Spontaneous Pregnancy in the Setting of Primary Ovarian Insufficiency and Breastfeeding: Does Immunosuppression Play a Role?

Patient: Female, 34-year-old Final Diagnosis: Pregnancy • premature ovarian insufficiency Symptoms: Amenorrhea • pregnancy Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology OBJECTIVE: Unusual clinical course BACKGROUND: Primary ovarian insufficiency is defined as primary hypogonadism in a woman under the age of 40 years. It commonly presents clinically with amenorrhea and infertility. It is often thought to be an autoimmune process. Breastfeeding also reduces the rate of conception by reducing pulsatile gonadotropin secretion, resulting in lactational amenorrhea. CASE REPORT: Here, we present a case of a patient with primary ovarian insufficiency. FSH and LH levels at diagnosis were in the menopausal range. After undergoing fertility treatments and failing to become pregnant, she achieved a first pregnancy with donor eggs through in vitro fertilization. After delivery, while solely breastfeeding her first baby, menses returned to normal and FSH and LH levels returned to normal. She then spontaneously conceived. She delivered a second baby without the need for assisted reproductive technology. CONCLUSIONS: Pregnancy alters the maternal immune system to produce maternal-fetal tolerance through complex mechanisms that are not completely understood. The immunosuppression of pregnancy in this patient may have repressed the autoimmune process in her ovaries, allowing her to ovulate and thus reverse her primary ovarian insufficiency. Several previous case reports and studies show that immunosuppression has reduced the symptoms of primary ovarian insufficiency and allowed conception in some patients. These studies and this case report raise the question of immunosuppression as a treatment for infertility caused by primary ovarian insufficiency.