29yr Suffers From POF, Successful IVF After First Try

Dr. Horng Shan Gwo

Successful Pregnancy with Ovarian Insufficiency: A Case Study

A 29-year-old patient came to consult about ovarian insufficiency after a friend, who had a similar issue, suggested she get her AMH level checked. Her results showed an AMH of 0.4.

Ovarian Insufficiency and Irregular Menstruation

She was also troubled by her very irregular menstrual cycle, sometimes going nearly two months without a period. Given her low AMH level, she worried that she might be approaching menopause.

Recently married and hoping to start a family, she felt overwhelmed by this unexpected diagnosis. I performed an ultrasound and found no visible primordial follicles, indicating her follicle count was indeed very low and their development was extremely irregular, making natural conception challenging.

I explained that with such ovarian function, she might enter menopause quickly, and while the quantity and quality of her eggs would be low, her youth still offered a chance for pregnancy. I advised her to start taking DHEA to support ovarian health, as she wasn't yet mentally prepared for artificial reproductive techniques.

Poor Sperm Quality and IVF Decision

A few months later, she and her husband returned for a follow-up. I arranged fertility tests, which revealed her husband had poor sperm quality. After discussing their options, they decided to proceed with IVF.

However, during the ultrasound, I still couldn't see her follicles, so I asked her to return a few days later. Eventually, we detected one or two primordial follicles, allowing us to start ovulation induction. We retrieved one egg, resulting in a single embryo. We discussed whether to wait and retrieve more embryos, but due to budget constraints, they decided to wait a few months for another egg retrieval.

Changing Strategy for Successful Implantation

When they returned for another check-up, the ultrasound still didn’t show any follicles. I asked her to come back in 2-3 days, but there were still no visible follicles until about two weeks later. This time, I used a different strategy by prescribing ovulation medications. After a few days, we saw the largest follicle measuring 1.3 cm, and identified 5-6 primordial follicles.

Since they had budgeted for only one more egg retrieval, I advised against taking the largest follicle and instead stimulated the other follicles to potentially retrieve more eggs. In the end, we obtained two eggs, combined with a previously frozen embryo, leading to a successful implantation and pregnancy!

Key Takeaways:

1. Age is still a significant factor affecting pregnancy chances.

2. The timing of ovulation induction should depend on follicle development rather than the menstrual cycle.

3. Egg quality cannot be assessed through ultrasound or blood tests; having a greater number of eggs increases the chances of success.

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