This is the story of a couple from the United Kingdom (UK) who approached Dr. Krithika Devi, Nova IVF Fertility, RA Puram, Chennai to make their dream of parenthood a reality. Mr. S, aged 42 and Mrs. P aged 38 had been married for 7 years and were finding it difficult to conceive naturally.
Major Challenges: Low Ovarian Reserve, History of Pulmonary TB, Hypothyroidism
The case posed quite a few challenges as both the partners were of advanced age and had a history of primary tuberculosis (Tb) and Hypothyroidism. Additionally, Mrs. P had a low ovarian reserve, with an AMH (Anti-Müllerian Hormone level) of 0.6 and had a medical history of pulmonary tuberculosis (TB) and Hypothyroidism.
How Does A Low Ovarian Reserve Impact Fertility?
Ovarian reserve refers to a woman’s fertility potential based on the number of eggs remaining in her ovaries. A woman is born with her entire life supply of eggs, which then continues to diminish with each menstrual cycle until she finally hits menopause. While a low ovarian reserve is normal in the case of women aged above 35, some women may experience it due to other factors like genetic defects, certain surgeries and intense medical procedures like radiation therapy for cancer.
Lower the ovarian reserve, lesser a woman’s chances of conceiving successfully. A low ovarian reserve is also linked to a higher risk of miscarriages when trying to conceive via IVF with one’s own eggs, owing to their poor quality.
The quantity of the ovarian reserve can be determined with simple tests that check the levels of Follicle-Stimulating Hormone (FSH), Anti-Mullerian Hormone (AMH) or Antral Follicle Count (AFC).
How Does Pulmonary TB Impact Fertility?
Though the Tuberculosis (TB) bacterium primarily affects the lungs, it can spread to other parts of the body like the uterus and the fallopian tubes in extreme cases. This is categorized as uterine tuberculosis (also known as pelvic TB) and could affect a woman’s ability to conceive naturally. Some acute cases of pelvic TB could even render the uterine wall so thin, leading to implantation failure.
Fortunately, in this case, Mrs. P only had a history of pulmonary TB.
How Does Hypothyroidism impact fertility?
Hypothyroidism is a condition that is characterized by an underactive thyroid. The thyroid gland is responsible for producing certain hormones vital for the release of eggs (ovulation) from your ovaries each month. With hypothyroidism, the production of these hormones is interrupted, causing irregular periods and impaired fertility. Some of the underlying causes of this condition—such as pituitary or autoimmune diseases—are also known to diminish a woman’s reproductive potential.
The Nova Way: ICSI-Self-cycle
After a thorough assessment and review of the case, the Nova team counselled the couple regarding two major options they could explore—ICSI via self-cycle or via a donor oocyte (egg) program. Since their mind was set on having their own biological child, the couple decided to move forward with the self-cycle option, despite the odds being against them.
What Is ICSI-Self-cycle?
The natural fertilization process involves the penetration of an egg (released during ovulation) by a single sperm from the ejaculate—the sperm must penetrate with the shell of the egg to fuse immediately with the female gamete.
This might not naturally happen in case of some couples due to various issues including advanced age, diminished levels or low quality of gametes or existing medical conditions in one or both the partners. And that’s where Assisted Reproductive Technology (ART) comes in. From an ART perspective, there are two major approaches that are considered to overcome these hurdles:
- Conventional In-Vitro fertilization (IVF): Conventional IVF is based on the interaction between the oocytes and the sperm. After the egg retrieval, each oocyte and the set of cells that surround it (granulose cells) are put in a drop of culture media containing a suspension of sperm at a given concentration. Each egg is then expected to be penetrated by a single sperm from this interaction.
- Intra Cytoplasmic Sperm Injection (ICSI): ICSI involves injecting a single, healthy sperm into an egg using a fine glass needle. This procedure helps overcome the limitations faced by unconventional IVF with regard to poor egg quality or semen samples. Therefore, ICSI is considered a more viable option.
Both of these approaches can be performed via self-cycle, with the couple’s own gametes, or via a donor program, with the gametes extracted from donors provided by reputed and trusted agencies affiliated with Nova IVF Fertility.
The Success Story
In the first IVF Cycle, only three eggs could be extracted from Mrs. P and no quality embryos were formed, causing the cycle to be discontinued without an embryo transfer. But the couple was determined to not lose hope—they decided to give it another shot with their own gametes.