Assisted Reproductive Technology in Hypogonadotropic Hypogonadism: A Case Series

Objective: To describe the differences found in evaluation and treatment for patients with hypogonadotropic hypogonadism (HH). The purpose of this study was to review the diverse presentation and subsequent tailored treatment for an infrequent diagnosis class. Design: Retrospective case series. Materials and Methods: The initial presentation, evaluation, and next step counseling for 6 consecutive patients with HH from 2022-2025 were reviewed. Patient demographics and past medical history were reviewed, along with the patients’ fertility evaluation. Patient decision-making and factors influencing treatment protocols and outcomes were then compared. Results: On average, patients with HH are younger than the general infertility population, with a median of 27.6 (range: 20 - 32 years old). They presented with a history of amenorrhea and low pituitary function. Gonadotropins were suppressed: the average FSH was 3.6 (range 0.2–10.2) and the average LH was 1.7 (<0.1–5.1). Notable variability was found in AMH (0.95–10.5) and AFC values (0–16). The etiology of pituitary dysfunction was genetic (2), idiopathic (2), metabolic (1), or surgical (1). Of the 6 patients, 2 went on to undergo attempts at ovulation induction, 3 opted to move with IVF, and 1 has remained in supportive hormonal care. Of those that entered into treatment, 2 of the 4 have had a live birth – both of these patients underwent IVF. Conclusions: Hypogonadotropic hypogonadism remains a low-prevalence diagnosis with a variety of etiologies. Treatment can be challenging given the financial cost. This small case series adds to the present data and support the need for larger studies to guide evidence-based management.