Gonadorelin (goe nad oh rell'; in) acetate (Lutrepulse - Ortho), a synthetic decapeptide identical in amino acid sequence to human gonadotropin-releasing hormone (GnRH), was recently approved by the US Food and Drug Administration for treatment of primary hypothalamic amenorrhea. Gonadorelin hydrochloride (Factrel) was previously available for diagnostic use (Medical Letter, 25:106, 1983). Analogs of GnRH have been used to treat endometriosis and advanced cancer of the prostate (Medical Letter, 27:71, 1985).

Infertility occurs in about 15% of couples. About one-third of cases are due to problems with ovulation or other female factors, another third are due to a male infertility factor, and the remaining third are unexplained. In older women, unexplained infertility is probably caused by diminished quality and quantity of oocytes. The first approach to treatment of female-factor infertility generally is the use of drugs that stimulate oocyte production.

Polycystic ovary syndrome (PCOS), an endocrine abnormality characterized by hyperandrogenism and anovulation, affects 5-10% of women of reproductive age in the US. It is often accompanied by obesity and insulin resistance. In recent years, antidiabetic drugs, although not approved for such use by the FDA, have been tried for treatment of this disorder. This review describes the effectiveness of metformin and the thiazolidinediones in women with PCOS. Also included is a dosage and cost table for some insulin-sensitizing drugs.

Urofollitropin (Metrodin - Serono), a human gonadotropin, is the latest drug to be approved by the US Food and Drug Administration (FDA) for induction of ovulation in various clinical situations, including in vitro fertilization (IVF).

Pneumocystis carinii pneumonia (PCP) is a common cause of death in patients with acquired immune deficiency syndrome (AIDS). PCP is the first serious opportunistic infection in more than 60% of patients with AIDS, and about 80% of AIDS patients develop PCP at least once (AE Glatt et al, N Engl J Med, 318:1439, June 2, 1988). Many studies using drugs to prevent PCP in patients with AIDS have recently been reported.

Infertility occurs in about 15% of couples. About one third of infertility is due to problems with ovulation or an anatomic abnormality of the fallopian tube or peritoneum, such as scarring, adhesions or endometriosis. Another third is due to a male infertility factor, most commonly insufficient sperm production or abnormal motility or morphology. The remaining third is unexplained. In older women unexplained infertility is probably caused by diminished quality and quantity of oocytes, decreased implantation and spontaneous pregnancy wastage.