Endocrine Abstracts

Hypopituitarism and impaired fertility in adulthood may result from congenital genetic defects detected during childhood or acquired pituitary dysfunction after apoplexy or resection of a pituitary tumor or following radiation therapy. This lecture will review the fertility options for hypopituitary patients, success rates and predictors of outcome for conception and live births. In those with normal pituitary function planning surgery and/or radiation to the hypothalamic-pituitary axis, banking of sperm, oocytes or embryos are newer options to preserve future fertility options. In those with partial or complete pituitary hormonal deficiencies, optimization of thyroid, adrenal and perhaps growth hormone function must be obtained before fertility options are discussed. In men, induction of spermatogenesis is usually achieved with intermittent human chorionic gonadotropin (hCG) alone, or in combination with recombinant follicle stimulating hormone (FSH), or human menopausal gonadotropins. Size of the testes at baseline predicts success, as therapy must restore or recapitulate the pubertal process to achieve normal spermatogenesis. In women with partial gonadotropin deficiency, induction of ovulation with clomiphene citrate may be an option. For most hypopit women with hypogonadotropic hypogonadism, therapeutic options include recombinant FSH with hCG alone or in combination with intrauterine insemination, or in vitro fertilization. Despite the expansion of treatment options, decreased response to ovulation induction, decreased live births, increased small for gestational age infants and peripartum complications have been reported in women with hypopituitarism. Further research is needed to plan future options for fertility in those pituitary patients undergoing treatment that will impair reproductive function, and to optimize the treatment options and success rates for patients with hypopituitarism desiring fertility.