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Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic

We present the case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done...

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Autores principales: Shrivastava, Jarul, More, Akash, Shrivastava, Virul, Shrivastava, Deepti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441188/
https://www.ncbi.nlm.nih.gov/pubmed/36081974
http://dx.doi.org/10.7759/cureus.27710
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author Shrivastava, Jarul
More, Akash
Shrivastava, Virul
Shrivastava, Deepti
author_facet Shrivastava, Jarul
More, Akash
Shrivastava, Virul
Shrivastava, Deepti
author_sort Shrivastava, Jarul
collection PubMed
description We present the case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done at her hometown hospital. This is a case of secondary infertility. Before coming to our center, she visited another center for infertility treatment, where in vitro fertilization (IVF) was done using self-oocyte, but intracytoplasmic sperm injection (ICSI) was not done. Unfortunately, the treatment did not succeed. On hysteroscopy, adhesions were found in the cavity, which were possibly formed due to the D&C procedure performed for past abortions. This condition is known as Asherman’s syndrome. Hence, hystero-adhesiolysis was done on January 20, 2021. Her latest report showed an anti-Mullerian hormone (AMH) value of 0.252 ng/dL, which was very low. Low AMH was indicative of low ovarian reserve. Her follicle-stimulating hormone (FSH) was 23 mIU/mL, which was too high, suggestive of poor egg quality. The antral follicular count was assessed through transvaginal ultrasound; the total count was three (one on the right, and two on the left). Ovum pick-up was done on March 15, 2021. Only one oocyte was retrieved from the patient (MI grade). The husband’s sperm count was 12 million/mL with low motility, which is known as oligoasthenozoospermia; hence, ICSI was performed. However, the embryo could not be formed. Therefore, on April 1, 2021, oocytes were retrieved from the donor, and ICSI was done using the semen sample of the husband. On April 6, 2021, two embryos at the day six stage were transferred to the patient’s uterus. Before the embryo transfer, tablet estrogen 2 mg was administered thrice daily. This was started from day two of menses till day 14th. After 14 days, the patient was given a progesterone injection for six days daily. After embryo transfer, tablet estrogen 2 mg was given thrice daily, and tablet progesterone 2 mg twice daily was given as support. After 14 days of embryo transfer, a beta-human chorionic gonadotrophic hormone (βhCG) test was done. Her βhCG was positive, and the couple was delighted. Diagnostic challenges occurred due to previous abortions, previous failure of IVF, history of hypothyroidism, AMH value of 0.252 ng/dL, and presence of adhesions. This is a case of secondary infertility with cavity adhesions with low AMH and low antral follicular count. The outcome was favorable at our fertility clinic. Because the patient is a known case of hypothyroidism, levothyroxine tablets were also prescribed.
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spelling pubmed-94411882022-09-07 Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic Shrivastava, Jarul More, Akash Shrivastava, Virul Shrivastava, Deepti Cureus Obstetrics/Gynecology We present the case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done at her hometown hospital. This is a case of secondary infertility. Before coming to our center, she visited another center for infertility treatment, where in vitro fertilization (IVF) was done using self-oocyte, but intracytoplasmic sperm injection (ICSI) was not done. Unfortunately, the treatment did not succeed. On hysteroscopy, adhesions were found in the cavity, which were possibly formed due to the D&C procedure performed for past abortions. This condition is known as Asherman’s syndrome. Hence, hystero-adhesiolysis was done on January 20, 2021. Her latest report showed an anti-Mullerian hormone (AMH) value of 0.252 ng/dL, which was very low. Low AMH was indicative of low ovarian reserve. Her follicle-stimulating hormone (FSH) was 23 mIU/mL, which was too high, suggestive of poor egg quality. The antral follicular count was assessed through transvaginal ultrasound; the total count was three (one on the right, and two on the left). Ovum pick-up was done on March 15, 2021. Only one oocyte was retrieved from the patient (MI grade). The husband’s sperm count was 12 million/mL with low motility, which is known as oligoasthenozoospermia; hence, ICSI was performed. However, the embryo could not be formed. Therefore, on April 1, 2021, oocytes were retrieved from the donor, and ICSI was done using the semen sample of the husband. On April 6, 2021, two embryos at the day six stage were transferred to the patient’s uterus. Before the embryo transfer, tablet estrogen 2 mg was administered thrice daily. This was started from day two of menses till day 14th. After 14 days, the patient was given a progesterone injection for six days daily. After embryo transfer, tablet estrogen 2 mg was given thrice daily, and tablet progesterone 2 mg twice daily was given as support. After 14 days of embryo transfer, a beta-human chorionic gonadotrophic hormone (βhCG) test was done. Her βhCG was positive, and the couple was delighted. Diagnostic challenges occurred due to previous abortions, previous failure of IVF, history of hypothyroidism, AMH value of 0.252 ng/dL, and presence of adhesions. This is a case of secondary infertility with cavity adhesions with low AMH and low antral follicular count. The outcome was favorable at our fertility clinic. Because the patient is a known case of hypothyroidism, levothyroxine tablets were also prescribed. Cureus 2022-08-05 /pmc/articles/PMC9441188/ /pubmed/36081974 http://dx.doi.org/10.7759/cureus.27710 Text en Copyright © 2022, Shrivastava et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Obstetrics/Gynecology
Shrivastava, Jarul
More, Akash
Shrivastava, Virul
Shrivastava, Deepti
Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title_full Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title_fullStr Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title_full_unstemmed Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title_short Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic
title_sort successful outcome in a middle-aged woman with secondary infertility using donor oocyte in vitro fertilization: a case report from a rural infertility clinic
topic Obstetrics/Gynecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441188/
https://www.ncbi.nlm.nih.gov/pubmed/36081974
http://dx.doi.org/10.7759/cureus.27710
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