title: Infertility and Reproductive Function in Patients with Congenital Adrenal Hyperplasia: Pathophysiology, Advances in Management, and Recent Outcomes.
abstract: Individuals with congenital adrenal hyperplasia have reduced fertility. However, reproductive outcomes have improved over the years. This review provides an update on the multiple pathologic processes that contribute to reduced fertility in both sexes, from alterations of the hypothalamic-pituitary-gonadal axis to the direct effect on gonadal function by elevated circulating adrenal androgens. In addition, elevated serum progesterone concentrations may hinder ovulation and embryo implantation in women, whereas in men testicular adrenal rest tumors can be a major cause of infertility. Suppression of adrenal androgen secretion represents the first line of therapy toward spontaneous conception in both sexes.
authors.affiliation: Pediatric Endocrinology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Oksana
authors.initials: O
authors.lastname: Lekarev
authors.affiliation: Pediatric Endocrinology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Lin-Su
authors.affiliation: Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Electronic address: vogiatzim@email.chop.edu.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Vogiatzi
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000150:complications*; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology* / Q000628:therapy*; D008297:Male
keywords: 21-Hydroxylase deficiency; Congenital adrenal hyperplasia; Fertility; Pregnancy; Testicular adrenal rest tumors (TART)