Intermittent spontaneous ovulation in patients with premature ovarian failure: Three case reports and review of literature

Abstract

BACKGROUND

Premature ovarian failure (POF) is the end-stage of a decline in ovarian function prior to the age of 40 years that involves symptoms associated with low estradiol (E₂) levels and a minimal probability of pregnancy. This increases the physical and psychological burden experienced by young women of reproductive age, particularly with regards to over-diagnosis.

CASE SUMMARY

Here, we report three cases (29, 22, and 33 years-of-age) diagnosed with POF after experiencing secondary amenorrhea for more than one year, serum levels of follicle-stimulating hormone (FSH) > 40 IU/L on two occasions with an interval of more than 4 wk, and negative progesterone withdrawal tests. All three patients were intermittently administered with drugs to create an artificial cycle. During the subsequent discontinuation period, the patients experienced intermittent follicular growth and spontaneous ovulation. One patient experienced two natural pregnancies (both with embryo arrest).

CONCLUSION

Our findings suggest that young patients with POF can experience unpredictable and intermittent spontaneous follicular development, ovulation, and even natural pregnancy. Clinicians should provide appropriate medical guidance and individualized treatments according to fertility requirements, genetic risks and hypoestrogenic symptoms as soon as possible.

Keywords: Premature ovarian failure; Follicular development; Natural pregnancy; Artificial cycle; Case report

Core Tip: Three cases (29, 22, and 33 years of age) diagnosed with premature ovarian failure after experiencing secondary amenorrhea for more than one year, serum follicle-stimulating hormone levels > 40 IU/L. During the discontinuation period of artificial cycle, three patients experienced unpredictable and intermittent spontaneous follicle development, ovulation, and even natural pregnancy.