Reassessing fecundity in women with classical congenital adrenal hyperplasia (CAH): normal pregnancy rate but reduced fertility rate

Abstract

Objective: Fertility in women with classical congenital adrenal hyperplasia (CAH) has been reported low; however, the true pregnancy rate for women trying to conceive with this condition is unknown. Our aim was to calculate pregnancy rate for women with CAH calculated as a proportion of those who had attempted conception. Fertility expressed as live birth rate is also calculated.

Patients: One hundred and six women with classical CAH followed in a multidisciplinary service [81 salt-losing (SL) and 25 nonsalt-losing (NSL) form].

Results: Twenty-five (23.6%) women with CAH women considered motherhood, 23 had actively tried conception of whom 21 (91.3%) achieved 34 pregnancies. Pregnancy rate is no different from that in the normal population (95%). Pregnancy rates were similar in the SL (88.9%) and NSL (92.9%) subgroups but those with NSL-CAH were more likely to seek motherhood than those with SL-CAH (16/25 vs. 9/81). Optimized glucocorticoid and mineralocorticoid regimes during fertility monitoring resulted spontaneous conception in nearly all recent cases. Fertility rate was 0.25 live births per woman compared with 1.8 in the UK population (P < 0.001).

Conclusion: We report a normal pregnancy rate (91.3%) for women with classical CAH, similar in SL and NSL subgroups. Fertility rate, however, remains much lower than in general population.