Synchronous Hyper-Accelerated Follicular (SHAF) Growth During Controlled Ovarian Stimulation: An Unusual Case Posing...

Abnormal follicular development during ovarian stimulation is a worrisome factor for the fertility specialist. Here, we report a unique case in which all the ovarian follicles developed in a synchronous but unusually accelerated pattern, posing an exceptional challenge. After starting the ovarian stimulation, we noticed follicles as large as 20 mm, 18 mm, and 17 mm on day 5 of stimulation. As most of the follicles grew to such an extent simultaneously, we named this pattern of follicular growth synchronous hyper-accelerated follicular growth. Finally, we revised our initial management protocol and adopted an alternative approach (the dual stimulation protocol) to achieve the desired result. In the second phase of stimulation, we were able to retrieve three follicles, which resulted in the formation of two embryos (4AA and 3BB). Ultimately, we successfully achieved a live birth after transferring these embryos. We are the first authors to report a case presenting with such an abnormal follicular growth pattern.