Malia (33y) and her husband, Paul (41y), presented to me a few months back. with 3 years of primary infertility (she had never conceived in the past). Paul had initiated 3 pregnancies in a previous marriage and by all tested parameters, was fertile. Malia on the other hand, was menopausal with absent ovulation and menstruation. She had been diagnosed with and treated for Leukemia 12 years prior and had been in full remission for the last decade. However, her chemotherapy had caused progressive ovarian failure such that her basal [E2} was <5 pg/ml, her [FSH] was >40MIU/ml, and her AMH, 0,02ng/ml. Her last menstrual period had occurred about 18 months prior. Malia tested “negative” for immunologic implantation dysfunction (IID). Malia, understood that her chance of propagating viable eggs of her own, was extremely small. However, I tried unsuccessfully to persuade the couple to use an egg donor. She insisted on first trying IVF with her own eggs and only if this was shown to be an exercise in futility, she might reconsider the egg donor option. Given the fact that Malia was hypoestrogenic (menopausal with a blood [estradiol] of <5pg/ml and likely had been so for several years, i was concerned that her uterus would be involuted endometrium (uterine lining) might have become unresponsive to estrogen. ultrasound examination confirmed the presence of a small uterus, failure develop an adequate following trial estrogen therapy, confirming my suspicion. suggested 2 months cyclical estrogen/progesterone hormone replacement therapy (hrt) followed by another evaluation look positive change. this undertaken, which found regained its size having responded well she presently continues on same hrt keep in holding pattern preparation aggressive stimulation protocol using robust agonist-antagonist conversion (a/acp) with priming (la10-e2v) along human growth (hgh) steroid (dexamethasone) augmentation. thereupon, if expanded blastocysts are propagated, recommendation transfer them fresh without subjecting biopsy preimplantation genetic testing (pgt). frankly, do not hold out much hope malia paul being successful ivf approach own eggs, fully expect we will future again tore visit need donor eggs. update you as case evolves!