[Gonadotropin treatment in ovarian insufficiency, stimulation of follicle maturation with human urinary FSH].

Thirty-two infertile patients with basal FSH/LH ratios of less than 0.5 were treated with a pure human urinary FSH preparation in various doses, in 57 cycles. With initially low FSH doses and increase in the dose according to the individual reaction (analogous to hMG therapy) ovulation and a normal luteal phase were achieved in 22 out of 25 cycles, and 6 pregnancies. In one cycle there was a clinical overstimulation syndrome in early pregnancy. Treatment with high doses of FSH at the beginning of the cycle proved unsuitable: normal follicle stimulation, ovulation and luteal phase only occurred in 12 out of 23 cycles, and there was no pregnancy. The combination of FSH therapy with initially high doses and subsequent stimulation with hMG resulted in ovulation in 9 out of 10 cycles without ensuing pregnancy. The behaviour of the endogenous LH under FSH therapy varied: with an initially high dose of FSH there was a clear drop in serum LH concentrations in 8 out of 23 cycles, and with an initially low dose in 5 out of 25 cycles. In 5 cycles the serum LH concentrations rose under FSH therapy. The results of the investigation confirm earlier observations that ovarian stimulation with FSH is possible in cases with low endogenous FSH/LH ratios, and that it is best accomplished by individualized therapy with an initially low dose. However, because of the different reaction of endogenous LH secretion, a better ovarian reaction than with hMG therapy could not be achieved with regard to ovulation and pregnancy rate, course of the luteal phase and overstimulation.