Dr. R.G Patel Success Stories
Case report of successful fertility preservation done for a patient of Ewing’s sarcoma.
A 23 year old female married for 3 years diagnosed with Ewing’s sarcoma after she had developed a knee swelling. She was about to start chemotherapy for Ewing’s sarcoma. Her oncologist suggested her to undergo fertility preservation as chemotherapy is extremely gonadotoxic and since they did not have a single child they decided to go with ahead with the option. Also Ewing’s sarcoma has a good survival rate post chemotherapy so it was only the most reasonable option for her to undergo embryo cryopreservation.
Since she was married we went ahead with embryo cryopreservation. She underwent stimulation with gonadotropins for period of 8 -10 days, and egg retrieval was performed under general anaesthesia. Her eggs thus retrieved were fertilised with her husband’s sperm and resulting 6 good grade embryos were frozen. A single attempt at embryo transfer at our centre with 2 embryos achieve a pregnancy rate of 70% and cumulatively 85% after 2 attempts and 95% with 3 attempts.
She was declared cured after undergoing 9 cycles of chemotherapy after 2 years of the diagnosis. She underwent a frozen embryo transfer in hormone replacement cycle and conceived in first attempt. She recently delivered a healthy female child with us.
Success story of healthy twins born to an infertile couple after 5 failed attempts at IVF- ET (embryo transfer) including 3 attempts of PGS tested normal embryos (male partner had balanced reciprocal translocation)
An infertile couple with unexplained infertility underwent 1st IVF cycle with us due to 3 failed attempts at IUI -H, she formed 9 embryos in her first stimulation cycle which was back in 2016. She underwent 2 rounds of frozen embryo transfer but failed to conceive. She still had 3 embryos frozen with us, but patient migrated to Pune due to career obligations.
In Pune couple underwent karyotype analysis and her husband was diagnosed with balanced reciprocal translocation, next they underwent 1 more IVF cycle in Pune with PGS (pre implantation genetic screening). Out of 8 embryos biopsied there they had 3 normal embryos and patient subsequently underwent 3 frozen embryo transfer cycles there with these normal embryos, but failed each time.
Completely drained at all levels physically, emotionally and financially patient consulted us once again, this time around all the way from Pune. After detailed evaluation & understanding of their case we decided to perform a frozen embryo transfer for her with the embryos remaining with us from her previous IVF cycle with us in 2016. She conceived a twin pregnancy. At 16 weeks we performed amniocentesis to determine presence of any trisomy or monosomy in the foetuses as their after was a carrier of balanced reciprocal translocation. To everyone’s delight both the foetuses just turned out to be carriers of the same balanced reciprocal translocation and did not have any aneuploidy. She had an otherwise uneventful antenatal course and delivered a healthy male and female child at term.
Success story of healthy baby born to a couple suggested for surrogacy at centres outside after having failed 8 attempts at IVF
42 year old lady married for 20 years with bilateral tubal block due to genital Koch’s had undergone 8 failed cycles of IVF (2 self & 6 egg donation) at 3 reputed centres of Ahmedabad and was finally suggested surrogacy due to thin endometrium.
But as surrogacy was neither acceptable nor affordable for them, they approached us with a lot of hope and faith. On high resolution sonography with us she was determined to have bilateral hydrosalpinx and an intramural fibroid measuring 3.8 cm not impinging on cavity. Hence we took her up for laparoscopy with bilateral salpingectomy and myomectomy. Then after 6 months of laparoscopy she underwent egg donation IVF with us, we placed 2 blastocysts in high dose estrogen hormone replacement cycle. She conceived in first embryo transfer attempt but unfortunate had a miscarriage at 6 weeks. Hence after 3 months again we performed second egg donation IVF cycle. 2 blastocysts were transferred, she conceived and had an otherwise uneventful antenatal course. She developed mild gestation hypertension at 36 weeks and was taken up for elective LSCS at 37 weeks in view of history of myomectomy and breech presentation. She delivered a healthy male child weighing 2.8 kg.
This case shows us that how in-depth evaluation with even a technique as simple as high-resolution sonography can uncover causes of repeated IVF failures. All the previous centres had deemed only her endometrium to be responsible for cause of failure. Whereas after noticing hydrosalpinx and fibroid and removal of same, we were able to achieve a pregnancy even with an endometrial thickness of as thin as 5.6 mm.
Success story of a Menopausal nulliparous lady
49 years old nulliparous, menopausal lady come to us with primary infertility of 30 years. She had history of laparoscopic removal of fibroids in 2013 followed by 2 cycles of IVF out sided at Mehsana which had failed.
On examination at Sunflower we found that her uterus was small but with fibroids. She was subjected to laparoscopic myomectomy and bilateral salpingectomy (as her tubes were found to be inflamed) and hysteroscopy.
She did not respond to oral estradiol as her uterus did not show any sign of endometrial formation. She was given oral and topical estradiol several times along with other medication to improve endometrial blood flow. Still her uterus did not show good endometrium.
It took several medications to help her endometrium grow.
