• Meiyan Jiang, Chong Wang, Xiaoyang Fei, and Zhenyun Lin.
• Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, China.
• Medicine (Baltimore). 2021 Sep 17; 100 (37): e27140.

RationalInduction of ovarian stimulation by use of the gonadotropin-releasing hormone agonist (GnRHa) long protocol in the luteal phase is a common practice and results in stable pregnancy and live births; it is often used in patients with normal ovarian function. Some patients with normal ovulation may be pregnant before ovulation induction, which can be easily confirmed by asking the patient about cessation of menstruation. However, some pregnancy complications may cause vaginal bleeding along with normal menstrual blood loss; in such a situation, hormone levels can often mirror that seen in pituitary down-regulation and the value of β-HCG may be less than 5 mIU/mL. Under these conditions, the physician might start the cycle of ovarian stimulation. During ovarian stimulation, the increase in β-HCG can cause premature luteinization and follicle maturation disorder, and poor embryo quality, which can easily be overlooked. In this study, we report a case of pregnancy at the end of controlled ovarian stimulation induced by GnRHa long protocol in the luteal phase, followed by follicle maturation disorder and poor embryo quality. This case provided a reference and served as a cautionary note that could perhaps obviate occurrence of similar cases.Patient ConcernsA 30-year-old woman with a diagnosis of unexplained infertility was scheduled for in vitro fertilization embryo culture (IVF) at our clinic. Pregnancy was confirmed at the end of controlled ovarian stimulation, which was followed by follicular maturation disorder and poor embryo quality.DiagnosisThe patient with a diagnosis of unexplained infertility was scheduled for IVF at our clinic.InterventionsOocyte retrieval was still arranged for her after confirmation of pregnancy. As per the β-HCG level and the trans-vaginal ultrasound examination findings, we considered 2 possibilities: an adverse intrauterine pregnancy or extra-uterine pregnancy. Therefore, we decided to terminate the pregnancy; hence, 50 mg/d of mifepristone was given for 2 days, combined with 200 μg misoprostol.OutcomesElevated β-HCG level had an adverse effect on maturation and fertilization of oocytes, and even embryo quality.ConclusionOnce pregnancy is confirmed, ovulation induction should be terminated as soon as possible.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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