Endocrine Abstracts

Women with acromegaly present often menstrual irregularity, anovularity and infertility. A direct role of GH and IGF1 excess on the hypothalamus–pituitary–gonadal axis, hyperprolactinemia and an impaired gonadotrophin secretion related to a tumor mass effect, or polycystic ovary syndrome have been suggested as possible mechanisms related to infertility. However, no systematic data are available on fertility in these patients. The aim of this retrospective study was to evaluate the fertility rate and characteristics in 120 women with acromegaly attending the outpatient service of our Department between 1995 and 2010, where 70 women with diagnosis of acromegaly were within the reproductive age range (21–43 years). Gonadal function was assessed on the basis of menstrual status and hormone profiles before and after treatment of acromegaly. Information on the desire of pregnancy, nature of conception (spontaneous or after ovarian stimulation) and pregnancy, was based on medical records and an ad hoc designed questionnaire distributed to these patients. At the diagnosis, 42 women (60%) had menstrual disturbances, mainly characterized by oligo-amenorrhea. Of these 25 (60%) had hypogonadotrophic hypogonadism, 12 (30%) had hyperprolactinemia, whereas 5 (10%) patients had a clear-cut polycystic ovary syndrome. During the active disease, 25 women (35%) had desire of pregnancy but had difficulties in conception and starting pregnancy. In the last 15 years, nine women became pregnant only after the normalization of GH and IGF1 levels. Three patients became pregnant after surgical treatment, whereas six women were receiving medical treatment with somatostatin analogs when they conceived, and treatment was continued during the pregnancy in two of them. Only one patient underwent ovarian stimulation and intrauterine insemination. In conclusion, fertility is commonly impaired in women with acromegaly, 60% of our patients had gonadal dysfunction, 35% of them had desire of pregnancy and 36% of these latter patients become pregnant but only after normalization of GH/IGF1 levels. Effective treatment for acromegaly, represented by surgery or medical therapy seem to improve fertility, since 30% of patients conceived after surgery and 70% become pregnant during treatment with somatostatin analogs.