Once her endometrium showed signs of improvement and triple line formation, she was subjected to IVF cycle of ovum donation and luckily, she conceived in first trial. During the course of her pregnancy, she developed PIH (Pregnancy Induced Hypertension), GDM (Gestational Diabetes Mellitus) and also showed funneling of internal OS with membrane bulging out.
She was put on medicines for hypertension, GDM and IV Atosiban for tocolysis. The course of her pregnancy was very stormy but despite all, she delivered a 1.9 kg healthy baby boy at 36 weeks.
Successful outcome with egg donation – IVF in case of couple with previous 3 children expired due to cystic fibrosis
A couple approached us after having lost three children within few days after birth from perfectly uneventful pregnancies.
Her third child was finally diagnosed to have cystic fibrosis.
When they consulted us, wife’s age was 38 years, on sonography and blood test she was diagnosed with decreased ovarian reserve.
Hence we discussed with the couple about egg donation IVF.
Next we ran targeted gene analysis of husband for cystic fibrosis and also did clinical exam of husband and egg donor to rule out presence of any other defective genes that may result in a child with genetic disorder.
Then we did egg donation IVF cycle, single blastocyst was transferred and resulted in a term birth of female child.
Two sisters with diminished ovarian reserve (Low AMH) conceived with own eggs and delivered healthy babies
Mrs. L, 40 year old with diminished ovarian reserve came to us with failure to bear a pregnancy despite 14 years of married life. She had undergone an array of fertility treatments before coming to us, certain centers had also offered her egg donation IVF as the last resort.
When she came to us she had only one request, to bear her own genetic child. So we put her on pretreatment for a period of 3 months to improve ovarian function, later her went for an IVF stimulation, however further stimulation was withheld after 8 days of injectables as there was no response( no follicle on sonography) and patient was called after 7 days to check for delayed response, to our surprise she had a single follicle on that day and after counseling her an about low chances of retrieval and egg quality we went ahead with egg retrieval once follicle reached mature size after ovulation triggering. A single egg was retrieved , ICSI was done and a single 4 cell embryos formed was cryopreserved. Next we counselled the patient for a second round of stimulation and egg retrieval to from atleast one more embryo. Now with already one embryo frozen with us patient was confident and with deep faith in us went in for a second round of stimulation with injectables and egg retrieval, this cycle she formed 2 embryos which were cryopreserved. Later she went to conceive a successful pregnancy with second attempt at embryo transfer. In view of her age a detailed genetic evaluation of child was performed in utero and it was normal. She had an uneventful antenatal course and delivered a healthy male child at term. The family was overwhelmed and so were we. It was only possible because of the faith, this particular patient had in us.
A year later her own sister, Mrs. F, 36 year old came to us with failure to conceive inspite of 5 years of married life and she too suffered from the same issue, diminished ovarian reserve. In her case too we put her on pre treatment in order to improve ovarian reserve. Her ordeal lasted a little longer. She underwent 3 rounds of stimulation and egg retrieval in order to from 2 good grade embryos. She conceived a twin pregnancy in her first attempt at embryo transfer. She delivered twin boys at term through LSCS.
The family is ecstatic and so are we, to have been a mode of bringing happiness to this beautiful family.
Case of live birth in case of thin endometrium
40 year old female married for 17 years with history of 2 first trimester miscarriages, last miscarriage was 15 years back with history of scanty menses after dilatation and evacuation visited us having been suggested surrogacy as last resort after having undergone hysteroscopy on 2 occasions for Asherman’s Syndrome and having failed twice at IVF with egg donation outside.
When she came to us we studied her endometrium after 10 days of estrogen, and thickness was 4 mm, hence we performed a relook hysteroscopy, cut few adhesions planned her for platelet rich plasma therapy. She was given estradiol valerate for 3 cycles coupled with progesterone in last 1 weeks and induce menses before we performed IVF with egg donation, she failed in her first embryo transfer attempt (her endometrial thickness was 6 mm before embryo transfer) , however in her subsequent attempt with 2 frozen thawed blastocysts patient conceived and has had an uneventful antenatal course except for mild pre-eclampsia and IUGR, she delivered a healthy male child weighing 2.2 kg at 36 weeks with elective LSCS.
A couple, both partners HIV positive were turned down by several IVF centres in view of their seropositive status for IVF.
ICSI (intra cytoplasmic sperm injection) nullifies the risk of HIV transmission from father, and highly active anti-retroviral therapy (HAART) to mother minimises risk of transmission to her child. Both were started on highly active anti-retroviral therapy, viral load was brought down in both partners. Then we proceeded with ICSI cycle, observing universal precautions. The couple conceived in their first embryo transfer attempt and have recently delivered a healthy baby at term through elective LSCS. Baby was given zidovudine prophylaxis and was kept on formula milk. They have tested the baby and he was found to be negative for HIV PCR, he is leading a perfectly healthy life at 1 year of age.
With HAART, HIV patients are leading perfectly healthy lives, with no decrease in life expectancy. With universal precautions in OT and IVF lab there is no fear of transmission of HIV to members of staff or other patients. Also children conceived though this manner have zero risk of transmission from parents.
