Hormonal effects in infants conceived by assisted reproductive technology.
OBJECTIVE
The purpose of this report is to describe 7 infants conceived by assisted reproductive technology (ART) who presented with breast development and/or pubic hair. The clinical presentation in these infants raises awareness that an altered intrauterine hormonal milieu may impact the fetal and infant stages of children conceived by ART.


METHODS
Between May 2001 and April 2004, 7 children between the ages of 5 and 21 months conceived by ART were referred by their pediatricians to the Division of Pediatric Endocrinology at the New York University School of Medicine for evaluation of possible precocious puberty. Patients were evaluated for the possibility of centrally mediated precocious puberty and pseudoprecocious puberty, with a possible ovarian or adrenal origin.


RESULTS
Endocrine evaluation in all patients indicated sex-steroid and hormone levels in the prepubertal range; pelvic sonography confirmed prepubertal ovaries with unstimulated uteri. Clinical follow-up of our patients thus far has not revealed progression of breast development, pubarche, or elevation in sex steroids.


CONCLUSIONS
It is well established that the developing endocrine system in the fetus and maturation of endocrine-control systems are influenced by hormone concentrations in the fetus. Whether ART alters the intrauterine hormonal milieu for the growing fetus conceived by ART is as yet unknown and is an area of ongoing investigation. Patients conceived through ART, including our patients who presented with hormonal manifestations, will need to be monitored throughout childhood and into adolescence and adulthood to determine if any perturbation exists on the timing of puberty and later fertility.
Department of Endocrinology and Nutrition, Hospital Clinico San Carlos, C/Martin Lagos s/n Madrid, Spain.
Patricia Martin
PM
Rojas-Marcos
Raphael
R
David
Brenda
B
Kohn
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis; D000365:Age Determination by Skeleton; D000735:Androstenedione / Q000097:blood; D001940:Breast / Q000254:growth & development; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D004970:Estrone / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000097:blood; D006197:Hair / Q000254:growth & development; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011629:Puberty, Precocious / Q000097:blood / Q000209:etiology*; D011994:Recombinant Proteins / Q000008:administration & dosage; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D013739:Testosterone / Q000097:blood
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011994:Recombinant Proteins; D004970:Estrone; D013739:Testosterone; D000735:Androstenedione; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone