Long Term Low Dose Pulsatile Luteinizing Hormone Releasing Hormone Therapy for the Treatment of Anovulatory Infertility

Abstract

Twenty‐seven women who had clomiphene‐resistant anovulation as the only cause of infertility were studied. They were divided into 2 groups on the basis of pre‐treatment endocrine and ultrasound assessment: hypogonadotropic hypogonadism (HH) (N=6) and polycystic ovarian disease (PCOD) (N=21). They were administered pulsatile luteinizing hormone releasing hormone (LHRH) therapy using miniaturized portable infusion pumps at a constant dose 15 ug per pulse every 90 minutes. The patients with HH were treated for a total of 31 cycles and 4 pregnancies were obtained. Twenty‐eight out of 31 cycles of therapy were ovulatory. The patients with PCOD were treated for a total of 65 cycles and, of these, 40 cycles were ovulatory. Ten patients became pregnant. When the patients with PCOD who ovulated were compared with those who failed to ovulate, it was found that the only predictor of successful therapy was the ponderal or body mass index. The mean ponderal index of those who ovulated was 22.20±2.62 (±SD) compared with 26.01±0.81 (±SD) for those who remained anovulatory. We conclude that pulsatile LHRH therapy is efficacious therapy for patients with HH but not as effective for patients with PCOD. In the latter group the ponderal index predicts for the likelihood of successful response to therapy.