Hypergonadotropic hypogonadism: looking beyond ovarian senescence

Gonadotropin resistant ovary syndrome (GROS) is a rare cause of primary infertility where ovarian reserve is present but they fail to respond to gonadotropin stimulation. This condition can be easily confused with premature ovarian insufficiency (POI) if thorough workup is not done as in both the cases serum FSH is high, but ovarian reserve is normal in GROS and low or absent in POI. So, we are presenting this case of GROS. A 28-year-old lady presented with oligomenorrhoea since menarche and primary infertility. On workup her serum FSH and LH levels were markedly elevated, serum estradiol was normal. Markers of ovarian reserve, ante Mullerian hormones (AMH) and antral follicle count (AFC), were normal. Her autoantibody assay was also normal. She did not respond to stimulation with high doses of gonadotropins (uHMG). Hypergonadotropic hypogonadism is not always POI. We should not miss diagnosis of GROS where it is possible to have own biological child by in vitro maturation of immature oocytes, whereas in POI donor oocyte is the only fertility option.

Birth Achieved After Effective Ovarian Stimulation Combined With Dexamethasone in a Patient With Resistant Ovary Syndrome: A Case Report and Review of the Literature

Background: Resistant ovary syndrome (ROS) was a rare endocrine disorder and there have been few reports of live births. As the ovarian resistance to FSH leading the immature oocytes, some researchers reported few live births after in vitro maturation (IVM) of oocytes, but it didn’t work in all ROS patients. Case presentation: A 30-year-old woman was diagnosed as ROS. GnRH analogue triptorelin acetat was used to administer downregulation, combining with corticosteroid dexamethasone (administered orally at 0.75mg three times daily) from the beginning of the downregulation to the day of oocyte collection. After 28 days of downregulation, gonadotropin (Gonal-f 225 IU and HMG 150 IU per day at first) was given for hyperstimulation. On the 11th day of gonadotropin administration, 10000 IU of hCG was given. 36h later, oocytes were retrieved and followed by IVF procedure. Two months later, the frozen embryos were thawed and transferred. 8 metaphase II oocytes were retrieved and 3 embryos were developed, in which 1 embryo was transplanted after thawed. the β-hCG value in serum was 246.7 mIU/ ml. The patient got pregnant and gave a live birth at the 35th week of pregnancy by Caesarean section. Conclusion This is the first report about treatment ROS patient with ovarian stimulation combined with dexamethasone. In some cases of ROS, high doses of exogenous gonadotropins in combination with immunosuppressive therapy could be an effective approach in patients with ROS.