Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients

Retrospective evaluation of pulsatile gonadotropinreleasing hormone therapy in amenorrheic persistent weight-recovered anorexia nervosa patients showed a high rate of pregnancy with higher hormonal response compared with the other hypothalamic amenorrhea forms.

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Volume 107, Issue 2, Pages 502–509

Authors:

Natacha Germain, M.D., Ph.D., Anaïs Fauconnier, M.D., Jean-Philippe Klein, M.D., Ph.D., Amélie Wargny, M.Sc., Yadh Khalfallah, M.D., Ph.D., Chrysoula Papastathi-Boureau, M.D., Bruno Estour, M.D., Ph.D., Bogdan Galusca, M.D., Ph.D.

Abstract:

Objective

To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA.

Design

Retrospective, observational, ambulatory study.

Setting

University hospital.

Patient(s)

Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA).

Intervention(s)

Gonadotropin-releasing hormone pulsatile therapy.

Main Outcome Measure(s)

Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies.

Results

The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA.

Conclusion(s)

This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.