Successful pregnancy in a woman with Kallmann's syndrome using human menopausal gonadotropin followed by low-dose human chorionic gonadotropin in the mid-to-late follicular phase

Abstract

Kallmann’s syndrome is characterized by hypogonadotropic hypogonadism and anosmia [1]. It is a rare disorder, occurring in only one per 50,000 women [2]. Induction of ovulation in women with hypogonadotropic hypogonadism requires follicle-stimulating hormone (FSH) for follicular growth, and both FSH and luteinizing hormone (LH) to induce optimal follicular steroidogenesis and ovulation. Numerous reports of achieving successful pregnancies in women with Kallmann’s syndrome have appeared in the literature. Recent evidence suggests that low-dose human chorionic gonadotropin (hCG) can also be used to mimic LH actions on developing follicles in a more sustained and stable manner, permitting the progression of folliculogenesis when the LH/ hCG receptors begin to be expressed in the granulose cells of larger ovarian follicles [3]. More specifically, serum levels of hCG during human menopausal gonadotropin (hMG) administration were inversely correlated with the occurrence of small preovulatory follicles [4]. We describe here a woman with Kallmann’s syndrome who was treated with a combination of hMG and low-dose hCG to achieve ovulation induction and successful pregnancy. A 29-year-old woman was referred to our hospital for investigation and treatment of infertility. She was first seen at the age of 19 years with a complaint of primary amenorrhea, having presented without any secondary characteristics and anosmia. She had very low serum gonadotropin and estrogen levels, and inadequate responses to repeated gonadotropinreleasing hormone (GnRH) tests. In addition, olfactory magnetic resonance imaging (MRI) revealed olfactory tract agenesis. She was diagnosed with Kallmann’s syndrome and