Comparison between pulsatile GnRH therapy and gonadotropins for ovulation induction in women with both functional hypothalamic amenorrhea and polycystic ovarian morphology

Abstract

Context: Ovulation induction in patients having both functional hypothalamic amenorrhea (FHA) and polycystic ovarian morphology (PCOM) has been less studied in the literature. As results remain contradictory, no recommendations have yet been established.

Objective: To compare pulsatile GnRH therapy versus gonadotropins for ovulation induction in “FHA-PCOM” patients and to determine if one treatment strikes as superior to the other.

Methods: A 12-year retrospective study, comparing 55 “FHA-PCOM” patients, treated either with GnRH therapy (38 patients, 93 cycles) or with gonadotropins (17 patients, 53 cycles).

Results: Both groups were similar, defined by low serum LH and E2 levels, low BMI, excessive follicle number per ovary and/or high serum AMH level. Ovulation rates were significantly lower with gonadotropins (56.6% versus 78.6%, p = 0.005), with more cancellation and ovarian hyper-responses (14% versus 34% per initiated cycle, p < 0.005). Pregnancy rates were significantly higher with GnRH therapy, whether per initiated cycle (26.9% versus 7.6%, p = 0.005) or per patient (65.8% versus 23.5%, p = 0.007).

Conclusion: In our study, GnRH therapy was more successful and safer than gonadotropins, for ovulation induction in “FHA-PCOM” patients. If results were confirmed by prospective studies, it could become a first-line treatment for this population, just as it is for FHA women without PCOM.

Chinese abstract

背景: 同时患有功能性下丘脑闭经 (FHA) 和多囊样卵巢 (PCOM) 的患者促排卵相关研究较为少见。结果尚存在争议, 因此没有相应建议的建立。

目的: 对比脉冲式GnRH治疗与促性腺激素对于”FHA-PCOM”患者促排卵的效果, 确定哪种治疗方法更优。

方法: 一项为期12年的回顾性研究, 对比55例”FHA-PCOM”患者, 促排卵方案为GnRH治疗 (38例, 93个周期) 或促性腺激素 (17例, 53个周期) 。

结果: 两组具有相似的血清低LH水平和E2水平、低BMI, 每侧卵巢卵泡数过多和/或高AMH水平。使用促性腺激素表现为明显更低的排卵率 (56.6% versus 78.6%, p = 0.005) 、更多的弃用以及卵巢高反应 (每个启动周期14% versus 34%, p < 0.005) 。GnRH治疗组的妊娠率显著更高, 无论是每个启动周期 (26.9% versus 7.6%, p = 0.005) 还是每个患者 (65.8% versus 23.5%, p = 0.007) 。

结论: 本研究发现, 在”FHA-PCOM”患者的促排卵治疗中, GnRH的有效性和安全性均高于促性腺激素。如果本结果被前瞻性研究证实, 有望成为该类患者的一线治疗方案, 正如不伴随PCOM的FHA患者的治疗方案。

Keywords:

• Functional hypothalamic amenorrhea
• gonadotropins
• polycystic ovarian morphology
• pregnancy
• pulsatile GnRH therapy

Acknowledgements

The authors thank Sharon Tetlow for assistance in language corrections.

Disclosure of interest

The authors report no conflicts of interest.