Pregnancy confirmed after controlled ovarian stimulation for infertility

Abstract

Rational: Induction of ovarian stimulation by use of the gonadotropin-releasing hormone agonist (GnRHa) long protocol in the luteal phase is a common practice and results in stable pregnancy and live births; it is often used in patients with normal ovarian function. Some patients with normal ovulation may be pregnant before ovulation induction, which can be easily confirmed by asking the patient about cessation of menstruation. However, some pregnancy complications may cause vaginal bleeding along with normal menstrual blood loss; in such a situation, hormone levels can often mirror that seen in pituitary down-regulation and the value of β-HCG may be less than 5 mIU/mL. Under these conditions, the physician might start the cycle of ovarian stimulation. During ovarian stimulation, the increase in β-HCG can cause premature luteinization and follicle maturation disorder, and poor embryo quality, which can easily be overlooked. In this study, we report a case of pregnancy at the end of controlled ovarian stimulation induced by GnRHa long protocol in the luteal phase, followed by follicle maturation disorder and poor embryo quality. This case provided a reference and served as a cautionary note that could perhaps obviate occurrence of similar cases. Patient concerns: A 30-year-old woman with a diagnosis of unexplained infertility was scheduled for in vitro fertilization embryo culture (IVF) at our clinic. Pregnancy was confirmed at the end of controlled ovarian stimulation, which was followed by follicular maturation disorder and poor embryo quality. Diagnosis: The patient with a diagnosis of unexplained infertility was scheduled for IVF at our clinic. Interventions: Oocyte retrieval was still arranged for her after confirmation of pregnancy. As per the β-HCG level and the trans-vaginal ultrasound examination findings, we considered 2 possibilities: an adverse intrauterine pregnancy or extra-uterine pregnancy. Therefore, we decided to terminate the pregnancy; hence, 50 mg/d of mifepristone was given for 2 days, combined with 200 μg misoprostol. Outcomes: Elevated β-HCG level had an adverse effect on maturation and fertilization of oocytes, and even embryo quality. Conclusion: Once pregnancy is confirmed, ovulation induction should be terminated as soon as possible.

Clomiphene citrate mild stimulation improved follicular development outcomes in PCOS women with high luteinizing hormone and poor ovarian response: A case report

“…All oocytes were fertilized on the first day after oocyte retrieval, and 3 oocytes had 2 pronuclei, 3 with 3PN. On the 3rd day of fertilization, 3 top-quality cleavage-stage embryos (8CII, 6CII*2) were obtained according to the Gardner's criteria, [8,9] then were frozen and preserved by vitrification (Table 1). This patient has signed the consent form for publication of this case which was approved by the Ethics Committee of Hangzhou Women's Hospital.…”