Pulsatile GnRH pump therapy induces ovulation and pregnancy in a treatment-resistant PCOS patient

Anovulatory infertility, a primary challenge for women of reproductive age, is frequently caused by Polycystic Ovary Syndrome (PCOS). Current standard ovulation induction protocols, including letrozole, clomiphene, and gonadotropins, often face limitations. Patients may develop drug resistance, leading to treatment failure, or experience severe complications like Ovarian Hyperstimulation Syndrome (OHSS). This highlights a critical gap for patients who do not respond to conventional therapies or are at high risk for adverse effects, necessitating alternative strategies to restore normal ovulatory function.

This case report details the treatment of a 28-year-old patient diagnosed with PCOS and anovulatory infertility. The patient presented with a normal BMI and normal luteinizing hormone (LH) levels. Prior to the reported intervention, she had undergone conventional ovulation induction using letrozole combined with human menopausal gonadotropin (HMG), which unfortunately failed to achieve conception. Subsequently, the patient was initiated on pulsatile gonadotropin-releasing hormone (GnRH) pump therapy. The abstract does not specify the exact dose, frequency, or duration of the GnRH administration, but it was delivered via a pump to mimic physiological pulsatile release.

Following the initiation of pulsatile GnRH pump therapy, the 28-year-old PCOS patient, who had previously failed conventional ovulation induction with letrozole and HMG, achieved successful ovulation. Crucially, this led to a confirmed pregnancy. A significant finding was the absence of Ovarian Hyperstimulation Syndrome (OHSS), a common and potentially severe complication associated with other ovulation induction methods. The patient also reported no other adverse effects throughout the treatment period. This outcome contrasts sharply with her previous treatment failures, demonstrating the efficacy of pulsatile GnRH in this specific case. The therapy effectively restored the physiological hormonal signaling required for follicular development and ovulation, circumventing the issues of drug resistance and hyperstimulation seen with other approaches. This suggests a precise modulation of the hypothalamic-pituitary-ovarian (HPO) axis.

The patient achieved successful ovulation and pregnancy with pulsatile GnRH pump therapy, without OHSS or other adverse effects.