Does pituitary suppression affect live birth rate in women with congenital hypogonadotrophic hypogonadism undergoing intra-cytoplasmic sperm injection? A multicenter cohort study

Abstract

In this retrospective multicenter cohort study, women with congenital hypogonadotrophic hypogonadism (CHH) (n = 57) who underwent intra-cytoplasmic sperm injection in-between 2010-2014 were compared to age-matched controls with tubal factor infertility (n = 114) to assess ovarian stimulation cycle and pregnancy outcomes. Live birth rates (LBRs) per started cycle were 31.6 and 24.6% in CHH and controls groups, respectively (p = 0.36). Comparable success rates were also confirmed with the logistic regression analysis (OR: 1.44, 95% CI: 0.78-2.67, p = 0.24). Of the 57 women with CHH, 19 were stimulated with the gonadotropin-releasing hormone (GnRH) antagonist protocol, 13 with the long-GnRH-agonist protocol. Pituitary suppression (PS) was not employed in the remaining 25 cases. Compared to women with PS, women without PS had significantly higher embryo implantation rates (21.6 versus 52.6%, p = 0.03). Although there was a trend favoring no PS, LBRs (25.0 versus 40.0%, p = 0.26) per cycle were short of statistical significance. LBRs per cycle (57.1 versus 31.2%, p = 0.11) and miscarriage rates (11.1 versus 16.7%, p = 0.75) were similar between CHH women who were given estrogen + progesterone and progesterone alone to support the luteal phase. In conclusion, the optimal stimulation protocol appears to be exogenous gonadotropin stimulation alone, without PS, and progesterone-only luteal phase support in CHH patients.

Successful pregnancy and delivery after a vitrified-warmed embryo transfer in a woman with Kallmann syndrome: A case report and literature review

“…Recently, Kuroda et al reported that a combination of freeze-all embryo and single vitrified-warmed ET with a hormone replacement cycle for HH, including IHH, had good cumulative pregnancy rates of 73.4% in up to 3 ET cycles 30) . Seven retrospective cohort studies comparing IHH with tubal or male infertility and other causes of poor ovarian responsiveness to gonadotropins have been reported 23 - 27 , 29 , 31) . In these reports, the total amount of gonadotropin used and the duration of ovarian stimulation were significantly higher in IHH than in other causes of infertility.…”

Reproductive outcomes in women with hypogonadotrophic hypogonadism, a case series study

“…Because of the low levels of FSH and LH, downregulation by either gonadotrophins-releasing hormone agonist (GnRH a) or antagonist (GnRH ant) was not required based on the results claim from detrimental effect of the pituitary suppression in women with congenital HH, on Table 1 The basal characteristics of the studied patients *As non-normal data distribution, the values were estimated by median and inter-quartile range (IQR) implantation and live birth rates [19]. Unlike our study, the previous results were applied to the patients with congenital and functional hypogonadism.…”