Andy,

On April 3rd, I posted on this board, a recent medical journal reference and abstract which discusses this issue of subfertility in classical CAH women. I will repost it again, below. If you would like a copy of the entire paper contact me and we can arrange something.

In addition to this recent paper, there has been some 1990’s published literature which discusses infertility occuring because of  raised progesterone levels. This has been documented as happening in some CAH women despite well controlled androgen and 17-OHP levels. The effect of raised progesterone levels seems to be that it causes a ’minipill’ effect and prevents the endometrial lining of the uterus to thicken and therefore unable to sustain to a pregnancy.

Hopefully medical research will lead to a more complete understanding of the many issues involved in CAH infertility and provide treatment modes that produce positive outcomes. It is an emotional issue, but I have no doubt that, for those of our younger children with CAH there will be even more options available to them in terms of fertility treatments in the future, should they require them. 

 

Fertility in Women with Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency published in Obstetrical and Gynecological Survey (Journal), Volume 58(4), April 2003, pages 275-284.

ABSTRACT: Fertility in women with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency appears to be reduced. The purpose of this review is to summarize the reported evidence about subfertility in women with CAH and to review the causes of reduced fertility. Compared with a non-CAH female population, pregnancy and live-birth rates are severely reduced in salt-wasting patients, mildly reduced in simple virilizing patients, and normal in nonclassic patients. Several factors have been suggested to contribute to the impaired fertility in CAH females: adrenal overproduction of androgens and progestins (17-hydroxyprogesterone and progesterone), ovarian hyperandrogenism, polycystic ovary syndrome, ovarian adrenal rest tumors, neuroendocrine factors, genital surgery and psychological factors such a delayed psychosexual development, reduced sexual activity and low maternal feelings. It is obvious that these factors are interrelated. Improving endocrine, surgical and psychological management could contribute to improving fertility chances in these patients.