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• W1972504613 abstract "ObjectiveThe clinical entity of polycystic ovarian syndrome (PCOS) coexisting with underlying hypothalamic amenorrhea (HA) has been formally described recently. We have previously reported in a pilot study (Dubourdieu et al, 2012), that pulsatile GnRH therapy was an effective and safe method of ovulation induction in this specific subgroup of infertile women, in comparison with gonadotropins treatment. The aim of this study was to confirm our preliminary results in a larger cohort of HA/PCOS women.DesignRetrospective cohort study.Materials and Methods50 women with secondary amenorrhea associated with weight loss due to low dietary intake and/or intensive physical exercise, and PCOS according to Rotterdam criteria were eligible. Forty four (88%) women had ovulation induction failure with clomiphene citrate and/or FSH alone and/or FSH+LH and/or hMG. Patients were treated with subcutaneous pulsatile GnRH therapy (one pulse, every 90 min, the starting dose of GnRH varying from 5 to 20 μg/pulse) for a total of 114 cycles. Ovulation was triggered with hCG when one follicle reached 17mm diameter, and all women had luteal phase support (hCG 1500 IU every 72 hours, 3 times).ResultsMean GnRH starting dose for the first cycle was 13.7 ± 3.7 μg/pulse. Ovarian response was adequate (mono or bifollicular) in 89.5% (n=102 ovulatory cycles). Biochemical pregnancy rate was 38.6% per started cycle (n=44) and 43% per ovulatory cycle. Ongoing pregnancy rate was 35% per started cycle (n=40) and 39.2% per ovulatory cycle. On average, 1.7 ± 0.9 cycles were necessary to obtain a biochemical pregnancy. We reported only one twin pregnancy (twin pregnancy rate 2.5%).ConclusionOur results confirm the efficacy and the safety of pulsatile GnRH therapy for ovulation induction in HA/PCOS women, with low multiple pregnancy rate, and suggest that it could be proposed to this specific subgroup of patients as a second line treatment in case of ovulation induction failure with CC and/or gonadotropins. ObjectiveThe clinical entity of polycystic ovarian syndrome (PCOS) coexisting with underlying hypothalamic amenorrhea (HA) has been formally described recently. We have previously reported in a pilot study (Dubourdieu et al, 2012), that pulsatile GnRH therapy was an effective and safe method of ovulation induction in this specific subgroup of infertile women, in comparison with gonadotropins treatment. The aim of this study was to confirm our preliminary results in a larger cohort of HA/PCOS women. The clinical entity of polycystic ovarian syndrome (PCOS) coexisting with underlying hypothalamic amenorrhea (HA) has been formally described recently. We have previously reported in a pilot study (Dubourdieu et al, 2012), that pulsatile GnRH therapy was an effective and safe method of ovulation induction in this specific subgroup of infertile women, in comparison with gonadotropins treatment. The aim of this study was to confirm our preliminary results in a larger cohort of HA/PCOS women. DesignRetrospective cohort study. Retrospective cohort study. Materials and Methods50 women with secondary amenorrhea associated with weight loss due to low dietary intake and/or intensive physical exercise, and PCOS according to Rotterdam criteria were eligible. Forty four (88%) women had ovulation induction failure with clomiphene citrate and/or FSH alone and/or FSH+LH and/or hMG. Patients were treated with subcutaneous pulsatile GnRH therapy (one pulse, every 90 min, the starting dose of GnRH varying from 5 to 20 μg/pulse) for a total of 114 cycles. Ovulation was triggered with hCG when one follicle reached 17mm diameter, and all women had luteal phase support (hCG 1500 IU every 72 hours, 3 times). 50 women with secondary amenorrhea associated with weight loss due to low dietary intake and/or intensive physical exercise, and PCOS according to Rotterdam criteria were eligible. Forty four (88%) women had ovulation induction failure with clomiphene citrate and/or FSH alone and/or FSH+LH and/or hMG. Patients were treated with subcutaneous pulsatile GnRH therapy (one pulse, every 90 min, the starting dose of GnRH varying from 5 to 20 μg/pulse) for a total of 114 cycles. Ovulation was triggered with hCG when one follicle reached 17mm diameter, and all women had luteal phase support (hCG 1500 IU every 72 hours, 3 times). ResultsMean GnRH starting dose for the first cycle was 13.7 ± 3.7 μg/pulse. Ovarian response was adequate (mono or bifollicular) in 89.5% (n=102 ovulatory cycles). Biochemical pregnancy rate was 38.6% per started cycle (n=44) and 43% per ovulatory cycle. Ongoing pregnancy rate was 35% per started cycle (n=40) and 39.2% per ovulatory cycle. On average, 1.7 ± 0.9 cycles were necessary to obtain a biochemical pregnancy. We reported only one twin pregnancy (twin pregnancy rate 2.5%). Mean GnRH starting dose for the first cycle was 13.7 ± 3.7 μg/pulse. Ovarian response was adequate (mono or bifollicular) in 89.5% (n=102 ovulatory cycles). Biochemical pregnancy rate was 38.6% per started cycle (n=44) and 43% per ovulatory cycle. Ongoing pregnancy rate was 35% per started cycle (n=40) and 39.2% per ovulatory cycle. On average, 1.7 ± 0.9 cycles were necessary to obtain a biochemical pregnancy. We reported only one twin pregnancy (twin pregnancy rate 2.5%). ConclusionOur results confirm the efficacy and the safety of pulsatile GnRH therapy for ovulation induction in HA/PCOS women, with low multiple pregnancy rate, and suggest that it could be proposed to this specific subgroup of patients as a second line treatment in case of ovulation induction failure with CC and/or gonadotropins. Our results confirm the efficacy and the safety of pulsatile GnRH therapy for ovulation induction in HA/PCOS women, with low multiple pregnancy rate, and suggest that it could be proposed to this specific subgroup of patients as a second line treatment in case of ovulation induction failure with CC and/or gonadotropins." @default.
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• W1972504613 title "Pulsatile GnRH therapy is an effective strategy for ovulation induction in women with hypothalamic amenorrhea and underlying polycystic ovary syndrome" @default.
• W1972504613 doi "https://doi.org/10.1016/j.fertnstert.2013.07.1128" @default.
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