Blunt S M, Butt W R
Solihull Hospital, West Midlands, UK.
Acta Endocrinol Suppl (Copenh). 1988;288:58-65.
Twenty-eight patients with hypogonadotropic hypogonadism resistant to clomiphene therapy were treated with pulsatile GnRH. All the patients ovulated and there were 20 pregnancies in 16 women. Administration of the GnRH sc was successful at inducing ovulation in 19 of 22 patients whereas the treatment was successful in all of the 17 patients treated iv. There was no difference between iv and sc therapy in the rate of ovulation. Treatment was stopped after ovulation and hCG given for luteal support. The follicular phase pulse frequency was usually 90 min. In one patient ovulation only occurred with frequencies of 60 min. Higher pulse doses were usually required with sc therapy for primary amenorrhoeic patients and for those with pituitary lesions. The additional use of clomiphene increased pituitary sensitivity to GnRH resulting in ovulatory cycles in patients refractory to treatment and in ovarian hyperstimulation in a normally responsive patient. Two of the 20 pregnancies were twin--the rest were singletons. None aborted. The median time to conception was 3 ovulatory cycles. Although there were no serious complications with iv or sc therapy, the iv route is now reserved for those patients unresponsive to sc treatment as the sc route is potentially safer and more acceptable to the patient. In correctly selected patients pulsatile GnRH is a highly effective and safe new treatment for the induction of ovulation.
28例对克罗米芬治疗抵抗的低促性腺激素性性腺功能减退患者接受了脉冲式GnRH治疗。所有患者均排卵，16名女性中有20次妊娠。皮下注射GnRH成功诱导22例患者中的19例排卵，而静脉注射治疗的17例患者全部成功。静脉注射和皮下注射治疗在排卵率上没有差异。排卵后停止治疗，并给予hCG进行黄体支持。卵泡期脉冲频率通常为90分钟。1例患者仅在60分钟的频率下排卵。对于原发性闭经患者和垂体病变患者，皮下注射治疗通常需要更高的脉冲剂量。额外使用克罗米芬可增加垂体对GnRH的敏感性，从而使难治性患者出现排卵周期，并使正常反应的患者发生卵巢过度刺激。20次妊娠中有2例为双胎，其余为单胎。无一例流产。受孕的中位时间为3个排卵周期。虽然静脉注射或皮下注射治疗没有严重并发症，但由于皮下注射途径可能更安全且患者更易接受，现在静脉注射途径仅用于对皮下注射治疗无反应的患者。在正确选择的患者中，脉冲式GnRH是一种诱导排卵的高效且安全的新疗法。
