Study on mechanisms of single folliculugenesis in human women and multiple pregnancy by ovulation induction.

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Sequential FSH and pulsatile GnRH treatment (FSH-GnRH treatment) has been developed in this project. The protcol of FSH-GnRH treatment is as follows ; Daily FSH injection was started on the 5th day of the cycle. It was switched to pubsatile GnRH administration when the follicle diameter reached to 11 mm. HCG (5000IU) was given for ovulation induction when the diameter of the dominant follicle reached to 18 mm. In luteal phase, patients received HCG (3000IU) injections 3-4 times to stimulatie luteal function.The incidence of single folliculogenesis per treatment cycle was 80% in FSH-GnRH treatment, however, that was 12.5% in fixed dose FSH treatment. We found that serum FSH levels increased by daily FSH injection and decreased after switched to pulsatile GnRH administration in FSH-GnRH treatment. The FSH levels during GnRH treatment were significantly lower than those in fixed dose FSH teratment, and this decline of FSH levels may be attributed to single folliculogenesis.The clinical effect of FSH-GnRH treatment was investigated in patients with hyothalamic anovulation and polycystic ovary syndrome (PCOS). In patients with hypothalamic anovulation, rates of ovulation and pregnancy and duration of treatment in FSH-GnRH treatment were similar to those in FSH treatment. However, multiple pregnancy rate and ovarian hyperstimulation syndrome (OHSS) rate in FSH-GnRH treatment were significantly lower than those in FSH alone treatment. In patients with PCOS,rates of multiple pregnancy and OHSS in FSH-GnRH treatment were also significantly lower than those in FSH treatment.These results indicate that FSH-GnRH treatment is the most useful method for ovulation induction in patients with hypothalamic anovuration and PCOS because it has very few side effects such as multiple pregnancy and OHSS.