The Cycle Characteristics and Outcomes of Infertile Nonclassic 21-Hydroxylase Deficiency Patients Undergoing Ovarian Stimulation for In Vitro Fertilization

Abstract

Background The objective of the work was to investigate the cycle characteristics and outcomes of infertile women with nonclassic 21-hydroxylase deficiency (21-OHD) undergoing in vitro fertilization (IVF). Methods Twenty-five infertile nonclassic 21-OHD patients were retrospectively observed. From cycle day 3, patients were given human menopausal gonadotropin (HMG) 150 IU/d or 225 IU/d daily. Dexamethasone was administered orally at 0.75 mg/d. Ovulation was co-triggered by human chorionic gonadotropin (hCG) and triptorelin. Binary logistic regression was performed to quantify the effect of IVF parameters on embryo transfer cycle outcomes. The receiver operating characteristic (ROC) curve was used to determine cutoff points of the selected confounders for predicting pregnant probabilities. Results In controlled ovarian hyperstimulation (COH) cycles, there was a trend that the viable embryos group consisted of more polycystic ovary (PCO) patients. In embryo transfer (ET) cycles, differences were detected in the usage rate of dexamethasone and the minimum progesterone (P4) and total testosterone (TT) values between the non-pregnant group and the biochemical pregnant group. Binary logistic regression analysis confirmed that decreasing minimum P4 and body mass index (BMI) value was respectively correlated with increasing pregnancy probability. ROC analysis proved that the cutoff values for minimum P4 and BMI were 0.45 ng/ml and 23.36 kg/m2. Conclusion In COH cycles, the ultrasonographic appearance of ovary helps to predict the number of viable embryos. In ET cycles, dexamethasone obviously improves the pregnancy rate. If the minimum P4 value before endometrial transformation cannot be kept below 0.45 ng/ml, we may consider cycle cancellation. Moreover, it is suggested that BMI of nonclassic 21-OHD women is regulated below 23.36 kg/m2.

Reproductive endocrine characteristics and in vitro fertilization treatment of female patients with partial 17α-hydroxylase deficiency: Two pedigree investigations and a literature review

“…It should be noticed that, unlike hydrocortisone and prednisolone, dexamethasone crosses the placental barrier to the fetus without inactivation ( 39 ). In our preceding study on 21-OHD patients undergoing IVF, we recommend stopping the administration of dexamethasone after embryo transfer to avoid possible adverse influences on the fetus ( 40 ).…”

Getting pregnant with congenital adrenal hyperplasia: Assisted reproduction and pregnancy complications. A systematic review and meta-analysis

“…With the strategy of frozen-embryo transfer, we could circumvent the adverse effect of progesterone on the endometrium. In endometrium preparation, the key lies in the suppression of endogenous progesterone to below 0.45 ng/ml by use of glucocorticoid (and mineralocorticoid when necessary) ( 72 ). The third indication is preimplantation genetic testing.…”

“…Since the age-adjusted risk of GDM increased with increasing BMI category among all ethnic groups ( 86 ), we recommended a better control of BMI before pregnancy for CAH patients. In addition, one study also proposed that keeping BMI below 23.36 kg/m would improve the pregnancy rate of embryo transfer among non-classical 21OHD women ( 72 ).…”

“…Fourteen cross-sectional and five cohort studies were included (7,8,(10)(11)(12)(13)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74), reporting outcomes of 1,311 pregnancies of CAH patients. The study characteristics of included studies are listed in Table 2.…”