[Hypogonadotropic form of amenorrhea. Principles of ovulation induction]

Analysis of the clinico-anamnestic and endocrine parameters of the reproductive system of 45 patients with hypogonadotropic amenorrhea helped single out three types of this condition. Drug doses and schemes of their administration to induce ovulation were selected individually with due consideration for the initial functional status of the reproductive system. The authors defined the basic principles of ovulation induction in patients with hypogonadotropic amenorrhea: the patients should be carefully selected according to WHO classification, with due regard for their clinico-anamnestic data and the function of the reproductive system (hormonal functional test); drug doses for substitution therapy and protocols of their administration should be selected individually, with consideration for the degree of hypophyseal-gonadal insufficiency; daily double (ultrasonic and hormonal) monitoring is needed for the correction of ovulation induction protocols; the choice of the optimal time of administration of the "ovulatory" dose should be based on the findings of double monitoring indicating follicle size 19-20 mm and the maximal activity of steroidogenesis (350 to 400 pmol/liter estradiol per follicle). The possibility of using lutrelef, an analog of gonadotropin releasing hormone, for ovulation induction in patients with the hypothalamic form of gonadotropic amenorrhea was studied. The drug was administered in a pulsed mode using Zykloma+ device (Ferring, Germany). The advantages of a physiological principle of substitution therapy were demonstrated, although the induction of cycles was not appreciably improved by this method as against substitution therapy with human menopausal gonadotropin.