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Induction of ovulation with pulsatile GnRH.

Z Shoham, R Homburg, H S Jacobs

    Bailliere'S Clinical Obstetrics and Gynaecology
    |September 1, 1990
    PubMed
    Summary

    Pulsatile gonadotropin-releasing hormone (GnRH) therapy is a safe and effective ovulation induction method for infertile women resistant to clomiphene citrate. Subcutaneous GnRH is preferred, with intravenous use reserved for non-responders.

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    Area of Science:

    • Reproductive Endocrinology
    • Human Genetics
    • Infertility Treatment

    Background:

    • Ovulation induction is crucial for treating infertility in anovulatory women.
    • Pulsatile gonadotropin-releasing hormone (GnRH) therapy offers a targeted approach for ovulation induction.
    • Understanding the genetic basis of GnRH deficiency is essential for developing novel therapeutic strategies.

    Purpose of the Study:

    • To evaluate the safety, simplicity, and effectiveness of pulsatile GnRH for ovulation induction in infertile women.
    • To determine the efficacy of GnRH therapy in specific patient populations, including those with idiopathic hypogonadotropic hypogonadism and weight-related amenorrhea.
    • To investigate the genetic underpinnings of GnRH deficiency in hypogonadotropic hypogonadism.

    Main Methods:

    • Subcutaneous administration of pulsatile GnRH (15 mcg/pulse every 90 min) as a primary treatment.
    • Monitoring patient progress via serial ultrasound scanning and serum gonadotropin and estradiol levels.
    • Utilizing cDNA cloning to map the human GnRH gene to chromosome 8 and exploring gene transfer in animal models.

    Main Results:

    • Pulsatile GnRH is safe, simple, and effective, particularly for patients resistant to clomiphene citrate.
    • Treatment is highly effective for idiopathic hypogonadotropic hypogonadism and weight-related amenorrhea, less so for PCOS and organic hypothalamic-pituitary disease.
    • The human GnRH gene is located on chromosome 8; gene transfer shows potential for restoring gonadal function in hypogonadal mice.

    Conclusions:

    • Pulsatile GnRH therapy is a preferred method for ovulation induction in selected infertile women.
    • Subcutaneous GnRH administration is advocated, with combination therapy or intravenous GnRH reserved for non-responders.
    • While the precise genetic cause of GnRH deficiency remains under investigation, GnRH replacement therapy effectively manages clinical syndromes.

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