Abstract
This unique study shows favorable outcomes to embryos developed from eggs retrieved following luteal phase stimulation and the children born from these eggs. A 40-year-old woman with a 10-year history of primary infertility was given hMG 150IU and letrozole 2.5 mg from cycle day 3 onwards. Her cycle transitioned into the luteal phase beginning on cycle day 10 as indicated by high serum progesterone levels. Follicle growth continued with hMG stimulation. GnRH agonist was given for the final stage of oocyte maturation. During collection, four mature oocytes were obtained and two top-quality embryos were vitrified for cryopreservation. Two months later, the two embryos were thawed and transferred during a natural cycle, creating a twin pregnancy and a favorable delivery. Three-year follow up showed that physical and psychomotor development of the twin babies were in the normal range of children conceived naturally. This case report documents that embryos developed following luteal-phase ovarian stimulation reached viability, and child development was found to be normal up to three years following birth. This study opens the door to the possibility of successful outcomes from luteal phase stimulation. This has a great potential for patients who did not respond well during the follicular phase, but most importantly, for newly diagnosed cancer patients who need immediate fertility preservation, i.e., to quickly produce viable oocytes.
Highlights
Ovarian stimulation is usually carried out with exogenous gonadotropins to induce multiple follicle development and to mature more oocytes for in vitro Fertilization (IVF) [1]
According to the traditional folliculogenesis, antral follicles in each ovary are recruited from the late luteal phase of the preceding menstrual cycle for the following follicle phase
The standard regimens of ovarian stimulation target the antral follicles in the follicular phase so gonadotropin stimulations always start during the early follicular phase of the menstrual cycle or within ten days of GnRH agonist administration [1]
Summary
Ovarian stimulation is usually carried out with exogenous gonadotropins to induce multiple follicle development and to mature more oocytes for in vitro Fertilization (IVF) [1]. The standard regimens of ovarian stimulation target the antral follicles in the follicular phase so gonadotropin stimulations always start during the early follicular phase of the menstrual cycle or within ten days of GnRH agonist administration [1]. Some studies have demonstrated that the small antral follicles observed in the luteal phase may not necessarily be in atresia, but may rather be in the early stages of follicular development [3]. A 40-year-old woman with a 10-year history of primary infertility and irregular menstrual cycle (of 23-29 days in length) and bilateral blocked tubes with one failed IVF attempt was referred to our unit Her endocrine evaluation revealed a FSH (follicle-stimulating hormone) level of 10.82 IU/l, LH of 10.5 IU/l, estradiol of 25 pg/ml and progesterone of 2.0 ng/ml. Their sizes were in the normal range of children conceived naturally in China
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