- Tahereh Eftekhar
- - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
- Shirin Ghazizadeh
 - - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
- Ladan Kashani
- - Department of Obstet . and Gynecol . of Tehran Medical Sciences University .Emam khomayni Hospital، Valiaser Hospital, Tehran, Iran
- Maryam Bagheri
- - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
Received: 4/1/2005 Accepted: 4/1/2005 - Publisher : Avicenna Research Institute |
|
| Related Articles |
|
| Other Format |
|
|
|
Abstract
Introduction: Hypothalamic amenorrhea is one of the most prevalent problems leading to anovu-lation which is due to decrease in pulsatile release of GnRH. This diagnosis can be confirmed only after exclusion of ovarian and pituitary causes lead to anovulation. The most prevalent form, which leads to suppress of reproductive physiology is termed functional hypothalamic amenorrhea. It is a kind of psycho-biological answer to events in life. Patients affected with hypothalamic amenorrhea who want to become pregnant must be induced by exogenous gonadotropin or GnRH to ovulate. Continuous and pulsatile forms of GnRH are administerred intra venously or subcutaneously by a portable mini-pump. Most patients consider this method inappropriate because they are obliged to hold a mini-pump with themselves even while they are sleeping. The GnRH pump is not available in Iran. Consequently, exogenous gonadotropin is used for an ovulation induction, then timed intercourse (TI) or intrauterine insemination (IUI) are recommended. More over, In vitro fertiliza-tion (IVF) or even intracytoplasmic sperm injection (ICSI) techniques could be used. TI is an easier and cheaper method in comparison with IVF and IUI. The objective of this study is to compare the pregnancy success rate of the two methods of TI and IUI. Materials and Methods: In this clinically retrospective study, hypothalamic amenorrhea patients referred to infertility clinics of Reproductive Health Research Center, Tehran, Iran. They registered between April 1999 to March 2005 were considered. Patients were selected based on meeting the entrance criteria of this study. TI or IUI, after induction of ovulation was administered and the rate of successful pregnancies was compareed. Among Entrance criteria, age between 20 to 40 years and normal spermogram could be cited. The cases with infertility due to the male factor, uterine anoma-ly and fallopian tube obstruction were excluded. Results: In the TI group, from 27 cycles, there were 19 pregnant women (70.37%). In the IUI group, from 29 cycles, there were seven pregnant women (24.13%). The difference between these two methods was significant (p=0.05). Differences in the number of abortions and ectopic pregnancies between the two groups were not significant. Duration of infertility, mean age, and other demogra-phic characteristic were not significant different factor between the two groups. Conclusion: The results of this study support the TI as the first-line treatment method of hypotha-lamic amenorrhea. Taking into consideration the easy usage, low cost, and lack of demand for equi-pment in this method could be recommended as the first step for treatment of hypothalamic ameno-rrhea's infertile patients.
Keywords:
Hypothalamic amenorrhea, Infertility, Timed intercourse, Insemination To cite this article:References
- Jaffe R.B. Long-term follow up of functional hypoth-alamic amenorrhea and prognostic factors. Obstet Gyn-ecol Sur.2002;57:512-514.
- Berga S.L. Functional hypothalamic amenorrhea. Curr Opinion Endocrinol Diabetes. 2001;8: 207-313.
- Berek J.S. Novak’s Gynecology. 13th Edition.2002. Lip-pincott Williams and Wilkins. Baltimore, USA.
- Speroff L., Glass R.H., Kase N.G. Clinical Gynecologic Endocrinology and Infertility. 6th Edition.1999. Lippincott Williams and Wilkins. Baltimore, USA.
- Marshall J.C., Eagleston C.A., McCartney C.R. Hypo-thalamic dysfunction. Molecul Cellul Endocrinol.2001; 183:29-32.
- Reame N.E., Sauder S.E., Case G.D. Pulsatile gonodo-tropin secretion in women with hypothalamic ameno-rrhea: evidence that reduced frequency of gonodotro-pin-releasing hormone secretion is the mechanism of persistent anovulation. J Clin Endocrinol Metab.1985; 61:851-858.
- Haisnleder D.J., Dalkin A.C., Marshall J.C. Regulation of gonodotropin gene expression. In: Knobil, E., Neill, J. (Eds), The physiology of Reproduction, second ed. Raven Press, New York, NY, p:1793, Chapter 31.
- Wolf L.J. Ovulation induction. Clin Obstet Gynecol. 2000;15:902-915.
- Gardner D.K., Weissman A., Howles C.M., Shoham Z. Textbook of Assisted Reproductive Techniqucs Labo-ratory and Clinical Perspectives (2nd Edition). 2004. Taylor and Francis.
- Dessole S., Germond M., Senn A., Welti H., De Gra-ndi P. Ovulation induction by Pulsatile intravenous administration of Gn-RH to patients with hypothalamic amenorrhea. Minerva Ginecology.1993;45:71-76.
- Marci R., Dessole S., Senn A, Grandi P., Germond M. Follow-up of 32 hypothalamo-hypopituritary patients treated with Pulsatile gonodotropin-releasing hormone or human menopausal gonodotropin. Gynecol Endocr-inol.1999;13(6):375-81.
- Kesrouani A., Abdallah M.A., Attieh E., Abboud J., Atallah D., Makhoul C. Gonadotropin-releasing horm-one for infertility in women with primary hypothalamic amenorrhea. Toward a more interventional approach. J Reprod Med. 2001;46:23-28.