Introduction: Hypothalamic amenorrhea (HA) is a condition treatable with pulsatile gonadotrophin-releasing hormone (GnRH). In case of ovulation failures under GnRH, hMG stimulation can be proposed as an alternative treatment in association with IVF. The purpose of this study was to perform a follow-up of all HA patients treated with GnRH and hMG in our Fertility Unit. Material and Methods: Thirty two patients, 24 to 32 years old, were treated for a total of 103 cycles with GnRH (20 µg/90 min during the follicular phase and 20µg/120 min after ovulation) between January 1989 and December 1996. Follicular growth was monitored using transvaginal ultrasound and blood estradiol (E2), progesterone (P), luteinizing hormone (LH) assays. Ovulation was confirmed by the presence of a follicular diameter ≥20 mm with E2 > 0.8 nmol/l and a spontaneous LH peak. Patients were proposed to have timed sexual intercourses during the following days or were inseminated with washed sperm (IUI). After several treatment failures, an alternative stimulation protocol using hMG was proposed to 7 patients (6 IVF, 1 IUI). Results: GnRH allowed ovulation to occur in 79 cycles (76.7%/cycle) leading to 62 timed sexual intercourses cycles and 17 IUI cycles. No ovarian hyperstimulation syndrome (OHSS) was observed. Twenty three pregnancies (29.1%/cycle) terminated in 9 spontaneous abortions (39.1%/pregnancy) and 14 deliveries (49%/patient). Four additional deliveries in three patients (5 babies) occurred after hMG stimulation. Five patients became spontaneously pregnant after pump stimulation arrest (N=2) or unsuccessfull IVF (N=3). Combining GnRH and hMG cycles, 18 deliveries were obtained in 15 patients. The direct and indirect effectiveness of these treatments was thus 62.5% (20 deliveries/32 patients). Conclusions: GnRH is an efficient and safe treatment of anovulation in women with HA. After GnRH or hMG ovarian stimulation cycles, spontaneous ovulation may be restored in certain HA patients with high chances of conception
Follow-up of thitrty two hypotalamo-hypopituary patients treated for 1 to 6 cycles with pulsatile Gonadotrophin-Releasing Hormone (GnRH): time and nature challenge the treatment
MARCI, Roberto;
1998
Abstract
Introduction: Hypothalamic amenorrhea (HA) is a condition treatable with pulsatile gonadotrophin-releasing hormone (GnRH). In case of ovulation failures under GnRH, hMG stimulation can be proposed as an alternative treatment in association with IVF. The purpose of this study was to perform a follow-up of all HA patients treated with GnRH and hMG in our Fertility Unit. Material and Methods: Thirty two patients, 24 to 32 years old, were treated for a total of 103 cycles with GnRH (20 µg/90 min during the follicular phase and 20µg/120 min after ovulation) between January 1989 and December 1996. Follicular growth was monitored using transvaginal ultrasound and blood estradiol (E2), progesterone (P), luteinizing hormone (LH) assays. Ovulation was confirmed by the presence of a follicular diameter ≥20 mm with E2 > 0.8 nmol/l and a spontaneous LH peak. Patients were proposed to have timed sexual intercourses during the following days or were inseminated with washed sperm (IUI). After several treatment failures, an alternative stimulation protocol using hMG was proposed to 7 patients (6 IVF, 1 IUI). Results: GnRH allowed ovulation to occur in 79 cycles (76.7%/cycle) leading to 62 timed sexual intercourses cycles and 17 IUI cycles. No ovarian hyperstimulation syndrome (OHSS) was observed. Twenty three pregnancies (29.1%/cycle) terminated in 9 spontaneous abortions (39.1%/pregnancy) and 14 deliveries (49%/patient). Four additional deliveries in three patients (5 babies) occurred after hMG stimulation. Five patients became spontaneously pregnant after pump stimulation arrest (N=2) or unsuccessfull IVF (N=3). Combining GnRH and hMG cycles, 18 deliveries were obtained in 15 patients. The direct and indirect effectiveness of these treatments was thus 62.5% (20 deliveries/32 patients). Conclusions: GnRH is an efficient and safe treatment of anovulation in women with HA. After GnRH or hMG ovarian stimulation cycles, spontaneous ovulation may be restored in certain HA patients with high chances of conceptionI documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
