# Growth hormone and gonadotropin association: A case report of full-term pregnancy in a patient with panhypopituitarism

## TL;DR

A woman with panhypopituitarism successfully had a full-term pregnancy after hormone treatment combining growth hormone and gonadotropins.

## Contribution

A successful treatment protocol using growth hormone before gonadotropin therapy in a PHP patient with poor ovarian response is reported.

## Key findings

- Growth hormone replacement improved ovarian response in a PHP patient.
- The patient produced 13 oocytes and achieved a successful pregnancy via IVF.
- A single fetus was delivered at 38 weeks via cesarean section.

## Abstract

Hypopituitarism is the inability of the anterior pituitary gland to properly
supply the hormone levels. When this disease affects all the hormones produced
by the anterior pituitary, it is called panhypopituitarism (PHP). Since
pituitary-derived hormones directly influence fertility, often the assisted
reproduction techniques are the only option to PHP women have a full-term
pregnancy. However, not all patients diagnosed with PHP properly respond to
ovulation induction. Thus, a poor response may indicate decreased ovarian
reserve or reflect a deficiency in other key components of ovarian function.
Here we presented a rare case of a 24-year-old woman diagnosed with PHP and poor
response to previous gonadotropin therapy. In our protocol the patient received
first growth hormone (GH) replacement for 5 months before starting
gonadotropins. When the serum IGF-I (insulin grow factor-I) level normalized,
she started ovulation induction with 225 IU/day of human menopausal gonadotropin
(hMG). After the ninth day of the cycle, ultrasounds were performed every 2 days
to control follicular growth. The puncture of the follicles was performed on the
twentieth day of the cycle and a surprising number of 13 oocytes were collected.
The oocytes were fertilized by the classical IVF method, resulting in 11 D3
embryos, of which 2 were freshly transferred. Beta hCG hormone levels were
determined, and a single fetus pregnancy was confirmed. The birth was by
cesarean section at 38 weeks of gestation. Therefore, we conclude that
GH/gonadotropin association in ovarian stimulation may improve the follicular
recruitment in PHP patients.