repaired or not, does not preclude patients from holding an ordinary driving licence." Possibly this statement should be extended to include suggestions relating to screening of patients of the relevant age group and sex to identify such high risk disease.

The addition of biosynthetic human growth hormone (GH) to treatment with human menopausal gonadotrophin (hMG) significantly augmented the ovarian response in four patients treated for in-vivo and three patients treated for in-vitro fertilization who had previously been resistant to hMG. The amount, duration of treatment and daily effective dose of hMG were all reduced by growth hormone. This action of growth hormone offers a new approach to ovulation induction.

Objective-To review treatment with pulsatile luteinising hormone Measurements and main results-One hundred pregnancies (seven multiple, 28 miscarriages). Cumulative rates of pregnancy were 93-100% at six months in women with idiopathic hypogonadotrophic hypogonadism, amenorrhoea related to low weight, and organic pituitary disease. In women with polycystic ovaries (cumulative rate of pregnancy 74%) adverse prognostic factors were obesity, hyperandrogenism, and high luteinising hormone concentrations, which were also associated with a high rate of early pregnancy loss.Conclusions-Treatment with pulsatile luteinising hormone releasing hormone is safe, simple, and effective, and the preferred method of inducing ovulation in appropriately selected patients. Compared with exogenous gonadotrophin treatment there is little need for monitoring, no danger of hyperstimulation, and a low rate of multiple pregnancies. IntroductionRestoring ovulation in women in whom failure to ovulate is the sole cause of infertility yields a fertility rate similar to that in normal women.' The ideal ovulatory treatment for in vivo fertilisation should produce unifollicular ovulation as efficiently as possible while avoiding hyperstimulation, multiple pregnancies, and undue inconvenience to the patient. The choice of treatment depends on the underlying cause of the failure to ovulate.Since the first reports that treatment with pulsatile luteinising hormone releasing hormone could result in ovulation and pregnancy in women with hypogonadotrophic hypogonadism in whom antioestrogen treatment had failed' we have used it as an

repaired or not, does not preclude patients from holding an ordinary driving licence." Possibly this statement should be extended to include suggestions relating to screening of patients of the relevant age group and sex to identify such high risk disease.