Dr. R.G Patel Success Stories
Case of very low ovarian reserve and azoospermia with incomplete maturation arrest.
Couple from Telangana came to Sunflower Women’s Hospital having primary infertility since 10 years. Lady had very less ovarian reserve (AMH: 0.36) and husband was having Azoospermia. She was put on DHEAS for 3 months to improve ovarian reserve. Her husband’s testicular biopsy report showed incomplete maturation arrest. Lady was planned for IVF cycle with own eggs with TESA. Two eggs were retrieved. In TESA, no sperm was retrieved. Husband had already been counseled for Micro TESA.
Micro TESA WAS done and to everyone’s joy, sperm was retrieved. ICSI was done with this sperm and 2 embryos were formed. Both the embryos were cryopreserved. Embryo transfer was done in subsequent cycle. The lady conceived in 1 st trial. At present healthy pregnancy is going on and couple is very happy.
Case of primary infertility with adenomyotic uterus, thin endometrium, and severe oligoasthenospermia with high FSH in male partner (10 IVF cycles failed outside)
NRI couple having infertility of 9 years came to us at Sunflower Women’s Hospital with multiple problems. Lady was having strong PCOS, grossly adenomyotic uterus with thin endometrium. Her husband was having severe Oligoasthenospermia with very high FSH. They had history of 10 cycles of IVF failed outside in different centers. Long with these problems, couple was also terribly depressed. After history and reassessment of wife and husband, medical and social counseling, we put them on medication to improve sperm count (for husband). Then couple was planned for IVF cycle with own eggs and own sperm. ICSI was done and good numbers of embryos were formed and all were cryopreserved.
Despite lack of time (since they were on limited period visa), decision for freezing all embryos was taken. Subsequently treatment for adenomyotic uterus and thin endometrium was done. Medicine and scratch therapy was given to improve endometrium. Later, she was taken up for frozen thaw embryo transfer and two day 5 embryos were transferred. She conceived in first cycle. At present healthy single pregnancy is going on. Couple is very happy, for them it was a miracle.
Case of primary infertility with azoospermia with B/L undescended testis
Doctor couple having primary infertility of 6 years came to us at Sunflower Women’s Hospital. Wife’s report showed decreased ovarian reserve. Her AMH is 0.8 and husband was having azoospermia with high FSH with B/L undescended testis. His USG scrotum showed B/L undescended testis at level of inguinal ring. Couple wanted IVF cycle with own eggs and own sperm. Both were put on medication to improve ovarian reserve and sperm quality for 2 to 3 months with counseling about possibilities of sperm. Occasional motile sperm was found in masturbation sample.
Couple was planned for IVF cycle with own sperm and own eggs. Sufficient eggs were retrieved and ICSI was done with occasional motile sperm. Three embryos were formed and transferred in fresh cycle. To our extreme happiness lady conceived in first trial and is in her third trimester now.
Case of infertility with dense pelvic kochs and hypertension.
Couple from Jodhpur Rajasthan came to our Sunflower Women’s Hospital with great hope. She had secondary infertility of twelve years with history of one abortion 11 years back. She had 12 IVF cycles failed outside with past history of pelvic Kocks for which she had taken AKT in past . She also had severe hypertension controlled only with four or five antihypertensive drugs.. Her husband and was 33 years with normal semen analysis, and normal on examination. Her uterus was very bulky and diffusely Adenomyotic with thin endometrium. She was posted for operative Laparoscopy . Hysteroscopy showed severe cervical stenosis and intrauterine adhesion. Fundal and lateral Metroplasty with adhesiolysis was done. Inj. Luprolide acetate 3.75 mg depot formulation (Lupride depot) was given for Adenomyotic uterus. . Next month patient is taken up for IVF cycle. Embryo transfer was very difficult.
Serial cervical dilatation was done and then ET was possible. To our surprise and joy, she got BHCg positive, and conceived with twins, pregnancy is going on.
Case of secondary infertility with military tuberculosis and adenomyotic uterus.
Couple having 10 years of secondary infertility with history of 6 early abortions. She came to our Sunflower Women’s Hospital with great hopes. She had 6 cycles of IVF failed outside. She had history of miliary tuberculosis in past and history of B/l big TO masses for which she was operated 10 years back.
