Kesrouani A, Abdallah M A, Attieh E, Abboud J, Atallah D, Makhoul C
Department of Obstetrics and Gynecology, Hotel Dieu de France University Hospital, Paris, France.
J Reprod Med. 2001 Jan;46(1):23-8.
To assess the effectiveness of a protocol of pulsatile gonadotropin releasing-hormone (GnRH) in treating infertility in women with primary hypothalamic amenorrhea.
Retrospective analysis of 44 cycles treated at an infertility center. Twenty-four patients with primary hypothalamic amenorrhea were treated intravenously with pulsatile GnRH using 5 micrograms per bolus every 90 minutes. Ultrasound monitoring and cervical assessment by Insler's scoring system allowed timed injection of human chorionic gonadotropin (hCG) and intrauterine insemination if needed. Luteal support was provided with hCG.
The ovulation rate was 95% with the 5-microgram dose. A single follicle was produced in 91% of cycles. The overall pregnancy rate per ovulatory cycle was 45%, and the pregnancy rate per patient was 83%. In patients treated previously with exogenous gonadotropins, poor results were observed. Only one case of mild overstimulation was reported.
Pulsatile GnRH is an effective and safe method of treating infertility in women with primary hypothalamic amenorrhea, thus simulating normal ovulation; however, more-interventional management, including the qualitative estrogenic response, may lead to optimal results and increase the pregnancy rate.
评估脉冲式促性腺激素释放激素（GnRH）方案治疗原发性下丘脑性闭经女性不孕症的有效性。
对一家不孕症中心治疗的44个周期进行回顾性分析。24例原发性下丘脑性闭经患者每90分钟静脉注射5微克脉冲式GnRH。通过超声监测和Insler评分系统进行宫颈评估，必要时可定时注射人绒毛膜促性腺激素（hCG）并进行宫内人工授精。使用hCG进行黄体支持。
5微克剂量时排卵率为95%。91%的周期产生单个卵泡。每个排卵周期的总体妊娠率为45%，每位患者的妊娠率为83%。在先前接受外源性促性腺激素治疗的患者中，观察到效果不佳。仅报告1例轻度过度刺激病例。
脉冲式GnRH是治疗原发性下丘脑性闭经女性不孕症的一种有效且安全的方法，可模拟正常排卵；然而，更多的干预性管理，包括定性雌激素反应，可能会带来最佳效果并提高妊娠率。
