Ali Abbara 1,2, Maria Phylactou 1,2, Pei Chia Eng 1,2, Sophie A Clarke 1,2, Toan D Pham 3, Tuong M Ho 3, Kah Yan Ng 1, Edouard G Mills 1,2, Kate Purugganan 2, Tia Hunjan 1, Rehan Salim 2, Alexander N Comninos 1,2, Lan N Vuong 3,4, Waljit S Dhillo 1,2
Published: March 19, 2023
1 Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK.
2 Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK.
3 HOPE Research Centre, My Duc Hospital, Ho Chi Minh City 700000, Vietnam.
4 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
Context: Limited data exist regarding whether the endocrine response to the gonadotropin-releasing hormone receptor agonist (GnRHa) triptorelin differs in women with polycystic ovary syndrome (PCOS) compared with healthy women or those with hypothalamic amenorrhea (HA).
Objective: We compared the gonadotropin response to triptorelin in healthy women, women with PCOS, or those with HA without ovarian stimulation, and in women with or without polycystic ovaries undergoing oocyte donation cycles after ovarian stimulation.
Methods: The change in serum gonadotropin levels was determined in (1) a prospective single-blinded placebo-controlled study to determine the endocrine profile of triptorelin (0.2 mg) or saline-placebo in healthy women, women with PCOS, and those with HA, without ovarian stimulation; and (2) a retrospective analysis from a dose-finding randomized controlled trial of triptorelin (0.2-0.4 mg) in oocyte donation cycles after ovarian stimulation.
Results: In Study 1, triptorelin induced an increase in serum luteinizing hormone (LH) of similar amplitude in all women (mean peak LH: healthy, 52.3; PCOS, 46.2; HA, 41.3 IU/L). The AUC of change in serum follicle-stimulating hormone (FSH) was attenuated in women with PCOS compared with healthy women and women with HA (median AUC of change in serum FSH: PCOS, 127.2; healthy, 253.8; HA, 326.7 IU.h/L; P = 0.0005). In Study 2, FSH levels 4 hours after triptorelin were reduced in women with at least one polycystic morphology ovary (n = 60) vs normal morphology ovaries (n = 91) (34.0 vs 42.3 IU/L; P = 0.0003). Serum anti-Müllerian hormone (AMH) was negatively associated with the increase in FSH after triptorelin, both with and without ovarian stimulation.
Conclusion: FSH response to triptorelin was attenuated in women with polycystic ovaries, both with and without ovarian stimulation, and was negatively related to AMH levels.
GnRH agonist; hypothalamic amenorrhea (HA); polycystic ovary syndrome (PCOS); triptorelin.