Vruchtbaarheid na behandeling met hoge doses geslachtshormonen ter groeiremming*

Objective

To study the long term effects on fertility of high-dose sex steroid treatment to reduce final height.

Design: Retrospective cohort study.

Methods

We compared 239 tall women and 60 tall men treated with high-dose sex steroids during puberty with respectively 174 untreated tall women and 56 untreated tall men. Reproductive history was assessed by interview in addition to ultrasound imaging of the testes or ovaries, endocrine parameters and semen analysis.

Results

Treated women had a significantly lower chance of conception (odds ratio (OR): 0.22) and increased risk of fertility problems (OR: 2.29) and of receiving infertility treatment (OR: 3.44). In addition, treated women had a lower chance of having at least one live birth (OR: 0.26). Ovarian function was assessed in 174 tall women (119 treated). Thirty-nine women (23%) exhibited a hypergonadotropic profile. Treated women had a significantly greater chance of being diagnosed with primary ovarian insufficiency (OR: 2.83). These women had increased follicle stimulating hormone levels while antral follicle counts were decreased. The incidence of fertility problems in the treated men was low and comparable with untreated men. Testicular volume and sperm quality were comparable between the groups. Treated men, however, had reduced serum testosterone levels (13.3 vs. 15.2 nmol/l).

Conclusion

High-dose sex steroid treatment leads in the long term in women to an increased risk of fertility problems and involuntary childlessness. Treated women have a higher risk of exhibiting signs of primary ovarian insufficiency. In treated men fertility seems not to be affected, but their serum testosterone levels are significantly reduced.

Conflict of interest: S.L.S. Drop received support from Ace Pharmaceuticals, Ferring Pharmaceuticals and Eli Lilly. J.S.E. Laven received support from Ferring Pharmaceuticals, Genovum, Merck Serono, Organon, Serono and Schering Plough. Financial support: this study was financed by Ace Pharmaceuticals, Ferring Pharmaceuticals and the “De Drie Lichten” foundation.