Etonogestrel implant for LH suppression in a novel DuoStim ovarian stimulation protocol using overlapping doses of corifollitropin alfa for social egg freezing: a case report

This article reports the case of a healthy nulliparous woman, 34 years old, weighing 70 kg with a BMI of 23.67 kg/m2, who was using an ENG 68 mg implant for contraception and was experiencing amenorrhea. She presented with 19 antral follicles on initial ultrasound (US) and desired social fertility preservation. Follicular phase controlled ovarian stimulation (COS) was initiated with the administration of corifollitropin alfa (CFA) 150μg on day 1, followed by an overlapping dose of CFA 100μg on day 5. US monitoring began on the ninth day of stimulation, and a trigger shot with recombinant chorionic gonadotropin (rhCG) 250μg was administered on day 11 when six follicles measured ≥16 mm. Follicular aspiration (FA) occurred 36 hours later, resulting in the retrieval of 13 oocytes; 11 were metaphase II (MII) and were vitrified. Luteal phase COS began one day after the first FA, using CFA 150μg. The trigger was administered again on day 11, with rhCG 250 μg, when eight follicles were ≥16 mm, followed by FA 36 hours later, resulting in the retrieval of six MII oocytes, all of which were vitrified. Our report is the first to highlight that a woman attempting fertility preservation while using an ENG implant for contraception may benefit from LH suppression during COS. Additionally, it proposes a novel protocol that applies CFA in overlapping doses, aiming for comfort and lower cost.