Combined pregnancy after gonadotropin therapy

Area of Science:

• Reproductive Endocrinology
• Obstetrics and Gynecology
• Assisted Reproductive Technologies

Background:

• Gonadotropin therapy is widely used to stimulate ovulation in infertility treatment.
• Multiple pregnancies, including heterotopic pregnancies, are known risks associated with gonadotropin therapy.
• Monitoring hormonal profiles, such as estriol excretion, is essential during ovulation induction protocols.

Observation:

• Three cases of combined pregnancy (intrauterine and ectopic) are presented following gonadotropin therapy (human pituitary gonadotropin and human menopausal gonadotropin).
• All intrauterine gestations were multiple pregnancies.
• The gonadotropin stimulation regimen was halted when estriol excretion reached 60-125 µg/day, with a subsequent 2.3- to 3.2-fold increase during the 'coasting' phase before human chorionic gonadotropin administration.

Findings:

• Two patients successfully delivered healthy infants after salpingectomy for the ectopic component.
• One patient experienced a spontaneous abortion.
• Elevated estriol excretion rates (140-350 µg/day) were observed during the coasting phase, indicating a significant ovarian response.

Implications:

• These cases highlight the importance of vigilant monitoring and management of gonadotropin therapy to mitigate risks of multiple and combined pregnancies.
• The observed estriol rise during the coasting phase suggests a robust follicular response that requires careful consideration in treatment protocols.
• Further research into optimizing gonadotropin dosing and monitoring strategies is warranted to improve outcomes in assisted reproduction.