Patient was exhausted with treatment and did not want pregnancy in her own uterus. She was
suggested surrogacy by several doctors. Her usg and examination showed severely adenomyotic uterus, bulky and fixed. Her husband’s reports was normal. We treated her Adenomyotic uterus for two months and took her up for IVF cycle in her own uterus. Luckily, she conceived in 1 st trial and got successful twin pregnancy. At present 24 weeks healthy twins pregnancy going on.
Case of pregnancy in couple with sever male factor with high DFI and Diminshed ovarian reserve with previous 5 IVF failed
A couple with severe male factor and 5 ICSI cycles failed at a reputed IVF centre in the city came to us in total despair. Husband has undergone varicocele repair and had severe oligoasthenoteratoospermia. We evaluated his sperm DNA fragmentation index, which was 93% and so decided to go ahead with TESA as source of sperm in next cycle after starting him on anti oxidants. His wife too had diminshed ovarian reserve, we were able to form a single embryo in the first stimulation cycle, hence we decided to pool embryos over 2 stimulation cycles and then did a frozen embryo transfer with 2 day 3 embryos formed in each cycle thus. To everyone’s surprise, they conceived in the first stimulation cycle with us. They were ecstatic and could not believe the results.
It is this in depth knowledge and better understanding of reproductive physiology that matters in treating couples like these.
Case of pregnancy in couple with azoospermia and trial testicular biopsy suggestive of maturation arrest.
A couple married for 10 years with non obstructive azoospermia in the husband consulted us for one second opinion after having been suggested to opt for donor sperm at an IVF center as trial biopsy revealed maturation arrest.
There are sometimes foci of normal spermatogenesis in testicles of patients with of non obstructive azoospermia even though trial biopsy shows maturation arrest in some foci. We explained this to him and the odds of sperm retrieval on micro TESE. We assessed his testicular size and hormonal levels, started him on HCG injections and medications and suggested they opt for ICSI with micro TESE . Also as his wife had a diminished ovarian reserve we started her on androgen to optimize number of eggs during ICSI cycle and then started stimulation after 3 months. We were able to retrieve few mature sperms on Micro TESE and later transferred 2 day 3 embryos.
When they were informed about their pregnancy results, their joy knew no bounds. They had completely lost hope of having their own genetic child after the trial biopsy results. They had only come to us for a second opinion, but when explained about the treatment options they agreed that they should try once. They completely left the onus onto our team after that decision and when they conceived in the first trail itself they could not stop tears of joy from rolling down.
Infertility treatment can be a long and stressful journey. We are offering these success stories to offer our patients hope during times of discouragement. By personalizing our extensive, research based and evidence based plans for each patient, we have been able to succeed where other fertility centers have failed. Whether it’s our years of experience, passion for treating infertility, innovative research or friendly staff, there are many reasons to choose DR. R. G. PATEL as your IVF consultant at SUNFLOWER WOMEN’S HOSPITAL.
Live-birth at term in case of grade 4 endometriosis
36 years lady from Jodhpur Rajasthan, married for 17 years attended our OPD with primary infertility. Detailed evaluation and USG revealed that she had Grade-4 endometriosis. She had undergone 4 Laparoscopies and 6 IVF cycles at various centers for the same.
We performed Pre-IVF Hysteroscopy with endometrial polypectomy. We performed IVF at Sunflower Hospital in Feb. 2016 after meticulous endometrial preparation.
She conceived in first trial of IVF at Sunflower Women’s Hospital and had Twin gestation. She had uneventful ANC and underwent Cesarean Delivery at term in August 2017 at Sunflower Women’s Hospital Ahmedabad.
Twin birth in couple after 2 IVF failures in South Africa
An African Origin Couple from Johannesburg attended Sunflower Women’s Hospital OPD with history of seven years primary Infertility. Woman had undergone 2 cycles of IVF in her country.
4D USG showed PCOS with Adenomyotic Uterus & Arcuate shaped endometrial cavity.
She was posted for operative hysteroscopy and cavity was restored to near normal.
She underwent ovarian stimulation (COH) at our center with subsequent ovum pick up (OPU). Embryos were prepared using husband sperm. We decided to freeze all embryos (cryopreservation) to enhance implantation and prevent OHSS.
Two embryos were transferred in subsequent cycle (thaw cycle) with endometrial preparation in October 2016.
She conceived in first attempt at Sunflower Women’s Hospital. She had Twin pregnancy (DCDA). She followed up with us till 14 weeks and went back to her country for further ANC and delivery. She delivered healthy twins in South Africa on 8th June 2017.
