Ovulation induction with subcutaneous pulsatile gonadotropin-releasing hormone in various ovulatory disorders

Pulsatile gonadotropin-releasing hormone (GnRH) was administered subcutaneously (SC) to 13 women for a total of 21 cycles. Ten of these women had hypothalamic amenorrhea (HA) and were treated for 16 cycles. Three had polycystic ovarian disease (PCOD) and were treated for five cycles. Endocrine assessment for daily measurements of serum luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, and progesterone and frequent pelvic ultrasound examinations were obtained. Ovulation occurred in 17 of 21 cycles (81%) with four resulting pregnancies (31% of patients, 19% of cycles). Of ten patients with HA, ovulation occurred in 15 of 16 cycles (93.75%), and four women became pregnant (40% of patients, 25% of cycles). Three pregnancies resulted in normal deliveries at term and one spontaneously aborted at 5 weeks. Among the three PCOD patients, ovulation was achieved in two of five cycles (40%). There were no pregnancies in this group. Overstimulation by ultrasound criteria occurred in one of the PCOD patients during an anovulatory cycle. There were no multiple pregnancies or any other complications in either group. We conclude that SC pulsatile GnRH is highly effective in HA patients; SC pulsatile GnRH seems substantially less effective in PCOD patients than in HA patients; and further experience is needed to optimize GnRH administration in PCOD.