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.

Chinese abstract

这是一项回顾性的多中心队列研究。实验组为2010-2014年间 57名先天性低促性腺激素性腺功能减退（CHH）并接受卵胞浆内单精子注射(ICSI)治疗的女性患者, 对照组为同期年龄相匹配的因输卵管性不孕而接受ICSI的114名女性患者, 评价两组卵巢刺激周期的结果和妊娠结局。实验组和对照组的每起始周期活产率分别为31.6% vs 24.6%(p = 0.36), 进一步应用logistic回归分析也得到了相似的结果(OR: 1.44, 95% CI: 0.78–2.67, p = 0.24)。在57名CHH患者中, 19名患者应用促性腺激素释放激素拮抗剂方案, 13名患者应用促性腺激素释放激素激动剂长方案, 剩余25名患者应用非垂体降调节方案。与垂体降调节方案的患者相比, 非垂体降调节方案的患者有较高的胚胎种植率(21.6 vs 52.6%, p = 0.03)。非垂体降调节方案组与垂体降调节方案组相比, 活产率有增高的趋势, 但无统计学意义 (25.0 vs 40.0%, p =0.26)。在CHH患者的黄体支持方面, 应用雌孕激素联合治疗和单用孕激素治疗的活产率与流产率相似(57.1 vs 31.2%, p =0.11, 11.1 vs 16.7%, p= 0.75)。综上所述, 对于CHH患者, 最佳的卵巢刺激方案为非垂体降调节的卵巢刺激方案, 以及单用孕激素进行黄体支持。

Keywords:

• Controlled ovarian stimulation
• congenital hypogonadotrophic hypogonadism
• GnRH AG/ANTAG
• luteal support
• pituitary suppression

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.