Androgen response in polycystic ovarian syndrome to FSH treatment after LHRH agonist suppression.

Anovulatory patients with clomiphene-resistant polycystic ovarian syndrome were treated by two different stimulation protocols. Follicular maturation was induced in 14 women with hMG; 12 of them received pure FSH in a later series after previous pituitary desensitization with the LHRH agonist D-Trp-6-LHRH (Decapeptyl). Both basal and stimulated serum androstenedione, testosterone, and free testosterone were elevated in the hMG-treated group compared with controls. However, only androstenedione exhibited a significant increase between early and late follicular levels. Marked suppression of these androgens has been observed after two weeks of LHRH agonist pretreatment, but nearly the same concentrations were obtained with pure FSH on the day of hCG administration. Again, only the increase of androstenedione levels proved to be significant. Polycystic follicular maturation, hyperstimulation, and peak estradiol levels were comparable with the two protocols. Nevertheless, more pregnancies were achieved using the LHRH agonist+FSH combination (4 vs. 1). It is suggested that 2 weeks' suppression of ovarian androgens with LHRH agonist is not sufficient to neutralize the unfavourable intraovarian mechanisms interfering with normal folliculogenesis. More data are required to confirm the superiority of LHRH agonist pretreatment in the management of polycystic ovarian syndrome.