7.9Ovulation induction in ovulation disorders: pulsatile gonadotrophin-releasing hormone (2)

StudyPopulationInterventionOutcomesResultsCommentsStudy typeEL
Balen et al. 1994571200 anovulatory women (103 clomifene-resistant PCOS; 77 hypogonadotrophic hypogonadism; 20 weight- related amenorrhoea)pGnRH (sc/iv/im) and gonadotrophinsCumulative pregnancy rates

Live birth rates

Miscarriage rates

Multiple pregnancy rates

OHSS rates/cycles
After 12 cycles of treatment:

Cumulative pregnancy rates:
PCOS: 73.2%
Hypogonadotrophic
hypogonadism: 82.1%
Weight-related amenorrhoea: 95%

Live birth rates:
PCOS: 62.4%
Hypogonadotrophic
hypogonadism: 65.4%
Weight-related amenorrhoea: 85.3%

Miscarriage rates:
PCOS: 15.5%
Hypogonadotrophic
hypogonadism: 22.9%
Weight-related amenorrhoea: 32.3%

Multiple pregnancy rates significantly greater in PCOS:
PCOS: 17.9%
Hypogonadotrophic hypogonadism: 3.6% (CI 5.12 to 23.36)
Weight-related amenorrhoea: 3.2% (CI 4.35 to 24.92)

OHSS rates/cycles:
PCOS: 3/603 (0.5%)
Multiple pregnancy rates fell after introduction of transvaginal ultrasoundCA RCR3
Filicori et al. 1994573292 anovulatory women (600 cycles) (73 PHA; 57 OHH; 39 MFO; 85 PCO; 38) OHApGnRH iv preceded by GnRHaOvulation rates/cycle

Pregnancy rates/cycle

Multiple pregnancy rates

Miscarriage rates

OHSS rates
Ovulation rates/cycle: 75%

Pregnancy rates/cycle: 23%

Multiple pregnancy rates: 3.8% (none after GnRH-a)

Miscarriage rates: 30% (45% in PCO)

OHSS: none
PHA = primary hypogonadotrophic amenorrhoea

OHH = other hypogonadotrophic
hypogonadism

MFO = multifollicular ovary

OHA = other hyperandrogenic anovulation
CA3
Braat et al. 199157248 women with normagonadotrophic and hypogonadotrophic amenorrhoea (244 cycles)pGnRH ivCumulative pregnancy rates

Mean pregnancy rate/cycle

Multiple pregnancy rates/cycle

Miscarriage rates

OHSS rates
After 12 cycles of treatment:

Cumulative pregnancy rates 93%

Mean pregnancy rate/cycle 22.5% (CI 16.4% to 28.65)

Multiple pregnancy rates/cycle 5/244 (2%)

Miscarriage rates: 14.5%

OHSS: none
Life-table analysisCA RCR3
Martin et al. 199357571 women with hypogondotrophic amenorrhoea (229 cycles)pGnRH iv versus hMGCumulative pregnancy rates

Ovulation rates/cycle

Multiple pregnancy rates/cycle

Miscarriage rates

OHSS rates
After 6 cycles of treatment:

Cumulative pregnancy rates:
pGnRH: 96%
hMG: 72%

Ovulation rates/cycle:
pGnRH : 29%
hMG: 25%

Non-significant:

Multiple pregnancy rates/cycle
pGnRH: 8.3% (all twins)
hMG: 14.8% (75% triplets or higher order)

Miscarriage rates:
pGnRH : 23.8%
hMG: 16.6%

OHSS: none
Life-table analysisCH2b

From: Evidence tables

Cover of Fertility
Fertility: Assessment and Treatment for People with Fertility Problems.
NICE Clinical Guidelines, No. 11.
National Collaborating Centre for Women's and Children's Health (UK).
London (UK): RCOG Press; 2004 Feb.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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