Spontaneous conception in a 40-year-old woman after allogeneic stem cell transplant with active graft-versus-host disease: A case report

This article presents a case of spontaneous conception and live birth in a 40-year-old woman who had undergone gonadotoxic chemotherapy and allogenic stem cell transplant for relapsed acute myelogenous leukemia complicated by treatment-refractory graft-versus-host disease. The patient's follicle stimulating hormone level was 44.4 mIU/mL at age 38 and then decreased to 4.1 mIU/mL at age 41, suggesting ovarian recovery. Her graft-versus-host disease subjectively improved during pregnancy. She ultimately delivered a healthy neonate. This case demonstrates the potential for ovarian recovery after stem allogenic cell transplant in a patient of advanced reproductive age and provides insight into the limited knowledge about graft-versus-host disease in pregnancy. As survival after stem cell transplant continues to improve, understanding the downstream consequences of the treatment, including for fertility and pregnancy, is of growing importance.