Efficacy and safety of human chorionic gonadotropin combined with human menopausal gonadotropin and a gonadotropin-releasing hormone pump for male adolescents with congenital hypogonadotropic hypogonadism

Background:Compared to adult studies,studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism(CHH)are limited and no universal treatment regimen is available.The aim of this study was to evaluate the feasibility of human chorionic gonadotropin(hCG)/human menopausal gonadotropin(hMG)therapy for treating male adolescents with CHH.Methods:Male adolescent CHH patients were treated with hCG/hMG(n=20)or a gonadotropin-releasing hormone(GnRH)pump(n=21).The treatment was divided into a study phase(0-3 months)and a follow-up phase(3-12 months).The testicular volume(TV),penile length(PL),penis diameter(PD),and sex hormone levels were compared between the two groups.The TV and other indicators between the groups were analyzed using a t-test(equal variance)or a rank sum test(unequal variance).Results:Before treatment,there was no statistical difference between the two groups in terms of the biochemistry,hormones,and other demographic indicators.After 3 months of treatment,the TV of the hCG/hMG and GnRH groups increased to 5.1±2.3 mL and 4.1±1.8 mL,respectively;however,the difference was not statistically significant(P>0.05,t=1.394).The PL reached 6.9±1.8 cm and 5.1±1.6 cm(P<0.05,t=3.083),the PD reached 2.4±0.5 cm and 2.0±0.6 cm(P<0.05,t=2.224),respectively,in the two groups.At the end of 6 months of treatment,biomarkers were in normal range in the two groups.Compared with the GnRH group,the testosterone(T)level and growth of PL and PD were significantly greater in the hCG/hMG group(all P<0.05).While the TV of both groups increased,the difference was not statistically significant(P>0.05,t=0.314).After 9 to 12 months of treatment,the T level was higher in the hCG/hMG group.Other parameters did not exhibit a statistical difference.Conclusions:The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH.The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy.Furthermore,results from the extended time-period showed positive outcomes at the 1-year mark;however,the long-term effectiveness,strengths,and weaknesses of the hCG/hMG regimen require further research.Trial Registration:ClinicalTrials.gov,NCT02880280;https://clinicaltrials.gov/ct2/show/NCT02880280.

Effect of Traditional Chinese Herbs Combined with Low Dose Human Menopausal Gonadotropin Applied in Frozen-thawed Embryo Transfer

Objective： To assess embryo implantation rate （IR） and pregnancy rate （PR） in women who received Bushen Wengong Decoction （补肾温宫汤, BSWGD）, a Chinese herbal formula, combined with low dose of human menopausal gonadotropin （hMG） prior to frozen-thawed embryo transfer （FET）. Methods： A total of 262 subjects （674 transferred embryos） who received FET were analyzed retrospectively. In them, 122 women were under 30 years old, 106 between 30-35 years and 32 over 35 years. The 85 subjects with normal ovulation were assigned to Group A, the natural menstruation cycling group, on whom no pre-transfer treatment was applied. The other 177 subjects with abnormal ovulation were assigned to Group B, and subdivided, according to the pre-transfer treatment they received, into three groups, Group B1 （50 cases） received BSWGD, Group B2 （58 cases） received hMG and Group B3 （69 cases） received both BSWGD and low dose hMG. The IR and PR of FET in the four groups were compared time on PR of FET were compared also. Besides, the influencing factors and the effect of the embryo cryoto FET were analyzed. Results： IR and PR were significantly higher in all age sects of Group B3 than those in Group A, showing significant difference （ P〈0.05）. IR and PR in subjects in age sects of 〈30 years and 〉 35 years in group B3 were significantly higher than those in Group B1 （ P〈0.05）, but no significant difference was shown in the two parameters between Group B 2 and Group B3 （P〉0.05）. PR in the subjects who received embryos with cryo-time of 〉 200 days was significantly lower than that in those with cryo-time of ~ 100 days （P〈0.05）. Embryo cryo-time, endometrial thickness, use of BSWGD and use of hMG were of significance in FET （ P〈 0.05）. Conclusion： A programmed cycle of BSWGD combined with low dose of hMG could improve the embryo IR and PR of FET. Embryo cryo-time, endometrial thickness, and the use of BSWGD and hMG are of significance for FET.

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-Müllerian hormone（AMH）on the outcome of ovulation induction using human menopausal gonadotropin（hM G）in women with polycystic ovary syndrome（PCOS）.Methods This prospective study included 63 anovulatory women with PCOS who underwent hM G ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic（ROC）curve was used to evaluate the prognostic value of circulating AMH.Results hM G responders had a significantly lower serum AMH concentration compared with non-responders（8.43±2.18 μg/L vs 11.05±2.85 μg/L, P〈0.001）. In multivariate Logistic regression analysis, AMH was an independent predictor of ovulation induction by hM G in PCOS patients. ROC curve analysis showed AMH was a useful predictor of ovulation induction by hM G in PCOS patients, having 91.7% specificity and 66.7% sensitivity when the threshold AMH concentration was 10.12 μg/L.Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hM G treatment in PCOS patients.

Hemorrhagic ovarian cyst without peritoneal bleeding in a patient with ovarian hyperstimulation syndrome: case report

Gynecologic and obstetric disorders presenting with abdominal pain are ectopic pregnancy,rupture of endometrial cysts, mature cystic teratoma and torsion of the adnexae. Hemorrhagic ovarian cysts, which included among the functional cysts, are often involved in acute abdomen leading to laparotomy intervention.