The reproductive outcome of women with hypogonadotropic hypogonadism undergoing in vitro fertilization

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 (p < 0.001). 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 (p < 0.001). Total gonadotropin dose used was higher in the HH group than the MF infertility group (p < 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 >15 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.

• ART outcome
• clinical pregnancy rate
• estimating ovarian reserve
• hypogonadotropic hypogonadism

Acknowledgments

This paper was selected as an oral presentation and won the ‘Under 34 Competition’ award in the 18th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), Vienna, Austria, 24–27 October 2013.

Declaration of interest

The authors report no declarations of interest. There remain no relevant potential conflicts of interest related to this original article. Also, there remains no affiliation with any organization with a financial interest, direct or indirect, in the subject matter or materials discussed in the manuscript (such as consultancies, employment, paid expert testimony, honoraria, speakers bureaus, retainers, stock options or ownership, patents or patent applications or travel grants). We did not receive any funding and/ or financial support from any commercial or other association for this study.

Author contributions

Corresponding author, drafting the manuscript conception and design of the study, acquisition of data, analysis and interpretation of data, article draft and revising the manuscript critically for important intellectual content: SY; Drafting the manuscript conception and design of the study, analysis and interpretation of data, article draft and revising the manuscript critically for important intellectual content: ASO-E; Acquisition of data: OY, SK, BS; Conception and design of the study, drafting the manuscript, article draft and revising the manuscript critically for important intellectual content: NY.