| Abstract: | The methods and results of treatment with human menopausal gonadotropins (hMG) and chorionic gonadotropin (hCG) in 26 patients (mean age 24 years, range 22-35 years) with hypogonadotropic primary amenorrhea and without chromosomal abnormalities are reported. The usual dose of hMG was 225 IU daily until the karyopycnotic index rose to 40% or more and the other clinical parameters revealed sufficient follicular maturation. A dose of hCG was then administered at the rate of 10,000 IU daily for 4 days. In 60 courses of treatment, we obtained 17 pregnancies (28.3%) in 13 patients (i.e., including some second pregnancies), 35 ovulations without pregnancy (58.3%), and seven patients did not respond (11.6%). Three patients who did not respond and who continued the treatment ovulated and became pregnant. Clinical hyperstimulation occurred in three patients on the first course of treatment. Two of them again presented this complication on repetition of treatment despite the precautions taken. Urinary estrogen and pregnanediol measurements on the 7th-11th day after hCG administration revealed considerable hormonal hypersecretion in 19 of 27 courses of treatment. In eight patients the high output of pregnanediol continued during the first 1-2 months of pregnancy and decreased thereafter. The rate of pregnancies seemed to be higher in patients with hypersecretion whereas clinical hyperstimulation did not correlate with the degree of the hormonal output. Pregnancies were all single and uneventful except for one abortion in a patient who was found to have mycoplasma infection. All patients gave birth to normal children and lactated normally. The increased dosage of hCG used in this series is considered to be a decisive factor in the induction of ovulation and the maintenance of pregnancies through the abundant steroid production it induced. |
