Summary of Studies Evaluating Gonadotropins in WHO 1 Patients
Summary of Results of the Only Published Study Comparing Gonadotropins and Pulsatile GnRH in WHO 1 Patients
Discussion
Based on the available literature, it seems that in case of WHO 1 anovulation both pulsatile GnRH and gonadotropin treatment are highly effective with some indication that the physiological pulsatile GnRH is slightly more effective with a lower risk for multiple pregnancy, carries a very low risk for OHSS, allows easy monitoring, and has a low patient burden. Intuitively, it may be more costly, but formal cost-effectiveness studies comparing all mentioned aspects are not available.
Summary
In the clinical practice of ovulation induction, pulsatile treatment with GnRH is of great value in patients with firmly established hypothalamic amenorrhea with cumulative pregnancy rates up to 90% after 12 cycles and should be considered as first choice when the adequate special care that it requires is available. When not available in concert with patient preference, referral to a well-equipped center or ovulation induction with chronic low-dose step-up gonadotropins are the alternative treatment modalities.
Level of Evidence for Statements
Statement | Level of Evidence |
One relatively small comparative nonrandomized study showed a nonsignificant higher cumulative conception rate with the pulsatile GnRH and a nonsignificantly lower rate of multiple pregnancies. | 3 |
Case studies show ovulation rate/cycle of 70%–100% and 38%–97% with pulsatile GnRH and gonadotropins, respectively. | 3 |
Case studies show pregnancy rates/cycle of 9%–30% and 20%–93% with pulsatile GnRH and gonadotropins, respectively. | 3 |
Case studies show multiple pregnancy rates of 0%–17% and 15%–38% with pulsatile GnRH and gonadotropins, respectively. | 3 |
Pulsatile GnRH does not require hormonal luteal support treatment. | 4 |
Pulsatile GnRH treatment requires simple once-a-month monitoring for verification of ovulation, resulting in less burden for the patient. | 4 |
Ovarian hyperstimulation is a very rare if not absent side effect of pulsatile GnRH treatment. | 4 |
