LHRH in treatment of chronic anovulation: effectiveness and limit.

To date pulsatile i.v. administration of LH-RH represents a new kind of ovulation induction with advantages in terms of costs, patient compliance and low risk of ovarian hyperstimulation. Many data show that this treatment is highly effective in the therapy of chronic anovulation due to hypothalamic failure but is scarcely effective in women with PCOD. 38 women with hypothalamic amenorrhoea, 13 women with chronic unexplained anovulation and 10 women with PCOD were treated by pulsatile i.v. administration of LH-RH, by means of infusion pump. The dose per pulse was chosen on the basis of the severity of the amenorrhoea and was either left unvaried or increased after 7-10 days of treatment as related to the ovarian response evaluated by estradiol levels and follicular diameters. The treatment was discontinued once ovulation was obtained and luteal function was supported by HCG. This personalized approach allowed us to contain the length of the follicular phase within physiological limits; a high ovulatory rate in the amenorrhoic women (92%) and in the women with unexplained anovulation (100%) was obtained, but very low in the PCOD group (10%). Immunoactive LH (RIA) and bioactive LH (RICT) plasma levels before treatment were evaluated. In comparison to eumenorrhoic women the bioactive-immunoactive ratios (B/I) were lower in the first and second group of patients, but higher in the third group. The B/I ratio, evaluated in 5 women with hypothalamic amenorrhea in the late follicular phase, during LH-RH treatment, increased to normal range. In women with a low B/I ratio before therapy a good ovulation rate was obtained by means of LH-RH treatment and our preliminary results suggest that the evaluation of bioactive LH before therapy could be a useful marker to predict the responsiveness of anovulatory women to LH-RH treatment.