title: Infertility reversed by glucocorticoids and full-term pregnancy in a couple with previously undiagnosed nonclassic congenital adrenal hyperplasia.
abstract: OBJECTIVE
  To report the case of a couple with infertility and two unsuccessful previous attempts of ovarian stimulation for in vitro fertilization (IVF), whose nonclassic congenital adrenal hyperplasia (NC-CAH) due to 21-hydroxylase deficiency (21-OHD) was diagnosed and verified by molecular studies.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Outpatient practice and academic hospital.
  
  
  METHODS
  A woman with hyperandrogenism, luteal phase deficiency, and polycystic ovaries, and a man with oligospermia, a high rate of abnormal forms of spermatozoa (>95%), decreased sperm motility, and normal testicular volume.
  
  
  METHODS
  Ultrasonography, semen analysis, endocrinologic assays, corticosteroids.
  
  
  METHODS
  Increased basal and adrenocorticotropic hormone (ACTH) stimulated 17α-hydroxyprogesterone (17-OHP) values were detected in both partners. CYP21A2 genotyping revealed compound heterozygosity in both wife and husband (wife: p.P30L/p.P453S; husband: p.P453S /p.V281L).
  
  
  RESULTS
  Hydrocortisone, 30 mg/day orally, was administered to both wife and husband. Forty days later, a pregnancy was detected. The prospective mother continued to receive hydrocortisone (25 mg/day) adjusted according to her hormone status. After a full-term uneventful pregnancy, a completely normal female was born. The baby had NC-CAH (genotype p.P30L/p.V281L).
  
  
  CONCLUSIONS
  Nonclassic congenital adrenal hyperplasia, a potential cause of infertility in couples, can be successfully treated with corticosteroids.
authors.affiliation: Third Department of Obstetrics and Gynecology, University of Athens, Attikon University Hospital, Athens, Greece. trakakis@yahoo.gr
authors.forename: Eftihios
authors.initials: E
authors.lastname: Trakakis
authors.forename: Maria
authors.initials: M
authors.lastname: Dracopoulou-Vabouli
authors.forename: Catherine
authors.initials: C
authors.lastname: Dacou-Voutetakis
authors.forename: George
authors.initials: G
authors.lastname: Basios
authors.forename: Charalambos
authors.initials: C
authors.lastname: Chrelias
authors.forename: Demetrios
authors.initials: D
authors.lastname: Kassanos
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D007248:Infertility, Male / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D011247:Pregnancy
chemical_list: D005938:Glucocorticoids