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Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 12-19

Hypogonadotropic hypogonadism and assisted reproductive techniques: a review

VMMC & Safdarjung Hospital, New Delhi, India

Correspondence Address:
Dr. Garima Kapoor
VMMC & Safdarjung Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

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Backgroud: Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disorder that manifests as absent or delayed pubertal development and infertility due to defective secretion or action of gonadotropin-releasing hormone (GnRH). The incidence is 1 in 10,000 in men and 1 in 50,000 in women. Materials and Methods: An online search was made on Google scholar and PubMed with search words hypogonadotropic hypogonadism (HHG), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination, male, and female, and the retrospective/prospective studies that met the inclusion criteria were selected. Inclusion criteria: The studies included were retrospective and researched the effect of assisted reproductive techniques (ART) on women with CHH. The studies were included if they had any one of the following primary outcomes: fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (PR) per cycle/embryo transfer (ET), and live birth rate (LBR). Exclusion criteria: (1) Review articles, (2) case reports, (3) duplication of studies, and (4) studies with no available endpoints. Secondary outcomes were any of the following: abortion rate, multiple gestations, ovarian hyperstimulation syndrome, and any adverse effect. The studies were reviewed for the demographic profile of the patients, drugs, and their doses used for stimulation protocol, fresh/ frozen sample used, ART procedure, number of metaphase II (M II) oocytes retrieved, FR, IR, clinical PR, and adverse outcomes. Results: Seven studies have shown a statistically significant increased requirement of dose and duration of gonadotropins in women with CHH while reporting a comparable metaphase II (M II) oocyte recovery rate, FR, PR, IR, and LBR, when compared with controls. Five studies were selected for male HHG with ART, varying from a sample size of 4 to 31. Inj human chorionic gonadotropin (HCG) and Inj human menopausal gonadotropin (HMG)/recombinant follicle-stimulating hormone (rFSH) was used to induce spermatogenesis for a period of 6 to 24 months. In men with azoospermia/unable to conceive after gonadotropin therapy, ICSI was performed. Testicular sperm extraction (TESE) was used for the extraction of sperm in azoospermic men. FR from 41.7% to 82%, CPR from 17.6% to 51.5%, and LBR from 20% to 41.3% have been reported. Conclusion: Controlled ovarian hyperstimulation (COH) with IVF/ICSI should be offered to those patients who fail to conceive naturally or with intrauterine insemination/gonadotropin therapy. Newer regimes of COH (HCG with HMG/FSH), vitrified-thawed ET for female HHG, and pretreatment with FSH followed by HCG and follitropins for induction of spermatogenesis in male HHG look promising and need to be researched further.

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