Abstract


Mirela Costa de Miranda*1, Daniel Fiordelisio de Carvalho1, Guiomar Madureira1, Fernanda Cavalieri Costa1, Marlene Inacio2, Larissa Garcia Gomes1, Berenice B Mendonca3 and Tania A Bachega1
1Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 2Universidade de São Paulo, Sao Paulo - SP, Brazil, 3Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, SAO PAULO, Brazil

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Mirela Costa de Miranda*1, Daniel Fiordelisio de Carvalho1, Guiomar Madureira1, Fernanda Cavalieri Costa1, Marlene Inacio2, Larissa Garcia Gomes1, Berenice B Mendonca3 and Tania A Bachega1
1Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 2Universidade de São Paulo, Sao Paulo - SP, Brazil, 3Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, SAO PAULO, Brazil

Introduction: Subfertility rates are reported in CAH females, however a high proportion never pursues conception. Infertility is reported to be associated with hormonal dysfunction, but also is associated to unsatisfactory intercourse and/or psychosexual behaviors. Objective: To evaluate the fertility rate in classical CAH females followed in our Center and to compare to the data of our normal population.

Methods: Data about sexual orientation/activity, pregnancy interest, hormonal control and therapy were retrospectively evaluated in 86 adults CAH females, followed in our Center in the last 20 years: 85 with classical forms of 21OHD deficiency (49SW, 36SV) and one with 11-hydroxylase deficiency (11OHD).

Results: Homosexual orientation frequency was 19% and other 46% never had sexual activity, due to fear of hurting or shame of her genitalia. Intention to conceive was expressed by 24 (28%) patients, significantly lower than normal population (76%). Only 20 (23%) patients effectively tried to conceive and pregnancy was succeeding in 17 (85%), 3 SW, 13 SV and one with 11OHD. Among the 3 women who didn’t achieved pregnancy 1 had bad compliancy, 1 had primary ovarian failure at 41y, when she initiated attempts and the last one is trying for 3 years, with mean progesterone levels of 6.16±6.6 ng/ml, mean 17-OHP of 36.6±53.3ng/ml and mean testosterone of 29±16ng/dl. Among women who got pregnant, 6 (35%) took less than 6 months of trying; mean time to conceive was 1.7±1.0 years. Only 1 woman needed in vitro fertilization, taking 5 procedures to succeed. The mean age of the first pregnancy in the normal population was 21yr and in our cohort was 27.8±4.1yr. Only one patient had gestational diabetes and hypertension. Progesterone, 17OHP and testosterone levels pre-gestation were 10±9.2ng/ml, 34±39.6ng/ml and 59.4±49.9ng/dl, respectively, and 17-OHP levels and testosterone during pregnancy were 58±59.8ng/ml and 74.4±33.2ng/dl, respectively. The mean dexamethasone dose was 0.3±0.14 mg/day and it didn’t change during and after pregnancy. None patients had adrenal crises during gestation and all of them received stress glucocorticoid doses during delivery. All patients were submitted to C-section and 19/21 term newborns presented adequate weight/height (mean: 2926±688g and 48±2cm, respectively). The fecundity rate was 1.3 child/patient, slightly lower than normal population (1.7)

Conclusion: Classical CAH females, specially the salt wasters, presented less interest to conceive and tend to become pregnant later than our normal population; these data may result of psychosexual behavior. Regarding the fertility rate considering only those women who wanted to get pregnant, most of them succeed spontaneously.

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