Multiple ovulations between ovarian stimulation treatment and primary ovarian insufficiency

Abstract

The release of several oocytes during the same menstrual cycle can occur both physiologically and iatrogenic, following ovarian stimulation treatments. Ovarian induction can be achieved either by mild stimulation, in the case of anovulatory or dysovulatory patients, or by controlled ovarian hyperstimulation, to obtain a large number of follicles in the In Vitro Fertilization procedure. At this time, the ideal ovarian stimulation treatment is to suppress the pituitary release of gonadotrophin-releasing hormone (GnRH), a co-opted regimen with high doses of exogenous follicle-stimulating hormone (FSH). The physiological process of multiple ovulations can lead to superfertilization (SF). SF is a biological process by which two eggs are fertilized successively, at intervals of a few days apart, both eggs coming from the same ovulation. Among the factors that can lead to superfertilization are mentioned: family history of dizygotic pregnancies (DZ), increased parity, advanced age, high stature of women, a high weight index, the use of oral contraceptives and folic acid. The premenopausal period is characterized by elevated levels of FSH and a low ovarian reserve, both conditions contributing to the development of multiple follicular and DZ pregnancies.