Polycystic ovarian syndrome with amenorrhea and infertility FSH sequential HMG low-dose incremental regimen for ovulation and multiple follicle development, with pregnancy by IVF-ET instead. The patient, Liu, 35 years old, was seen in April 2004 because she had not been pregnant after marriage without contraception for 9 years. She had been living together for 9 years after marriage, with normal sex life and no contraception and no pregnancy. she had her first menstrual period at the age of 14, which was irregular for 2-3 months to 6 months, with a period of 5-7 days, medium volume and no dysmenorrhea. In October 2002, she underwent a long protocol of superovulation and IVF-ET at Qilu Hospital, and her dosage and medication history are unknown. 20 eggs and 14 embryos were obtained, and ovarian hyperstimulation (OHSS) occurred after fresh transfer. After fresh transfer, ovarian hyperstimulation (OHSS) occurred and no pregnancy occurred. The patient was unsuccessful in 3 frozen embryo transfers (FET). Last menstrual period: February 6, 2004 for progesterone withdrawal bleeding. On examination: height 168 cm, weight 75 Kg, body mass index 26.57, blood pressure 130/80 mmHg. The development of both breasts was normal, and there was no nipple overflow, and there was long hair above the nipples. Gynecological examination: normal vulva development, female pubic hair distribution, vaginal patency, smooth cervix, anterior uterus, normal size, movable, no pressure pain, no abnormalities in both adnexa. Vaginal ultrasound: uterus size: 4.5×3.7×3.4cm, uniform myometrial echogenicity. The right ovary was 4.2×3.1×2.3cm with more than 20 small follicles of 0.3-0.5cm and strong echogenicity of the ovarian medulla, while the left ovary was 3.9×3.2×2.3cm with more than 20 small follicles of 0.3-0.5cm and strong echogenicity of the ovarian medulla. Reproductive endocrine examination: follicle stimulating hormone (FSH) 5.5IU/L, luteinizing hormone (LH): 10.4IU/L, estradiol (E2): 100pg/ml, prolactin (PRL): 21.3ng/ml, thyroid stimulating hormone (TSH): 2.3uIU/l, testosterone (T) 0.55ng/dl, insulin (INS fasting): 25.4 uIU/L (normal value 7-15uIU/L), hysterosalpingogram suggested normal uterine cavity morphology, bilateral patent fallopian tubes, male partner’s semen routine suggested mild weak spermatozoa. Preliminary diagnosis: primary infertility, polycystic ovary syndrome, insulin resistance. The male partner had weak spermatozoa. Diagnostic scraping was performed on the first day of withdrawal bleeding, and the endometrial pathology was changed in the secretory phase. The patient was treated with a cycle of Daimler-35 combined with metformin, and was also advised to eat a low-calorie diet and exercise. At the follow-up visit, the patient described her experience of diet control, eating more vegetables and fruits, not craving for the table during meals and leaving the table quickly after feeling full, and her weight dropped to 60 Kg, after 3 months. After 3 months, her weight dropped to 60 Kg, and her reproductive endocrine follicle stimulating hormone (FSH) was 5.4 IU/L, luteinizing hormone (LH): 5.8 IU/L, estradiol (E2): 42.3 pg/ml, prolactin (PRL): 20.3 ng/ml, testosterone (T) 0.43 ng/dl, and insulin (INS fasting): 12.3 uIU/L. Because the patient had several ovulation promotions in the past, and had Since the patient had a history of IVF-ET ovulation, she was given FSH combined with HMG in small incremental doses to promote ovulation. On the 5th day of menstruation, she was first given mafloquine 1 tablet daily for 21 tablets, and on the 21st day of menstruation, she was given albuterol 150ug intramuscularly, 1 tablet daily for 10 days, and the luteinizing hormone (LH) in blood decreased to below 5IU/L. Then on the 3rd, 5th, 7th and 9th days of menstruation, she was given urinary follicle stimulating hormone 75IU for 4 times and 7 days, and replaced by urinary sex stimulating hormone 75IU daily for 7 days. The difference between the larger and smaller follicles on both sides of the ovaries did not exceed 0.4 cm, so the dose was increased to 150 IU daily for 5 days, and there was a dominant follicle on both sides of the ovaries, 1 on the left side of 1.75 cm and 1 on the left side of 1.65 cm. On the left side, there were 1.75 cm, 1.65 cm, 1.5 cm, 1.0-1.1 cm, 1.75 cm, 1.65 cm, 1.45 cm, 0.9-0.9 cm, and more than 10 on the right side. On September 22, 2004, she was given 6000 IU of chorionic gonadotropin at 9:00 p.m., and the eggs were retrieved on September 24, 2004. 7 eggs were obtained and luteal support was given after the procedure. After regular antenatal checkups, a male baby was delivered by cesarean section at 39 weeks of gestation, weighing 3550 grams, with normal developmental appearance, and was followed up to 6 years old with normal development. 2. Discussion The patient has been married for 9 years and her menstrual cycle varies in length, sometimes up to 6 months or even 1 year, requiring progesterone to induce menstruation. She had a body mass index of 26.3 and was insulin resistant, so she was given metformin and Daing 35 to correct the endocrine disorder. The patient had a long menstrual cycle and thus a long duration of medication, and was treated with an incremental regimen of ovulation to mature the follicles, and was switched to IVF-ET due to the high follicular selection. Since LH is at a high level and FSH is relatively deficient in this group of patients, the selection process for recruitment of antral follicles is done under the influence of estrogen and FSH. The use of pure FSH (including Metrodin-HP and Gonal-F) during the recruitment phase of the dominant follicle is closer to the physiological process. In this study, u-FSH was chosen. To avoid the simultaneous recruitment of multiple follicles and to mimic the secretion profile of FSH in the body of the natural cycle as much as possible, a low-dose initiation protocol was used, and after the preferential selection of the sinusoidal follicle, that follicle acquired LH receptors by granulosa cells under the action of FSH, then FSH was discontinued and sequential HMG was administered, as it contains both FSH and LH, both of which act synergistically to develop the dominant follicle to the preovulatory follicle. Since the FSH threshold window for single follicle development is extremely narrow, in order to find the lowest effective dose of FSH for each PCOS patient, it must be slowly increased and patiently fumbled to achieve single follicle development. The patient had a history of IVF-ET treatment and therefore was easy to use. The patient had a history of IVF-ET treatment and was therefore receptive to the treatment regimen. The dose was reduced compared to the standard long regimen, reducing the risk of ovarian hyperstimulation. If multiple follicles develop during ovulation, switching to IVF-ET is an effective and economical approach.