Pregnancy after DHEA-S for low ovarian reserve due to laparoscopic ovarian drilling

Abstract

A 32-year-old married for three years, who had taken treatment for primary infertility, approached for assisted reproductive techniques (ART) after the failure of 10 cycles of ovulation induction with clomiphene citrate (CC) and laparoscopic ovarian drilling (LOD) two years ago. She was evaluated and found to have anti-Mullerian hormone (AMH) of 0.63 ng/ml and antral follicle count (AFC) of four and was treated with dehydroepiandrosterone sulphate (DHEA-S) for three months. Her AMH increased to 1.2 ng/ml and AFC to seven and she underwent three cycles of ovulation induction and intrauterine insemination (IUI) which was unsuccessful. She conceived naturally after the fourth cycle of ovulation induction with gonadotropins without cycle monitoring. Her Pregnancy was supported with progesterone until 36 weeks, and she underwent elective lower segment Caesarean section (LSCS) for mid-pelvic contraction at 38 weeks of pregnancy. The Caesarean section inspection of the ovaries showed bilateral charring and a few tubo-tubal adhesions. Her postoperative period was normal and mother and baby were discharged on the fifth postnatal day.