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Successful Pregnancy in First Attempt of IVF Using Gonadotrophins in a Woman with Hypogonadotrophic Hypogonadism Yee Tsing CHEONG, Hatta TARMIZI

Sabah Women’s And Children’s Hospital, Kota Kinabalu, Sabah, Malaysia

Objectives Results

Conclusions

References

Adashi EY, Hennenbold JD: Single-gene mutations resulting in reproductive dysfunction in women. N Engl J Med 1999;340:709-718

Bhagavath B, Podolsky RH, Ozata M, et al: Clinical and molecular characterization of a large sample of patients with hypogonadotropic hypogonadism. Fertil Steril 2006;85:706-713

De Roux N, Young J, Misrahi M, et al: A family with hypogonadotropic hypogonadism and mutations in the gonadotropin-releasing hormone receptor. N Engl J Med 1997;337:1597-1602

Hardelin JP, Levilliers J, del Castillo I, et al: X chromosome-linked Kallmann syndrome: Stop mutations validate the candidate gene. Proc Natl Acad Sci USA 1992;89:8190-8194

MacColl G, Quinton R, Bouloux PMG: GnRH neuronal development: Insights into hypogonadotrophic hypogonadism. Trends Endocrinol Metab 2002;13:112-118

Nachtigall LB, Boepple PA, Pralong FP, et al: Adult-onset idiopathic hypogonadotropic hypogonadism: A treatable form of male infertility. N Engl J Med 1997;336:410-415

Seminara SB, Oliveira LM, Beranova M, et al: Genetics of hypogonadotropic hypogonadism. J Endocrinol Invest 2000;23:560-565

To report a case of successful pregnancy following in-vitro fertilization in a woman with hypogonadotrophic hypogonadism.

Hypogonadotrophic hypogonadism is one of the causes of infertility.

In women with hypogonadotrophic hypogonadism, successful pregnancies are possible following induction of follicular growth using both follicle-stimulating hormone and luteinizing hormone.

Methods

Case reportA 33-year-old lady presented to the Fertility Unit at Sabah’s Women’s and Children’s Hospital with 2-year history of infertility.

She was diagnosed to have hypogonadotrophic hypogonadism at the age of 20 when she presented with primary amenorrhoea. The diagnosis was confirmed with low levels of serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH), 0.9 IU/L and 0.3 IU/L respectively.

Her other endocrine profiles were normal. Other investigations which were performed included a normal female karyotype of 46,XX and a normal magnetic resonance imaging (MRI) of the brain.

She was given hormone replacement therapy with oestrogen and progestogen which resulted in regular withdrawal bleeding.

During her fertility consultation, both couple decided to have in-vitro fertilization. Husband semen analysis was normal.

We described a case of singleton pregnancy in a 33-year-old patient, presenting with primary hypogonadotrophic amenorrhea, treated with combination of recombinant FSH and human menopausal gonadotrophins and performing in-vitro fertilization in first attempt.

This stimulation regime led to ten oocytes obtained during oocyte retrieval. Seven of them were fertilized.

A singleton pregnancy ensued and a normal infant was delivered vaginally.

OPTIONALLOGO HERE

OPTIONALLOGO HERE

The patient underwent controlled ovarian hyperstimulation using antagonist regime and a combination of recombinant FSH and human menopausal gonadotrophins. A total of 2,300 IU of recombinant FSH and 1,500 IU of human menopausal gonadotrophins were administered over 10 days.

10,000IU of human chorionic gonadotrophin (hCG) injection was given 36 hours prior to oocyte retrieval. A total of 10 oocytes were retrieved. Eight of these were mature metaphase II oocytes.

In-vitro fertilization was performed. Subsequently, 7 oocytes were fertilized. Day 3 embryo transfer was performed with replacement of 2 embryos of grade II quality. The remaining 5 embryos were frozen.

Two weeks after embryo transfer, BHCG was performed and the level was 72.3IU/L. Subsequently, ultrasound scan showed a single viable fetus. She received hormonal support which consisted of both oestrogen (oral progynova 1mg BD) and progestogen (vaginal progestogen gel, Crinone). These were continued until 12 weeks of pregnancy. The rest of her antenatal progress was otherwise unremarkable.

At 35 weeks of pregnancy, the patient went into premature labour and successfully delivered a healthy baby boy weighing 3.2 KG vaginally.

Methods