Two Successful Pregnancies in A Woman with Marked Diminished Ovarian Reserve-One with Regular Menses and One in Overt Menopause
Jerome H Check* and Priya Srivastava
ABSTRACT
An FSH receptor up- regulation technique has been used to induce ovulation with successful achievement of healthy babies even in women with hypergonadotropic amenorrhea with estrogen deficiency. For many years the same technique has been used in women who were not in menopause but still having menses. One had diminished oocyte reserve (DOR). A 32-yearold woman with 2 1/2 years of infertility was advised to consider donor eggs by her first consult with an infertility specialist because she had mild DOR even though basal body temperature charts indicated possibly achieving pregnancies naturally but having early miscarriages. Her first pregnancy with our group only required progesterone supplementation. Interestingly, she went into complete ovarian failure during that pregnancy. Her second successful pregnancy was achieved by restoring follicular sensitivity by restoring FSH receptors in the granulosa theca cells with P supplementation once a mature dominant follicle was achieved without any addition of exogenous gonadotropins. The case illustrates the importance of early monitoring of hormone levels shortly after delivery if a woman desires another baby since amenorrhea is common post-delivery for several months. The treating physician may not be alarmed to evaluate ovarian reserve status just because of amenorrhea for a period of time. Both babies were healthy with no evidence of aneuploidy.
