Overcoming oral medication allergy and cervical stenosis in an anovulatory in vitro fertilization patient: a case report

BACKGROUND: We present a rare and challenging case showing how an allergy to oral medications and cervical stenosis can complicate fertility treatment. The novelty lies in the exclusive use of injectable medications for both in vitro fertilization and frozen embryo transfer, the use of non-oral medications for luteal support, the off-label gonadotropin regimen for frozen embryo transfer stimulation, and the use of cervical dilatation to allow an atraumatic embryo transfer. CASE PRESENTATION: A 32-year-old white woman with long-term anovulatory infertility had a rare allergy to oral agents commonly used in reproductive medicine and a history of large loop excision of the transformation zone surgery, resulting in cervical stenosis. She was diagnosed with type D polycystic ovary syndrome and required ovarian stimulation for timed intercourse or intrauterine insemination, which needed to be conducted with injectable gonadotropins. However, owing to a very short cervix, which represented a contraindication for multiple pregnancy, and the anticipated difficulty in achieving monofollicular ovulation because of a high ovarian reserve, ovarian stimulation for in vitro fertilization was chosen. To reduce the risk of ovarian hyperstimulation syndrome, fresh embryo transfer was cancelled. Stimulation was conducted exclusively with injectable medications for in vitro fertilization, off-label for frozen embryo transfer, and with non-oral medications for luteal support. In addition, cervical dilatation was required because of stenosis from previous surgery, enabling an atraumatic embryo transfer. A successful pregnancy was achieved, resulting in a live birth at 33 weeks of gestation. CONCLUSION: This case demonstrates that exclusive use of injectable and non-oral medications and cervical dilatation can overcome significant barriers such as oral medication allergy and cervical stenosis, leading to a successful live birth in a complex infertility case. It underscores the need for an individualized approach when standard protocols are not feasible.