85 and 104 initiated cycles, respectively) treated by pulsatile GnRH therapy for induction ovulation.
  
  
  RESULTS
  The two groups were similar except for markers of PCOM (follicle number per ovary, serum Anti-Müllerian Hormone level and ovarian area), which were significantly higher in patients with "FHA-PCOM". There was no significant difference between the groups concerning the ovarian response: with equivalent doses of GnRH, both groups had similar ovulation (80.8 vs 77.7 %, NS) and excessive response rates (12.5 vs 10.6 %, NS). There was no significant difference in on-going pregnancy rates (26.9 vs 20 % per initiated cycle, NS), as well as in miscarriage, multiple pregnancy or biochemical pregnancy rates.
  
  
  CONCLUSIONS
  Pulsatile GnRH seems to be a successful and safe method for ovulation induction in "FHA-PCOM" patients. If results were confirmed by prospective studies, GnRH therapy could therefore become a first-line treatment for this specific population, just as it is for women with FHA without PCOM.
authors.affiliation: Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre hospitalier régional universitaire de Lille, CHRU, Avenue Eugène Avinée, 59037, Lille, France. agathe.dumont@hotmail.fr.
authors.forename: Agathe
authors.initials: A
authors.lastname: Dumont
authors.affiliation: Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre hospitalier régional universitaire de Lille, CHRU, Avenue Eugène Avinée, 59037, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Dewailly
authors.affiliation: Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre hospitalier régional universitaire de Lille, CHRU, Avenue Eugène Avinée, 59037, Lille, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Plouvier
authors.affiliation: Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre hospitalier régional universitaire de Lille, CHRU, Avenue Eugène Avinée, 59037, Lille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Catteau-Jonard
authors.affiliation: Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre hospitalier régional universitaire de Lille, CHRU, Avenue Eugène Avinée, 59037, Lille, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Robin
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000188:drug therapy*; D054304:Anti-Mullerian Hormone / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Excessive ovarian response; Functional hypothalamic amenorrhea; Polycystic ovarian morphology; Pregnancy; Pulsatile GnRH therapy