title: Excessive follicular response to controlled ovarian stimulation in a woman with menopausal FSH levels: case report.
abstract: A suspected poor responder to controlled ovarian stimulation (COS), with menopausal levels of follicular phase serum FSH, required coasting due to an excessive ovarian response. A 27 year old woman was referred to our Fertility Centre for ovum donation following repeated elevated, early follicular phase FSH levels (34.3, 27.1, 20.3 IU/l). Further investigations revealed the presence of antiovarian antibodies and a trial of COS, with the additional use of prednisolone, was proposed in view of her regular 28 day cycle. As 23 follicles were noted and an oestradiol level of 10,461 pmol/l following 7 days of stimulation with 450 IU of recombinant FSH per day, gonadotrophins were withheld for 9 days. Ten oocytes were retrieved and two grade I embryos were transferred. Pregnancy did not occur and she developed mild ovarian hyperstimulation syndrome. During a second cycle, multiple follicular development was again observed with an oestradiol level >13,200 pmol/l, despite a lower dose of gonadotrophin, and coasting was required for 4 days. Nineteen oocytes were collected, of which nine fertilized and cleaved. Two grade I embryos were replaced, leading to a singleton pregnancy. This patient subsequently had a vaginal delivery of a normal male baby at term. Young women with regular menstrual cycles and grossly elevated FSH levels may benefit from further investigation of autoantibodies and their ovarian response to exogenous gonadotrophins.
authors.affiliation: Centre for Reproductive Medicine, St Bartholomew's Hospital and the London Hospitals Trust, London EC1A 7BE, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Tozer
authors.forename: T
authors.initials: T
authors.lastname: Al-Shawaf
authors.forename: C M Y
authors.initials: CM
authors.lastname: Gillott
authors.forename: A M
authors.initials: AM
authors.lastname: Lower
authors.forename: J G
authors.initials: JG
authors.lastname: Grudzinskas
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007247:Infertility, Female / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008593:Menopause / Q000097:blood*; D009865:Oocytes; D006080:Ovarian Follicle / Q000187:drug effects / Q000503:physiopathology*; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D005640:Follicle Stimulating Hormone