Authors: Jerome H Check, Brooke Neumann.
Rationale: Infertility may be related to an exaggerated cellular immune response during the luteal phase that is normally needed to remodel some of the thick-walled uterine arteries to create thin-walled spiral arteries. This excessive inflammatory response may cause immune rejection of the fetal semi-allograft leading to infertility.
Objective: To determine if the combination of luteal phase progesterone supplementation to stimulate greater secretion of the immunomodulatory protein called the progesterone induced blocking factor (PIBF) and daily treatment with the dopaminergic drug dextroamphetamine to release more dopamine to decrease excessive cellular permeability in order to prevent excessive infiltration of irritants into pelvic tissues causing excessive inflammation could correct a long term infertility problem in a woman with diminished oocyte reserve and symptoms of the increased cellular permeability syndrome.
Finding: By treating with supplemental vaginal P in the luteal phase as well as dextroamphetamine daily, a woman with DOR and secondary unexplained infertility for five years was able to conceive on her very first cycle of dextroamphetamine and P supplementation, and delivered a live full-term baby. Furthermore, the dextroamphetamine completely corrected her very severe constipation and abdominal pain. It should be noted that her only conception occurred after two years of primary infertility on her second in vitro fertilization embryo transfer (IVF-ET) cycle. Furthermore, she failed to conceive for her second pregnancy for four additional years trying naturally and failed after two more IVF-ET cycles.
Conclusions: Dopaminergic drugs should be considered to be employed besides P (three IVF cycles with P supplementation without dopaminergic drugs failed to achieve a pregnancy) especially in women with some manifestation of the increased cellular permeability syndrome, e.g., unexplained DOR and pathological constipation. This is the second case of treatment-resistant severe constipation and abdominal pain treated with dextroamphetamine. This case also emphasizes that 1) mild male factor problems do not necessarily require intrauterine insemination or IVF-ET, 2) successful pregnancy with DOR is possible with a woman’s own oocytes and does not require IVF-ET with or without pre-implantation genetic diagnosis testing.
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