Pregnancy in a patient with premature ovarian failure

Spontaneous pregnancy in patients with premature ovarian failure, although previously reported, remains quite rare. We report a patient with premature ovarian failure who spontaneously conceived and carried the pregnancy to full term. A 26 year old, white female with primary hypothyroidism (diagnosed in 1979) was first seen by us in January 1984 for secondary amenorrhea of six months duration. Menarche occurred at age 13 and menstrual periods were regular until May 1983. She experienced hot flashes in the summer of 1983, and also complained of dryness in her vagina. Serum estrogens were low, and serum gonadotropins were elevated. Physical exam was within normal limits except for a slight, diffuse enlargement of the thyroid gland. Antithyroglobulin and anti-microsomal antibodies were positive. She was clinically and bio-chemically euthyroid while taking exogenous L-thyroxine. A diagnosis of premature ovarian failure was, therefore, made. Therapy was initiated with Premarin and Provera, and she began to have regular withdrawal bleeding. In February 1991, she presented to her obstetrician stating that she was pregnant. The course of the pregnancy was uncomplicated. A cesarean section was performed at 40.5 weeks gestation and she delivered a live female infant. This case confirms that, although rare, patients with premature ovarian failure may spontaneously ovulate and conceive. The course of pregnancy in patients with ovarian failure appears to be normal.