Endocrine Abstracts

Hypopituitarism is relatively rare disorder characterized by different kind of pituitary deficit, and GH-deficiency as well as hypogonadotropic hypogonadism (HH) are the most often met ones. The prevalent cause of hypopituitarism is organic lesion of hypothalamo-pituitary region (pituitary tumors, craniopharyngiomas, empty sella turcica and etc). Successful neurosurgery and optimal replacement hormonal treatment allow patients to appeal to a doctor about pregnancy. Results of fertility restoration in 22 patients with hypopituitarism were compared in this study. Women 22–34 y.o. with duration of HH from 2 to 10 years were observed: 4 patients with isolated HH, 12 – with other adequately treated pituitary deficiencies. Before ovulation stimulation patients were treated with 17β-estradiol (2–4 mg) and dydrogesterone (10–20 mg) in sequence manner no less than for 12 months, this period was used for restoration of physiological endometrium function, increase of uterus volume, correction of treatment of other pituitary deficits (if needed). AMH levels were normal in 19 women and low in 3. In eight women there were 16 stimulations of superovulation according to standard ‘long’ or ‘short’ IVF protocols (group 1), 1–8 eggs were obtained per protocol. In other 8 women there were 12 ovarian stimulations using human recombinant gonadotropins with individualised dose titration (group 2), 1–3 ovulated follicles were usually observed per stimulation. In more 8 women (including 2 with previous unsuccessful ovarian stimulation) 12 mild stimulations of ovulation according to individualized IVF protocols were done (group 3), 1–3 eggs per protocol. Individual approach for groups 2 and 3 included: pre-treatment for 2–3 months with low (37.5 MU) rFSH doses in case of low number of antral follicles, estrogen treatment continuation during ovarian stimulation, addition of rLH to rFSH from 6–7 day of stimulation in case of retardation of follicle growth. Moreover, in group 3 GnRH agonists/antagonists were not used because spontaneous LH surge were not expected. Total doses of gonadotropins used for ovarian stimulation were same or below in groups 2 and 3 compared with group 1. During pregnancy replacement treatment of accompanying pituitary deficits were correlated. Rates of ‘take-home-baby’ were 56.25%, 66.67% and 66.67% accordingly. Main reasons for failure were other infertility factors (male, immunological, concurrent gynaecological). Thus, modern assisted reproductive technologies can help patients with hypopituitarism to restore fertility but individualized approach is highly recommended taking into account both assisted reproductive technologies features and hypopituitarism points. Pregnancy attainment in a woman with hypopituitarism is real ART of medicine.