Pulsatile luteinizing hormone secretion and clomiphene and bromocriptine response in amenorrheic women with normoprolactinemia and gestagen withdrawal bleeding.

This study was carried out to determine whether the ovulatory response with clomiphene citrate and bromocriptine in 20 amenorrheic women with normoprolactinemia and gestagen withdrawal bleeding is influenced by the pretreatment pattern of pulsatile luteinizing hormone (LH) secretion. Two patients who had no LH pulse for 3-5 h failed to respond to clomiphene. One of them was treated with bromocriptine, but ovulation did not occur. Eleven of 12 patients who had one or more LH pulses and LH pulse/h ratios of less than 1 for 3-5 h ovulated with clomiphene. One clomiphene nonresponsive patient ovulated with combined therapy of bromocriptine and clomiphene. All 6 patients who had LH pulse/h ratios of greater than or equal to 1 for 3-5 h failed to ovulate with clomiphene. Three of them were treated with bromocriptine. Two of 3 patients ovulated with bromocriptine alone and 1 ovulated with combined therapy of bromocriptine and clomiphene. These results suggest that the pretreatment pattern of pulsatile LH secretion may predict the clinical response to clomiphene and bromocriptine treatment in amenorrheic women with normoprolactinemia and gestagen withdrawal bleeding.