Impact of hypogonadotropic hypogonadism on ovarian reserve and response

Objective To evaluate the hormonal profile, antral follicle count (AFC) and ovarian response of patients with hypogonadotropic hypogonadism (HH). Design Observational retrospective cohort including infertile women with HH undergoing assisted reproductive treatment (ART). Setting University-affiliated infertility center. Patient(s) Thirty-three women with HH who underwent ART between January 2007 and September 2018. The control group comprised 66 age-matched counterparts with tubal or male factor infertility. The patients with an abnormal karyotype, and those presenting primary or secondary amenorrhea due to other causes, were cautiously excluded. Intervention(s) None. Main outcome measure(s) The primary outcome was serum levels of anti-Mullerian hormone (AMH) and AFC. We also investigated whether HH impacts ovarian response and reproductive outcomes. Result(s) Although AFC was similar between groups, HH patients showed significantly higher AMH levels (4.6 +/- 2.7 ng/mL vs. 3.0 +/- 1.9, p = 0.010) and lower basal FSH and LH. While the HH group needed longer stimulation [13 days (11-26) vs. 10 (7-14), p < 0.001] and higher gonadotropin doses [2700 IU (825-6300) vs. 2100 (425-5000), p = 0.038 ], no significant differences were detected in either the number or maturity of retrieved oocytes, or in the fertilization rate, number of embryos transferred, implantation rate, clinical pregnancy rate and live birth rate per cycle. Conclusion(s) HH patients present higher AMH levels, but similar AFC. Despite requiring longer stimulation and higher gonadotropin doses, ovarian response and reproductive outcomes seem unaffected.