FOLIC-ACID DEFICIENCY ANEMIA RESEMBLING O NSET OF A HELLP-SYNDROME INTWIN PREGNANCY AFTER MAXIMAL STERILITY THERAPY AND INNOVATIVE HORMONAL-STIMULATION

We report on a twin pregnancy in a 32-year old patient suffering from secondary male factor infertility due to eugonadotrophic azoospermia. In the first IVF/ICSI (in vitro fertilisation/intracytoplasmic sperm i njection) trial using testicular sperms extracted from cryopreserved t esticular biopsies (cryo TESE), pregnancy was achieved. The stimulatio n was done using recombinant FSH (Puregon(R)) under midcyclic suppress ion with a GnRH-antagonist (ganirelix 0,25 mg) in a multicenter phase II study. The pregnancy was uncomplicated until 26 + a weeks of gestat ion. On this day the patient was admitted because of numerous haematom as and severe thrombocytopenia (76/nl). A HELLP syndrome was suspected and further diagnosis was performed. Megacytotic anaemia due to folic acid deficiency (MCV 117 fi, folic acid in plasma 1.6 ng/ml) was foun d without further laboratory findings of a HELLP syndrome. Anaemia was interpreted as partial pernicious anaemia. After supplementation with folic acid and parental vitamin B12 the pregnancy was uncomplicated. In the 30 + 4. week of gestation a primary Caesarean section was done because of premature rupture of the membranes, untreatable labour and partial placenta detachment. Both twins were healthy and showed no mal formations. This is the first established pregnancy in Germany accordi ng to this stimulation protocol. The diagnosis of symptomatic folic ac id deficiency or partial pernicious anaemia is rare in Germany and can be easily misdiagnosed as a more common complication like a HELLP syn drome.