Augmentation of gonadotropin-releasing hormone induced follicular growth with exogenous gonadotropins.

Three women with hypothalamic amenorrhea (HA) were treated with pulsatile gonadotropin-releasing hormone (GnRH). They responded with high luteinizing hormone (LH) values, minimal increments in follicle-stimulating hormone (FSH) values, and failure of follicular development. In subsequent GnRH-stimulated cycles, 1 ampule of human menopausal gonadotropin (hMG) was given intramuscularly for 3 consecutive days once the dominant follicle had attained a diameter of 7 to 8 mm. In all women, subsequent administration of human chorionic gonadotropin (hCG) produced presumptive evidence of ovulation. Five cycles were induced in three women using this regimen. A conception occurred in all three. One woman has conceived a second time. It was concluded that some women with HA respond to GnRH with an inappropriate LH and suppressed FSH response that may be overcome successfully using small doses of hMG.