EC Gynaecology

Ovulation induction was performed in four women with hypogonadotropic hypogonadism, using human menopausal gonadotrophin with follicle stimulating hormone, in varying doses. One patient with Sheehan’s syndrome, while three patients of congenital hypogonadotropic hypogonadism, were treated with gonadotrophins for fertility promotion. In these patients, folliculogenesis was considered as optimum, when a follicle of size 17 mm or more, was achieved. Follicle development in our patients was monitored with transvaginal ultrasonography alone, and serum estradiol assays were not performed, to keep the cost of treatment low. The duration of induction to obtaining a mature follicle, in this study varied from twelve to thirty seven days. Intrauterine insemination or in-vitro fertilization were not used as an adjunct to ovulation induction, for enhancing fertility in this study. All four women conceived within 1 - 2 cycles of ovulation induction and a single embryo was visualised on ultrasonography. A careful dose titration of gonadotrophins provided fertility, while preventing both ovarian hyperstimulation and multiple pregnancy; making the study unique and admirable.

 Keywords: Hypogonadotropic Hypogonadism; Ovulation Induction; Gonadotrophins

1. El-Taha L., et al. “Ovulation induction for hypogonadotropic hypogonadism”. Ovarian Stimulation. Aboulghar M and Rizk, B. (ed): Cambridge University Press, University Printing House, United Kingdom (2022): 208-219.
2. Letterie GS., et al. “Ovulation induction using s.c. pulsatile gonadotrophin-releasing hormone: effectiveness of different pulse frequencies”. Human Reproduction1 (1996): 19-22.
3. The Practice Committee of American: Society for Reproduction. “Use of exogenous gonadotrophins”. Fertility and Sterility 90 (2009): S7-S12.
4. Messinis IE. “Ovulation induction: a mini review”. Human Reproduction10 (2005): 2688-2697.
5. Mattle V., et al. “Side effects of pulsatile GnRH therapy for induction of ovulation”. Expert Review of Endocrinology and Metabolism 5 (2008): 535-538.
6. Yildirim M., et al. “Estrogen-progestogen pre-treatment before Hmg induction in hypogonadotropic patients”. International Journal of Gynecology and Obstetrics3 (2000): 249-250.
7. Hayashi M., et al. “Successful pregnancy following gonadotropin therapy in a patient with hypogonadotropic hypogonadism resulting from craniopharyngioma”. International Journal of Clinical Practice2 (2002): 149-151.
8. Filicori M., et al. “The use of LH activity to drive folliculogenesis: exploring uncharted territories in ovulation induction”. Human Reproduction Update 6 (2002): 543-557.
9. Ernest Loumaye and others, on behalf of the Recombinant LH Study Group. “Clinical evidence for an LH ‘ceiling’ effect induced by administration of recombinant human LH during the late follicular phase of stimulated cycles in World Health Organization type I and type II anovulation”. Human Reproduction2 (2003): 314-322.
10. Huseyin K., et al. “Management of ovulation induction and intrauterine insemination in infertile patients with hypogonadotropic hypogonadism”. Journal of Gynecology Obstetrics and Human Reproduction 10 (2019): 833-838.