Successful pregnancy in a patient with biologically inactive LH or partial LHCGR resistance
P. Rao1, A. Straffen1, J. Skull2 & H. Jones1
Introduction: LH resistance is very rare and there are only a few case reports in the literature. We describe a patient who presented to us with secondary amenorrhea and very high isolated LH levels who subsequently had a successful pregnancy with IVF.
Case report: A 16 year old girl was referred to us to investigate the cause of her oligomenhorrea. She had attained menarche at the age of 13 and had only 5 periods in 3 years. She had no symptoms/signs of any endocrine abnormality.
Her blood results showed elevated LH levels more than 250 U/l. Her FSH, prolactin and the rest were normal. There was no evidence of interference from heterophile antibodies. MRI scan of her pituitary was normal. We suspected she had LHCGR mutation causing LH resistance, however genetic analysis did not identify any such mutation in exon 11.
She was started on the OCP. There was some suppression of LH from the baseline although incomplete. She was having regular bleeding on the OCP. In 2008 she wanted to start a family. Since she did not have LHCGR gene mutation, we wondered if the receptor function was normal and hence decided to give a trial of IVF cycle. She received Zoladex to induce pituitary down regulation followed by recombinant FSH to induce follicular growth and hCG. She had a successful pregnancy. Currently her LH is not fully suppressed in spite of being on the OCP confirming that the hypothalamic pituitary dysfunction persists.
Conclusion: LH resistance in women is a very rare phenomenon. Our patient is likely to have either partial LHCGR resistance or biologically inactive LH. Our patient had a positive pregnancy with IVF making it a success story however the molecular diagnosis for her LH resistance is still unclear.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.