| name | endo-fha-avoid-kisspeptin-leptin-infertility |
| description | This skill recommends against using kisspeptin or leptin to treat infertility in patients with functional hypothalamic amenorrhea (FHA) except within research or closely monitored trials due to limited evidence. Use when a clinician states, “Let’s not prescribe kisspeptin for her infertility,” or encounters triggers such as “Avoid kisspeptin outside trials” or “Do not use leptin for ovulation induction.” |
Avoid kisspeptin and leptin for treating infertility in FHA
STEP 1 — Gather Information
Confirm diagnosis of FHA (exclusion of organic causes, history of stress/weight loss/exercise, amenorrhea ≥3 months or cycle >45 days), assess fertility desire, ensure a complete fertility workup has been performed, and review current medications or prior experimental therapies.
STEP 2 — Rule In / Rule Out
If the patient has FHA and is seeking infertility treatment → proceed; if FHA is absent or pregnancy is not desired → skill not applicable.
STEP 3 — Classify or Stratify
Determine whether the patient is enrolled in a research protocol or closely monitored trial investigating kisspeptin or leptin; if yes → consider use under protocol; if no → classify as outside investigational setting.
STEP 4 — Decide
If outside a research/trial setting, advise against prescribing kisspeptin or leptin for infertility; instead, recommend first-line options per guideline (pulsatile GnRH if available, gonadotropins, or clomiphene citrate if adequate estrogen level) and emphasize behavioral/nutritional rehabilitation.
Clinical Guardrails / Mimics / Pitfalls
Do not use kisspeptin or leptin outside of research due to insufficient efficacy data; avoid substituting these agents for proven therapies; monitor for potential side effects and ensure patient understands experimental nature; do not rely on kisspeptin/leptin as a shortcut for weight gain or stress reduction.
Concrete Clinical Example
A 28‑year‑old woman with FHA secondary to low body weight and stress desires pregnancy; after confirming FHA and completing a fertility workup, the clinician considers kisspeptin but, noting no trial enrollment, advises against its use, recommends weight gain, CBT, and, if GnRH unavailable, a trial of gonadotropins with careful monitoring.
Source: Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2017, DOI:10.1210/jc.2017-00131
