Comparison between pulsatile GnRH therapy and gonadotropins for ovulation induction in women with both functional hypothalamic amenorrhea and polycystic ovarian morphology.
BACKGROUND
Ovulation induction in patients having both functional hypothalamic amenorrhea (FHA) and polycystic ovarian morphology (PCOM) has been less studied in the literature. As results remain contradictory, no recommendations have yet been established.


OBJECTIVE
To compare pulsatile GnRH therapy versus gonadotropins for ovulation induction in "FHA-PCOM" patients and to determine if one treatment strikes as superior to the other.


METHODS
A 12-year retrospective study, comparing 55 "FHA-PCOM" patients, treated either with GnRH therapy (38 patients, 93 cycles) or with gonadotropins (17 patients, 53 cycles).


RESULTS
Both groups were similar, defined by low serum LH and E2 levels, low BMI, excessive follicle number per ovary and/or high serum AMH level. Ovulation rates were significantly lower with gonadotropins (56.6% versus 78.6%, p = 0.005), with more cancellation and ovarian hyper-responses (14% versus 34% per initiated cycle, p < 0.005). Pregnancy rates were significantly higher with GnRH therapy, whether per initiated cycle (26.9% versus 7.6%, p = 0.005) or per patient (65.8% versus 23.5%, p = 0.007).


CONCLUSIONS
In our study, GnRH therapy was more successful and safer than gonadotropins, for ovulation induction in "FHA-PCOM" patients. If results were confirmed by prospective studies, it could become a first-line treatment for this population, just as it is for FHA women without PCOM.
a Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre , CHRU Lille , France.
Agathe
A
Dumont
a Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre , CHRU Lille , France.
Didier
D
Dewailly
a Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre , CHRU Lille , France.
Pauline
P
Plouvier
a Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre , CHRU Lille , France.
Sophie
S
Catteau-Jonard
a Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre , CHRU Lille , France.
Geoffroy
G
Robin
D000328:Adult; D000568:Amenorrhea / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000494:pharmacology*; D006062:Gonadotropins / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications*; D007247:Infertility, Female / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D017063:Outcome Assessment, Health Care; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011247:Pregnancy; D012189:Retrospective Studies
D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone
Functional hypothalamic amenorrhea; gonadotropins; polycystic ovarian morphology; pregnancy; pulsatile GnRH therapy