Spontaneous conception and successful live birth during hormone replacement therapy in a patient with iatrogenic premature ovarian insufficiency: a case report.

BACKGROUND: Premature ovarian insufficiency (POI) is defined as loss of ovarian function before the age of 40 years. It has a profound impact on patients' quality of life, particularly due to infertility and menopausal symptoms related to estrogen deficiency. Although most patients diagnosed with POI require assisted reproductive technologies (ART) or oocyte donation to achieve pregnancy, a small subset experiences a spontaneous resumption of ovarian function, leading to natural conception in approximately 5 to 10% of cases. Notably, this likelihood of spontaneous pregnancy is postulated to be substantially lower in iatrogenic POI than in cases of idiopathic or spontaneous etiologies. CASE PRESENTATION: We report a rare case of 37-year-old woman diagnosed with iatrogenic POI after repeated bilateral ovarian surgeries for endometriosis. Despite biochemical evidence of ovarian insufficiency, including an elevated follicle-stimulating hormone (FSH) level of 66.55 IU/L and low anti-Müllerian hormone (AMH) levels of 0.02 ng/mL, she presented with spontaneous conception during hormone replacement therapy. The pregnancy course was largely uneventful except for a transient episode of threatened abortion, which resolved with conservative management. A healthy infant was delivered at 36 weeks of gestation via cesarean section without complications. CONCLUSION: We report a rare case of spontaneous ovarian recovery and natural conception in a patient with iatrogenic POI following recurrent endometriosis surgeries. This case highlights the need for clinicians to recognize the potential for spontaneous pregnancy in this population and provide appropriate counseling on fertility and contraception during hormone replacement therapy.