Abstract
That ovarian insufficiency and resulting infertility can have iatrogenic causes is well known; but that never before included corticosteroid therapy. We now report two longstanding so-called “unexplained” infertility cases which, upon presentation to our center were diagnosis with secondary ovarian insufficiency (SOI) as a consequence of abnormally low adrenal androgen production following prolonged corticosteroid therapy. Androgens at small growing follicle stages act synergistically to follicle stimulating hormone (FSH) in fostering follicle growth and maturation. Hypoandrogenism, therefore, reduces numbers and quality of follicles and oocytes and, in most severe cases, can lead to complete arrest of folliculogenesis and SOI. Both women demonstrated caseation of pituitary ACTH secretion, leading to very low peripheral androgen levels. Discontinuation of exogenous corticosteroid therapies and exogenous androgen supplementation with dehydroepiandrosterone (DHEA) reversed their abnormal endocrine profiles. One patient since conceived through in vitro fertilization, while the second patient is still in treatment. Here presented observation suggests that iatrogenic-induced ovarian insufficiency - and, in most severe case SOI - may be more common than is currently appreciated and, frequently, may be misdiagnosed as “unexplained” infertility.