Successful treatment of infertile women with hypothalamic primary and secondary protracted amenorrhoea using gonadotrophin releasing hormone analogue and human menopausal gonadotrophin.

Thirty-one women with hypothalamic primary or protracted secondary amenorrhoea were treated with human menopausal gonadotrophin (HMG) in 89 cycles, but adequate follicular growth failed to occur. They were then treated with a gonadotrophin releasing hormone analogue (GnRHa) and HMG in 91 cycles. An adequate ovarian response occurred in 68 cycles (74.7%) and pregnancy occurred in 26 cycles (28.6%). GnRHa and HMG produced an adequate ovarian response in hypothalamic amenorrhoeic patients who failed to respond to HMG alone. The strong initial agonistic effect of GnRHa produced sudden high levels of FSH that might possibly have initiated folliculogenesis which was continued by HMG.