Induced multiple follicular growth and ongoing twin pregnancy by IVF in a woman with premature menopause

Abstract

Menopause, natural or premature, was long been considered to be incompatible with conception with the own eggs of the women affected. Here we describe a case of a 32-year-old woman with premature menopause, characterized by amenorrea, the absence of antral follicles in the ovaries, high basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and extremely low antimullerian hormone (AMH) levels. After preliminary treatment with contraceptive pill for two months, and an injection of recombinant human chorionic gonadotropin (HCG) to boost intrinsic androgen production, ovarian stimulation, using a customized protocol with a patient-tailored combination of recombinant FSH and LH, in addition to daily injections of growth hormone, resulted in the recovery of 3 metaphase II eggs after double triggering with recombinant HCG. After transfer of two embros, obtained by intracytoplasmic sperm injection, an ongoing twin clinical pregnancy was achieved. These data show that oocyte recovery, fertilization, embryo development and pregnancy can be achieved, with the use of a customized ovarian stimulation protocol, even in young women with clear signs of advanced premature menopause.