| Popis: |
Chronic intermittent intravenous administration of 13 micrograms LHRH every 88 minutes for 28 days, was successful in inducing ovulation in two patients with 3a type secondary hypothalamic amenorrhoea. A catheter phlebitis was the only side effect of the treatment and it could be easily prevented by more flexible, thin venous catheters. The minimum laboratory need for monitoring the treatment, and the absence of hyperstimulation of the ovaries suggested the superiority of this substance to hMG for ovulation induction in clomiphene negative patients.Pulsatile LHRH administration is a practical approach for ovulation induction in clomiphene resistant patients with hypothalamic amenorrhea. LHRH (synthetic GnRH) is used to differentiate various types of secondary amenorrhea of functional origin. Immature (3c), prepubertal (3b), and adult (3a) amenorrheas have been differentiated by the negative gestagen test. 2 features make GnRH useful in ovulation induction: its ability to exert a self-priming function, thereby enhancing LH and FSH release, and its ability to modulate pituitary responsiveness and prevent ovarian hyperstimulation. 2 patients with hypothalamic amenorrhea were given LHRH administered intravenously, in a chronic pulsatile fashion. A portable computerized infusion pump, activated once every 88 minutes, delivered 13 mc of LHRH solution via an indwelling antecubital catheter. Blood samples were drawn daily or every other day, and plasma, LH, FSH, E2, and progesterone were measured by radioimmunoassay. Basal body temperature was also monitored. E2, LH, and FSH levels verified ovulation, and progesterone values showed normal corpus luteum function. Both patients showed a biphasic pattern of basal body temperature. Catheter phlebitis was the only side effect, which could be prevented by using a thinner, flexible catheter. The benefits of LHRH administration for ovulation induction are: no ovarian hyperstimulation; minimum laboratory monitoring requirements; and only the basal body temperature must be registered. These benefits suggest the superiority of LHRH administration over hMG administration for ovulation induction in clomiphene-resistant, normoadrenergic patients. |
