During the past several years the development of gonadotropin-releasing hormone agonist (GnRH-a) therapy has provided the gynecologist with significant new therapies in infertility and general gynecology.
Perhaps 25% to 33% of female infertility is the result of ovulatory failure. The initiating problem may be located in one or multiple foci in the hypothalamic-pituitary-ovarian axis. Since 1971 when gonadotropin-releasing hormone (GnRH) was first isolated, numerous studies have demonstrated its value in diverse regimens designed to overcome ovulatory dysfunction. Gonadotropin-releasing hormone, located primarily in the hypothalamus, is normally released in a pulsatile fashion into the pituitary portal circulation, where it stimulates the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Despite intensive study and widespread availability, the use of GnRH has often proved disappointing in the induction of ovulation for patients with ovulatory dysfunction and for patients undergoing controlled ovarian hyperstimulation for in vitro fertilization/gamete intrafallopian transfer. Leuprolide ([D-Leu6, Pro