In Vitro Fertilization Using Luteinizing Hormone-ReleasingHormone Injections Resulted in Healthy Triplets withoutIncreased Attack Rates in a Hereditary Angioedema Case

Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) is a rare, autosomal dominant disorder. The management ofpregnant patients with C1-INH-HAE is a challenge for the physician. Intravenous plasma-derived nanofiltered C1-INH (pdC1INH)is the only recommended option throughout pregnancy, postpartum, and breastfeeding period. In order to increase pregnancy rates,physicians use fertilization therapies increasing endogen levels of estrogens. Therefore, these techniques can provoke an increase inthe number and severity of edema attacks in C1-INH-HAE. Our patient is a 32-year-old female, diagnosed with C1-INH-HAE type 1since 2004. She had been taking danazol 50–200 mg/day for 9 years. Due to her pregnancy plans in 2013, danazol was discontinued.PdC1INH was prescribed regularly for prophylactic purpose. Triplet pregnancy occurred byin vitrofertilization using luteinizinghormone-releasing hormone (LHRH) injections. In our patient, LHRH injections were done four times without causing any severeattack duringin vitrofertilization. Angioedema did not worsen during pregnancy and delivery due to the prophylactic use ofintravenous pdC1INH in our patient. According to the attack frequency and severity, there was no difference between the threepregnancy trimesters. To our knowledge, this is the first published case of C1-INH-HAE receivingin vitrofertilization therapieswithout any angioedema attacks during pregnancy and delivery and eventually having healthy triplets with the prophylactic use ofintravenous pdC1INH.