Hager Marlene, Patsch Antonella, Thieme Sophie Luise, Robin Geoffroy, Dewailly Didier, Ott Johannes
Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
Gynecol Endocrinol. 2025 Dec;41(1):2495604. doi: 10.1080/09513590.2025.2495604. Epub 2025 Apr 28.
Nearly 50% of women with functional hypothalamic amenorrhea (FHA) reveal polycystic ovarian morphology (PCOM), a known risk factor for ovarian hyperstimulation syndrome. However, gonadotropin releasing hormone-agonist (GnRH-a) triggers are not recommended in FHA, since an inadequate endogenous surge in luteinizing hormone (LH) is expected. We aimed to challenge this concept and evaluated LH levels after GnRH stimulation in FHA-women with and without PCOM. In a retrospective cohort study, 82 women with FHA, who underwent a GnRH stimulation test, were included. Thirty-five women revealed PCOM (42.7%). Twenty minutes after GnRH stimulation, there was an increase of serum LH levels in FHA-PCOM (median basal: 2.7 mIU/mL, IQR 1.1-4.6 versus median stimulated: 13.5 mIU/mL, IQR 7.8-21.6, 0.001) and in FHA-nonPCOM patients (median basal: 2.5 mIU/mL, IQR 0.5-3.9 versus median stimulated: 5.7 mIU/mL, IQR 2.4-13.9, 0.001). Overall, positive correlations ( 0.001) were found between basal and stimulated LH levels. In FHA-PCOM patients, 42.9% of patients revealed stimulated LH levels >15 mIU/mL, while this was the case in 19.1% of FHA-nonPCOM patients ( 0.034). In women with FHA-PCOM, ovulation induction with a GnRH-a trigger might be feasible. Future research should focus on the prediction of an adequate response to GnRH triggers in the IVF setting.
近50%的功能性下丘脑性闭经（FHA）女性呈现多囊卵巢形态（PCOM），这是卵巢过度刺激综合征的一个已知风险因素。然而，FHA患者不建议使用促性腺激素释放激素激动剂（GnRH-a）扳机，因为预计黄体生成素（LH）的内源性峰值不足。我们旨在挑战这一概念，并评估了有或无PCOM的FHA女性在GnRH刺激后的LH水平。在一项回顾性队列研究中，纳入了82例接受GnRH刺激试验的FHA女性。35例女性呈现PCOM（42.7%）。GnRH刺激后20分钟，FHA-PCOM患者（基础值中位数：2.7 mIU/mL，四分位数间距1.1 - 4.6，刺激后中位数：13.5 mIU/mL，四分位数间距7.8 - 21.6，P<0.001）和FHA-非PCOM患者（基础值中位数：2.5 mIU/mL，四分位数间距0.5 - 3.9，刺激后中位数：5.7 mIU/mL，四分位数间距2.4 - 13.9, P<0.001）的血清LH水平均升高。总体而言，基础和刺激后的LH水平之间存在正相关（P<0.001）。在FHA-PCOM患者中，42.9%的患者刺激后的LH水平>15 mIU/mL，而在FHA-非PCOM患者中这一比例为19.1%（P = 0.034）。对于FHA-PCOM女性，使用GnRH-a扳机进行促排卵可能是可行的。未来的研究应聚焦于预测体外受精（IVF）环境下对GnRH扳机的充分反应。
