Successful induction of ovulation and conception with combined gonadotropin-releasing hormone agonist plus highly purified follicle-stimulating hormone in patients with polycystic ovarian disease.

Five women (group A) with polycystic ovarian disease (PCOD) and sterility for at least 3 yr were treated for 1 cycle for ovulation induction with a combined regimen of GnRH agonist (GnRH-A) plus highly purified FSH. The patients received GnRH-A (Buserelin; 200 micrograms, sc, twice a day) for 6 weeks and then GnRH-A combined with FSH highly purified (2 ampules a day; 75 IU FSH and less than 0.11 IU LH in each ampule). Ovarian response was evaluated by plasma estradiol (E2) assay and ultrasound examination, performed daily. Furthermore, plasma FSH and LH levels were assayed 3 times a week. Once a follicle was considered sufficiently developed, the combined regimen was withheld, and 24-48 h later hCG (5000 IU, im) was given. The results are compared with those of 31 ovulatory cycles induced by im FSH highly purified (group B) in PCOD patients with the same FSH administration, clinical, and monitoring protocols. Ovulation was achieved in all cycles treated by GnRH-A plus FSH. Two singleton and a twin pregnancy resulted. Multiple follicular development occurred in all cycles. Plasma E2 levels were generally in the normal range. Echographic and endocrine features in the 2 groups were as follows. 1) basal ovarian volume and ovarian enlargement were similar. 2) Group A had a greater number of follicles than did group B (P less than 0.01), while E2 to number of follicles and E2 to ovarian volume ratios were greater (P less than 0.01) in group B. 3) The linear correlations between plasma E2 levels and ovarian volume were markedly different in groups A and B (P less than 0.01). The regression line for group B had a steeper slope than that for group A. This finding indicates that at a fixed ovarian volume plasma E2 levels were significantly lower in group A than in group B. We conclude that the combined GnRH-A and FSH regimen may constitute an alternative and promising tool for the induction of ovulation in patients with PCOD.