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December 2, 1983

Pulsatile Administration of Low-Dose Gonadotropin-Releasing Hormone: Ovulation and Pregnancy in Women With Hypothalamic Amenorrhea

Author Affiliations

From the Department of Reproductive Medicine, School of Medicine, University of California, San Diego, La Jolla. Dr Miller is now with Stanford (Calif) University Medical Center. Dr Reid is now with the Division of Reproductive Endocrinology and Infertility, Etherington Hall, Queen's University, Kingston, Ontario. Drs Miller and Reid are former fellows in the Division of Reproductive Endocrinology and Infertility. Dr Cetel is a fellow in the Division of Reproductive Endocrinology and Infertility. Dr Yen is a Senior Clayton Foundation Investigator.

JAMA. 1983;250(21):2937-2941. doi:10.1001/jama.1983.03340210035021

We administered pulsatile low doses of gonadotropin-releasing hormone (GnRH) (1 to 5 μg) to patients whose anovulation was caused by relative and absolute deficiency of endogenous GnRH. Eight such patients, including one with previous pituitary stalk transection, were treated during a total of 23 cycles; pulses of GnRH were administered via a portable pump every 96 or 120 minutes. Activation of pituitary-ovarian function with orderly development of a single dominant follicle, a luteinizing hormone surge, and ovulation occurred in 20 of the 23 cycles. The other three cycles were anovulatory. All patients responded, and five (62%) of the eight conceived, for a total of seven pregnancies and four full-term deliveries of normal infants. This study demonstrates that small pulsatile doses of GnRH can activate cyclic pituitary-ovarian function in hypogonadotropin-acyclic women and induce ovulation resulting in pregnancy and live birth.

(JAMA 1983;250:2937-2941)