Hypothalamic Disorders During Ovulation, Pregnancy, and Lactation

Abstract The hypothalamus is a key regulator of multiple physiologic functions, including the initiation of reproductive cascade by gonadotropin-releasing hormone (GnRH) neurons. The latter are pivotal to ensure gonadal maturation and subsequent fertility. Disorders of the hypothalamus that affect ovulation and reproductive capacity include congenital diseases, functional disorders, tumors, infiltrative diseases, iatrogenic causes, and drug-induced toxicities. Functional hypothalamic amenorrhea (FHA), an acquired form of GnRH deficiency, is a common cause of anovulatory infertility. Treatment should be directed to achieving adequate management of the precipitating factors. Congenital hypogonadotropic hypogonadism (CHH) is a rare form of GnRH deficiency; reversal is possible in a subset of patients. Pulsatile GnRH therapy, or gonadotropin treatment if the latter is unavailable, can successfully restore ovulation and fertility in most FHA and CHH women. Several of these hypothalamic disorders need careful assessment during pregnancy, while lactation may be impaired as well in cases of concomitant pituitary damage.