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Obstetrics & Gynecology 1983;61:292-298
© 1983 by The American College of Obstetricians and Gynecologists
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Ovulation Induction and Conception Using Subcutaneous Pulsatile Luteinizing Hormone- Releasing Hormone

MACHELLE M. SEIBEL, MD, MICHAEL KAMRAVA, MD, COLIN McARDLE, MD and MELVIN L. TAYMOR, MD

From the Department of Obstetrics and Gynecology and the Charles A. Dana Biomedical Research Institute, Beth Israel Hospital; and the Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts

Abstract

Initial experiences with luteinizing hormone-releasing hormone for ovulation induction have been disappointing. The realization that endogenous luteinizing hormone-releasing hormone is released in a pulsatile fashion, however, has led to a renewal of interest using this method of administration. Three patients with hypothalamic amenorrhea were treated with luteinizing hormone-releasing hormone using a timed infusion syringe. The first two patients received 20 µg of luteinizing hormone-releasing hormone subcutaneously every two hours (240 µg/day) for 17 days. In both cases, a single preovulatory follicle was visualized on ultrasound on day 14 and disappeared on day 15. Luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone values were typical of an ovulatory cycle. The third patient received 12 ng of luteinizing hormone-releasing hormone every two hours (150 µg/day) for ten days and the follicle failed to develop fully. Increasing the dosage to 240 µg/day resulted in hormonal and ultrasonic evidence of ovulation. Luteal function was maintained in all cases with 2500 IU of human chorionic gonadotropin intramuscularly on days three, five, and eight after ovulation. The first two patients conceived, as evidenced by positive titers of |J subunit for human chorionic gonadotropin followed by a rise in the subsequent value. These data support the following conclusions: 1) Response to luteinizing hormone-releasing hormone appears to be dose-related; 2) subcutaneous administration of luteinizing hormone-releasing hormone is effective without the inherent risks or discomfort of intravenous catheters; 3) it is not necessary to administer luteinizing hormone-releasing hormone throughout the entire cycle and human chorionic gonadotropin may be given for luteal maintenance; 4) because pulsatile infusion of luteinizing hormone-releasing hormone works via an intact hypothalamic pituitary system, a luteinizing hormone surge can occur in the absence of an exogenous midcyle luteinizing hormone-releasing hormone surge; 5) the physiologic levels of gonadotropins resulting from ovulation induction with luteinizing hormone-releasing hormone may increase the chances that only a single preovulatory follicle will develop.






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Copyright © 1983 by the American College of Obstetricians and Gynecologists.