45 Year old woman delivers twins after 30 years of marriage
An elderly couple, from Pali Rajasthan (Husband 51 & wife 45 years) married for 30 years, came to Sunflower Women’s Hospital with Primary Infertility & previous 9 IVF cycles failed.
Husband’s semen report showed severe oligo-astheno-terato-zoo spermia (OATA). The wife was menopausal and her 4D USG showed small uterus with thin & atrophic endometrium.
Medications to improve uterine size and improve endometrial receptivity were given for 3 months.
Pre IVF Hysteroscopy was done. Uterine cavity showed adhesions (Asherman’s Syndrome) excision and recreation of endometrial cavity was done.
With good endometrial preparation we took the patient for IVF-OD. We had decided to transfer 3 embryos in December 2016 as we wanted to maximize her chances of conception. She conceived in first cycle and had triplet pregnancy. Subsequently single fetal reduction was done to twins.
Twin pregnancy continued uneventfully under our constant vigilance. She underwent Cesarean Section at term in August 2017 and had healthy babies.
- An NRI couple with primary infertility of 10 years presented to Dr R G Patel’s OPD.
- She had previous 5 failed IVF-ED cycles done in other IVF Centers.
- In Sunflower Women’s Hospital after thorough hormonal evaluation and 4D USG; she was stimulated by HMG (150 IU).
- OPU revealed 3 ovum, all of them were fertilized by her husband’s sperms. Day 3 ET was done of 3 Grade-I embryos ET was done.
- Luteal support was given in standard doses of estradiol valerate, micronized progesterone, dydrogesterone & LMWH.
- Day 15 HCG revealed positive results & she had single intra uterine pregnancy from her own embryo on the first attempt at our center.
- At present she is 32 weeks and attending ANC OPD without significant risk factors.
- A 45 years elderly lady came to Dr R G Patel’s OPD with secondary infertility with (no living children) of 28 years.
- She was diagnosed to have multiple myoma & adenomyosis. Medically, she had severe hypertension with hypothyroidism.
- She had undergone laparoscopic myomectomy 2 times in two different hospitals. One laparoscopy was converted to open surgery due to multiple adhesions.
- She has attended various fertility centers &was actually advised Hysterectomy for menorrhagia & Dysmenorrhea.
- Patient was mentally depressed but still had a glimmer of hope to have a child, hence she came to Dr R G Patel .
3D USG at Sunflower Women’s Hospital revealed irregular bulky adenomyotic uterus with multiple fibroids with uterus having poor echotexture and totally ill defined endometrium & hydrosalpinx in both tubes.
- She was posted for Laparoscopy after detailed counselling , physician workup & informed consent.
- Laparoscopy revealed frozen pelvis and dense adhesions and bilateral big tubo ovarian masses. Adhesiolysis, bilateral salpingectomy & 8 fibroids from different locations were removed.
- Post Laparoscopy she was given GnRH Analogues for 2 cycles.
She was posted for IVF- Egg Donation with husband’s Sperms.
To everybody’s joy, she conceived in the first cycle & had single intra uterine pregnancy.
- At present she is in her third trimester & regularly attending our ANC OPD.
- A couple attended Dr R G Patel’s OPD with previous 5 miscarriages & secondary infertility of 5 years.
- Endocrinological Evaluation & 4 D USG revealed extreme strong PCOS (AMH 19 ng/ml) with small uterus and thin endometrium. Husband’s semen analysis showed severe oligoasthenozoospermia (OTA- Total count of 1.4 million, nil progressive motility.)
- Dietary modifications & medicines were advised to the wife.
- Husband was prescribed 3 months course of sperm nutrients & hormone therapy.
- Wife was posted for laparoscopy & Ovarian Drilling was done long with tubal patency & hysteroscopy.
- She was stimulated with gonadotropins & OPU was done. ICSI was done with husbands spem and all embryos were cryo preserved. Fresh Embryo transfer was not done as endometrium was thin (4 mm).
- Embryo Transfer was done in subsequent cycle with endometrial preparation using estradiol valerate & Granulocyte stimulating factor. Even on day of ET endometrium was only 5.6 mm but triple line appearance.
- She conceived in the first cycle & had singleton pregnancy.
- Currently she is 34weeks & has had uneventful Antenatal Care (No GDM or PIH).
- We plan to wait till 37 weeks & then take decision on USG & Doppler.
