Hypergonadotropic hypogonadism (suspected POI)

Hypergonadotropic hypogonadism (suspected POI) means that the ovaries produce too few reproductive hormones. This happens due to decreased sensitivity of the cells in the ovaries to gonadotropin hormones (luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH) which are responsible for stimulating the ovaries to produce hormones. As a result, FSH and LH are too high, while estrogen and testosterone are too low. Additionally, a low level of Anti-Mullerian hormone (AMH) can signal primary ovarian insufficiency (POI), a condition where the egg supply is depleted earlier than usual, triggering the onset of menopause before the average age of 40.

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Impact of hypergonadotropic hypogonadism on fertility

Hypergonadotropic hypogonadism can disrupt your menstrual cycle by interfering with egg maturation and ovulation and causing periods to stop (a condition called amenorrhea). Amenorrhea can either be primary (never getting a period) or secondary (periods stop for at least 3-6 months). 

Women under 32 with primary ovarian insufficiency generally have the same chances of getting pregnant per cycle as other women their age with a normal egg reserve, but a smaller time frame to build their family. Once the egg reserve is used up and menopause begins, it’s no longer possible to get pregnant.

Potential causes of hypergonadotropic hypogonadism

Here’s what can cause hypergonadotropic hypogonadism:

• Chromosomal abnormalities (Turner syndrome)
• Defects in the enzymes involved in the synthesis of reproductive hormones
• Resistance to gonadotropin hormones due to mutations in the receptors

• Surgery on the reproductive organs
• Autoimmunity
• Cancer treatments
• Infections (such as sexually-transmitted diseases and mumps)
• Certain medications (antiandrogens, opioids)
• Primary ovarian insufficiency

Symptoms of hypergonadotropic hypogonadism

Hypergonadotropic hypogonadism can cause the following physical signs in women:

• Amenorrhea
• Late puberty
• Low sex drive
• Loss of body hair
• Hot flashes
• Infertility

Diagnosis of hypergonadotropic hypogonadism

Healthcare providers use several tests to diagnose hypergonadotropic hypogonadism. After assessing your symptoms and medical history, diagnostic tests may include:

• Physical examination 
• Blood tests to check the levels of FSH, LH, estrogen, and AMH
• Genetic tests that look for chromosomal abnormalities

If your tests show low estrogen levels, you may be recommended to get a bone density scan (called a DEXA scan) to check your bone metabolism.

Treatment to improve fertility

Women with hypergonadotropic hypogonadism and suspected POI are recommended to visit a fertility clinic as soon as possible for treatment to have the best chances of getting pregnant. Hormone replacement therapy with estradiol and progesterone can restore balance to your reproductive hormones.
IVF is also a good option to help women with a depleted egg reserve conceive. You can take hormonal medication which stimulates the ovaries to mature and release eggs during ovulation. During IVF, several mature eggs are retrieved from the ovaries, placed in a petri dish together with sperm, and a fertilized egg gets implanted into the uterus. You can choose to freeze eggs or embryos for use in a later IVF cycle, in case you need to try again or want to have another baby later on. If there aren’t enough eggs left in the ovaries, you can also consider using donor eggs for IVF.

This article has been verified by a medical professional

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