Pregnancy and birth in an in-vitro fertilization cycle after controlled ovarian stimulation in a woman with a history of allergic reaction to human menopausal gonadotrophin

We report a case of an allergic reaction to i.m. injections of urinary human menopausal gonadotrophin (HMG) and a successful management of the problem by using recombinant follicle stimulating hormone (rFSH) administered i.m. The patient underwent two zygote intra-Fallopian transfer (ZIFT) cycles, in which ovarian stimulation was carried out by a combination of gonadotrophin-releasing hormone agonist (GnRHa) and HMG. A twin pregnancy was achieved after the first cycle. The patient delivered two premature boys at 28 weeks one of whom died after 25 days from severe respiratory distress. During the second ZIFT cycle the patient developed an allergic reaction with redness and swelling in many parts of her body 30 min after every HMG injection. Despite the allergic reaction, the cycle was completed with a second ZIFT. No pregnancy was achieved in this cycle. The patient came back to our centre for a third attempt during which ovarian stimulation was accomplished with a combination of GnRHa and rFSH. Adverse reaction as well as general discomfort were not reported by the patient during ovarian stimulation with rFSH. A successful singleton pregnancy was achieved after intrauterine embryo transfer with the birth of a healthy girl after 38 weeks. If any allergic reaction is present after injection of HMG it is advisable to stimulate a subsequent cycle with rFSH.