This study will explore the effects of administration of GnRH upon the pituitary gland and ovaries on women with abnormal menstrual function. Anovulatory Infertility - Recruitment to this protocol continues to be active with patients with primary GnRH deficency and hypothalamic amenorrhea. Results continue to be excellent in patients with GnRH deficency (primary and hypothalamic amenorrhea) and GnRH deficiency acquired secondary to surgery and/or radiation for tumors of the head and neck. Studies of the free a-subunit (FAS) response to pulsatile (GnRH in women with congenital GnRH-deficiency (IHH) have indicated that this response is unique to women with congenital GnRH deficency and is not seen in hypothalamic amenorrhea or GnRH deficency which is secondary to cranial irradiation or surgery. These studies which suggest that the FAS response to GnRH may be a useful test to distinguish delayed puberty from GnRH deficiency were published this past year. The studies in which they determined that the increase in the frequency of pulsatile GnRH which occurs between the late luteal phase and the subsequent follicular phase is an important determinant of the rate of rise of FSH, the dynamics of inhibin B secretion and of subsequent folliculogenesis have now been published. In addition, the studies which confirmed that it is possible to generate a midcycle surge with 1/3 the dose that is optimal for normal folliculogenesis in GnRH women are in press. Three patients have been studied in the past year.
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