Overcoming Infertility In A Patient With Low Ovarian Reserve And Uterine Adenomyosis, Sharing Our Experience
Mrs S, aged 35 years visited the centre in 2023 September, married for 8 years with no conception.
She was diagnosed with a case of uterine adenomyosis and low ovarian reserve. She gave a history of having had two cycles of IVF ICSI with one miscarriage in the 3rd month.
Given uterine adenomyosis and low egg reserve, she was advised of oocyte donation and surrogacy.
We evaluated the couple thoroughly. For the male partner's sperm, DFI and semen analysis were done along with tests for general health. For the female partner, 3D ultrasound hormones for fertility assessment as well tests for general health and nutrition were done. A hysteroscopy was done to assess the cavity.
Her AMH was 0.5 suggestive of low ovarian reserve.
Pre-IVF medication was given for 60 days for the female partner after thorough counselling regarding the procedure and prognosis she was taken up for ovarian stimulation with gonadotropins. We retrieved 5 oocytes after ICSI was done and two top-grade blastocysts were cryopreserved for frozen embryo transfer.
Adenomyosis of the uterus is a condition where the endometrial cells in the womb layer are present in the myometrium, during menstrual cycles thickening and bleeding occur in the uterine muscles as well causing uterine enlargement and pain. Patients with Adenomyosis have decreased endometrial receptivity and increased risk of miscarriage.
GnRH Agonist injection pretreatment before embryo transfer can help in decreasing Adenomyosis, improving implantation and decreasing the chances of miscarriages after IVF treatment.
With this in mind, we were given 6 months of GnRH agonist after which a frozen embryo transfer was done.
She got pregnant in the very first attempt, being a precious pregnancy, our obstetrics team closely followed the patient during the antenatal period. In the 8th month of pregnancy, she had spontaneous labour and delivered a healthy baby with no requirement for NICU admission for the baby.
Our commitment to patient care helped the couple to become parents!
We are grateful to be of help in the couple's journey to parenthood.
Dr Sunitha Ilinani and team
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successful pregnancy in patient with extremely low sperm count with ICSI treatment
Mrs d and Mr g aged 28 and 32 respectively visited the centre for fertility evaluation.
Couple have been married for 2 yrs and have been trying to conceive since one year.
Routine evaluation as per standard protocol was carried out which included an ultrasound and hormone tests for the lady and a semen analysis for the male partner.
The semen analysis revealed the sperm count as 0.5 million with only 20%motility and 1% normal morphology. This is considered as very low sperm count ,normal count as per WHO standard should be more than 15 million.
Patient was advised to repeat the semen analysis after 15 days, a second report done after 15 days also showed similar low sperm count.
Patient was advised to consult in-house male infertility specialist for opinion regarding further evaluation and treatment.
Patient was advised hormonal ultrasound evaluation to understand the reason for the low sperm count.
The evaluation revealed ap very high FSH value around 20 suggestive of impending testicular failure.
Patient was advised to immediately freeze the semen sample.
Couple couple were counselled for IVF ICSI where eggs are collected from the female partner and sperm is then injected into each each healthy mature egg.
ICSI is intracytoplasmic sperm injection, it is an advanced fertility teatment and especially useful in couples where male partner has very low sperm count and it is impossible to get pregnant naturally given the low sperm count.
Female partner was given gonadotrophin injection so that multiple eggs grow which were then collected via transvaginal ultrasound guidance, the collected eggs were then screened by the expert embryology team and in each mature egg sperm was injected.
The procedure resulted in 4 grade 1 embryos, two embryos were transferred and two were frozen for future use. The Apollo fertility team is happy to note that couple had a successful pregnancy.
ICSI for extremely low sperm count is advanced fertility treatment and when done by expert embryology team can help couples to achieve pregnancy.
Team Apollo fertility
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Innovative use of thin endometrium along with ivf icsi resulted in Successful outcome in patient with multiple failed iui cycles
Mrs h and Mr m aged 32 and 34respectively married for 7 years, had been trying to conceive for the same number of years.
Mrs h had irregular cycles and was diagnosed as a case of pcos.
She also had 7 iui cycles and 12 ovulation induction cycles at various reputed centres with no successful outcome .
Given the long history of treatment failures she was advised ivf icsi, patient was counselled regarding the procedure and success rate.
A thorough pre ivf evaluation was carried out as per the standard protocol by the expert clinical team at Apollo fertility.
Couple were informed that the patients endometrial layer is very thin , endometrial layer is nothing layer wear the embryo implants and this layer needs to be more than 8 mm when measured by ultrasound.
In Mrs h it was observed it was only 6 mm.
Thin endometrium is very challenging to treat and routinely pts are advised estrogen and oral supplements which may not help in all patients, and these patients tend to have poor results in ivf treatments and occasionally patients are even advised surrogacy.
The clinical team at Apollo fertility decided to try an innovative treatment to improve the thickness of the endometrial layer, and advised instilling PRP into the endometrial cavity to improve the thickness of endometrium, PRP involves taking patients own blood processing in the lab and adding growth factors which is then instilled into patients endometrial cavity on specific days at the time of ivf treatment to improve the thickness. Couple agreed to go ahead with the same.
As per standard protocol an antogonist protocol was used to stimulate the ovaries so that multiple eggs develop at the same time PRP was instilled on specific days for improvement of endometrial thickness.
the ivf icsi procedure resulted in two A grade Blastocysts which were transferred, on the day embryo transfer the endometrium was 10 mm thick thanks to the PRP treatment. Post embryo transfer ot was put on supportive medication.
After 15 days a beta hcg was done which was positive for pregnancy.
Routine treatment protocols do not work in all patients, treatments needs to be individualised in order to ensure successful pregnacies in IVF treatments cycles.
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