Pulsatile low dose luteinizing hormone-releasing hormone treatment for induction of follicular maturation and ovulation in women with amenorrhoea

Abstract

Abstract. Chronic intermittent low dose luteinizing hormone-releasing hormone (LRH) therapy was given to 7 normoprolactinaemic women with long-standing secondary amenorrhoea, low-normal gonadotrophin levels and low endogenous oestrogen production (WHO group I). Four of them were involuntarily infertile. A portable, computerized infusion pump (Zyklomat, Ferring) delivered 20 μg LRH every 90 min through a chronic indwelling catheter inserted sc in the fat tissue of the lower abdominal wall. The LRH administration was continued until menstruation or pregnancy. Nine treatment courses over 21 to 69 days were given. Twelve ovulatory cycles were induced by the pulsatile LRH treatment. The corpus luteum function was normal in 7 cycles. Temporary interruptions of the pump function in 2 patients and haematomas at the catheter site in another 2 patients may have caused the luteal phase insufficiency. One of the 4 infertile women became pregnant. She developed ovarian hyperstimulation during her first treatment cycle. The ovarian enlargement regressed despite continued LRH therapy and a second ovulatory cycle was induced. Thus, pulsatile administration of low doses of LRH can induce follicular maturation, ovulation and normal corpus luteum function in hypo- or normogonadotrophic women with secondary amenorrhoea with low endogenous oestrogen production. The LRH therapy can be given with the same pulse frequency throughout the induced cycle. Should pregnancy not occur the pulsatile LRH treatment can be continued without interruption to induce a second ovulatory cycle.