Pregnancy after in vitro fertilization in an elderly primigravida with Shereshevsky-Turner Syndrome: A case report

Abstract Background Shereshevsky-Turner Syndrome is a chromosomal condition that affects females owing to full or partial missing of X-monosomy in all or part of the body's cells. Shereshevsky-Turner Syndrome is characterized by severe hormonal disorders and defects of the cardiovascular and urinary systems. With the advent of assisted reproductive technology (ART), pregnancy has become more accessible for this group of cases, often with donor eggs. In the available literature, it was not possible to find exact information during the time of selection of progestogen support, the duration of the appointment, and the term of withdrawal. Case presentation This is the case of a 36-yr-old primigravid woman suffering from STs, mosaic karyotype comprising of 3 clones: 45X (69), 46XX (23), 47XXX (8), and 1000 interphase nuclei. In this case, we left high-maintenance doses of progesterone due to the application of ART and concomitant extragenital pathology, leading to a decrease in all functions of the placenta, including the endocrine. The woman was monitored before, during, and after the pregnancy. She was delivered at 37 wk and 6 days of gestation. Conclusion ART increases the possibility of having a pregnancy and gestation in cases with a wide variety of genital and extragenital pathologies.


Introduction
Given the pronounced congenital hypogonadism, pregnancy and childbirth in these women can only be supported by correct and timely hormone replacement therapy (4

Case Presentation
We examined the case of a 36-yr-old primigravid woman with STs. She had a mosaic karyotype with • From 10-36 wk, acetylsalicylic acid 75 mg was prescribed daily in the evening.
• Methyldopa 250 mg once daily for 10 wk prior to delivery.

Ethical considerations
The pregnant woman gave informed consent to conduct this study.

Discussion
We report the case of a woman with STs, managed by a multidisciplinary team, who achieved pregnancy and successful delivery. Pregnancy in a pregnant woman with STs is associated with a high risk of miscarriage, hypertensive complications, and perinatal and maternal mortality. However, such pregnant women are of high interest to the physician given current punitive medicine. In this clinical case, the possibility of prolonging pregnancy to term is associated with mosaic chromosomes, the absence of severe extragenital pathology, timely prevention, and the identification of concomitant diseases such as thrombophilia, chronic arterial hypertension, hypothyroidism, chronic pyelonephritis, and chronic cholecystitis. Correction of somatic pathology was conducted in conjunction with related specialists, which was simple to carry out. However, hormone therapy, dosage, duration of the prescription, and withdrawal period were complicated since the woman was an IVF pregnancy and had concomitant hypergonadotropic hypogonadism. The great hope for prolonged pregnancy is inspired because the placenta performs the main endocrine function during pregnancy, which begins to form at 8 wk and ends by 16-20 wk of pregnancy (6). However, we withdrew high-maintenance doses of progesterone because of the use of ART and the concomitant extragenital pathology, which led to a decrease in all functions of the placenta, including the endocrine (6).
We carried out a monthly determination of the progesterone level, considering the desires and financial capabilities of the woman. We believe this is an optional study because, in our case, the change in the progesterone level does not correlate with a gradual decrease in doses of progesterone administered from outside. However, it is difficult to draw conclusions based on a single clinical example. The issues of delivery in such cases are very interesting. In our case, a question arose about the possibility of spontaneous childbirth. However, with the development of hypertensive pregnancy complications, the doctors' fear of losing a child during childbirth did not come true. However, the question of the delivery method is very controversial, given the level of production of hormones that control the activities of delivery (7,8). The birth process is likely possible in such cases since the oxytocin produced in the pituitary gland will affect it in any case. Considering hypogonadism, it is impossible to predict how the uterus and cervix will respond. Although with timely hormonal correction, starting from adolescence, a completely adequate response is possible, which is a full-fledged birth process with the birth of a healthy child. The same questions arise with breastfeeding in such women. How long is breastfeeding possible? Is it worth examining and stimulating? Full-fledged breastfeeding within a year and a half after childbirth is recorded. In our case, this cannot happen, despite the woman's desire, which, in all likelihood, does not depend on the underlying pathology. In addition to hormonal support, one of the major problems was congenital thrombophilia, carried out in this case against the background of LMWH with a satisfactory fetal condition. Despite the absence of pathology during Dopplerometry, ultrasound, and CTG, a fetus was born with minor signs of fetal growth retardation syndrome and a good Apgar score. Thus, ART expands the possibilities of having pregnancy and gestation in women with various genital and extragenital