Introduction: The uterus develops during puberty and increases not only in length but also in width and depth, to achieve a mature shape. Pubertal induction with exogenous oestradiol aims to mimic this. Research to date shows variable results for the attainment of an adult uterine configuration in females with hypogonadism. Suboptimal uterine development is hypothesised to be a contributing factor for adverse reproductive outcomes in females with hypogonadism undergoing egg donation IVF.
Methods: This is a single centre, retrospective, cross sectional study of females who underwent pubertal induction. Nulliparous females with a history of hypogonadism and pubertal induction, attending University College London Hospital, were recruited. A pelvic ultrasound was performed by a single observer and uterine dimensions and clinical data were recorded. The reference group consisted of 28 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography.
Results: Fifty-six females with hypogonadism were recruited; nine with Gonadotrophin Deficiency, 19 with Premature Ovarian Insufficiency and 28 with Turner Syndrome. The mean age of those with hypogonadism at the time of ultrasound scan was 25.5 years compared to 33.5 years for the reference group. Those with hypogonadism presented at an average age of 12.7 years and started oestradiol therapy at a mean age of 15.1 years. Females with hypogonadism achieved menarche significantly later than those with spontaneous puberty (16.6 years vs 13.2 years P=<0.05). Those with hypogonadism achieved significantly reduced total length, anterior posterior (AP), transverse and uterine volume measurements compared to the reference group (length 67.3 mm vs 73.1 mm P=< 0.05, AP 24.3 mm vs 30.4 mm P=< 0.05, transverse 36.03 mm vs 41.6 mm P=< 0.05, volume 35.0 ml vs 48.9 ml P=< 0.05)
Conclusion: Despite standard Oestradiol therapy, those with hypogonadism achieved significantly smaller uteri compared to the reference group. Not only was the uterine length suboptimal but also the AP and transverse measurements, suggesting an immature shape. Inadequate uterine development may contribute to negative fertility and pregnancy outcomes and therefore, understanding which factors influence uterine size in this cohort, will be paramount to optimise pubertal induction treatment.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes