Thursday, 26 December 2013

Uterine lining damage and infertility, a case study

Uterine lining damage and infertility, a case study

The severity of agony and frustration could be felt very clearly during the discussion with an infertile couple sitting in front of me. We were going through the case history and it was surely quite pessimistic.

It was a peculiar case of secondary infertility after successful full-term childbirth. The first baby boy was quite healthy and the pregnancy was smooth.

However, the secondary infertility has really tested their patience a lot and 3 IVF attempts and equal number of Frozen Embryo Transfers. Each pregnancy had resulted in bleeding, pain and a lot of physical discomfort. They had undergone every possible test and everything seems to be normal. Her ovulation was great, her tubes were fine and her husband was producing enough sperms! However, the pregnancy was not happening in spite of all these supporting factors.

I checked the case papers. To my surprise, they had tried all the aspects of infertility treatment;Laparoscopy, hysteroscopy, IVF and FET. After getting disappointed from everything, they were sitting next to me for a second opinion!

The strange case of uterine lining problem

It wasn’t less than a Sherlock Homes mystery for me and I decided to play the role of master detective. First of all I convinced the couple to undergo fresh set of investigations. Not because I didn’t trust the earlier reports, but to do the investigations in my way. Secondly, I assured the couple about the success of the pregnancy. The female had conceived once and delivered a healthy baby, so there were always better chances of success.

As the first step, I decided to perform Hysterosonogram to confirm the uterine cavity and checked the IVF records to understand the thickness of the uterine lining. Hormonal tests were conducted to confirm the uterine lining and… BINGO!

I found the fundamental cause of her problem. Investigations concluded that basal Endometrium was incapable of getting stimulated by estrogen, the female hormone. It is the internal germinal layer that gets refreshed every year. The layer was damaged severely and the chances of recovery were nil. There was no option left other than trying for surrogacy!

The treatment

Treatment method was equally peculiar in this case. We found some surrogates and the couple selected the best according to their choice. We prepared both the ladies by giving hormonal stimulation. For the patient, it was done to achieve matured eggs whereas in the surrogate to prepare the uterus for pregnancy. The matured eggs were fertilized with her husband’s sperms in the laboratory and the embryos were transferred to the uterus of the surrogate.

Hormonal treatment was the most important part of the whole process. We need to match the timings of fertilization and transfer of embryo to make sure the success of implantation. The process was successful and the couple was blessed with a cute baby girl after full-term pregnancy.

The case was certainly a challenge for me and my team because of the symptoms of unexplained infertility. However, with the determination of the patient and a dedicated work by our team, we could achieve a happy ending!

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