Skip to main content
SpringerLink
Log in

The Use of a Combined Regimen of GnRH Agonist Plus a Low-Dose Oral Contraceptive Improves the Spontaneous Pulsatile LH Secretory Characteristics in Patients with Polycycstic Ovary Disease After Discontinuation of Treatment

  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose: The fertility rate in women with polycystic ovarydisease (PCOD) is influenced by the type of treatmentreceived. The present study evaluated the possiblecorrelation between treatment and pulsatile release ofgonadotropins.

Methods: Spontaneous episodic secretion of luteinizinghormone (LH) and follicle-stimulating hormone (FSH) andhormonal parameters were monitored before and after 1, 3, and6 months after treatments suspension. Twenty-four PCODpatients were randomnly divided into two groups of 12subjects. Group A was treated with gonadotropin-releasinghormone (GnRH)-analogue plus oral contraceptive (OC).Group B was treated only with OC. Both groups were treatedfor 6 months and followed up for 6 months.

Results: In all subjects the therapeutic regimens reducedthe androgenic milieau and the gonadotropin plasma levels.Spontaneous pulsatile secretion of LH and FSH wassignificantly modified in both groups, but patients who receivedthe combined regimen showed a significantly greaterreduction of LH plasma levels and a significantly greater decreaseof LH pulse amplitude throughout the 6 months aftertreatment suspension. Ferriman=nGallway score and ovarianvolumes were significantly reduced in patients who receivedthe combined treatment than in the OC-treated patients.

Conclusions: These data support the evidence of a higherefficacy of the combination of GnRH-a + OC than OC alonein restoring a normal and adequate spontaneous episodicgonadotropin discharge and in decreasingFerriman—Gallway score and ovarian volumes in patients with PCOD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Balen AH, Conway GS, Kaltsas G, Techatraisak K, Manning PJ, West C, Jacobs HS: Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995;10:2107–2111

    Google Scholar 

  2. Yen SSC, Vela P, Rankin J: Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarain disease. J Clin Endocrinol Metab 1970;30:435–442

    Google Scholar 

  3. Venturoli S, Porcu E, Fabbri R, Magrini O, Gammi L, Paradisi R, Forcacci M, Bolzani R, Flamigni C: Episodic pulsatile secretion of FSH, LH, prolactin, oestradiol, oestrone, and LH circadian variations in polycystic ovary syndrome. Clin Endocrinol 1988;28:93–107

    Google Scholar 

  4. Waldstreicher J, Santoro NF, Hall JE, Filicori M, Crowley Jr WF: Hyperfunction of the hypothalamic-pituitary axis in women with polycystic ovarian disease: Indirect evidence for partial gonadotroph desensitization. J Clin Endocrinol Metab 1988;66:165–172

    Google Scholar 

  5. Berga SL, Guzick DS, Winters SJ: Increased luteinizing hormone and alpha-subunit secretion in women with hyperandrogenic anovulation. J Clin Endocrinol Metab 1993;77:895–901

    Google Scholar 

  6. Graf MA, Bielfeld P, Distter W, Weiers C, Kuhn-Velten W: Pulsatile luteinizing hormone secretion pattern in hyperandrogenic women. Fertil Steril 1993;59:761–767

    Google Scholar 

  7. Apter D, Butzow T, Laughlin GA, Yen SSC: Accelerated 24–h LH pulsatile activity in adolescent girls with ovarian hyperandrogenism: Relevance to the developmental phase of polycystic ovarian syndrome. J Clin Endocrinol Metab 1994;79:119–125

    Google Scholar 

  8. Rebar R, Judd HL, Yen SSC, Rakoff J, VandenBerg G, Naftolin F: Characterization of the inappropriate gonadotropin secretion in polycystic ovary syndrome. J Clin Invest 1976;57:1320–1329

    Google Scholar 

  9. Hayes FJ, Taylor AE, Martin KA, Hall JE: Use of gonadotropin-releasing hormone antagonist as a physiologic probe in polycys tic ovary syndrome: assessment of neuroendocrine and androgen dynamics. J Clin Endocrinol Metab 1998;83:2343–2349

    Google Scholar 

  10. Yen SSC: Polycystic ovary syndrome. Clin Endocrinol 1980;12:177–208

    Google Scholar 

  11. Nestler JE, Jakubowicz DJ: Decreases in ovarian cytochrome p450c17alfa activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl Med 1996;335:617–623

    Google Scholar 

  12. Dunaif A, Scott D, Finegood D, Quintana B, Whitcomb R: The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab 1996;81:3299–3306

    Google Scholar 

  13. Pucci E, Genazzani AD, Monzani F, Lippi F, Angelini F, Gargani M, Barletta D, Luisi M, Genazzani AR: Prolonged treatment of hirsutism with flutamide alone in patients affected by polycystic ovary syndrome. Gynecol Endocrinol 1995;9:221–228

    Google Scholar 

  14. Ciotta L, Cianci A, Calogero AE, Palumbo MA, Marletta E, Sciuto A, Palumbo G: Clinical and endocrine effects of finasteride, a 5α-reductase inhibitor, in women with idiopathic hirsutism. Fertil Steril 1995;64:299–306

    Google Scholar 

  15. Tolino A, Petrone A, Sarnacchiaro F, Cirillo D, Ronsini S, Lombardi G, Nappi C: Finasteride in the treatment of hirsutism: New therapeutic perspectives. Fertil Steril 1996;66:61–65

    Google Scholar 

  16. Ciotta L, Cianci A, Giuffrida G, Marletta E, Agliano A, Palumbo G: Clinical and hormonal effects of gonadotropin-releasing hormone agonist plus an oral contraceptive in severely hirsute patients with polycystic ovary disease. Fertil Steril 1996;65:61–67

