Serum Levels of FSH, LH-HCG and Progesterone during HMG-HCG and Clomid-HMG-HCG Therapy in Anovulatory Patients

Serum levels of FSH, LH-HCG and progesterone were determined daily by radioimmunoassay or competitive protein binding assay in 11 cycles from 8 anovulatory patients treated with HMG-HCG or Clomid-HMG-HCG. Hormonal profiles obtained in treated cycles were compared with those of normal cycles. The composite hormonal patterns in 6 cycles which resulted in successful ovulation during HMG-HCG therapy were as follows; 1) The mean FSH levels during the follicular phase (17.7 mIU/ml) were higher than that in the normal cycle (7.8 mIU/ml) and no FSH peak was observed around the time of ovulation. 2) No gradual increase of LH was found during the latter half of the follicular phase while LH-HCG peak following HCG injection lasted for 3 days. 3) The mean serum level of progesterone during the luteal phase (19.6 ng/ml) was higher than that of the normal cycle (12.0 ng/ml). Two cycles in patients with operated pituitary chromophobe adenoma or Sheehan's syndrome ended in anovulation under HMG-HCG therapy. The basal levels of FSH and LH were low and signs of complete maturation of the ovarian follicle were not achieved. In three cycles treated with Clomid-HMG-HCG, the hormonal pattern was similar to that in cycles under HMG-HCG therapy. In addition, an increase of LH during the early follicular and preovulatory phases was obtained. In order to simulate hormonal patterns of the normal menstrual cycle under HMGHCG therapy, the additional use of Clomid during the follicular phase and a single large dose injection of HCG at the time of ovulation are recommended. (See pp. 1265--1280)