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New Treatment Overcomes Panhypopituitarism, Results in Pregnancy and Live Birth

WESTPORT, CT (Reuters Health) Jan 09 - In a new treatment protocol for patients with growth hormone deficiency secondary to panhypopituitarism, growth hormone is administered for 3 months before ovulation stimulation is attempted. Use of this protocol resulted in a live birth of a normal child at 39 weeks, according to a case report from France involving a 32-year-old woman in whom three prior attempts at ovulation induction had failed.

Dr. Georges Weryha and associates, of the Centre Hospitalier Universitaire de Nancy, Vandoeuvre, France, confirmed somatotropic deficiency in the patient by measuring serum growth hormone level <0.2 ng/mL, which did not increase during an insulin-tolerance test. The report appears in the December issue of Fertility and Sterility.

Three months' treatment with biosynthetic human growth factor 1 U/day s.c. normalized the patient's level of insulin-like growth factor-1 (IGF-1). At this point, a new cycle of ovulation was induced using a human menopausal gonadotropin/human chorionic gonadotropin protocol. Once pregnancy was diagnosed, the growth hormone was discontinued.

In previous reports, patients have been treated with growth hormone for 4 to 21 days in combination with gonadotropins. The investigators note that, while ovulation has been induced in 50% to 100% of patients, the reported number of births has been fewer than one in three patients.

The investigators based their rationale on the knowledge that IGF-1 and follicle-stimulating hormone are synergistic in stimulating follicular maturation. Continued growth hormone treatment increases IGF-1, which in turn increases the follicle's sensitivity to follicle-stimulating hormone.

"Therefore," Dr. Weryha's group concludes, "the preparation of the ovary and the recruitment of preantral follicles by growth hormone before gonadotropin stimulation should be considered for further clinical trials in patients who respond poorly to gonadotropins."

Fertil Steril 2000;74:1248-1250.

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