Multiple follicular growth under pulsatile gonadotrophin releasing hormone stimulation.

Pulsatile gonadotrophin releasing hormone (GnRH) treatment in patients with secondary hypothalamic amenorrhoea results in higher multiple pregnancy rates than expected. This multiple pregnancy rate is significantly higher when conception occurs during the first treatment cycle and when higher pulse doses are used. This is probably due to higher follicle stimulating hormone (FSH) levels, leading to multiple follicular growth. The endocrinology of pulsatile i.v. GnRH treatment cycles in patients with hypothalamic amenorrhoea as well as in patients with normal cycles revealed higher FSH levels during the first days of treatment compared with unstimulated control cycles. It was possible to induce multiple follicular growth in normally cycling women with pulsatile GnRH. To prevent multiple pregnancies in patients with hypothalamic amenorrhoea, a low pulse dose should be used, especially during the first treatment cycles.