Pregnancy despite imminent ovarian failure and extremely high endogenous gonadotropins and therapeutic strategies: case report and review.
OBJECTIVE
To attempt ovulation induction in a woman with premature ovarian failure who had very high serum follicle stimulating hormone (FSH) levels (e.g., 164 mIU/ml) by merely using ethinyl estradiol without gonadotropins.


METHODS
Ethinyl estradiol (20-40 microg) was used to lower serum FSH. Monitoring of follicular maturation was performed using sonography to determine follicle size and serum estradiol. Progesterone vaginal suppositories (200 mg twice daily) were used following demonstration of oocyte release from the follicle.


RESULTS
Follicle maturation and ovulation was achieved in six of ten treatment cycles. A clinical pregnancy occurred in the ninth treatment cycle and a live delivery of a healthy baby occurred.


CONCLUSIONS
Despite small ovaries, amenorrhea, and failure to have withdrawal menses following progesterone, absence of antral follicles on initial ultrasound, and consistently extremely high serum FSH, ovulation and pregnancy is possible by merely lowering the serum FSH.
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The University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ, USA.
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Kaplan
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D000328:Adult; D004967:Estrogens / Q000627:therapeutic use*; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D006080:Ovarian Follicle / Q000187:drug effects / Q000254:growth & development; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000188:drug therapy*; D011374:Progesterone / Q000627:therapeutic use; D013488:Suppositories
D004967:Estrogens; D013488:Suppositories; D004997:Ethinyl Estradiol; D011374:Progesterone; D005640:Follicle Stimulating Hormone