THU627 Fertility Outcomes And Anti Mullerian Hormone Levels In Women With Hypopituitarism
Authors: Fitz Victoria W , Sailer Clara Odilia , Remba-Shapiro Ilan , Gonzalez Nichola Bomani , Pierre Widvine , Bormann Charles , Souter Irene , Nachtigall Lisa B 
Published: October 2023

Abstract
Disclosure: V.W. Fitz: None. C.O. Sailer: None. I. Remba-Shapiro: None. N. Bomani Gonzalez: None. W. Pierre: None. C. Bormann: None. I. Souter: None. L.B. Nachtigall: None.
Background: Disruption of the hypothalamic-pituitary-gonadal (HPG) axis due to pituitary gland disorders presents a challenge for patients who desire conception. Women with hypopituitarism often require assisted reproductive technology (ART) to conceive. Anti-Mullerian Hormone (AMH) has been established as a marker of ovarian reserve in patients with normal HPG function, however, levels in women with hypopituitarism have not been reported. In this cohort, we investigate pre-conception AMH levels, reproductive treatments and fertility outcomes in women with hypopituitarism. Methods: We reviewed a large database and identified 19 patients with hypopituitarism who had undergone fertility treatment and 142 age-matched controls with male factor infertility. Clinical characteristics and AMH levels are shown using mean (SD) or median (IQR). AMH ratio using the lower limit of normal as denominator is used to normalize to the reference range as several assays with different reference ranges were used during the timeframe of data collection. Mann-Whitney U was used to compare AMH levels. A p value of &lt;0.05 was considered statistically significant. Results: Patients with hypopituitarism and controls had a mean age of 33.4 years (2.5) and 33.3 years (2.2) p=0.857, at initial fertility evaluation, respectively. 17/19 (89.5%) patients in the hypopituitarism group experienced spontaneous menarche and had a post-pubertal onset of hypopituitarism. Hormonal deficiencies included GH (9), ACTH (8), TSH (10), FSH/LH (13), and vasopressin (3). Causes of hypopituitarism included 8 pituitary adenomas (7 functioning and 1 non-functioning), 3 Rathke’s cleft cysts, 4 intracranial neoplasms, 2 congenital or idiopathic hypopituitarism and 1 intracranial trauma. Median AMH level was 2.60 ng/mL (0.90-3.50) vs. 3.48ng/mL (1.99-4.70) p=0.017, and AMH ratio was 3.11ng/mL (1.13-4.17) vs. 4.11ng/mL (2.60-6.25) p=0.070, in the hypopituitary group and in controls, respectively. Among the 19 patients with hypopituitarism, 13 underwent ovulation induction (OI) with intrauterine insemination (IUI) or timed intercourse (TIC), 12 underwent in vitro fertilization (IVF), and 6 were treated with both OI and IVF. 18/19 (94.7%) conceived and 16/19 (84.2%) had a livebirth. Four patients (21%) conceived spontaneously. Among the patients who underwent OI, 4/13 (30.8%) had ≥1 livebirth with a median of 2 cycles (range 1-4) until first birth. Among the patients who underwent IVF, 10/12 (83.3%) had ≥ 1 livebirth with a median of 1.50 cycles (range 1-4) until first birth. Conclusions/Impact: Patients with hypopituitarism conceive through a variety of assisted reproductive technologies and may conceive spontaneously. Overall, AMH levels are comparable to age matched controls. Reproductive interventions among women with hypopituitarism are successful, with most patients achieving at least one livebirth.
Presentation: Thursday, June 15, 2023