His 39-year-old partner presented a normal weight (body mass index: 24.6 kg/m2). She had no significant medical history concerning assisted reproduction. She has a normal menstrual history. Since 2003, she has had two spontaneous pregnancies that resulted in one birth and one late-term abortion. The cause was determined to be that the heart stopped beating. She has undergone one in vitro fertilization attempt, which resulted in one embryo transferred but with no biochemical pregnancy. For this cycle, her hormonal profile was normal: FSH (6.2 IU/L, normal range: 4.7-21.5 IU/L), LH (4.3 IU/L, normal range: 1.0-18.0 IU/L), progesterone (0.9 nmol/L on day 21 of the menstrual cycle, normal range: (<=3.2 nmol nmol/L), prolactin (1.2 nmol/L, normal range: 0.17-1.30 nmol/L), TSH (1.6 mIU/L, normal range: 0.5-5.0 mIU/L), FT4 (6.2 pmol/L, normal range: 10.30-23.17 pmol/L), and FT3 (3.5 pmol/L, normal range: 3.53-6.45 pmol/L) and her karyotype analysis indicates 46, XX.
The patient reported been previously treated (in other facilities and the previous years) with antioxidants, L-carnitine, clomiphene citrate, and recombinant human chorionic gonadotropin (hCG), yielding no improvement in semen parameters. Since then, the patient has discontinued any previous treatments for in vitro fertilization or antioxidants for 24 months. Here, a semen sample was collected by masturbation after 3-day abstinence. Seminogram analysis indicated that the patient suffered from OAT. Characteristics are presented in Table 1. The patient was administered once a day 1.5 IU of human growth hormone (hGH)/IGF-1 (Saizen 5.83 mg/mL, 1.33 mg equivalent to 4IU) by intradermal injection for 2 months, typically at 10:00 pm. The dose and method of delivery were chosen because multiple reports have shown that at this concentration, IGF-1 can elicit a response. During the in vitro fertilization procedure, the patient did not indicate any adverse side-effects during treatment, post-treatment, and at his partner's final appointment. After 60 days of daily treatment, a subsequent semen sample was collected and the specimen was evaluated within 1 h after collection. To note, the patient was still under treatment at the time of the second seminogram. Marked improvement in semen parameters was noted as determined for concentration, progressive mobility, and total progressive motility (TPM; Table 1). Due to the improvement in the quality of the semen sample, and because the partner's controlled-ovarian stimulation concluded successfully, the sperm was used for in vitro fertilization, and the patient was instructed to stop taking the IGF-1.
The female partner underwent a standard ovarian stimulation protocol with a daily dose of gonadotropin-releasing hormone (GnRH) antagonists with total dosage of FSH 2700 UI and hCG 10,000 UI. A total of 12 M-II ovules were captured and were fertilized by intracytoplasmic sperm injection (fertilization rate = 75%). Of the nine embryos, three had <10% fragmentation at day 3, 6-8 cells at day 3, and were symmetrical. At day 5, three blastocysts were of Grade 2. Three embryos were transferred, and pregnancy was confirmed 14 days after transfer measuring hCG (288 mIU/L) and the presence of two gestational sacs and fetal heartbeats at week 20. She has given birth to twins, one male and one female.