A couple (both software engineers) from Pune approached us after failing having failed in 8 IVF cycles elsewhere at reputed centres as they had friend who recommended us to them as last ray of hope.
Female partner’s age was 40 years, she had PCOS (polycystic ovarian syndrome). In view of their repeated failures, inspite of undergoing pre implantation genetic screening, blastocyst transfer , and personalised embryo transfer based on ERA results (endometrial receptivity array), all other centres had suggested her to opt for egg donation but they were hell- bent on having their own genetic child.
In their case we opted for surrogacy in view of their history of repeated IVF failure, we started her on gonadotropin stimulation, performed egg retrieval, ICSI (intra cytoplasmic sperm injection) with husband’s sperm, resulting 6 good grade blastocyst were frozen, and later transferred to her surrogate. Her surrogate conceived in second embryo transfer attempt with us and delivered a healthy male child at term. The joy of this couple knew no bounds when they held their son for the first time after 14 years of marriage and running from pillar to post in their struggle with infertility.
We also believe in giving each couple their own genetic child and leave no stone unturned in achieving the same.
A couple came to us with inability to conceive inspite of 10 years of marriage, both were highly qualified (Ph. D.). The male partner had azoospermia and was diagnosed with bilateral undescended testis. Both testis were in inguinal canal and his S. FSH level was 44. Several reputed centres and andrologists had suggested them to opt for donor sperm as the only resort. But the couple were not willing to give up.
They came to us with a lot of hope and faith. We put the male partner on medications for 6 months and reassessed the semen analysis every month. After 3 months we started seeing few sperm after high speed centrifugation in his ejaculated semen sample. We froze these samples. We later started his wife on Gonadotropins, performed egg retrieval and performed ICSI (intra cytoplasmic sperm injection) on her oocytes with her husband’s sperm. 2 good quality embryos were formed and frozen and later transferred in hormone replacement cycle. They conceived in their first attempt and have beautiful 5 month old baby girl of their own.
It is this kind of faith our patients have in us that pushes us to deliver these kind of miracles.
PGD for beta thalassemia trait
A doctor couple consulted us in their first trimester with natural pregnancy, completely unaware that they were both beta thalassemia minor, which was detected during her antenatal blood work up. Hence she was planned for amniocentesis at 16 weeks. And to their despair, fetus was affected with thalassemia major. Hence they terminated the pregnancy at 18 weeks.
Beta Thalassemia is an autosomal recessive disorder which leads to anemia. Beta thalassemia major children required blood transfusion at the frequency of almost every week. A couple in whom both partners are beta thalassemia minor : there is 50 % chance of having a child with beta thalassemia minor, 25% chance of having a child with beta thalassemia major and 25% chance of having a normal child.
For their next child we performed ICSI with PGD (pre implantation genetic diagnosis) for beta thalassemia. We performed trophoectoderm embryo biopsy on 4 blastocysts, and embryos were labeled and then frozen. 1 embryo was unaffected and 1 was beta thalassemia minor, the remaining 2 were beta thalassemia major. The PGD normal frozen thawed embryo was transferred in hormone replacement cycle, she conceived in her first attempt and has a 20 week ongoing pregnancy at present.
With PGD it is now possible to screen for genetic disorders even before conception, thereby avoiding the physical and emotional stress to the couple of pregnancy termination.
Successful outcome in a case of 100% immotile sperms after 4 ICSI failures elsewhere.
A couple came to us with history of previous 4 ICSI cycles failed at reputed centres in Dehli. The male partner had 100 % asthenozoospermia (all sperms were non motile but alive). Inspite of having good blastocysts for embryo transfer each time the couple failed to get pregnant.
Hence we worked up the couple from point of view of recurrent implantation failure; however cause could not be determined. In their case the cause of 100% asthenozoospermia was a structural defect in the sperms. The tail of the sperm has proteins which allow the sperm to swim, which because of certain genetic reasons is defective in few males, leading to this condition. However since they had fialed in previous 4 ICSI cycles with ejaculated sperm, the male partner was planned for testicular sperm aspiration on the day of wife’s egg retrieval with us. We performed ICSI with testicular sperm. Good blastocysts were formed which were frozen. We did pre IVF hysteroscopy, and transferred 2 frozen – thawed blastocysts in subsequent menstrual cycle. The couple were delighted with a positive result in the first attempt with us.
It is these kind of difficult cases which need that extra effort for diagnosis and planning treatment. And since we have a good understanding of reproductive physiology we are able to tackle these cases well.
Successful pregnancy outcome in woman previously weighing 130 kg after bariatric surgery.
27 year old female visited us with history of 3 recurrent abortions and failure to conceive for 4 years after last abortion. She weighed 130 kg and was diabetic on treatment. She had tried all sorts of exercise programs and diets to lose weight but all in vain. When she consulted us we advised her to undergo bariatric surgery before undergoing any treatment for infertility. She heeded our advice and managed to lose 42 kg in a span of 2 years. She then underwent IVF cycle with us and conceived in her first attempt. She delivered a baby girl on 13.2.19 with no complications.
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”.