Efficacy and safety of pulsatile gonadotropin-releasing hormone therapy among patients with idiopathic and functional hypothalamic amenorrhea: a systematic review of the literature and a meta-analysis

Pulsatile gonadotropin-releasing hormone is an effective and safe treatment modality, and it should be considered the first-line treatment among women with amenorrhea of hypothalamic origin.

Like Comment

Volume 109, Issue 4, Pages 708–719.e8

Authors:

Anastasios Tranoulis, Ph.D., Alexandros Laios, Ph.D., Andreas Pampanos, Ph.D., Drakoulis Yannoukakos, Ph.D., Dimitrios Loutradis, Ph.D., Lina Michala, Ph.D.

Abstract:

Objective

To systematically review and appraise the existing evidence in relation to the efficacy and safety of pulsatile gonadotropin-releasing hormone (pGnRH) for the treatment of women with hypothalamic amenorrhea (HA).

Design

Systematic review and meta-analysis.

Setting

Not applicable.

Patient(s)

A total of 35 studies (three randomized and 32 observational) encompassing 1,002 women with HA.

Intervention(s)

None.

Main Outcome Measure(s)

Primary outcomes: ovulation rate (OvR), pregnancy per ovulatory cycle rate (POR), and live birth per ovulatory cycle rate (LBOR). Secondary outcomes: multiple gestation (MG), ovarian hyperstimulation syndrome (OHSS), and superficial thrombophlebitis (ST) rates. The summary measures were expressed as proportions and 95% confidence intervals (CI).

Result(s)

Pulsatile GnRH treatment appears to achieve high OvRs. A trend toward high PORs and LBORs among women with HA is demonstrated. SC pGnRH achieves comparable OvR compared with IV pGnRH. The incidence of OHSS is low and of mild severity. Treatment with pGnRH is associated with low but slightly higher MG rates compared with the general population. IV administered pGnRH is rarely associated with ST.

Conclusion(s)

The high OvRs leading to a high rate of singleton pregnancies and the low likelihood of OHSS render the pGnRH treatment modality both effective and safe for the treatment of women with HA of either primary or secondary origin.


Read the full text here.


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.

No comments yet.