The patient was a 38-year-old G2P0020, blood group O Rh positive, genotype AA with a BMI of 19 kg/m2. She presented to our service because of secondary amenorrhea and infertility of 2 years' duration. She had a history of pulmonary tuberculosis that was treated for 6 months in Cameroon with rifampicin, ethambutol, isonazide and pyrazinamide for 2 months and rifampicin and isonazide plus vitamin B to prevent peripheral neuropathy for a further 4 months. There was no family history of premature ovarian insufficiency or auto-immune disease. Her history was notable for laparoscopic surgery in Paris, France, in 1998, where 2 small fibroids were removed and biopsy done on both ovaries. Histology showed right ovarian dystrophy with no primordial ovarian follicles or corpus luteum scar, and uterine leiomyomata. There was left ovarian atrophy with one primordial follicle and one atretic follicle. The diagnosis of Stein-Leventhal syndrome was incorrectly made. Her hormonal profile done in France, revealed an estradiol of 15rhog/ml, FSH levels of 68.2 IU/ml and 92.03 IU/ml, LH 61.7 IU/ml and 43.91, and inhibin B 15rhog/ml (normal >45rhog/ml). Complementary laboratory test results done in Cameroon revealed Prolactin 91.57 mIU/l, T3 1.53 nmol/l, T4 90.68 nmol/ml, THS (ultra sensitive) 0.65 ng/ml and Testosterone 0.06 ng/ml.
The patient underwent the progesterone challenge test with Synergon  (progesterone, estrone) which was negative. The husband had normal semen parameters. The diagnosis of premature ovarian insufficiency was discussed and the couple was counseled to undergo egg donor In-vitro fertilization.
After obtaining informed consent, we matched the anonymous donor-controlled ovarian stimulation cycle with the recipient's endometrial preparation. For this purpose, we used the short agonist protocol (triptorelin (Decapeptyl ) 0.1 mg/day plus menotropin (Menogon ) 150 IU/day) starting from the third day of the donor's cycle untill we obtained three leading follicules of 17-18 mm in diameter. The donor was monitored with standard trans-vaginal sonography and serum estradiol levels.
We prepared the patient's (recipient YE) endometrium for embryo transfer with estradiol valerate (progynova ) 8 mg/day in three divided doses for 14 days starting from the first day of the donors menses. A trans-vaginal sonogram was performed every 3 days to monitor the endometrial thickness until we obtained an endometrial thickness of about 14 mm. The husband's sperm was prepared with the density gradient centrifugation as previously described. A total of four fresh donor oocytes were obtained and were inseminated and the patient (recipient) began progesterone (utrogestan  vaginal tablets) 600 mg/day from the day of oocyte insemination. Two fresh 8-cell (grade A) embryos were transferred to the recipient YE (patient) on day 3 of insemination after the standard IVF procedure. The remaining two (grade C) embryos were discarded for lack of facilities for gamete freezing at the time. (However, since 2012 our IVF centre has the facilities to freeze gametes and embryos.)
After embryo transfer, the recipient continued with progesterone suppositories(utrogestan ) and estradiol valerate (progynova ) and underwent her first plasma beta hCG assay 2 weeks after embryo transfer. The test result was positive, with a value of 248 IU/L. She underwent a trans-vaginal ultrasound scan 2 weeks after the positive pregnancy test that revealed an intra-uterine gestational sac of 13 mm diameter (Fig. 1). A repeat trans-vaginal ultrasound scan done about 2 weeks from the latter showed a singleton intrauterine pregnancy with a crump-rump length of 17 mm corresponding to 8 weeks 1 day gestation Fig. 2).  
Her pregnancy follow-up was uneventful until she developed preterm labour at 36 weeks 4 days gestation and fetal distress was diagnosed on cardiotocography. She gave birth by cesarean section to a female baby who weighed 2360 g. At cesarean section, the presentation was breech with two turns of nuchal cord. One and 5-min Apgar scores were 8 and 10, respectively. The baby was sent to the neonatal intensive care unit (NICU) for follow up. Two years later, YE requested for IVF with autologous eggs which, it was explained, was not possible. She is now living with one child.