Unexplained infertility and its treatment with intermittent GnRH application

Area of Science:

• Reproductive endocrinology
• Infertility research
• Hormonal regulation

Background:

• Spontaneous luteinizing hormone (LH) fluctuations are crucial for reproductive function.
• Patients with unexplained infertility often exhibit altered LH secretion patterns.
• Previous treatments for infertility may not have addressed underlying hormonal dysregulation.

Purpose of the Study:

• To investigate LH secretion patterns in patients with unexplained infertility.
• To evaluate the efficacy of intermittent gonadotropin-releasing hormone (GnRH) administration in normalizing LH fluctuations.
• To assess the impact of GnRH therapy on follicular maturation and pregnancy rates.

Main Methods:

• Estimation of spontaneous LH fluctuations in infertile patients.
• Administration of sex steroids to observe effects on LH levels.
• Intermittent GnRH application using an automatic pump (Zyklomat) at different doses (10 and 20 micrograms per pulse).
• Monitoring of follicular maturation and pregnancy outcomes.

Main Results:

• Patients with unexplained infertility showed irregular LH bursts and decreased pulse frequency.
• Sex steroid administration suppressed LH levels, eliminating detectable pulses.
• Intermittent GnRH therapy successfully induced regular LH fluctuations.
• Enhanced follicular maturation was observed with 20 micrograms GnRH per pulse, though this dose may be supra-physiological.
• Three pregnancies were achieved in patients resistant to clomiphene and human menopausal gonadotropins.

Conclusions:

• Irregular LH secretion is a feature of unexplained infertility.
• Intermittent GnRH therapy can restore physiological LH pulsatility.
• GnRH pulsatile therapy represents a promising treatment for infertility, improving follicular development and leading to conception.