Adrenal Condition's Effects on Women's Fertility Studied
Nonclassical congenital adrenal hyperplasia has mild effect on fertility; miscarriage risk remains
MONDAY, Feb. 1 (HealthDay News) -- Women with nonclassical congenital adrenal hyperplasia (NC-CAH) due to 21-hydroxylase deficiency have only mild fertility problems, but clinicians should consider treating them with glucocorticoids to lower their risk of miscarriage, according to a study published online Jan. 15 in the Journal of Clinical Endocrinology & Metabolism.
Maud Bidet, of the Assistance Publique-Hôpitaux de Paris, and colleagues studied 190 women with NC-CAH, including 161 women who had presented at the center and 29 first-degree relatives. The researchers analyzed the cohort for effects on fertility, treatment, and pregnancy outcomes.
Of the cohort, the researchers note that 95 women had wanted to become pregnant, and 187 pregnancies occurred in 85 women, resulting in 141 births in 82 women. Ninety-nine of the pregnancies occurred before NC-CAH diagnosis (three followed ovulation induction and 96 were spontaneous), and 88 occurred after diagnosis (11 were spontaneous and 77 followed hydrocortisone treatment). Among women receiving glucocorticoid treatment, the rate of miscarriages was 6.5 percent, compared to 26.3 percent in women who did not have the treatment. Two of the 141 babies born to the women had classical CAH.
"Subfertility is mild in NC-CAH. However, the rate of miscarriages is lower in pregnancies occurring with glucocorticoid treatment and argues for treating NC-CAH women wanting pregnancy. In addition, considering the high rate of heterozygotes for CYP21A2 mutations in the general population, it is essential to genotype the partner of patients with a severe mutation to predict the risk of classical CAH and offer genetic counseling," the authors conclude.