Successful live birth after in vitro maturation treatment in a patient with autoimmune premature ovarian failure: a case report and review of the literature

Abstract

Objective

We report a successful live birth after oocytes in vitro maturation (IVM) and fresh embryo transfer in a patient with autoimmune premature ovarian failure (POF) and performed a review of the literature of livebirths obtained after oocytes IVM treatment in this indication.

Methods

The patient was a 24-year-old woman with autoimmune POF diagnosed post-partum, who developed autoimmune polyglandular syndrome with serum anti-ovarian and anti-21-hydroxylase antibodies. The patient had typical symptoms of POF: secondary amenorrhea with hypoestrogenism, elevated gonadotropins and infertility; however, the serum anti-Müllerian hormone level and total antral follicle count remained normal. IVM of immature oocytes was performed after the administration of 150 IU highly purified human menopausal gonadotropin for three consecutive days and an injection of 10,000 IU human chorionic gonadotropin to trigger ovulation.

Results

The six oocyte–cumulus complexes collected matured in vitro. After intracytoplasmic sperm injection (ICSI), five embryos were obtained. Pregnancy was achieved after the fresh transfer of two embryos and appropriate endometrial preparation. A normal female child was delivered following a 37-weeks pregnancy characterized by the onset of adrenal insufficiency and unstable diabetes.

Conclusions

We report a successful livebirth after IVM treatment in a patient with autoimmune premature ovarian failure (POF). Management of reproductive age women with autoimmune pathology requires fertility counseling. Early diagnosis of autoimmune POF is important for early conception and oocyte preservation, because the only other option at present is ovum donation.

自身免疫性卵巢早衰患者体外成熟治疗后成功活产一例并文献复习 摘要

目的：报道1例自身免疫性卵巢早衰（POF）患者行卵母细胞体外成熟（IVM）和新鲜胚胎移植后成功活产的病例, 并复习有关卵母细胞体外成熟（IVM）治疗获得活产的文献。方法：患者为24岁, 产后诊断为自身免疫性POF, 血清抗卵巢抗体和抗21-羟化酶抗体阳性, 发展为自身免疫性多腺体综合征。患者有典型的卵巢早衰症状：继发性闭经伴雌激素低下、促性腺激素升高和不孕, 但血清抗苗勒氏管激素水平和窦卵泡计数均正常。在连续3d注射150IU高纯度人绝经期促性腺激素和10000IU人绒毛膜促性腺激素激发排卵后, 对未成熟卵母细胞进行体外成熟培养。结果：收集到的6个卵母细胞-卵丘复合体在体外成熟。卵胞浆内单精子注射（ICSI）后获得5个胚胎。在新鲜移植两个胚胎和适宜的子宫内膜准备后, 成功妊娠。患者伴有肾上腺功能不全和不稳定型糖尿病妊娠37周后活产一个正常的女婴。结论：我们报告了一例自身免疫性卵巢早衰（POF）患者在IVM治疗后成功活产。患有自身免疫性疾病的育龄妇女的治疗需要生育咨询。自身免疫性卵巢早衰的早期诊断对早期受孕和卵母细胞保存非常重要, 因为目前唯一的其他选择是卵子捐献。

Keywords:

• Premature ovarian failure
• premature ovarian insufficiency
• autoimmunity
• infertility
• in vitro maturation

Acknowledgments

The authors thank Dr. Nicolas Proust, who referred the patient to our fertility center, and Prof. Sophie Christin-Maitre for advice in fertility care.

Disclosure statement

The authors report no conflict of interest.