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Meta-Analysis
. 2018 Nov 19;18(1):85.
doi: 10.1186/s12902-018-0313-8.

Assisted reproductive techniques with congenital hypogonadotropic hypogonadism patients: a systematic review and meta-analysis

Yinjie Gao  1 , Bingqing Yu  1 , Jiangfeng Mao  1 , Xi Wang  1 , Min Nie  2 , Xueyan Wu  3
Affiliations
Meta-Analysis

Assisted reproductive techniques with congenital hypogonadotropic hypogonadism patients: a systematic review and meta-analysis

Yinjie Gao et al. BMC Endocr Disord. .

Abstract

Background: After hormonal replacement therapy (HRT) including androgen replacement or sequential therapy of estrogen and progesterone, The combination of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) and pulsatile GnRH, is not sufficient to produce sufficient gametes in some patients with Congenital hypogonadotropic hypogonadism (CHH). A Systematic review and meta-analysis was performed to determine that assisted reproductive techniques (ART) can effectively treat different causes of infertility.

Methods: To determine the effect of ART on fertility of CHH patients and investigate whether outcomes are similar to infertility due to other causes, we conducted a systematic review and meta-analysis of retrospective trials. Clinical trials were systematically searched in Medline, Embase, and the Cochrane central register of controlled trials databases. The keywords and major terms covered "hypogonadotropic hypogonadism", "kallmann syndrome", "assisted reproductive techniques", "intrauterine insemination", "intracytoplasmic sperm injection", "testicular sperm extraction", "in vitro fertilization", "embryo transplantation" and "intra-Fallopian transfer".

Results: A total of 388 pregnancies occurred among 709 CHH patients who received ART (effectiveness 46, 95% confidence interval 0.39 to 0.53) in the 20 studies we included. The I2 in trials assessing overall pregnancy rate (PR) per embryo transfer (ET) cycle was 73.06%. Similar results were observed in subgroup analysis by different gender. Regression indicates pregnancy rate decreases with increasing age. Fertilization, implantation and live birth rates (72, 36 and 40%) showed no significant differences as compared to infertility due to other causes.

Conclusions: Despite CHH patients usually being difficult to generate gametes, their actual chances of fertility are similar to subjects with other non-obstructive infertility. ART is a suitable option for CHH patients who do not conceive after long-term gonadotropin treatment.

Keywords: Assisted reproductive techniques; Congenital hypogonadotropic hypogonadism; Fertility; Hormonal replacement therapy.

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Conflict of interest statement

Ethics approval and consent to participate

All analyses were based on previous published studies, thus no ethical approval and patient consent are required according to the regulation of Peking Union Medical College Hospital ethic committee. All previous published studies were approved by ethics committee respectively.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of studies identified in the systematic review
Fig. 2
Fig. 2
Forest plot for the pregnancy rate. ES = effect size; CI = confidence interval
Fig. 3
Fig. 3
Forest plot for subgroup analysis by different gender
Fig. 4
Fig. 4
Influence of age at pregnancy rate Influence of age (X-axis) on pregnancy rate (Y-axis). The size of the circles indicates sample dimension.
Fig. 5
Fig. 5
Forest plots for the fertilization rate a, implantation rate b and live birth rate (c)
Fig. 6
Fig. 6
Frequencies of abortion and multiple pregnancies. (a)Different colors represent four adverse events, including abortion(blue),multiple pregnancy(red),OHSS(green) and ectopic pregnancy(purple);(b)8.20% patients of all suffered abortion(red);(c)12.8% patients of all had multiple pregnancy. Y=Yes; N=No
See this image and copyright information in PMC

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