[Critical evaluation of clinical and hormonal parameters for the optimal timing of induction of ovulation with gonadotropins (author's transl)].

In 9 hypogonadotrophic, normoprolactinemic women with primary or secondary amenorrhea, who were infertile, 16 treatment cycles with menopausal gonadotropin and chorionic gonadotropin (HMG-HCG) were carried out. Nine treatment cycles were monitored indirectly with the cervical factor and hormonal cytology. The concomitant serum estradiol and progesterone values were later determined by radioimmunoassays. The other 7 treatment cycles were monitored by daily serum estradiol determinations. There were 4 pregnancies. Successful induction of ovulation with subsequent pregnancies was only obtained in the treatment cycles monitored by serum estradiol determinations (pregnancy rate 60%). Classical signs of overstimulation with ascites and hydrothorax occurred twice in treatment cycles which were monitored by clinical means only. Neither the maturation index nor the cervical factor reflected a quantitative overstimulation of the ovaries. The daily radioimmunological determination of estradiol prevented overstimulation of the ovaries, and permitted optimal timing of the induction of ovulation with HCG. In our experience, the maturation index determined from vaginal cytology and the clinical determination of the cervical factor are inappropriate parameters to monitor individually a successful induction of ovulation with HMG-HCG.