Recently, induction of a transient hypogonadotropic state with synthetic steroids or GnRH agonist(Gonadotropin releasing hormone-agonist) has been suggested to synchronize follicular development and to improve estradiol response to controlled
ovarian
hyperstimulation(COH) in PCOS(polycystic ovary syndrome) patients.
PCOS patients were defined on the basis of the sonographic criteria and menstrual irregularities or basal serum luteinizing hormone(LH)level more than 8 mIU/mL.
The objective of this study was to evaluate the effect of combined application with oral contraceptives(OCs) and GnRH-agonist on endogenous gonadotropin suppression preceded induction of follicular stimulation. From January, 1994 to June, 1995,
this
study was carried out with 35 PCOS patients. Seventeen patients(study group, 22 cycles) were daily administered 1 pill(ethinyl estradiol 0.03mg+gestodene 0.075gm) of OCs beginning on the third day of menstrual cycle during 21 days followed by
subcutaneous GnRH-agonist(Decapeptyl) 0.1mg/day, overlapping with the final three days of OCs administration before COH cycle, and then human menopausal gonadotropin(hMG)/follicle-stimulation hormone(FSH)(2 ampoules per day) was started on the
third day
of withdrawal bleeding, atwhich point the dose of Decapeptyl was decreased to 0.05mg/day. Eighteen patients(control group, 28cycles) were administered subcutaneous Decapeptyl 0.1mg/day from day 21 of menstrual cycle and hMG/FSH was started same
day
as
study group. Both group were injected 10,000IU of hCG(human chorionic gonadotropin) for triggering the final stage of follicular maturation and ovulation induction.
The results were as follows: There were no significant differences in fertilization rate and pregnancy rate in the study group compared with the control group(46.3% vs. 45.2% and 36.3% vs 32.1%). Howere, after correction of menstrual cycle
variability,
in the case of menstrual cycle length than 35 days, we had observed some differences of pregnancy rate in the study group compared with the control group(44.4% vs. 29.1%).
In conclusion, pituitary suppression with the combination of OCs and GnRH-agonist can be used as a treatment for PCOS patients with high serum LH levels and menstrual irregularities to prevent spontaneous LH surges and to improve clinical
outcomes.
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