Failure of ovarian stimulation (first IVF cycle)
In her first cycle of IVF treatment, minimal ovarian stimulation (CC, human menopausal gonadotrophin (HMG) and growth hormone (GH)) was used. CC 50 mg was taken orally daily for 3 days, and HMG 75 U q.o.d. and GH were taken beginning on day 1 of CC (cycle day 3). On stimulation day 8, two leading follicles developed (mean measurements of 18 mm, 14.5 mm); her serum estradiol (E2) level was 2271 pmol/L, luteinizing hormone (LH) level was 7.5 IU/L, and progesterone (P) level was 2.05 nmol/L; and her endometrial thickness was 5.6 mm. GnRH-a 0.1 mg was prescribed followed by oocyte retrieval 36 hours later. One oocyte was retrieved, and one embryo was frozen on day 3 due to endometrial factors. In the next cycle (natural cycle, endometrial thickness of 5.6 mm), the embryo (at the 14-cell stage) was transferred after assisted hatching. After 14 days, her serum HCG was lower than 5 IU/L.
OC treatment and ovarian stimulation for IVF (Fig. 1)
Three months later, she began her second cycle of IVF treatment. Her basal FSH was 23.13 IU/L, and after combined oral contraceptives (OCs) for 7, 7, 12, 7, and 7 days (total 40 days) were used, her FSH levels changed to 32.22, 27.26, 28.25, 19.50, and 15.82 IU/L, respectively. On day 40 of OCs, she was treated with CC 50 mg, HMG 75 IU and GH 4 U daily. On stimulation day 10, the leading follicles developed with mean diameters of 18.5, 13.5 and 12.5 mm, and her serum LH level was 16.31 IU/L, E2 level was 5358.38 pmol/L, P level was 1.80 nmol/L, and endometrial thickness was 4.8 mm. GnRH-a 0.1 mg was prescribed followed by oocyte retrieval 36 hours later. Only one oocyte was retrieved. According to the doctor’s opinion, the embryo was grown into a 3CC-grade blastocyst (Fig. 2). Five days after the day of ovum pick up (DOPU), her endometrial thickness measured 4.2 mm, and ET was performed without any difficulty, with the 17.3 cm COOK Embryo Transfer Catheter to the fundus of uterus. Luteal support was applied with oral E2 2 mg daily, oral dydrogesterone 20 mg daily and micronized P 100 mg vaginally twice a day during pregnancy until 90 days of gestation. Her serum beta-HCG at 14 days after ET was 2893 IU/L. A single intrauterine gestational sac was observed at a gestational age of 47 days (6+ 5 weeks). At 39 weeks’ gestation, she received a cesarean section, and a healthy male infant weighing 3250 g was delivered.