[Anovulation of hypothalamic origin. Treatment by pulsatile injection of hypothalamic gonadotropin releasing hormone]

In two patients with severe hypogonadotrophic hypogonadism intermittent pulsatile delivery of gonadotrophin hormone (LHRH) 5 to 20 micrograms every 90 minutes by means of the Zyklomat pump promptly resulted in ovulation and pregnancy. The comparative effectiveness of the intravenous and subcutaneous routes was evaluated by radioimmuno assay of LHRH in plasma. The pulsatile patterns of LH was satisfactory with both routes, but plasma levels of LHRH were about 7 times lower with the subcutaneous route. The dosage range (5-20 micrograms) of LHRH must be adjusted to the severity of the hypothalamic deficiency and to the route of administration. The use of the pump, the monitoring of ovulation and the indications for this type of treatment are discussed.