Successful Intrauterine Insemination Following Estradiol Pretreatment in a Patient with Primary Ovarian Insufficiency: A Case Report

Abstract

Background: Premature ovarian insufficiency (POI) is a clinical condition characterized by impaired ovarian function to secrete gonadal hormones, leading to hypoestrogenism and amenorrhea before the age of 40. Oocyte depletion in POI significantly reduces the chance of spontaneous conception, making infertility a key concern. Various in vitro fertilization (IVF) stimulation protocols, including estrogen pretreatment, have been investigated to facilitate conception with autologous oocytes in patients with POI. The principle of estrogen pretreatment involves administering exogenous estrogen to suppress elevated pituitary gonadotropins (FSH and LH), thereby restoring normal follicular development.

Case Presentation: This article presents a case of a 32-year-old patient with POI, characterized by severely diminished ovarian reserve, as evidenced by an AMH level of 0.03 ng/ml and an antral follicle count (AFC) of 1. Our patient had been attempting to conceive for 14 months and reported shortened menstrual cycles. Hysterosalpingography revealed bilaterally patent fallopian tubes, and the patient’s partner demonstrated normozoospermia. The patient was initially scheduled for IVF with controlled ovarian stimulation and estrogen pretreatment. However, a spontaneously matured follicle was detected during the course of estrogen therapy. Consequently, the patient was advised to undergo intrauterine insemination (IUI) following ovulation triggering with human chorionic gonadotropin (hCG). The procedure resulted in a clinical pregnancy and culminated in a term live birth.

Conclusion: In POI patients using for estrogen pretreatment autologous oocytes, may enhance ovarian responsiveness. If a mature follicle emerges during estrogen pretreatment, ovulation induction with IUI offers a viable path to natural conception.