First Birth Achieved After In Vitro Maturation of Oocytes From a Woman Endowed With Multiple Antral Follicles Unresponsive to Follicle-stimulating Hormone

Context: The association of primary amenorrhea, gonadotropin levels at menopausal range, and normal antral follicle endowment is a rare clinical condition that suggests unresponsiveness of antral follicles to FSH. This affection is frequently misdiagnosed ovarian failure and patients are referred to egg donation to treat their infertility. Because these patients notably have an age-compatible number of antral follicles, we hypothesized that in vitro maturation (IVM) of oocytes might constitute a useful approach for treating their infertility. Objective: We report the first pregnancy and live birth obtained after IVM of oocytes in a 29-year-old patient suffering from ovarian resistance to FSH. Design: This is a case report. Setting: The work was conducted in a university hospital. Patient: Whereas serum FSH (40.3 and 38.4 mIU/mL) and LH (35.7 and 31.7 mIU/mL) levels were repeatedly around the menopausal range, serum anti-Mullerian hormone (4.50 and 4.36 ng/mL) levels and total counting of antral follicles (23 and 18 follicles) remained normal. Intervention: We aspirated antral-stage follicles and subsequently matured the oocytes in vitro. Main Outcome Measure: We assessed the competence of oocytes retrieved in a patient suffering from ovarian resistance to FSH. Results: Aspiration of antral-stage follicles allowed the retrieval of 15 immature oocytes. Following IVM, 12 of them reached metaphase II. Seven embryos were obtained and three of them were transferred into the uterus. This patient became pregnant and delivered a healthy baby at term. Conclusions: We report the first pregnancy and live birth achieved using IVM in a woman whose ovaries were resistant to FSH. This approach was based on the remarkable normalcy of AMH and antral follicle measurements in this patient. Therefore, IVM is a viable alternative to egg donation for women suffering from resistance to FSH. Importantly, this condition should be looked for as it may lurk undetected in women wrongly diagnosed with ovarian failure.