One hundred pregnancies after treatment with pulsatile luteinising hormone releasing hormone to induce ovulation.

Abstract

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

Pregnancy and pituitary disorders

“…In hypopituitary patients, the pregnancy rate is reported as 47% and birth rate as 42% (263). The ovulation and conception rates are higher, and spontaneous miscarriage rates are lower in isolated hypogonadotropic hypogonadism (HH) cases (264). Uterine size is reported to be similar in HH and hypopituitarism (265).…”

Effect of Radiation on the Human Reproductive System

“…Although impaired GH secretion after a single fraction dose of 10 Gy has been reported in children (20), the elevated basal and GnRH stimulated gonadotropin levels in patients with gonadal damage following their TBI and preparative chemotherapy suggests that gonadotropin secretion is intact. Similarly, in adults who received 12 Gy TBI in six fractions over 2 days, there was ill no evidence of gonadotropin or any other pituitary hormone deficiency (21).…”

“…All patients suffered temporary laspermia beginning about 3 months after irradiation. Recovery of spermatogenesis was first noted between 10 and 18 months after irradiation in five patients.…”

“…Homburg et al (10) Littley et al (6) have shown that following radiotherapy for pituitary tumors Gy in 8-15 fractions over 10-22 days using linear accelerator equipment, 4 or 8 MeV), anterior pituitary hormone deficiency occurs in a welldefined order, with the growth hormone (GH) axis the most susceptible (Fig. 1).…”

“…Due to the radiosensitivity of spermatogonia, spermatocytes, and, ultimately, spermatids disappear from the testis after irradiation. The combined life span of spermatocytes and spermatids is about 46 days, and transport through the epididymis and vas deferens takes [4][5][6][7][8][9][10][11][12] days. Thus, during the first 50-60 days after low dose irradiation (1.5-2 Gy), sperm production remains above 50% of control values and then drops dramatically with resultant temporary oligo-or azoospermia.…”