Hypothalamic Hypogonadism: Induction of Ovulation and Pregnancy by Subcutaneous Pulsatile Injections of Gonadotrophin-Releasing Hormone

Abstract

5 female patients with isolated hypothalamic hypogonadism were given subcutaneous pulses of gonadotrophin-releasing hormone (GnRH), 2.5–15 µg every 90 min, for 2–6 months by means of an automated pump. This treatment produced an increase in serum LH, FSH, and estradiol levels in 4 patients, all of whom became pregnant. The estradiol levels failed to rise in 1 patient, in spite of an adequate LH and FSH response, and a subsequent biopsy showed evidence of primary ovarian failure in addition to the hypothalamic deficit. We conclude that subcutaneous pulsatile GnRH administration is a simple, safe, and relatively inexpensive way to induce ovulation in patients with hypothalamic hypogonadism.

Male Hypothalamic Hypogonadism: Induction of Spermatogenesis by Subcutaneous Pulsatile Gonadotrophin-Releasing Hormone

“…In addition, we estimate that the weekly cost of the average dose of GnRH (18 pg/pulse) was approxi mately the same as that for starting doses of more conventional treatment with hCG and Pergonal. Although 80% of woman treated with subcutaneous pulsatile GnRH will ovu late [10], spermatogenesis occurs in half [4] or less [5] of the male patients treated. Our results, using a slightly different regimen, are very similar.…”

“…When fertility is desired, both hCG and human menopausal gonadotrophin (Pergonal) injections are used [9], The replacement of the presumed missing GnRH for these patients is in theory more physiological and should improve chances of fertility. Pulsatile GnRH therapy is effective in inducing ovulation in women with the same disorder [10].…”