This is the story of a couple who approached Dr. Swapna Y. at our Nova IVF Fertility Clinic Vijayawada in Jan 2018 to make their dream of parenthood a reality. The 31-year-old lady was presented with primary infertility of 4 yrs, and the couple was finding it difficult to conceive naturally.
The patient had irregular periods and severe polycystic ovaries. She was also on thyroxine 75mcg for hypothyroidism. However, her male partner was healthy and had a normal semen analysis.
The couple had approached another Fertility Clinic in the past. Detailed case history revealed that during this earlier treatment at other clinics, she was given different tablets and medicine doses to stimulate follicular development for several cycles. Follicular tracking scans were also performed, but despite all treatment, these did not show any follicular growth.
Laparoscopy and ovarian drilling were performed, and hysteroscopic partial septal resection was done. However, post-procedure cycles continued to remain irregular and follicular growth continued to remain absent. Effectively, there was no gain from this treatment so far.
Post this, Injections (Hmg) were also given at the other clinic. However, even this failed to result in follicular development, and the couple still had no improvement in medical conditions and the ability to conceive.
The couple was determined to try out other options, and they started to search for the best fertility centres in Vijayawada. And that’s when they found out about Nova IVF.
Hypothyroidism and its impact on fertility
The butterfly-shaped thyroid gland, located at the base of the neck, controls the body’s metabolism and other systems. Hypothyroidism is a term used to define a condition where metabolism is slowed down, resulting in weight gain. Hormones secreted by the thyroid are required to function properly. In addition to controlling the rate at which the body converts carbohydrates, protein, and fats into fuel, thyroid hormones also control heart rate and can affect the menstrual cycle, affecting fertility.
PCOS and its impact on fertility
Polycystic ovary syndrome (PCOS) is a common endocrine disorder, mostly occurring in women, especially those that have metabolic issues. Impacted women have higher levels of insulin and androgens (male-type hormones). This hormonal imbalance may cause a range of symptoms and affect fertility.
Women with PCOS take longer to conceive because they have irregular periods; they don’t ovulate every month. Being overweight, their fertility is reduced, and it takes longer to conceive.
A PCOS diagnosis can be made if at least 2 of the following conditions are met:
- Irregular periods
- Higher levels of androgen hormones
- 12 or more follicles or partly developed eggs, seen as dark circles on ovary ultrasound
Impact of Low Ovarian Reserve on Fertility
In PCOS, abnormal hormone levels prevent follicles from growing and maturing to release egg cells. These immature follicles accumulate in the ovaries, and affected women may have 12 or more of these follicles. The overall number of these follicles usually decreases with age, and hence fertility reduces with age. To manage this condition, a follicular stimulating hormone is administered to patients for fertility issues, in addition to making them manage weight. This may be administered as oral pills or as an injection.
What is Ovarian Drilling, and how does it help?
Ovarian drilling, also called multi-perforation or laparoscopic ovarian diathermy, involves surgically puncturing the membranes surrounding the ovary using a laser beam or a surgical needle using a laparoscope. This surgical treatment can trigger ovulation during polycystic ovary syndrome (PCOS).
Treatment plan at Nova IVF Fertility, Vijayawada
The couple visited our Nova IVF Clinic in Vijayawada and were eager to meet Dr. Swapna as they have read and heard a lot about her being one of the best fertility specialists in town. Dr. Swapna met the couple and advised the patient for IUI with recombinant FSH 100 IU daily injections for follicular stimulation for 12 days. However, the injection did not result in follicular development, and hence the IUI cycle had to be cancelled.
The patient was advised a higher dose stimulation with recombinant FSH 250IU, followed by ICSI. However, this time also, there was no follicular growth after seven days.
The R-FSH dosage was further increased to 300IU, resulting in multi-follicular development. Subsequently, egg collection was done, and ICSI was performed. This yielded ten good quality blastocysts.
However, mild ovarian hyperstimulation was present in the patient, and hence all embryos were frozen to avoid ovarian hyperstimulation syndrome. The patient recovered very well after the procedure.
Frozen embryo transfer was done with two blastocysts, and the pregnancy test was positive with DCDA twins. However, this pregnancy, unfortunately, resulted in a spontaneous miscarriage in the 5th month.
The couple again had frozen embryo implantation done in the uterus, and this resulted in a healthy live birth of a single baby towards the end of the 9th month.
Understanding IUI & ICSI Procedures
Intrauterine insemination (IUI), also referred to as Artificial Insemination, is the first line of infertility treatment. In IUI, the doctor transfers specially washed and high-quality semen directly into the uterus, via a thin catheter, during ovulation. This line of treatment is ideal for sperm motility, and morphology issues as the IUI procedure bypasses the need for sperms to travel inside the uterus to meet the egg and fertilize the same. As the cost for IUI is much lesser as compared to IVF, people with unexplained infertility try out IUI initially.
Intracytoplasmic Sperm Injection (ICSI) is a superior micromanipulation in-vitro technique used in assisted reproductive technology. It is primarily used to address male sperm quantity or female egg quality issues resulting in infertility. In ICSI, a single sperm cell is directly injected by the embryologist into the cytoplasm of an egg in a specialized laboratory. The sperm is individually injected by the embryologist, using advanced reproductive techniques and instruments, bypassing the stage where the sperm must naturally penetrate the egg. This procedure helps overcome the limitations faced by unconventional IVF about poor egg or semen quality issues.
Understanding Ovarian Hyperstimulation syndrome and associated risks
Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. Usually, it impacts only women taking injectable hormone medications for follicular stimulation. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. Along with several other complications such as increased thirst, pain in the abdomen, it may also result in kidney damage, miscarriage, or may also be a risk to the life of the patient. So it is very much advised to be monitored by an expert fertility doctor.
Special Care that was taken by Dr. Swapna and the Nova IVF team at Vijayawada
This was a case of resistant polycystic ovaries not responding to many drugs, doses, injections, and surgery. Hence, during ICSI, increasing the dosage for follicular growth had to be done very carefully and gradually. Too much of the dosage may result in ovarian hyperstimulation syndrome, which sometimes can be life-threatening. Dr. Swapna and the team helped achieve follicular growth, and oocytes could be retrieved. ICSI subsequently resulted in very good quality blastocysts and a healthy live birth without causing ovarian hyperstimulation syndrome to the patient.