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J Cases Obstet Gynecol, 2017;4(3):52-54

Journal of Cases in
Ob s te tri cs & G yn e co l o g y

Case Report

Triplet Pregnancy Outcome Experience Following Ovulation Induction
Treatment of A Hypogonadotropic Hypogonadism Patient

Ezgi TURGUT1,*, Burak AKSELIM1, Oktay KAYMAK1, Yetkin KARASU1, Yusuf ERGUN1
1Department of Obstetrics And Gynecology, Ankara Training and Research Hospital, Ankara, Turkey


Hypogonadotropic hypogonadism (HH) is the situation of lack of the Gonadotropin Releasing Hormone (GnRH) release from hypothala-
mus or the inadequate response of the hypophysis gland to the GnRH stimulation. Congenital HH is a rare clinical situation which exhib-
its itself with low sex hormone levels. Patients mostly present with amenorrhea, delayed puberty, infertility. Pregnancy can be achieved by
ensuring ovulation with GnRH or gonadotropin replacement. The multiple pregnancy rates following ovulation have been reported be-
tween 20% and 50%. Diabetes, anemia, amniotic fluid abnormalities, pregnancy-related hypertension, eclampsia, cervical insufficiency, pla-
centa previa, the use of tocolysis, twin to twin transfusion, preterm and cesarean delivery rates are increased among high order pregnancies.

Key Words:

Hypogonadotropic hypogonadism; triplet pregnancy; intrauterine insemination; multiple pregnancies

Introduction ry in order to prevent the incidence of these complications.
In this case report, we aimed to show the maternal and fetal
Hypogonadotropic hypogonadism (HH) is rare etio- outcomes of a triplet pregnancy of a woman with HH who has
logic form of female infertility. In these patients pre-
diction of the ovarian reserve is not always possible Case Presentation
before the treatment. After the implementation of ovu-
lation induction by using gonadotropins, higher order A 32-years-old patient with a diagnosis of HH has pre-
pregnancies can be observed due to multifolliculary de-
velopment with a reported incidence of 20-50% [1]. sented to our antenatal unit with a diagnosis of triplet preg-
Utilization of assisted reproductive techniques for women nancy who has conceived with ovulation induction by using
with HH has the advantage of lower multiple pregnancy rates gonadotropins and utilization of intrauterine insemination
due to the restriction of transferred embryo numbers. In triplet in another fertility clinic. The patient was applied to our
pregnancies, the risk of maternal and neonatal complications hospital at 12th gestational week. Upon evaluation of the
is higher than twin pregnancies. Monitoring and appropri- patient’s history, she was diagnosed with idiopathic HH
ate management of these high risk pregnancies is mandato- during investigation of primary amenorrhea when she was
18-years-old. Physical and ultrasonographic examination
Article History: of the patient revealed tanner stage 1 telarche and tanner
Received: 25/10/2016 stage 2 pubarche regarding her sexual development level
Accepted: 28/05/2017 and her uterus was hypoplastic concomitant with atrophic
ovaries. Her hormonal profile has been evaluated and FSH,
*Correspondence: Ezgi TURGUT
Tel: +90 312 595 30 00
Fax: +90 312 363 33 96

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