- Mrs. S. M. P. was 38 years and married for 11 years, had tried all types of infertility treatments and three cycles of IVF treatment failed at a reputed centre outside. Her ovarian reserve was very less and she and her husband were desperate to conceive with her own eggs. She was advised egg donation for which she was reluctant. Depressed and dejected, the couple contacted DR R G PATEL for treatment. In her previous cycles she had only two eggs retrieved and one embryo formed. After improving ovarian reserve with DHEAS tablets for two months, DR R G PATEL modified the IVF stimulation protocol, collected two eggs, did ICSI and cryopreserved the resultant single grade 1 embryo. He started stimulation again and collected the resultant two eggs and cryopreserved the resultant single embryo. This modified stimulation protocol was done for a total of three times and three embryos were formed and cryopreserved. Lady was allowed to get into natural period and then estradiol valerate was given in increasing doses to build up endometrium and the three cryopreserved embryos were transferred after thawing. To everybody’s great joy, she conceived and single fetus grew well. She delivered a 2.9 kg healthy baby boy at 38 weeks.
- Mrs. VRP was 43 years old with primary infertility of 19 years and history of very scanty periods. She had tried all sorts of treatment including 3 cycle of IVF with donor eggs but failed. All the primary investigations were normal except that her endometrial lining never grew beyond 4 to 5 mm. Her hysteroscopy was normal except for a small sized uterine cavity. Fundal and lateral Metroplasty was done to increase the uterine cavity volume. Granulocyte colony stimulating factor was instilled twice during endometrial stimulation before Embryo Transfer, endometrial mechanical scratch therapy was done to enhance endometrial receptivity but none gave satisfactory results. All efforts to increase endometrial thickness were in vain. In her 4th IVF donor egg cycle under DR R G PATEL, she was put on injection human menopausal gonadotrophins serially for 7 days and to our great surprise and joy her endometrium was 7.5 mm and showed triple line appearance on (TVS) USG. She conceived in the same cycle and conceived single pregnancy. Course of pregnancy was smooth and delivered healthy 2.6 kg baby boy at 37.4 weeks.
- 31 years obese (weight 80 Kg & BMI 34) woman with primary infertility of eleven years, having strong features of PCOS & AMH was 10.5.
- She has undergone 5 cycles of IUI + COH & Laparoscopy with LEOS & 3 IVF cycles in other centers.
- She showed extremely poor endometrial development to standard therapy (estradiol valerate). So she was given therapy for weight loss & endocrine milieu improvement. Second look hysteroscopy with sample to rule out Pelvic Tuberculosis (Tb-PCR negative)
- Endometrial Preparation was done after with sildenafil, L- Arginine, Granulocyte stimulating factor & Growth hormone preparation in addition to standard estradiol Valerate. In spite of all these medications her endometrium development was not satisfactory (always less than 5 mm).
- She was posted for second Look Laparoscopy & extensive PCO Drilling was done (multiple punctures & wedge incisions).
- She underwent IVF- OD in our center which showed biochemical pregnancy (HCG positive) but she underwent spontaneous miscarriage.
- Patient went for second opinion & was diagnosed as “End Organ Failure” & advised Surrogacy.
- She came to us again after gap of 1 year & left the final decision to us. We decided to give her one more trial after extensive endometrial preparation in a thaw cycle as we had Day3 embryos cryo preserved in our center. In This trail there was biochemical evidence of pregnancy Luteal Phase Support with micronized progesterone, Dydrogesterone & estradiol valerate. TVS done later confirmed single intra uterine gestational sac.
- At present she is 6 weeks pregnant with cardiac activity present.
- This case under lies the importance of “Second look Laparoscopy” with repeat Ovarian Drilling & also of the old saying… “Never Give Up”
- 39 years lady with Primary Infertility of 17 years presented to OPD of Dr R G Patel with Decreased Ovarian Reserve (AMH 0.5) & Small Uterus. Semen report of husband showed severe OTA. She had under gone 7 cycles of IVF (own & donor gametes) at other various IVF centers.
- After confirming findings she was advised estradiol valerate to improve uterine size. Hysteroscopy was done with fundal & lateral metroplasty. Husband was given medications to improve sperm count & motility.
- She underwent IVF – Ovum Donation with ICSI was done with semen sample after masturbation showing very few (2-3) sperms at our center.
- She showed positive HCG on follow up. She was given standard Luteal Support. At present she is 7 weeks pregnant with twin pregnancy.
- This case underlies the importance of “Adjuvants in Semen Improvement” & “Role of Hormones in improving uterine size & vascularity”.