Luteinizing hormone response to gonadotrophin-releasing hormone in normal women undergoing ovulation induction with urinary or recombinant follicle stimulating hormone

Abstract

Oestradiol enhances pituitary sensitivity to gonadotrophin-releasing hormone (GnRH) in normal women, while in women undergoing ovulation induction the putative factor gonadotrophin surge attenuating factor (GnSAF) attenuates the response of luteinizing hormone (LH) to GnRH, To study the relationships between oestradiol and GnSAF during ovulation induction, 15 normally ovulating women were investigated in an untreated spontaneous cycle (control, first cycle), in a cycle treated with daily i.m. injections of 225 IU urinary follicle-stimulating hormone (FSH) (Metrodin HP(R), uFSH cycle) and in a cycle treated with daily s.c. injections of 225 Hi recombinant FSH (Gonal-F(R), rFSH cycle). Treatment with FSH started on cycle day 2. The women during the second and third cycle were allocated to the two treatments in an alternate way. One woman who became pregnant during the first treatment cycle rFSH) was excluded from the study, In all cycles, an i.v. injection of 10 mu g GnRH was given to the women (n = 14) daily from days 2-7 as well as from the day on which the leading follicle was 14 mm in diameter (day V) until mid-cycle (n = 7), The response of LH to GnRH at 30 min (Delta LH), representing pituitary sensitivity, was calculated. In the spontaneous (control) cycles, Delta LH values increased significantly only during the late follicular phase, i.e. from day V to mid-cycle, at which time they were correlated significantly with serum oestradiol values (r = 0.554, P < 0.01), Initially during the early follicular phase in the uFSH and the rFSH cycles, Delta LH values showed a significant decline which was not related to oestradiol (increased GnSAF bioactivity). Then, Delta LH values increased significantly on cycle day 7 and further on day v with no change thereafter up to mid-cycle, On these two days, Delta LH values were correlated significantly with serum oestradiol values (r = 0.587 and r = 0.652 respectively, P < 0.05). During the pre-ovulatory period, Delta LH values in the FSH cycles were significantly lower than in the spontaneous cycles. Significantly higher serum FSH values were achieved during treatment with uFSH than rFSH, However, serum values of oestradiol, immunoreactive inhibin, and Delta LH as well as the number of follicles greater than or equal to 12 mm in diameter did not differ significantly between the two FSH preparations. These results suggest that in women undergoing ovulation induction with FSH, oestradiol enhances pituitary sensitivity to GnRH, while GnSAF exerts antagonistic effects. The rFSH used in this study (Gonal-F(R)) was at least as effective as the uFSH preparation (Metrodin-HP(R)) in inducing multiple follicular maturation in normally cycling women.