INTRODUCTION
Premature ovarian insufficiency (POI) is characterised by diminished ovarian reserve, poor response to ovarian stimulation, and low chance of spontaneous conception. In vitro activation (IVA) has emerged as a potential treatment option for selected patients with residual ovarian activity.
METHODS
A 32-year-old woman presented in Alhaya with a 4-year history of primary infertility and 1 year amenorrhea. She had severely diminished ovarian reserve, with anti-Müllerian hormone (AMH) <0.07pmol/L, elevated follicle-stimulating hormone (FSH) of 41.2IU/L, and absent antral follicle count (AFC) on ultrasound. She was diagnosed with POI and underwent pre-IVA estrogen optimisation.
Bilateral IVA surgery was performed in July 2025
RESULTS
Follow-up demonstrated fluctuating hormonal profiles and a single AFC in August 2025. She underwent IVF stimulation; however, despite 16 days of stimulation, there was no follicular growth and IVF was abandoned. After being lost to follow-up, she experienced her first spontaneous natural menses in January 2026 and conceived naturally approximately 7 months after IVA. pregnancy was confirmed at 9 weeks’ gestation (REDD 4.12.2026).
CONCLUSIONS
This case highlights the potential long-term effect of IVA in activating dormant primordial follicles. Because it takes approximately 6 months for follicles to develop from the primordial to the antral stage, patients should be followed-up long-term after IVA. Nevertheless, this case highlights the need to clarify patient selection criteria for spontaneous pregnancy after IVA surgery.
By
Wan Syahirah Yang Mohsin; Gan Shu Kee; Lee Soon Soo, Colin; Kazuhiro Kawamura
Alhaya International Women’s Specialists Sdn. Bhd.
NO. 3.01, Left Wing, Level 3, Damansara Specialist Hospital, 2, Jalan Bukit Lanjan 3, Bukit Lanjan, 60000 Kuala Lumpur, Federal Territory of Kuala Lumpur
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