Follicular development, acquisition of mature oocytes, and pregnancy after 2 weeks of leuprolide acetate administration during the midluteal phase

• Published in: Fertility and sterility Vol. 92; no. 3; pp. 1170.e9 - 1170.e11
• Main Authors: Vlahos, Nikos F., M.D, Choussein, Souzana, M.D, Economopoulos, Konstantinos P., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2009
• Subjects: Adult; embryo transfer; Embryo Transfer - methods; Estrogens - blood; Female; Fertility Agents, Female - pharmacology; Fertility Agents, Female - therapeutic use; Fertilization in Vitro - methods; Humans; in vitro fertilization; Infertility, Female - therapy; Internal Medicine; leuprolide; Leuprolide - pharmacology; Leuprolide - therapeutic use; long protocol; Luteal Phase - drug effects; Luteal Phase - physiology; mature follicle; Obstetrics and Gynecology; Oocytes - cytology; Oocytes - drug effects; Oocytes - physiology; Ovarian Follicle - drug effects; Ovarian Follicle - growth & development; Ovarian Follicle - physiology; Ovarian stimulation; Pregnancy - physiology; Pregnancy Outcome; Progesterone - blood; Treatment Outcome; in vitro fertilization; leuprolide; mature follicle; Ovarian stimulation; long protocol; embryo transfer
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2009.05.067

Objective To present a case of aberrant follicular development, acquisition of mature oocytes, and pregnancy after 2 weeks of leuprolide acetate administration during the midluteal phase. Design Case report. Setting Department of Obstetrics and Gynecology, Aretaieio University Hospital, Athens, Greece. Patient(s) A 37-year-old white woman who was scheduled to undergo ovarian stimulation according to the long luteal phase protocol for IVF and ET because of male factor infertility. Intervention(s) Twenty-first day serum P level was 5.9 ng/dL, and a daily dose of 0.1 mg leuprolide acetate was initiated. Fifteen days later the patient presented for evaluation because of absence of uterine bleeding. Sonographic evaluation revealed the presence of five large follicles. Serum E2 and P levels at this time were 1,895.0 pg/mL and 0.2 ng/mL, respectively. The patient received recombinant hCG (250 mg), and 36 hours later she underwent oocyte retrieval. Three oocytes were retrieved and fertilized by intracytoplasmic sperm injection. After the transfer of two embryos a singleton pregnancy was achieved, leading to an uneventful delivery. Main Outcome Measure(s) Serum E2 and P and ultrasound evaluation of ovaries. Result(s) She had a singleton pregnancy, and she delivered at 39 weeks of gestation. Conclusion(s) The presence of recruitable follicles during the luteal phase of the cycle that responded to endogenous gonadotropins during the flare response before pituitary suppression could be a logical explanation of this observation.