Induzione dell’ovulazione con GnRH pulsatile in donne affette da amenorrea ipotalamica

Abstract

Ovulation and pregnancy rates following follicular maturation by administration of pulsatile gonadotrophin-releasing hormone (GnRH) were studied in women with hypothalamic amenorrhea (HA). Nine patients were treated for a total of 32 cycles. Pulse of GnRH was administered at a dose of 20 µg/90 min during the follicular phase and 20 µg/120 min after ovulation for up to 5 days . Follicular growth was monitored using estradiol (E2), progesterone (P), luteinizing hormone (LH) assays and vaginal echography. Ovulation was confirmed by E2 level > 0.8 nmol/l, a follicle diameter ≥20 mm and a LH peak. The couples were proposed to have sexual intercourses during the next days; after several unsuccesful cycles some patients were inseminated with washed sperm. Ovulation occurred in 24/32 cycles (75.0%); seven pregnancies (29.1%) were achieved and five full term deliveries (5/7=57.3%). In conclusion, HA patients treated with a 20 µg pulse dose reach ovulation in 75.0% of the cycles.Compared to lower pulse doses, the stimulation length is reduced without leading to either multiple pregnancies or ovarian hyperstimulation syndrome (OHSS)