Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies

Abstract

Context:Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome.Objective:We evaluated fertility treatment and pregnancy outcomes in five women with childhood-onset combined pituitary hormone deficiencies (CPHD).Patients and Methods:Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal).Results:All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks).Conclusion:Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients.

Management of Hypopituitarism

“…FSH and LH or their equivalent (recombinant forms) are administered by injections and are necessary for fertility. Reduced fertility outcomes in the context of ovulation per cycle or achievement of live-birth have been reported in some [78], but not in all studies [79].…”

Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

“…Women and girls with parasellar lesions are at risk of infertility because of the potential detrimental effects of surgery and radiotherapy on the hypothalamic-pituitary axis. Retrospective studies report pregnancy rates of between 47 and 76% amongst women with hypopituitarism [86][87][88][89][90]. In childhood, both hypopituitarism and isolated HH may lead to smaller uterine dimensions and ovarian volume compared with healthy controls [91].…”

“…COS protocols for assisted reproduction in women with HH are described in Table 3. The reported pregnancy rates after COS amongst HH women vary wildly, from 19.4 to 100%, with a 3.6-41.7% risk of multiple pregnancies [88][89][90][95][96][97][98][99][100]. Higher gonadotropin doses are generally used than in patients with other causes of infertility [101].…”

Growth Hormone and Reproduction: Lessons Learned From Animal Models and Clinical Trials

“…In a different model of childhood onset CHPD, Correa reports on five cases from a single center. Pregnancy has been obtained in all cases with controlled ovarian stimulation and GH –LT4 co-treatment (17).…”