GnRH analog administration in patients with polycystic ovarian disease

To evaluate the hormonal response to the short protocol of gonadotropin-releasing hormone (GnRH) analog (GnRHa) in patients with polycystic ovarian disease (PCOD).

We enrolled 35 patients (20 infertile) with ultrasonographic and hormonal PCOD characteristics. GnRHa Suprefact was applied subcutaneously at a daily dose of 0.9 ml for 9 consecutive days starting on the 10th-15th day after induced or spontaneous bleeding. Blood sampling for follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), estrone (E1) and dehydroepiandrosterone sulfate (DHEA-S) was performed before the treatment and on days 3 and 4 of GnRHa administration. Student's t-test was used for the analysis of differences between various mean values. All statistical analyses were performed by the computerized statistical package CSS-Statistica.

Pretreatment hormonal levels (FSH 5.68 +/- 1.86 IU/l, LH 14.16 +/- 1.72 IU/l, E2 0.29 +/- 0.20 nmol/l, E1 0.35 +/- 0.17 nmol/l, T 3.52 +/- 1.40 nmol/l, DHEA-S 7.15 +/- 2.89 mumol/l) barely differed on day 3 of GnRHa administration, except for the rise in LH (17.14 +/- 10.97 IU/l), which was still not significant. On day 9 of GnRHa application, significant suppression of FSH (3.16 +/- 1.55 IU/l) and LH (8.05 +/- 5.00 IU/l) was registered compared with pretreatment levels, without changes in the FSH:LH ratio, and in other parameters studied. Although there were no changes in ultrasound characteristics on day 9 of GnRHa administration compared with basal findings, bleeding occurred 14-18 days after the last GnRHa dose in 32 patients. There were three pregnancies out of 20 infertile patients in the treated cycles.

Significant suppression of FSH and LH in PCOD patients does not interfere with ovarian steroid production, which is probably maintained due to higher follicular sensitivity to normal FSH and LH levels. Alternatively it may be the consequence of the unaltered FSH:LH ratio in spite of GnRHa-suppressed absolute values. However the recommencement of menstrual bleeding and 15% of pregnancies in the investigated infertile patients suggest the occurrence of certain temporary intraovarian events, which probably continue after the cessation of GnRHa administration.