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Case 1
Medical History
Mrs. Tan, 31 years old, primary infertility. She had her first menses at 13 years old. She had irregular menses at 20 years old and began medication to maintain menstruation. G0P0A0L0, no history of infectious diseases, diabetes, thyroid disease, genetic disease or relevant family history. Generally normal for her male partner.
Auxiliary Examinations
Gynecologic ultrasound: uterus size 6.3 *4.6 cm, normal morphology, right ovary size 3.3*1.9 cm with 3 follicles of 0.2-0.4 cm, left ovary size 1.8*1.0 cm with 3 follicles of 0.2-0.4cm. Endocrine hormone (June 12, 2019): FSH 16.38 IU/L, LH 10.03 IU/L, AMH 0.27 ng/mL, chromosomal karyotype 46, XX, TSH 1.14 U/L, ALT 12.00 U/L, GGT 28.00 U/L, GLO 26.9 g/L.
FSH Follow-up Results
December 27, 2019, basic FSH: 11.24 IU/L
October 8, 2020, basic FSH: 8.71 IU/L
FSH Trajectory and Pregnancy Prediction
The FSH trajectory predicts a Low level U-shape curve, with a predicted pregnancy probability of 78.80%.
Assisted Reproduction Process/Pregnancy Outcome
In May 2020, the first cycle of IVF was performed using a natural cycle protocol for oocyte retrieval, resulting in 1 oocyte retrieved, 1 high-quality embryo obtained on D3, but no pregnancy after transfer.
In June 2020, the second cycle of IVF was attempted with a different ovulation stimulation protocol, but no oocytes were retrieved.
In December 2020, the third cycle of IVF was conducted using a modified natural cycle protocol for ovulation stimulation, resulting in 1 oocyte retrieved, 1 blastocyst frozen on D5, but no pregnancy after transfer.
In March 2021, the fourth cycle of IVF was attempted using a mild stimulation protocol for ovulation stimulation, resulting in 1 oocyte retrieved, 1 blastocyst frozen on D6, but no transfer was performed.
In March 2022, spontaneous pregnancy and delivery occurred.
Case 2
Medical History
Mrs. Zhao, 29 years old, primary infertility with history of bilateral ovarian endometriosis cystectomy. Her menstrual cycles are regular, with menarche at 14 years old, lasting 3 days with a cycle length of 24-28 days. She experiences normal menstrual flow and mild menstrual pain. G0P0A0L0. No history of infectious diseases, diabetes, thyroid disease, genetic diseases or relevant family history. Her mother had early menopause at age of 40-45. The male partner's examination is generally normal.
Auxiliary Examinations
Gynecological ultrasound: normal uterine morphology, with 4 follicles of 0.2-0.4cm observed in the right ovary and 1 follicle of 0.2-0.4cm in the left ovary. Endocrine hormone (January 1, 2019): FSH 18.42 IU/L, LH 25.39 IU/L, AMH 0.439 ng/mL, chromosomal karyotype 46, XX, TSH 2.680 U/L, ALT 10.00 U/L, GGT 13.00 U/L, GLO 23.1 g/L.
FSH Follow-up Results
June 24, 2019, basic FSH: 11.14 IU/L
November 15, 2019, basic FSH: 14.26 lU/L
August 25, 2020, basic FSH: 13.00 lU/L
FSH Trajectory and Pregnancy Prediction
The FSH trajectory predicts a Low level U-shape curve, with a predicted pregnancy probability of 65.40%.
Assisted Reproduction Process/Pregnancy Outcome
In June 2020, the patient underwent the first cycle of IVF treatment using a natural cycle protocol for oocyte retrieval, resulting in the retrieval of 1 oocyte and the obtainment of 1 high-quality embryo on D3. However, pregnancy was not achieved after transplantation.
In September 2020, the patient underwent the second cycle of IVF treatment using a natural cycle protocol for oocyte retrieval, but no oocytes were retrieved.
