Induction of ovulation by prolonged pulsatile administration of luteinizing hormone releasing hormone (LRH) in patients with clomiphene resistant polycystic ovary-like disease

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Abstract
Induction of ovulation with pulsatile administration of LHRH by automatic portable infusion pump for 74 and 147 consecutive days in 2 patients with clomiphene-resistant PCO[polycystic ovary]-like disease is described. The patients exhibited 6 ovulatory cycles. One patient conceived during the 4th cycle. During the treatment a unilocular cyst, probably a lutein cyst, developed in 1 patient, but subsequently disappeared spontaneously under uninterrupted therapy. No chemical hyperstimulation was observed. Follicular phases lasted for 32 and 13 days in patient I and for 19, 25, 14 and 22 days in patient II. Luteal phases lasted for 16 and 15 days in patient I and for 17, 18 and 15 days, respectively, in patient II. Total urinary estrogen and pregnanediol excretion did not differ from that seen in normal cycles. LH [luteinizing hormone] baseline and peak values and LH responses declined to normal levels accompanied by a normalization of the LH/FSH ratio during pulsatile LHRH treatment in both patients. The first pre-ovulatory episode occurred already after partial normalization of the LH/FSH ratio. The endocrinology of the 2nd LHRH induced cycles of patients I and II was not different from cycles similarly induced in hypogonadotropic patients. Ovulation induction with pulsatile LHRH administration in patients with clomiphene-resistant PCO-like disease is possible. This mode of treatment may not only be effective, but may prove to be safer than ovulation induction with menopausal gonadotropins in patients with clomiphene-resistant PCO-like disease.