    Google Scholar 

  17. Heiner JS, Greendale GA, Kawakami AK, Lapolt PS, Fisher M, Young D, Judd HL: Comparison of a gonadotropin-releasing hormone agonist and a low dose oral contraceptive given alone or together in the treatment of hirsutism. J Clin Endocrinol Metab 1995;80:3412–3418

    Google Scholar 

  18. Genazzani AD, Petraglia F, Battaglia C, Gamba O, Volpe A, Genazzani AR: A long-term treatment with gonadotropin-releasing hormone agonist plus a low-dose oral contraceptive improves the recovery of the ovulatory function in patients with polycyctic ovary syndrome. Fertil Steril 1998;67:463–468

    Google Scholar 

  19. Genazzani AD, Petraglia F, Fabbri G, Monzani A, Montanini V, Genazzani AR: Evidence of luteinizing hormone secretion in hypothalamic amenorrhea associated with weight loss. Fertil Steril 1990;54:222–226

    Google Scholar 

  20. Genazzani AD, Petraglia F, Benatti R, Montanini V, Algeri I, Volpe A, Genazzani AR: Luteinizing hormone (LH) secretory burst duration is indipendent from LH, prolactin or gonadal steroid plasma levels in amenorrheic women. J Clin Endocrinol Metab 1991;72:1220–1225

    Google Scholar 

  21. Genazzani AD, Petraglia F, Pianazzi F, Volpogni C, Genazzani AR: The concomitant release of androstenedione with cortisol and luteinizing hormone pulsatilee releases distinguishes adrenal from ovarian hyperandrogenism. Gynecol Endocrinol 1993;7:33–41

    Google Scholar 

  22. Oerter KE, Guardabasso V, Rodbard D: Detection and characterization of peaks and estimation of instantaneous secretory rate for episodic pulsatile hormone secretion. Computers Bio-Res 1986;19:170–191

    Google Scholar 

  23. Genazzani AD, Rodbard D: Evaluation of methods for detection of pulsatile hormone secretion: sensitivity vs. specificity. Acta Endocrinol 1991;124:295–306

    Google Scholar 

  24. Falsetti L, Pasinetti E: Treatment of moderate and severe hirsutism by gonadotropin-releasing hormone agonists in women with polycystic ovary syndrome and idiopatic hirsutism. Fertil Steril 1994;61:817–822

    Google Scholar 

  25. Adashi EY: Potential utility of gonadotropin-releasing hormone agonists in the menagement of ovarian hyperandrogenism. Fertil Steril 1990;53:765–779

    Google Scholar 

  26. Lemay A, Surrey ES, Friedman AJ: Extending the use of gonadotropin-releasing hormone agonists: The emerging role of steroidal and nonsteroidal agents. Fertil Steril 1994;61:21–34

    Google Scholar 

  27. Azziz R, Ochoa TM, Bradley EL, Dowing Potter H, Boots LR: Leuprolide and estrogens versus oral contraceptive pills for the treatment of hirsutism: A prospective randomized study. J Clin Endocrinol Metab 1995;80:3406–3411

    Google Scholar 

  28. Carr BR, Breslau NA, Givens C, Byrd W, Barnett-Hamm C, Marshburn PB: Oral contraceptive pills, gonadotropin-releasing hormone agonists, or use in combination for treatment of hirsutism: A clinical reasearch center study. J Clin Endocrinol Metab 1995;80:1169–1178

    Google Scholar 

  29. Genazzani AD, Rodbard D, Forti G, Petraglia F, Baraghini GF, Genazzani AR: Estimation of instantaneous secretory rate of luteinizing hormone in women during the menstrual cycle and in men. Clin Endocrinol 1990;32:573–581

    Google Scholar 

  30. Speroff L, Glass RH, Kase NG. Steroid contraception. In L Speroff, RH Glass, NG Kase (eds), Clinical Gynecologic Endocrinology and Infertility. Baltimore, Williams & Wilkins, 1989, pp 461–498

    Google Scholar 

  31. Genazzani AD, Petraglia F, Gastaldi M, Volpogni C, Gamba O, Massolo F, Genazzani AR: Evidence suggesting an additional control mechanism regulating episodic secretion of luteinizing hormone and follicle stimulating hormone in prepubertal children and post-menopausal women. Hum Reprod 1994;9:1807–1812

    Google Scholar 

  32. Genazzani AD, Massolo F, Ferrari E, Gandolfi A, Petraglia F, Genazzani AR: Long-term GnRH agonist administration revealed a GnRH independent mechanism stimulating FSH discharge in humans. Eur J Endocrinol 1996;134:77–83

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Modena, Italy

    Alessandro D. Genazzani, Cesare Battaglia & Barbara Malavasi

  2. Department of Obstetrics and Gynecology, University of Modena, Via del pozzo 71, 41100, Modena, Italy

    Alessandro D. Genazzani

  3. Department of Obstetrics and Gynecology, University of Pisa, Italy

    Felice Petraglia

  4. Department of Obstetrics and Gynecology, University of Udine, Italy

    Andrea R. Genazzani

Authors
  1. Alessandro D. Genazzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cesare Battaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ombretta Gamba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felice Petraglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Malavasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea R. Genazzani
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genazzani, A.D., Battaglia, C., Gamba, O. et al. The Use of a Combined Regimen of GnRH Agonist Plus a Low-Dose Oral Contraceptive Improves the Spontaneous Pulsatile LH Secretory Characteristics in Patients with Polycycstic Ovary Disease After Discontinuation of Treatment. J Assist Reprod Genet 17, 269–275 (2000). https://doi.org/10.1023/A:1009410416638

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1009410416638

Search

Navigation