Oestrogen Treatment and Subsequent Pregnancy in Two Patients With Severe Hypergonadotrophic Ovarian Failure

Abstract

This report describes in detail the histological and hormonal findings in a patient with Turner's syndrome (45,XO) and a patient with premature menopause (46,XX), who both conceived after withdrawal or reduction of substitution therapy with oestrogens. The aetiology of severe hypergonadotrophic ovarian failure is discussed, and theories regarding a possible relationship between the oestrogen treatment and subsequent pregnancy are hypothesized.

The Gonadotrophin Resistant Ovary Syndrome: A Curable Disease?

“…Secondary hypergonadotrophic, hypo-oestrogenic amenorrhoea is generally considered to be an irreversible process, and oestrogen therapy is usually instituted to save the patient from the symptoms of oestrogen deprivation. However, eight patients have recently been reported who, during or just after cyclic oestrogen replacement therapy for this condition, became pregnant (Polansky & De Papp, 1976;Shapiro & Rubin, 1977;Shangold et a/., 1977;Starup et al, 1978;Szlachter et al, 1979). Although none of these patients was proven to have the ROS applying the above-mentioned criteria, it was decided to try, in our patient, to return the gonadotrophins to normal and possibly to institute regular ovulatory cycles using exogenous ovarian steroids.…”

Autoimmune endocrinopathies 4 The association of autoantibodies directed against ovarian antigens in human disease: a clinical review

“…This therapeutic approach was based on the histological de-scription of an inflammatory process in the ovary, an oophoritis. Thus, in addition to other observations regarding the reversibility of ovarian dysfunction based on the use of sexual steroids [2, 16,17] the use of corticosteroids emerged as a therapeutic possibility in patients presenting oophoritis. However, it must be pointed out, that in order to confirm this diagnosis a laparotomy is required in order to obtain a representative biopsy sample, a fact which has also been stressed by others [18][19][20].…”

The Gonadotropin Resistant Ovary Syndrome

“…Pregnancies have been reported in women with secondary amenorrhea, elevated gonadotropins, and a diagnosis of premature ovarian failure. These pregnancies have occurred during or after cyclic estrogen and progestin treatment, 9,12,17,47,54,60 after the administration of human menopausal gonadotropins, 12,59,61 or spontaneously. 55 Shangold and colleagues 9 reported in 1977 the only patient to date with convincing evidence for the gonadotropin resistant ovary syndrome who conceived.…”