Unexpected pregnancy during hormone-replacement therapy in a woman with elevated follicle-stimulating hormone levels and amenorrhea

Abstract

Pregnancy in patients with hypergonadotropic amenorrhea, although previously reported, remains quite rare. Women may conceive spontaneously or following different regimens of ovulation induction, thus indicating that ovarian failure is not always permanent. The case of an 18-year-old woman with premature ovarian failure, who conceived during hormone-replacement therapy, is reported. During hormone-replacement therapy, elevated gonadotropin levels returned to the physiologically normal range. It is suggested that this restored the receptors to luteinizing hormone and to follicle-stimulating hormone, which might have been downregulated. This hypothesis is supported by previous results from clinical trials and experimental work on a rat model.

Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports

“…Although HRT does not address infertility, a very small percentage of patients will go on to spontaneously ovulate and conceive while on HRT [5][6][7][8][9][10][11][12][13][14][15]20]. One possible explanation for this observation is that the estrogen included in the HRT regimens may reduce the serum FSH level and thereby trigger follicle growth by inhibiting FSH-mediated down-regulation of the FSH receptor [3,21,22].…”

“…While on HRT, a very small percentage of POI patients may ovulate and conceive spontaneously. Indeed, there are several case reports in the literature involving POI patients who spontaneously and unexpectedly conceived on HRT [5][6][7][8][9][10][11][12][13][14][15].…”

Serum estradiol level during withdrawal bleeding as a predictive factor for intermittent ovarian function in women with primary ovarian insufficiency

“…We compared homoscedastic samples using a two-sample t-test or the Welch test for heteroscedastic samples. When at least one of the samples was not normally-distributed, they spontaneously and unexpectedly conceived on HRT [6,8,[15][16][17][18][19][20][21][22][23]. For couples affected by POI, the only practical alternatives for having a child are adoption or oocyte or embryo donation [13].…”

“…The DOD also has a negative relationship with follicle growth and pregnancy, although a significant difference was not proved, presumably due to the small sample size. There are several case reports in the literature involving POI patients who spontaneously and unexpectedly conceived [6,8,[15][16][17][18][19][20][21][22][23], but very few had reported statistical analysis of this population due to the rarity of POI. Bidet et al [26] reported predictive factors for spontaneous resumption of ovarian function in POI patients.…”

Resumption of ovarian function after 4 years of estro-progestin treatment in a young woman with Crohn’s disease and premature ovarian insufficiency: a case report

“…It is presumed that chronically elevated gonadotropins levels result in receptor downregulation or desensitization. Suppression of the elevated endogenous gonadotropins using estro-progestins have been found to restore ovarian responsiveness in selected patients with POI [10,14,24], as estrogens may enhance the stimulatory effect of FSH on granulosa-cell FSH receptors as well as FSH binding to its receptors [19]. The down-regulating effect of estro-progestin treatment on ovarian FSH receptor has been found to be time-dependent and dose-dipendent in mice [16], therefore a prolonged estro-progestin treatment could be necessary in case of severe ovarian receptor down-regulation.…”