Growth hormone and gonadotropin association: A case report of full-term pregnancy in a patient with panhypopituitarism.

Abstract

Hypopituitarism is the inability of the anterior pituitary gland to properly supply the hormone levels. When this disease affects all the hormones produced by the anterior pituitary, it is called panhypopituitarism (PHP). Since pituitary-derived hormones directly influence fertility, often the assisted reproduction techniques are the only option to PHP women have a full-term pregnancy. However, not all patients diagnosed with PHP properly respond to ovulation induction. Thus, a poor response may indicate decreased ovarian reserve or reflect a deficiency in other key components of ovarian function. Here we presented a rare case of a 24-year-old woman diagnosed with PHP and poor response to previous gonadotropin therapy. In our protocol the patient received first growth hormone (GH) replacement for 5 months before starting gonadotropins. When the serum IGF-I (insulin grow factor-I) level normalized, she started ovulation induction with 225 IU/day of human menopausal gonadotropin (hMG). After the ninth day of the cycle, ultrasounds were performed every 2 days to control follicular growth. The puncture of the follicles was performed on the twentieth day of the cycle and a surprising number of 13 oocytes were collected. The oocytes were fertilized by the classical IVF method, resulting in 11 D3 embryos, of which 2 were freshly transferred. Beta hCG hormone levels were determined, and a single fetus pregnancy was confirmed. The birth was by cesarean section at 38 weeks of gestation. Therefore, we conclude that GH/gonadotropin association in ovarian stimulation may improve the follicular recruitment in PHP patients.