In December 2020, the patient underwent the third cycle of IVF treatment using a mild stimulation protocol for ovulation induction, resulting in the retrieval of 1 oocyte and the cryopreservation of a D5 blastocyst. Pregnancy was achieved after transplantation, leading to a successful birth.
Case 3
Medical History
Mrs. Guo, 33 years old, primary infertility. Her menstrual cycles are regular, with menarche at 12 years old, lasting 4-5 days with a cycle length of 27-30 days. She experiences normal menstrual flow and mild menstrual pain. G0P0A0L0. No history of infectious diseases, diabetes, thyroid disease, genetic disease or relevant family history. The male partner's examination is generally normal.
Auxiliary Examinations
Gynecological ultrasound: normal uterine morphology, with a 3.2*3.0cm echogenic fluid cyst observed in the right ovary, and the left ovary appears solid. Endocrine hormone (August 30, 2018): FSH 27.40 IU/L, LH 12.24 IU/L, AMH 1.552 ng/mL, chromosomal karyotype 46, XX, TSH 2.08 U/L, ALT 10.00 U/L, GGT 13.00 U/L, GLO 28.80 g/L.
FSH Follow-up Results
January 9, 2019, basic FSH: 22.37 IU/L
June 25, 2019, basic FSH: 28.28 lU/L
August 8, 2019, basic FSH: 36.47 IU/L
May 10, 2020, basic FSH: 37.40 IU /L
August 22, 2021, basic FSH: 22.90 IU/L
FSH Trajectory and Pregnancy Prediction
The FSH trajectory predicts a Stable curve, with a predicted pregnancy probability of 2.40%.
Assisted Reproduction Process/Pregnancy Outcome
In July 2019, the patient underwent the first cycle of IVF treatment using a natural cycle protocol for oocyte retrieval, resulting in the retrieval of 1 oocyte but no embryos suitable for transfer.
In May 2020, the patient underwent the second cycle of IVF treatment using a mild stimulation protocol for ovulation induction, but no oocytes were retrieved.
In December 2020, the patient underwent the third cycle of IVF treatment using a natural cycle protocol for oocyte retrieval, but no oocytes were retrieved. It was suggested that the patient consider oocyte donation.
In 2023, she achieved pregnancy and gave birth after receiving oocyte donation.
Case 4
Medical History
Mrs. Xu, 37 years old, primary infertility. She had her menarche at the age of 12 and became irregular at 27 years old, requiring medication to maintain menstruation. G0P0A0L0. In 2016, she was diagnosed with subclinical hypothyroidism, and treated with Euthyrox. No history of infectious diseases, diabetes, thyroid gland disease, genetic disease or relevant family history. The male partner's examination is generally normal.
Auxiliary Examinations
Gynecological ultrasound: a uterine size of 2.7*2.0cm with a normal morphology. The right ovary is not clearly visible, and a 2.5*2.0cm echogenic fluid cyst is observed in the right adnexal region. The left ovary measures 0.8*0.4cm and appears solid. Endocrine hormone (March 28, 2019): FSH 49.69 IU/L, LH 17.05 IU/L, AMH <0.076 ng/mL, karyotype 46, XX, TSH 5.94U/L, ALT 27.00U/L, GGT 140.00U/L, GLO 22.90g/L.
FSH Follow-up Results
October 29, 2019, basic FSH: 49.93 IU/L
August 10, 2020, basic FSH: 57.20 lU/L
March 1, 2021, basic FSH: 48.94 IU/L
August 30, 2021, basic FSH: 37.72 IU/L
February 28, 2022, basic FSH: 39.94 lU/L
July 11, 2022, basic FSH: 42.36 lU/L
Mar 6, 2023, basic FSH: 42.94 IU/L
FSH Trajectory and Pregnancy Prediction
The FSH trajectory predicts a High level U-shape curve, with a predicted pregnancy probability of 0.40%.
Assisted Reproduction Process/Pregnancy Outcome
ln 2023, she received oocyte donation in our hospital for pregnancy.