title: Continuous high-dose estrogen controls serum FSH and LH levels: new treatment strategy for extremely low ovarian reserve patients, two case reports.
abstract: At present, there are no proven therapies to improve ovarian function in women with premature ovarian insufficiency (POI) or in those with extremely low ovarian reserve (LOR). We report successful IVF outcomes achieved with continuous high-dose estrogen supplementation in patients with LOR. Patients were 33- and 42-year-old nulligravidae with high-serum FSH (over 30 IU/L) and undetectable serum AMH (under 0.1 ng/mL) levels; however, neither patient fulfilled the diagnostic criteria for POI. After cycle cancellation and unsuccessful IVF treatment, both patients received conjugated estrogen (CE) supplementation (2.5-3.75 mg/day) from day 2 of their menstrual cycle to the day of HCG administration in their IVF treatment cycles. Following continuous high-dose estrogen supplementation, oocytes were successfully retrieved from both patients and fertilized. Both patients also achieved ongoing pregnancy through frozen-thawed embryo transfer cycles. In conclusion, high-dose estrogen supplementation down-regulated serum FSH and LH within their physiological ranges, which led to functional follicle growth and prevented early luteinization. Further studies will be needed to confirm the effect of this treatment on POI patients and to establish a new and individualized protocol for LOR patients.
authors.affiliation: Kamiya Ladies Clinic , Sapporo , Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Honnma
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Asada
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Baba
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Endo
mesh_terms: D000328:Adult; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D054315:Oocyte Retrieval; D065851:Ovarian Reserve / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D004967:Estrogens; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone