Gonadotropin therapy of female infertility. Analysis of results in 416 cases.

This report is based on 416 infertile female patients who were treated for 1,033 cycles with gonadotropins. 28.6% of the patients conceived after hMG/hCG treatment in 79.8% of these pregnancies, healthy children were born. Spontaneous abortion or premature birth occurred in 20.2% of the cases. The twin rate was 28.6%, the triplet rate 5.5%. Most of the abortions occurred in the first trimester (52.2%). No malformations were seen. The pregnancy rate showed striking differences in the various diagnostic groups: hypogonadotropic amenorrhea 44.4%, normogonadotropic amenorrhea 50%, anovulatory cycles 22%, corpus luteum insufficiency 14.8%. The abortion rates for these four groups were as follows: hypogonadotropic amenorrhea 25%, normogonadotropic amenorrhea 14.7%, anovulatory cycles 4.8%, corpus luteum insufficiency 36.3%. A detailed analysis of the treatment cycles is given for the four groups: the number of ampoules of hMG/hCG increased from 21.4 ampoules in patients with corpus luteum insufficiency to 47.7 ampoules in patients with hypogonadotropic amenorrhea. The inactive phase increased from 5.6 days in patients with corpus luteum insufficiency to 8.5 days in patients with hypogonadotropic amenorrhea. Estrogen values around the time of ovulation and in the corpus luteum phase were much lower in patients with spontaneous uterine bleedings. Hyperstimulation syndrome occurred less frequently in these patients. The percentage of pregnancies decreased in patients with corpus luteum insufficiency from 8.1% in the first treatment cycle to 4.8% in the following treatment cycles, whereas it increased from the first to the following cycles in the other diagnostic groups. Patients with anovulatory cycles and corpus luteum insufficiency respond differently to hMG/hCG treatment than patients with normogonadotropic amenorrhea. The inactive and active phase are important parameters for the evaluation of ovulation induction with hMG/hCG, hMG/hCG treatment is of little value in patients with corpus luteum insufficiency.