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Fertility issues in hypopituitarism

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Abstract

Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.

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Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed for this review article.

Abbreviations

ART:

Assisted reproductive technologies

AMH:

Anti-mullerian hormone

AFC:

Antral follicle count

AVP:

Vasopressin

HPO:

Hypothalamic-pituitary-ovarian

OI:

Ovulation induction

FSH:

Follicle-stimulating hormone

hMG :

Human menopausal gonadotropin

rFSH :

Recombinant FSH

LH:

Luteinizing hormone

E2:

Estradiol

OHSS:

Ovarian hyperstimulation syndrome

TVUS:

Transvaginal ultrasound

hCG:

Human chorionic gonadotropin

TIC:

Timed intercourse

IUI:

Intrauterine insemination

IVF:

In vitro fertilization

GH:

Growth hormone

IGF-1:

Insulin-like growth factor-1

CBG:

Cortisol-binding globulin

CRH:

Corticotropin-releasing hormone

ACTH:

Adrenocorticotropin hormone

11ßHSD2:

11-Beta-hydroxysteroid dehydrogenase 2

AVP-D:

AVP deficiency

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Stanford University Medical Center, 300 Pasteur Drive, Grant-S025, Stanford, Palo Alto, CA, 94305-5103, USA

    Julie Chen, Julia J. Chang & Laurence Katznelson

  2. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Palo Alto, CA, USA

    Esther H. Chung, Ruth B. Lathi & Lusine Aghajanova

  3. Department of Neurosurgery, Stanford University, Palo Alto, CA, USA

    Laurence Katznelson

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  1. Julie Chen
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J.C., J.J.C., L.K. conceptualized the manuscript. J.C., J.J.C., E.H.C. drafted the manuscript. J.C., J.J.C., E.H.C., R.B.L., L.A., L.K. critically revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Julie Chen.

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Competing interests

Julie Chen: Advisory board for Biomarin, Bayer, Immunovant. Julia J. Chang: no relevant financial or non-financial interests to disclose, Esther H. Chung: Advisory Board for Turtle Health, Ruth B. Lathi: Advisory board for Biorad, Lusine Aghajanova: Advisor for Orchid Health, Laurence Katznelson: Advisor for Novo Nordisk.

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Chen, J., Chang, J.J., Chung, E.H. et al. Fertility issues in hypopituitarism. Rev Endocr Metab Disord (2023). https://doi.org/10.1007/s11154-023-09863-9

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