Adolescent infertility--to treat or not to treat.

OBJECTIVE

To present the set of reasons for and against fertility treatment for a very young patient.

DESIGN

An expert opinion based on clinical experience.

SETTING

An academic-affiliated fertility clinic situated in East Jerusalem.

PATIENT(S): A 16-year-old married teenager with 2 years' duration of infertility due to polycystic ovarian syndrome was referred to our infertility center after treatment with six cycles of clomiphene citrate and ovarian drilling.

INTERVENTION(S): Counseling of the options of fertility treatments, weight reduction, physical exercise, metformin intake, and an additional gonadotropins-intrauterine insemination cycle with IVF backup.

MAIN OUTCOME MEASURE(S): Successful pregnancy while avoiding the risk of ovarian hyperstimulation syndrome.

RESULT(S): The patient conceived a single embryo and on the 30th week of gestation suffered premature uterine contractions and gave birth to a 1,330-g preterm male newborn.

CONCLUSION(S): Adolescent contraception and unintended pregnancies are prevalent issues in the Western world, whereas adolescent infertility is unheard of. Early age of marriage and conception imposes tremendous dilemma to the society of reproductive endocrinologists. This important cultural issue ought to be debated regarding the age at marriage, the age at first pregnancy, and the treatment of infertility in married "minors" who need treatment. Such a debate is likely to encourage development of formal guidelines for practitioners, which would clearly be beneficial.