Ongoing pregnancy and healthy live births following very short ovarian stimulation of incidentally observed big antral follicles in oligoamenorrheic patients with extremely decreased ovarian reserve

Abstract

In the present case series our aim is to present seven patients with extremely decreased ovarian reserve and oligomenorrhea, conceived with in vitro fertilization following a very short ovarian stimulation of incidentally detected big antral follicles. The study included women pursuing in vitro fertilization due to premature ovarian failure risk. When an incidental growing antral follicle was detected under ultrasound, immediate ovarian stimulation was initiated if the blood estradiol, luteinizing hormone and progesterone levels were correlated. Serum anti-Mullerian hormone measurements of all patients were consistent with extremely diminished ovarian reserve (ranged between 0.01 and 0.09ng/ml) and FSH levels varied between 13-104IU/l. The mean stimulation length ranged between 2-4 days. A total of 8 oocytes were retrieved; 6 MII, 1 GV and 1 degenerated. All 6 MII oocytes were fertilized with intracytoplasmic sperm injection. Two patients conceived after fresh embryo transfer, whereas the one conceived following frozen thawed embryo transfer. The ongoing pregnancy rate was 50% per transfer, and two of them resulted in a healthy live birth. In conclusion, close monitoring of oligoamenorrheic infertile patients who are at high risk of imminent ovarian failure using ultrasound and blood hormone levels is very important. Albeit low, the possibility of having a healthy pregnancy following “a very short ovarian stimulation” in such a specific patient group is emphasized.

Evaluation of the ovarian reserve in women and adolescent girls with Hashimoto's thyroiditis by serum anti-Müllerian hormone level: A systematic review and meta-analysis

“…Ovarian reserve plays an important role in pregnancy and keeping menstrual regularity and AMH is considered as the most sensitive marker to predict the ovarian reserve in clinical practice [ 31 ].In recent years, plenty of researchers explored the association between ovarian reserve and HT using AMH level. Some studies showed HT was associated with decreased AMH level [ [15] , [16] , [17] , [18] ].…”

What should be the strategy in case of a big follicle at the start of the cycle? Shall we start the stimulation or postpone it to the next cycle?

“…These women were also likely to have large antral follicles due to advanced follicular maturation in the very early days of the follicular phase. Turan et al ( 20 ) reported the IVF conception of seven patients with DOR following a very short ovarian stimulation of incidentally discovered large antral follicles in the early follicular phase. Six embryos were obtained after eight oocytes from seven patients were removed, and two live births and a 50% ongoing pregnancy rate per transfer were the results ( 20 ) .…”