Treatment Observation on Primary Infertility Hypothalamic Amenorrhea Caused by Idiopathic Hypogonadotropic Hypogonadism

doi:10.3877/cma.j.issn.1673-5250.2011.06.011

Objective

To explore characteristics and outcomes of reproductive therapies on patients with hypothalamic amenorrhea (HA).

Methods

From July 2003 to November 2010, the data of 11 patients with HA who were treated in Jining First People's Hospital were analyzed retrospectively. All the patients were diagnosed as idiopathic hypogonadotropic hypogonadism (IHH). The ovulation induction followed treatment protocols. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Jining First People's Hospital. Informed consent was obtained from all participates. After taking the artificial cycle for 3 months, all the patients received ovulation induction solutions: Option A [human menopausal gonadotropin (hMG) + human chorionic gonadotrophin (hCG)] and option B [hMG+ highly purified human urinary follicle stimulating hormone (HP-hFSH) + hCG]. After dominant follicle developed and matured, patients were recruited for intrauterine insemination (IUI) or timed intercourse and then received luteal support therapy after ovulation.

Results

A total of 26 treatment cycles of ovarian stimulation treatment were conducted on 11 HA patients. Taking 22 treatment cycles as observation point, the ovulation rate was 84.61% (22/26), and 4 cycles were cancelled for poor responses to gonadotropins, economic or other reasons. In 22 effective treatment cycles, 7 clinical pregnancies were achieved, in which 1 case was spontaneous abortion, 1 case died of umbilical cord around neck and 5 cases delivered at term. The cycle clinical pregnancy rate was 31.82% (7/22) and the cumulative clinical pregnancy rate was 63.64% (7/11). Gonadotropin (Gn) medication time of option B was shorter than that in option A (P<0.05). The number of dominant follicle on hCG day and endometrial thickness on hCG day between two groups had no significant difference (P>0.05).

Conclusion

Exogenous Gn is an effective way to treat HA caused by IHH and anovulatory infertility with satisfactory ovulation rate and pregnancy rate.

Key words: hypothalamic amenorrhea, idiopathic hypogonadotropic hypogonadism

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