LHRH treatment of hypothalamic amenorrhoea
Guoth, J.; Zsolnai, B.
Acta Medica Hungarica 43(2): 223-228
1986
ISSN/ISBN: 0236-5286 PMID: 3295744 Document Number: 356692
Pulsatile LHRH administration is a practical approach for ovulation induction in clomiphene resistant patients with hypothalamic amenorrhea. LHRH (synthetic GnRH) is used to differentiate various types of secondary amenorrhea of functional origin. Immature (3c), prepubertal (3b), and adult (3a) amenorrheas have been differentiated by the negative gestagen test. 2 features make GnRH useful in ovulation induction: its ability to exert a self-priming function, thereby enhancing LH and FSH release, and its ability to modulate pituitary responsiveness and prevent ovarian hyperstimulation. 2 patients with hypothalamic amenorrhea were given LHRH administered intravenously, in a chronic pulsatile fashion. A portable computerized infusion pump, activated once every 88 minutes, delivered 13 mc of LHRH solution via an indwelling antecubital catheter. Blood samples were drawn daily or every other day, and plasma, LH, FSH, E2, and progesterone were measured by radioimmunoassay. Basal body temperature was also monitored. E2, LH, and FSH levels verified ovulation, and progesterone values showed normal corpus luteum function. Both patients showed a biphasic pattern of basal body temperature. Catheter phlebitis was the only side effect, which could be prevented by using a thinner, flexible catheter. The benefits of LHRH administration for ovulation induction are: no ovarian hyperstimulation; minimum laboratory monitoring requirements; and only the basal body temperature must be registered. These benefits suggest the superiority of LHRH administration over hMG administration for ovulation induction in clomiphene-resistant, normoadrenergic patients.