|
Venn and colleagues
identified from medical records 1248 Australian women who had been
assessed and/or treated with estrogens (3mg DES or 150µg
ethinyl estradiol daily) for tall stature during the years 1959 to
1993, to assess the effects of this treatment on long-term fertility.
A group of 184 self-referrals (members of Tall Girls Inc an
Australian advocacy group) were included in the study. To be included
subjects had to have had a bone age determination at the time of
assessment. Subjects were invited to complete a written questionnaire
and computer-assisted telephone interview. The interview included
questions regarding reproductive history including whether or not
they had ever seen a doctor due to difficulty becoming pregnant,
whether they had ever tried unsuccessfully for more than 12 months to
become pregnant, and whether or not they had ever taken fertility
drugs as treatment for infertility. The time to pregnancy was
analyzed for each month of attempting pregnancy. Data from the
medical records included age at menarche, treatment type, duration of
treatment, and first and last assessment of estimated mature height
by Bailey and Pinneau method.
The final sample size
included 618 women (75% of the treated and 95% of the untreated). The
mean age of these women was 39.8 years (treated) and 37.7 years
(untreated). Both groups were similar in terms of marital status and
highest level of education. Self-reported current height was greater
in the treated women (179.0cm vs 176.8cm). Both groups were similar
in terms of history of smoking, oral contraceptive use, age of first
sexual intercourse and lifetime number of male sexual partners. There
were no differences between the women treated with DES or ethinyl
estradiol on any parameter. Women who had been treated with estrogen
were more likely to report problems with fertility. When the data
were adjusted for age, the women who had been treated were less
likely to have ever been pregnant and to have ever had a live birth.
Treated women were more likely to have tried unsuccessfully for 12
months to become pregnant, to have seen a doctor because of
difficulty becoming pregnant, and to have taken fertility drugs.
Height was not related to fertility problems and the differences
between the 2 groups remained when the self-referred women were
excluded from the analysis. A significant, but weak duration of
treatment effect was observed.
The authors state
that the data were not sufficient to establish a pathophysiological
cause for the reduced fertility. They also state that the likelihood
of ever becoming pregnant and having a live birth, although
statistically reduced for women who had been treated for tall
stature, was only slightly lower than that for untreated women and
that newer treatments for infertility may reduce that difference.
Venn
A, Bruinsma F, Werther G, et al. Oestrogen treatment to reduce the
adult height of tall girls: long-term effects on fertility. Lancet
2004;364:1513-8.
Editor’s
Comment: Clearly there has been a significant drop in the number
of girls seeking treatment to reduce mature height potential over the
past 20 years. However, the authors note that a recent survey of
pediatric endocrinologists in the United States reveals that 23% have
treated such girls over the past 5 years. Thus, although the absolute
number of girls seeking treatment is low, such treatment is still
being sought and is available. The current study, although not the
first to show the possibility of adverse reproductive effects of
estrogen treatment for tall stature, is perhaps the largest long-term
follow-up to date. The information is interesting and important.
Pediatric endocrinologists need to be able to discuss these facts
with each family seeking to reduce their daughter’s mature
height potential. It is reassuring that no obvious safety concerns
were identified through these interviews and chart data.
William L. Clarke, MD
|
Current GGH - Vol. 24 No. 1
print version (pdf)
Printer Friendly
Email Paper