COMPARISON OF PULSATILE GNRH AND HUMAN GONADOTROPINS (HMG+HCG) FOR THE TREATMENT OF INFERTILITY IN HYPOGONADOTROPIC HYPOGONADIC WOMEN (17-YEAR EXPERIENCE)

This study was undertaken to compare the outcomes of treating hypogonadotropic hypogonadic women with pulsatile GnRH and gonadotropins (HMG + HCG) and to evaluate severity-dependent factors (FSH-LH, estradiol and and puberty level) on the results. The existing data about the outcomes of infertility treatment with pulsatile GnRH or gonadotropins was reviewed in 66 hypogonadotropic hypogonadic women during 1985-2002. Cases with other causes of amenorrhea were excluded from the study and then after approving the diagnosis via clinical and paraclinical criteria, the patients were treated with one of the methods non-randomly. Patients received 12-65 vials of (75unit/vial) HMG or pulsatile GnRH (20mg/2hr for 14-20 days in each cycle). Drug prescription was continued until follicular diameter reached 18mm, and then secretory phase was supported by HCG. The overall pregnancy rate in hypogonadotropic hypogonadic women was 69.7% per woman (17.2% per cycle). The rate of pregnancy was 17.9% per cycle in HMG treated cases and 15.5% per cycle in pulsatile-GnRH treated cases. Basic levels of FSH, LH and estrogen, which were abnormally low in all patients, were not significant related to the outcome of the treatment. The proportion of multiple pregnancies after pulsatile GnRH was significantly lower than that of gonadotropins (P = 0.03). The incidence of severe ovarian hyperstimulation was zero and 3 percent after pulsatile GnRH and HMG-therapy respectively which showed no significant difference. Thus, it can be concluded that the success of the treatment after both methods was relatively high, but the pulsatile GnRH treatment is associated with milder ovarian stimulation.