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Ovulation induction in gonadotrophin-resistant women.

Baillieres Clin Obstet Gynaecol

June 1993

The patient who has gonadotrophin-resistant ovaries and who requires ovulation induction or superovulation for IVF presents a serious problem. The diagnosis is usually made in the first treatment cycle which is either abandoned due to a failure of response, requires inordinately high doses of gonadotrophins to induce a response or fails to induce satisfactory oestradiol levels and/or follicular development. This situation is often associated with advanced maternal age and high day 3 concentrations of FSH.

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The clinical syndrome of the resistant ovary is described in a 24-yr-old woman (XX genotype) with secondary amenorrhea and primary infertility. She presented an increased secretion of gonadotrophins with a decreased secretion of estrogens. In the ovarian tissue only primary ovarian follicles and a thickened tunica albuginea were found.

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A woman with myasthenia gravis who developed hypergonadotrophic amenorrhoea was studied. This patient fulfilled all accepted criteria for the diagnosis of the gonadotrophin resistant ovary syndrome: high levels of serum LH and FSH by radioimmunoassay and urinary gonadotrophin excretion by bioassay, low serum oestradiol, lack of response to exogenous gonadotrophin and ovaries with multiple non-stimulated primordial follicles. The serum of this patient contained a substance which behaving like a gamma globulin, inhibited FSH specific binding to receptors in an in vitro system.

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A patient with the resistant ovary syndrome is reported. It is suggested that lack of synchronization between steroidogenesis in the granulosa and theca cells is responsible for the (acquired) occurrence of this syndrome. Feedback inhibition of pituitary gonadotrophin secretion was achieved by exogenously administered ovarian steroid hormones.

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