Gonadotropin releasing hormone (GnRH) is normally produced by the hypothalamus in the brain. It ‘instructs” the pituitary to release the gonadotropins, follicle stimulating hormone (FSH) and luteinizing hormone (LH), which in turn instruct the follicles on the ovaries to develop (FSH) and mature/ovulate (LH).

GnRH is most likely to be used for the treatment of hypothalamic amenorrhoea disorder - when a woman does not menstruate as a consequence of reduced GnRH production. It is a safe and relatively cheap method of treatment. GnRH must, just as it is in a natural state, be administered in small “pulses”. This is achieved using a small pump that is worn 24 hours a day. The pump is attached to a belt and a needle is inserted generally under the skin of the abdomen.

Test for disorders in the pituitary gland, the thyroid gland or the adrenal gland are conducted. A semen analysis can also be performed beforehand to check for sperm disorders.

GnRH is administered 24 hours a day (even during sleeping and bathing) at 90-minute intervals through a pump with a needle, which is introduced under the skin of the abdomen (subcutaneous). The pump can also be attached via a thin hose into a vein in the lower arm (intravenous). The pump is the biggest disadvantage of the treatment.

During treatment, regular monitoring of the ovaries occurs to see if follicle maturation occurs. Because it imitates the natural hormonal events of the body, intensive check ups are not necessary during every cycle.

The most difficult part of the treatment is knowing when to have intercourse. Ovulation can occur at any moment between day 10 and day 22 of treatment, but normally happens around day 14. Ultrasound, LH levels in the blood or predictor sets for identifying ovulation can help in pinpointing ovulation.

• Discomfort (due to the pump)
• Headaches
• Nausea
• Sometimes a superficial skin or vein infection may occur where the needle is inserted.