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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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