Spontaneous pregnancy in premature ovarian insufficiency: a
Premature ovarian insufficiency (POI) affects approximately 1% of women under the age of 40 years and is associated with female infertility. The symptoms are similar to those of menopause: oligo/amenorrhea, hypoestrogenism, elevated level of gonadotropins, and diminished number of follicles within the ovaries. The present case has been reported in the journal Menopause Review.

A 27-year-old woman was referred to the gynaecological endocrinology clinic with oligomenorrhoea, and periodic stomach and spine pain. Menarche occurred at age of 16 years, followed by regular menstrual bleeding. At 19 years, she commenced on birth control pills that she continued for three years.

Laboratory tests showed elevated follicle-stimulating hormone (FSH) level at 102.2 mIU/ml (normal levels 3.03-8.08 mIU/ml), oestradiol (E2) at < 10 pg/ml (21-251 pg/ml), and luteinising hormone (LH) 45.9 mIU/ml (1.8-11.78 mIU/ml). Repeated laboratory results confirmed the diagnosis of premature ovarian insufficiency.

Hormone replacement therapy (HRT) was implemented to minimise bone loss and decrease the risk of cardiovascular events. The patient was treated with cyclical hormone therapy using oestrogen (2 mg oestradiol) with the addition with progestin for 14 days in the cycle (10 mg dydrogesterone). This patient spontaneously and unexpectedly conceived after six months on HRT.

After recognising the pregnancy, HRT treatment was discontinued. During the first trimester of pregnancy several episodes of vaginal bleeding occurred. Progesterone therapy was then implemented. Pregnancy proceeded without any further complications. At the 39th week of gestation a healthy child was born.

Clinical pearls:-
- Oocyte donation is the only proven and recommended treatment for infertility in women with POI.

- It is important to admit the probability of ovulation occurrence in the case of patients with oligo/amenorrhoea. The chances of resuming ovarian function depend chiefly on whether the amenorrhoea is primary or secondary.

- Another important predictor of resumption of ovarian activity are the results of laboratory tests of FSH, oestradiol, and inhibin B levels

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Dr. N●●●●a G●●●a
Dr. N●●●●a G●●●a Obstetrics and Gynaecology
Age old therapy of giving cyclical oestrogen progesterone given in the days to young pts as a routine tt when hormonal assessment was not easily available, has proved its efficacy in modern era too.
Feb 7, 2019Like1