Induction of ovulation with synthetic gonadotrophin-releasing hormone in women with constant anovulation induced by contraceptive steroids.

The ovarian response to stimulation with follicle-stimulating hormone/luteinizing hormone-releasing hormone (FSH/LH-RH) was studied in young, healthy, and fertile women with constant iatrogenic anovulation caused by depot medroxyprogesterone acetate or depot chlormadinone acetate injected for contraceptive purposes. Results were compared with those in unstimulated controls. The response was observed directly on the ovaries at laparotomy performed after treatment with FSH/LH-RH. A wedge biopsy provided ovarian tissue for histological and histochemical studies of steroid dehydrogenase activity. Treatment with FSH/LH-RH caused a trophic effect on the ovaries, with evidence of follicular development; ovulation occurred in two out of 16 treated women. Preovulatory mature follicles were found in three others.Clearly the FSH/LH-RH-induced release of FSH and LH caused follicular growth up to Graafian follicles, mature preovulatory follicles, and ovulation. Mitosis in granulosa and theca cells was also observed. A wide individual variation in gonadal response to hypothalamic FSH/LH-RH was evident, however. Nonetheless, our data support the possibility that treatment with FSH/LH-RH may prove valuable in patients with anovulatory sterility of hypothalamic origin.