title: Pregnancy outcome of assisted reproductive technology cycle in patients with hypogonadotropic hypogonadism.
abstract: BACKGROUND
  Ovulation induction in patients with hypogonadotropic hypogonadism (HH) is a challenge to the treating physician. The threshold for ovarian response in HH may differ substantially from that of normal patients. To reach that threshold levels of follicle stimulating hormone, in a step-up protocol longer duration of stimulation is required in some cases so as to prevent multiple pregnancy and to eliminate the risk of ovarian hyperstimulation syndrome.
  
  
  OBJECTIVE
  To evaluate the duration of stimulation, quality of oocytes, and embryo, and the pregnancy outcome in the assisted reproductive technology (ART) cycles in patients with HH.
  
  
  METHODS
  Over the period of 4 years, we had 14 patients with HH in whom 21 cycles of ovulation induction were done. Of these 7 patients underwent oocyte retrieval and intracytoplasmic sperm injection (ICSI). We present a retrospective study of these 7 patients who underwent ART to evaluate the duration of stimulation, quality of oocytes and embryo, and the pregnancy outcome.
  
  
  RESULTS
  In the study group on ovulation induction with gonadotropins, only one patient had the duration of stimulation of the standard 12 days, the remaining 6 patients took ≥12 days to respond to stimulation (maxium being 54 days). Mean ET in these patients was 8.9 mm. Six patients had >70% good quality MII oocytes. One patient responded poorly and had only 2 good quality MII oocytes (50%). After ICSI procedure, resultant embryos were of grade 1 and 2 in all the patients irrespective of the duration of stimulation. Fertilization rate in these patients was 85% (except in one 50% fertilization rate), and the cumulative pregnancy rate was 68.6%.
  
  
  CONCLUSIONS
  In the patients with HH the quality of oocytes and embryos, and the pregnancy rate is not affected even if the duration of stimulation is prolonged.
authors.affiliation: Department of Reproductive Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: Monna
authors.initials: M
authors.lastname: Pandurangi
authors.affiliation: Department of Reproductive Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Tamizharasi
authors.affiliation: Department of Reproductive Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
authors.forename: N Sanjeeva
authors.initials: NS
authors.lastname: Reddy
keywords: Embryo; gonadotropins; hypogonadotropic hypogonadism; intrauterine insemination; oocytes; ovulation induction