2018 年 65 巻 2 号 p. 107-112
Combined use of follicle stimulating hormone (FSH) and luteinizing hormone (LH) is generally believed to be essential for ovarian stimulation in the patients with WHO Group I ovulation disorders. We presented an infertile case with WHO Group I successfully treated by recombinant human FSH (rhFSH) administration alone. A 32-year-old woman visited our clinic complaining secondary amenorrhea and wishing for a child. Serum LH, FSH, estradiol, and progesterone levels were 1.4 mIU/ml, 3.1 mIU/ml, <5 pg/ml, and 0.1 ng/ml respectively. Because the LH-RH provocation test was normal response, she was diagnosed as WHO Group I ovulation disorder with partial absence of GnRHmediated hypothalamic activity caused by low body weight. As lifestyle interventions (normalizing body weight and exercise) were not effective, rhFSH administration was initiated. After that, multiple follicles were developed although serum LH was less than 0.1 mIU/ml in the mid- to late-follicular phase. After human chorionic gonadotropin administration, oocytes were retrieved, fertilized and cultured in vitro. Subsequently she successfully conceived with freeze-thawed blastocyst transfer at hormone replacement cycle. Our case indicated that LH was not necessarily essential for the development of ovarian follicles at least in the mid- to late-follicular phase even in patients with WHO Group I ovulation disorder.
