IVF Outcomes of Patients in women with Isolated Hypogonadotropic Hypogonadism: a retrospective study in China

Abstract

Abstract Background: Isolated Hypogonadotropic Hypogonadism (IHH) is a rare reproductive disorder due to the dysfunction of the gonadotropin-releasing hormone axis. Without an exogenous hormone supplement, patients with IHH typically fail to enter or develop through puberty and retain infertility. This study was conducted to 1) address the population characteristic of IHH and their clinical outcomes who underwent IVF treatment, 2) evaluate the predictor for the ovarian response for IHH. Methods: This retrospective cohort study included 83 women with IHH who underwent fresh ART cycles and non-diagnosed controls (n=676). The receiver operating characteristic curves were generated to assess the predictor for the ovarian response. The IVF outcomes and strategy patterns administered in IHH were investigated in univariate and regression analyses to optimize the live birth rate. Results: The fertilization rate and 2PN rate in both fertilized methods (IVF and ICSI) were significantly higher in IHH groups, as was the number of transferable embryos. The highest clinical pregnancy (CP) rate was seen in IHH with a high ovarian response group (63.6%), followed by patients with normal ovarian response in controls. Among patients diagnosed as CP, significantly more live births were observed in IHH groups, even subdivided by the ovarian response. For high ovarian response, AMH levels were the most accurate and reliable predictor (ROC = 0.871). Among IHH patients, the initial Gn dose was significantly lower in CP groups than in non-CP. AMH was the negative factor for initial Gn and total Gn, while AFC was a positive factor in the duration of Gn use. Conclusions: The study findings suggest patients with IHH were good responders to IVF treatment and the lower initial Gn dosing needs to be considered for normal ovarian responders in IHH. AMH was the best-performed predictor for the ovarian response. The "low and slow" Gn dosing protocol for IHH was practicable with a satisfied IVF outcome in the clinic.