Heriyanto Agus, Tjahyadi Dian, Rachmawati Anita, Mulyantari Ayu Insafi
Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Am J Case Rep. 2025 Aug 3;26:e947396. doi: 10.12659/AJCR.947396.
BACKGROUND The current literature lacks extensive case-based evaluations of primary ovarian insufficiency (POI) in the context of severe male-factor infertility. This case series presents 4 patients with extremely low AMH levels and varied male infertility, aiming to illustrate clinical decision-making and treatment outcomes. Adjunct therapies such as growth hormone (GH), dehydroepiandrosterone (DHEA), Sildenafil, and Pentoxifylline were incorporated to assess protocol effectiveness. CASE REPORT All 4 patients had low AMH levels and male partners with differing degrees of oligoasthenoteratozoospermia (OAT), except 1 with normozoospermia. Intracytoplasmic sperm injection (ICSI) was performed in all cases. The treatment protocols varied: 3 used high-dose gonadotropins (FSH 300-375 IU with LH and GH), while 1 used a minimal stimulation protocol (Clomiphene Citrate + FSH 150 IU). Embryo transfer methods included both fresh and frozen (FET). Two cycles failed to implant, 1 led to a biochemical pregnancy (ß-hCG 9.22 mIU/mL), and 1 progressed to clinical pregnancy (25%), following endometrial receptivity enhancement in the normozoospermic case. Protocol adjustments were made based on ovarian response and sperm quality. All sample collections and treatments were conducted at Hasan Sadikin Hospital. CONCLUSIONS This case series highlights the complexity of managing infertility in patients with POI and coexisting male-factor infertility. Personalized stimulation, strategic sperm optimization, and endometrial preparation were critical. One patient achieved a clinical pregnancy and 1 had a biochemical pregnancy, indicating a 50% biological response. Further studies are needed to evaluate advanced therapies, including ovarian rejuvenation and enhanced sperm selection, in this challenging patient population.
当前文献缺乏在严重男性因素不孕症背景下对原发性卵巢功能不全（POI）进行广泛的基于病例的评估。本病例系列介绍了4例抗缪勒管激素（AMH）水平极低且男性不育情况各异的患者，旨在阐述临床决策和治疗结果。纳入了生长激素（GH）、脱氢表雄酮（DHEA）、西地那非和己酮可可碱等辅助治疗方法以评估方案有效性。
所有4例患者的AMH水平均较低，男性伴侣患有不同程度的少弱畸精子症（OAT），其中1例为正常精子症。所有病例均进行了卵胞浆内单精子注射（ICSI）。治疗方案各不相同：3例使用高剂量促性腺激素（FSH 300 - 375 IU加LH和GH），1例使用最小刺激方案（枸橼酸氯米芬 + FSH 150 IU）。胚胎移植方法包括新鲜胚胎移植和冷冻胚胎移植（FET）。2个周期未着床，1个周期导致生化妊娠（β-hCG 9.22 mIU/mL），在正常精子症病例中，1个周期在增强子宫内膜容受性后进展为临床妊娠（25%）。根据卵巢反应和精子质量进行了方案调整。所有样本采集和治疗均在哈桑·萨迪金医院进行。
本病例系列突出了POI合并男性因素不孕症患者不孕管理的复杂性。个性化刺激、策略性精子优化和子宫内膜准备至关重要。1例患者实现了临床妊娠，1例出现生化妊娠，表明生物学反应率为50%。需要进一步研究以评估在这一具有挑战性的患者群体中包括卵巢复壮和改进精子选择在内的先进治疗方法。
