PMID- 29605411 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 1556-5653 (Electronic) IS - 0015-0282 (Linking) VI - 109 IP - 4 DP - 2018 Apr TI - Efficacy and safety of pulsatile gonadotropin-releasing hormone therapy among patients with idiopathic and functional hypothalamic amenorrhea: a systematic review of the literature and a meta-analysis. PG - 708-719.e8 LID - S0015-0282(17)32175-1 [pii] LID - 10.1016/j.fertnstert.2017.12.028 [doi] AB - OBJECTIVE: To systematically review and appraise the existing evidence in relation to the efficacy and safety of pulsatile gonadotropin-releasing hormone (pGnRH) for the treatment of women with hypothalamic amenorrhea (HA). DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): A total of 35 studies (three randomized and 32 observational) encompassing 1,002 women with HA. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcomes: ovulation rate (OvR), pregnancy per ovulatory cycle rate (POR), and live birth per ovulatory cycle rate (LBOR). SECONDARY OUTCOMES: multiple gestation (MG), ovarian hyperstimulation syndrome (OHSS), and superficial thrombophlebitis (ST) rates. The summary measures were expressed as proportions and 95% confidence intervals (CI). RESULT(S): Pulsatile GnRH treatment appears to achieve high OvRs. A trend toward high PORs and LBORs among women with HA is demonstrated. SC pGnRH achieves comparable OvR compared with IV pGnRH. The incidence of OHSS is low and of mild severity. Treatment with pGnRH is associated with low but slightly higher MG rates compared with the general population. IV administered pGnRH is rarely associated with ST. CONCLUSION(S): The high OvRs leading to a high rate of singleton pregnancies and the low likelihood of OHSS render the pGnRH treatment modality both effective and safe for the treatment of women with HA of either primary or secondary origin. CI - Copyright (c) 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved. FAU - Tranoulis, Anastasios AU - Tranoulis A AD - Department of Obstetrics and Gynaecology, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, United Kingdom. Electronic address: tasostranoulis@yahoo.com. FAU - Laios, Alexandros AU - Laios A AD - Department of Obstetrics and Gynaecology, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, United Kingdom. FAU - Pampanos, Andreas AU - Pampanos A AD - Department of Genetics, Alexandra Hospital, University of Athens, Athens, Greece. FAU - Yannoukakos, Drakoulis AU - Yannoukakos D AD - Molecular Diagnostics Laboratory, INRaSTES, National Center for Scientific Research "Demokritos", Aghia Parasevi, Athens, Greece. FAU - Loutradis, Dimitrios AU - Loutradis D AD - Department of Reproductive Endocrinology, Alexandra Hospital, University of Athens, Athens, Greece. FAU - Michala, Lina AU - Michala L AD - Department of Reproductive Endocrinology, Alexandra Hospital, University of Athens, Athens, Greece. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20180328 PL - United States TA - Fertil Steril JT - Fertility and sterility JID - 0372772 RN - 0 (Fertility Agents, Female) RN - 33515-09-2 (Gonadotropin-Releasing Hormone) SB - IM CIN - Fertil Steril. 2018 Apr;109(4):621-622. PMID: 29653714 MH - Adolescent MH - Adult MH - Amenorrhea/complications/diagnosis/*drug therapy/physiopathology MH - Female MH - Fertility Agents, Female/*administration & dosage/adverse effects MH - Gonadotropin-Releasing Hormone/*administration & dosage/adverse effects MH - Humans MH - Hypothalamus/*physiopathology MH - Infertility, Female/diagnosis/*drug therapy/etiology/physiopathology MH - Live Birth MH - Ovulation/*drug effects MH - Ovulation Induction/adverse effects/*methods MH - Pregnancy MH - Pregnancy Rate MH - Pulse Therapy, Drug MH - Risk Assessment MH - Risk Factors MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - Hypothalamic amenorrhea OT - infertility OT - meta-analysis OT - pulsatile GnRH EDAT- 2018/04/02 06:00 MHDA- 2018/12/12 06:00 CRDT- 2018/04/02 06:00 PHST- 2017/10/29 00:00 [received] PHST- 2017/12/21 00:00 [revised] PHST- 2017/12/21 00:00 [accepted] PHST- 2018/04/02 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2018/04/02 06:00 [entrez] AID - S0015-0282(17)32175-1 [pii] AID - 10.1016/j.fertnstert.2017.12.028 [doi] PST - ppublish SO - Fertil Steril. 2018 Apr;109(4):708-719.e8. doi: 10.1016/j.fertnstert.2017.12.028. Epub 2018 Mar 28.