Infertility: Recurrent gestational trophoblastic disease following in-vitro fertilization

Recurrence of gestational trophoblastic disease (GTD) followingtwo attempts at in-vitro fertilization (IVF)/embryo transferis reported in a childless couple after 17 years of unsuccessfultrials of ovulation induction. The diagnosis of bilateral tubalobstruction was finally established, indicating IVF treatment.After the first IVF/embryo transfer treatment, the woman developedGTD and was treated with methotrexate. After a second IVF attempt,GTD was again diagnosed. This time there was no response tomethotrexate, thus necessitating second-line chemotherapy. Etoposide,methotrexate, actinomycin D, cyclophosphamide, oncovine wasused, and after only four treatment cycles the -human chorionicgonadotrophin (HCG) dropped to <5 mlU/ml. After 26 monthsof follow-up, the -HCG continues to be undetectable. Preimplantationevaluation and ovum donation are described as measures to minimizethe risk for GTD recurrence in a future IVF/embryo transfer.