The reproductive outcome of women with hypogonadotropic hypogonadism undergoingin vitrofertilization

Abstract

The aim of this study was to evaluate the reproductive outcome and assisted reproductive technology (ART) outcomes of patients with hypogonadotropic hypogonadism (HH) and to compare the results with male factor (MF) infertility patients. The reproductive outcome of 33 HH patients was evaluated retrospectively and compared with results of 47 patients with mild male factor infertility. For ovulation induction, human menopausal gonadotropin (hMG) was used in HH patients and recFSH was used in MF infertility patients. HH patients were divided into subgroups according to retrieved oocyte numbers and the groups were compared with each other. The main outcome measures were total gonadotropin dose used, duration of stimulation, human chorionic gonadotropin (hCG) day estradiol level and endometrial thickness, oocyte number retrieved, and rate of clinical pregnancy. ART outcomes and cycle characteristics of 33 HH patients were compared with 47 MF infertility patients. There was no difference in age and body mass index (BMI) between the groups, but mean follicle stimulating hormone FSH and luteinizing hormone LH levels were significantly lower in the HH group (p50.001). Duration of stimulation was 12.5 ± 2.06 days in the HH patients and 10.08 ± 1.62 days in the MF infertility patients and the difference was significant (p50.001). Total gonadotropin dose used was higher in the HH group than the MF infertility group (p 5 0.001). However, there were no differences in hCG day estradiol levels, endometrial thickness on hCG day, total oocyte number retrieved, MII oocyte number, and pregnancy rate. In the HH subgroups, patient ages were significantly lower in the 415 oocyte retrieved group. Although patients with HH have a long-term estrogen deficiency, their response to controlled ovarian hyperstimulation treatment is similar to normal women. However, the HH group is heterogeneous and estimating the ovarian reserve before treatment is not always possible in this group.

The effects of low‐dose human chorionic gonadotropin combined with human menopausal gonadotropin protocol on women with hypogonadotropic hypogonadism undergoing ovarian stimulation for in vitro fertilization

“…It is also reported that high HMG dosage may be detrimental to oocytes and embryos . In our study, whilst the oocytes retrieved were obviously fewer than those in documented studies, the number of MII oocytes was no less than any of other studies. The peak E2 level was much higher, and the mean E2 level per follicle reaches over 1100 pmol/L, approximately two to three times greater than that in other studies.…”

“…When compared with the previous studies, it is clear that the clinical pregnancy rate and the implantation rate in this protocol are higher. The rate of abortion was 4%, which is significantly lower than all the documented data and indicates a higher quality of embryos. Finally, a cumulative pregnancy rate per woman of 52.2% was achieved after the first embryo transfer cycle.…”

“… The rate of abortion was 4%, which is significantly lower than all the documented data and indicates a higher quality of embryos. Finally, a cumulative pregnancy rate per woman of 52.2% was achieved after the first embryo transfer cycle. Therefore, in the light of these satisfying pregnancy outcomes, it is reasonable to conclude that low‐dose hCG combined with HMG is a feasible protocol for HH women undergoing IVF.…”

“…Compared with previous studies focusing on the cycle characteristics and outcomes of HH women in IVF, the HMG duration was much the same but the total HMG dose was apparently lower in our study. Such a mismatch may be explained partially by the higher BMI of subjects in other reported studies, but it cannot be neglected that nearly twice the HMG dosage was required in a study consisting of 58 patients with similar BMIs . Subsequently, the use of low‐dose hCG should be the more important cause for lower need of HMG in this study.…”

“…To date, several studies have demonstrated that HH patients perform well in IVF, showing good ovarian responses and sound potential for pregnancy. Despite the fact that HH patients are affected by the long‐term deficiency of normal sex hormone, IVF proves to be as successful as in women with other causes of infertility, including tubal factor infertility (TF), male factor infertility (MF) and unexplained infertility (UEI) . However, in all these reports, the ovarian stimulation protocols use human menopausal gonadotropin (HMG) only.…”