Successful Pregnancy in a Woman With Primary Infertility Associated With Isolated Hypogonadotropic Hypogonadism and Partial Empty Sella Syndrome: A Case Report

Empty sella syndrome (ESS) is a radiological condition characterized by herniation of cerebrospinal fluid into the sella turcica, resulting in compression of the pituitary gland. Although often incidental, ESS may be associated with selective pituitary hormone deficiencies, including gonadotropin deficiency, leading to hypogonadotropic hypogonadism (HH) and infertility. We report the case of a 34-year-old woman with 14 years of primary infertility and a history of primary amenorrhea. Hormonal assessment revealed profound gonadotropin deficiency with a follicle-stimulating hormone (FSH) of 0.39 IU/L, luteinizing hormone (LH) less than 0.10 IU/L, and estradiol below 5 pg/mL, with preserved thyroid and prolactin function. Anti-Müllerian hormone (AMH) level was 0.8 ng/mL. Pituitary magnetic resonance imaging (MRI) demonstrated a partial empty sella without adenoma. Hysterosalpingography and semen analysis were normal. Ovulation induction with human menopausal gonadotropin resulted in pregnancy after one stimulation cycle. Cesarean section was performed at 38+3 weeks of gestation, delivering a healthy male newborn weighing 3180 g with an Apgar score of 10/10. Partial empty sella syndrome may be associated with isolated central hypogonadism leading to infertility, and individualized gonadotropin therapy can restore ovulation and achieve a successful pregnancy outcome.