Application of Human Menopausal Gonadotropins in the Treatment of Idiopathic Hypogonadotropic Hypogonadism (IHH)-Based Infertility in Females: A Case Report

Abstract

Rationale

Idiopathic hypogonadotropic hypogonadism (IHH) is a prevalent congenital genetic disorder with multiple inheritance patterns. IHH can manifest as normal hypogonadotrophic sexual hypofunction (nIHH) or with an abnormal sense of smell, known as Kallmann. It primarily affects the production and effectiveness of gonadotropin-releasing-hormone (GnRh), leading to reduced follicle-stimulating hormone and luteinizing hormone levels. This results in infertility and underdeveloped secondary sexual characteristics.

Patient Concerns

A 29-year-old female presented with infertility.

Diagnosis

IHH diagnosis was confirmed through magnetic resonance (MR) scan, endocrine tests, physical examination, and B ultrasonic inspection. Additionally, genetic studies, including chromosome analysis, were conducted for the patient. The results confirmed no genetic abnormalities or concerns.

Interventions

The patient underwent multiple ovulation induction programs.

Outcome

After several ovulation induction cycles, the patient conceived and delivered a live baby.

Lessons

For IHH patients, a tailored human menopausal gonadotropin (HMG) dose is recommended. High-dose HMG can benefit those with poor follicular response. The addition of letrozole (5–7.5mg) may enhance follicular response during stimulation. Our approach, which emphasizes the combined use of high-dose HMG, letrozole, and the adjustment of FSH and LH ratios, offers a unique perspective compared to traditional treatments. If HMG treatment is ineffective, alternative ovulation induction methods, such as r-fsh combined with r-lh or HMG combined with rLH, can be considered. Adjusting the FSH and LH ratio and varying rFSH and rLH additions might help achieve dominant follicles and live birth in resistant cases. This case report underscores the potential benefits of our regimen, suggesting its consideration for future research and clinical applications.

Keywords:

• HMG
• IHH
• infertility
• rLH

Abbreviations

MR, Magnetic Resonance; IHH, idiopathic hypogonadotropic hypogonadism; HMG, human menopausal gonadotropin; r-LH, Recombinant human luteinizing hormone; hCG, human chorionic gonadotropin; GnRh, gonadotropin-releasing hormone.

Data Sharing Statement

The datasets generated during the present study are available from the corresponding author on reasonable request.

Acknowledgments

We thank Yingjie Ma for the design and guidance of this article.

Disclosure

The authors report no conflicts of interest in this work.