A DOR/POI Patient is Pregnant: A Success Story Involving the Retrieval of Only Two Eggs

A 36-year old patient from out of state contacted us in order to consult on her particular infertility case. She’d had a long history of irregular periods, and her AMH was 0.022 indicating she was both DOR (Diminished Ovarian Reserve) and POI (Primary Ovarian Insufficiency). She’d worked with her local specialist and attempted IUI, but the sperm used were immotile, lacking in the ability to swim properly. Next, she and her specialist decided to try traditional or conventional IVF, which involves high stimulation in terms of a number of fertility drugs used. Then, the specialist suggested a version of mini-IVF, which involved taking 5mg of Letrazole and 150U of Follistim daily. Unfortunately, the patient developed cysts and continued to develop cysts when switching to Birth Control preparation. Her successive attempts at both IVF and IUI failed.

Hanabusa IVF was then called in as a consultant on her case. We began to monitor her hormonal levels on Day 3 of her cycle, noting that she seemed to have one follicle and her Estradiol level was 55mg/ml, and her FSH was 13mIU/ml. We then suggested she take 50mg of Clomid once a day. On the 9th day, an ultrasound revealed one lead follicle (17mm) and two smaller follicles (13-14mm) and three even smaller follicles (each less than 10mm). At this point, her Estradiol level was 313pg/ml; her FSH was 9.7 mIU/ml, her LH showed 5.8 mIU/ml, and her progesterone was .5ng/ml. The Estradiol of 313pg/ml indicated that her follicles were close to maturity. While many would focus on maturing the two medium-sized follicles, risking over-maturing the lead follicle—the one with the greatest chance of becoming a normal embryo—we chose to keep focused on the lead follicle. We gave the patient HCG, and a retrieval was performed 36 hours after this. Using local anesthesia, two eggs were retrieved from the two largest follicles, and both eggs were fertilized growing into blastocysts on Day 5. PGS tests revealed one normal embryo, which came from the lead follicle.

In this case, it seems as if the patients’ previous IVF and IUI failures were due to the result of too much medicine. As this patient’s future success indicates, treatment protocol requires adjustment depending on the patient’s very specific situation. In her case of DOR/POI, a careful monitoring of hormone levels was critical to success. It’s also worth noting that in cases of DOR/POI Clomid may be preferable to Letrozole since Clomid does not affect Estradiol levels and so Estradiol can still be used to follow egg development. This case is also a good indication that it is important to optimize the lead follicle as this is the follicle that ultimately produced the normal embryo. While many may think that retrieving only two eggs seems too little considering the effort involved in undergoing these procedures, as long as the cycle is managed properly, two eggs are, in cases such as this, all one needs to achieve a successful pregnancy.
A 36-year old patient from out of state contacted us in order to consult on her particular infertility case. She’d had a long history of irregular periods, and her AMH was 0.022 indicating she was both DOR (Diminished Ovarian Reserve) and POI (Primary Ovarian Insufficiency). She’d worked with her local specialist and attempted IUI, but the sperm used were immotile, lacking in the ability to swim properly. Next, she and her specialist decided to try traditional or conventional IVF, which involves high stimulation in terms of a number of fertility drugs used. Then, the specialist suggested a version of mini-IVF, which involved taking 5mg of Letrazole and 150U of Follistim daily. Unfortunately, the patient developed cysts and continued to develop cysts when switching to Birth Control preparation. Her successive attempts at both IVF and IUI failed.

Hanabusa IVF was then called in as a consultant on her case. We began to monitor her hormonal levels on Day 3 of her cycle, noting that she seemed to have one follicle and her Estradiol level was 55mg/ml, and her FSH was 13mIU/ml. We then suggested she take 50mg of Clomid once a day. On the 9th day, an ultrasound revealed one lead follicle (17mm) and two smaller follicles (13-14mm) and three even smaller follicles (each less than 10mm). At this point, her Estradiol level was 313pg/ml; her FSH was 9.7 mIU/ml, her LH showed 5.8 mIU/ml, and her progesterone was .5ng/ml. The Estradiol of 313pg/ml indicated that her follicles were close to maturity. While many would focus on maturing the two medium-sized follicles, risking over-maturing the lead follicle—the one with the greatest chance of becoming a normal embryo—we chose to keep focused on the lead follicle. We gave the patient HCG, and a retrieval was performed 36 hours after this. Using local anesthesia, two eggs were retrieved from the two largest follicles, and both eggs were fertilized growing into blastocysts on Day 5. PGS tests revealed one normal embryo, which came from the lead follicle.

In this case, it seems as if the patients’ previous IVF and IUI failures were due to the result of too much medicine. As this patient’s future success indicates, treatment protocol requires adjustment depending on the patient’s very specific situation. In her case of DOR/POI, a careful monitoring of hormone levels was critical to success. It’s also worth noting that in cases of DOR/POI Clomid may be preferable to Letrozole since Clomid does not affect Estradiol levels and so Estradiol can still be used to follow egg development. This case is also a good indication that it is important to optimize the lead follicle as this is the follicle that ultimately produced the normal embryo. While many may think that retrieving only two eggs seems too little considering the effort involved in undergoing these procedures, as long as the cycle is managed properly, two eggs are, in cases such as this, all one needs to achieve a successful pregnancy.