menotropins and beta-Thalassemia

Topics: Adult; beta-Thalassemia; Chorionic Gonadotropin; Drug Combinations; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Menotropins; Ovulation Induction; Treatment Outcome

To describe infertility treatment and pregnancy outcome in a patient with transfusion-dependent beta-thalassemia major and hypopituitarism.. Case report.. University-affiliated infertility clinic.. Twenty-four-year-old infertile patient with homozygous beta-thalassemia.. Co-treatment with GH and gonadotropins.. Ovulation induction with clomiphene citrate or gonadotropins alone was unsuccessful. Combined treatment with hMG, hCG, and recombinant human GH followed by intrauterine insemination resulted in a viable twin pregnancy.. Human GH as an adjunct to hMG and hCG seems to be a sensible approach in the treatment of infertile homozygous beta-thalassemic patients among which very few pregnancies are reported.

Topics: Adult; beta-Thalassemia; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Growth Hormone; Homozygote; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Recombinant Proteins; Twins

Delayed puberty and hypogonadism are frequently observed in patients with homozygous beta-thalassaemia. We evaluated the pituitary-testicular axis in 30 thalassaemic men, aged from 17 to 35 years who were regularly transfused and underwent chelation therapy, while emphasis was given to pituitary reserves of gonadotrophins and the correlation of hormones with serum ferritin (SF). The investigation included endocrinological examination, evaluation of serum basal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and gonadotrophin-releasing hormone (GnRH) test and also spermiograms. According to the results, patients were divided into three groups: group A, which included 18 eugonadal patients with moderately elevated SF, group B which included six patients who had hypogonadotrophic hypogonadism and excessive elevation of SF, and group C, which included six patients characterized as intermediate, with regard to sexual maturation and SF levels. In conclusion, beta-thalassaemia major leads to variable pituitary iron overload and thus hypophyseal damage. This endocrine disturbance is becoming less frequent nowadays with early and intensive chelation therapy.

Topics: Adolescent; Adult; beta-Thalassemia; Chorionic Gonadotropin; Drug Combinations; Ferritins; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hypogonadism; Male; Menotropins; Pituitary Gland; Puberty, Delayed; Spermatozoa; Testis; Treatment Outcome

The objective of this paper was to assess the ability of gonadotropin administration to induce ovarian steroidogenesis, follicle maturation and ovulation in hypogonadal women affected by beta-thalassemia. Thirteen hypogonadal thalassemic women underwent a test with gonadotropin-releasing hormone (GnRH), with estimation of serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. They were then administered human menopausal gonadotropin (hMG) for a period ranging from 11 to 15 days with a total dose variable from 3,300 to 4,200 IU. In each patient, the initial dosage of 300 IU daily, adopted for the first 9 days, was modified subsequently according to the ovarian morphology, as shown by serial echographic examinations and by serum estradiol levels. In those patients in whom a dominant follicle was evidenced and the occurrence of pregnancy could be excluded, induction of ovulation was attempted by administration of 10,000 IU of human chorionic gonadotropin (hCG). All patients displayed a reduced LH and FSH rise in response to GnRH. Upon hMG administration, they exhibited echographic evidence of follicular growth with a clear-cut increase of serum estradiol, which peaked between the 9th and the 16th day from the start of treatment. In two out of three patients in whom a dominant follicle developed, ovulation was induced successfully by hCG injection, as shown by the increase of serum progesterone and by the ultrasonographic demonstration of a corpus luteum. This study has shown that, by proper pharmacological stimulation, the steroidogenic function of the gonads and even ovulation can be reinstated in hypogonadal thalassemic women.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; beta-Thalassemia; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hypogonadism; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Ultrasonography