Pituitary gonadotropin responsiveness to repeated gonadotropin releasing hormone (GnRH) stimulations in patients with chronic anovulation.

To evaluate whether repeated gonadotropin releasing hormone (GnRH) stimulations were superior to single GnRH administrations for the accurate assessment of pituitary gonadotropin responsiveness, the GnRH-stimulated luteinizing hormone (LH) and follicle stimulating hormone (FSH) responses of 49 hyperandrogenic patients (HA) were compared with those of 20 hypogonadotropic patients (HH) and of 24 normally cycling women (N). Blood samples were obtained at frequent intervals during GnRH administrations (25 micrograms twice within 2 h). Unstimulated LH concentrations were higher (p less than 0.001) in HA than in N and HH women. However, basal FSH levels differed only in HA from HH women (p less than 0.001). Following either GnRH stimulation, increased (p less than 0.01) LH and FSH releases were noted in all N, HA and HH women. The GnRH-stimulated LH and FSH responses to either GnRH injections were highest (p less than 0.01) in HA and lowest (p less than 0.01 vs. N) in HH women. The net LH and FSH increases over unstimulated concentrations (delta LH or FSH) in response to either GnRH stimulation were highest (p less than 0.01 or less) in HA women. By contrast, no differences were determined in the delta LH and FSH levels between the first and second GnRH stimulations within each group. These observations document different unstimulated and stimulated gonadotropin concentrations in normal cycling and anovulatory women. Gonadotropin responses to single GnRH administrations differ for anovulatory patients. Since the gonadotropin responses to the second GnRH stimulation are comparable to those during the first GnRH injections, repeated GnRH stimulations may not help to distinguish the degree of pituitary responsiveness in ovulatory from anovulatory women.