The birth of a healthy baby in a woman with resistant ovarian syndrome after in vitro oocyte maturation with embryo transfer without cycle segmentation

Background: Resistant ovarian syndrome (ROS) is a rare disease of unknown etiology. Infertility is a common problem among women with ROS. The possibility of pregnancy in the standard IVF program with hormonal stimulation in this group of patients is excluded due to the lack of a reaction of antral follicles to endogenous and exogenous releasing follicle-stimulating hormone (rFSH). The only tactic to overcome infertility in these women until recently was only oocyte donation. To date, there is progress in achieving live birth in patients with ROS by means of their own oocytes after maturation of immature oocyte-cumulus complexes (OCCs) obtained from antral ovarian follicles (in vitro maturation, IVM). In addition, after this procedure, it is possible to effectively synchronize the IVM program in one protocol, which has its advantages for both the physician and the patient.

Case report: The paper demonstrates a case of birth of a healthy baby in a woman with ROS after IVM with embryo transfer without cycle segmentation. The patient turned after many unsuccessful IVF attempts with hormonal stimulation. On Day 2 of the menstrual cycle, a start was made in gonadotropin-releasing hormone stimulation. The total dose of rFSH preparations was 1350 IU. Due to the lack of an ovarian response, the patient was transferred to the IVM program on Day 9 of hormonal stimulation. On the days following the discontinuation of stimulation, estradiol was topically applied to prepare the endometrium for embryo transfer in the same cycle. Follicles with in vitro maturation were punctured on day 13 of the menstrual cycle. Ultrasound on the puncture day excluded spontaneous ovulation; the dominant follicle was not identified; all the antral follicles measured 8-9 mm; the M echo of the uterus was 9 mm. Nineteen immature OCCs were extracted under ultrasound control by standard aspiration. After 48 hours, thirteen oocytes at Stage II were fertilized through intracytoplasmic sperm injection (ICSI) using a husband’s cryopreserved sperm. Two embryos of the fifth day were transferred to the uterus; whereas three embryos were cryopreserved. The luteal phase was supported. On day 21 after embryo transfer, ultrasound determines an ovum in the uterine cavity; the heartbeat is clear, rhythmic. On April 8, 2022, a 41-week-old healthy girl was born. She had Apgar scores of 8–9.

Conclusion: Our experience with the birth a healthy baby shows the possibility of effective synchronization of IVF with IVM without cycle segmentation, which allows one to minimize the costs and time for the program.