Fertility and pregnancy in women with hypopituitarism: a systematic literature review.

CONTEXT: Human reproduction is mainly governed from the hypothalamic-adrenal-gonadal (HPG) axis, which controls both ovarian morphology and function. Disturbances in the secretion of other anterior pituitary hormones (and their respective endocrine axes) interfere with HPG activity and have been linked to fertility problems. In normal pregnancy, maintenance of homeostasis is associated with continuous changes in pituitary morphology and function, which need to be considered during hormone replacement in patients with hypopituitarism.
DESIGN: We conducted a systematic PubMed literature review  from 1969-2019, with the following keywords: fertility and hypopituitarism, pregnancy and hypopituitarism, and ovulation induction and hypopituitarism. Case reports or single case-series of up to 2 patients/4 pregnancies were excluded.
RESULTS: Eleven publications described data on fertility (n = 6) and/or pregnancy (n = 7) in women with hypopituitarism. Women with hypopituitarism often need assisted reproductive treatment, with pregnancy rates ranging from 47-100%. In patients achieving pregnancy, life birth rate ranged from 61-100%. While glucocorticoids, levothyroxine and desmopressin are safely prescribed during pregnancy, growth hormone treatment regimens vary significantly between countries, and several publications support a positive effect in women seeking fertility.
CONCLUSIONS: On this first systematic review on fertility, ovulation induction and pregnancy in patients with hypopituitarism we show that while literature is scarce, birth rates are high in patients achieving pregnancy. However, prospective studies are needed for evaluating outcomes in relationship to treatment patterns. Replacement therapy in hypopituitarism should always mimic normal physiology, and this becomes challenging with changing demands during pregnancy evolution. © Endocrine Society 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.