Value of subcutaneous and intravenous pulsatile gonadotropin releasing hormone in polycystic ovary disease

Abstract

Nine patients with clomiphene-resistant polycystic ovary disease (PCOD) were treated with pulsatile gonadotropin releasing hormone (GnRH). The patients were started on subcutaneous (SC) GnRH. If they failed to ovulate on SC therapy, intravenous (IV) therapy was administered. Nine patients were treated for a total of 22 cycles; 13 were SC and 9, IV. There were nine ovulatory cycles (41%); four were SC (31%) and five, IV (56%). Two conceptions occurred, both among the IV cycles. One conception was a singleton; the infant was delivered uneventfully at term. The second conception was quadruplets, with the delivery of four healthy infants at 36 weeks. These data suggest that ovulation and conception in clomiphene-resistant PCOD patients using pulsatile GnRH are more likely to occur after IV than SC administration. However, the overall pregnancy rate was not greater than with gonadotropin treatment, and the risk of multiple births after IV administration is potentially high.