Think outside the box!
Updated: Oct 8, 2021
Mrs. A, 31yr old doctor, has been trying to conceive for the past 2 years. Multiple ovulation induction/timed intercourse cycles have failed and an IUI (Intrauterine Insemination) failed. HSG/tube test and husband’s semen analysis came out normal.
After one month of follicular study (ultrasound is done every 3-4 days to track ovulation). I noticed her endometrium was not growing beyond 5mm (at least 7mm is required to sustain a healthy pregnancy) and ovulation was not happening.
We planned another cycle of IUI with different medicines compared to what was given to her by her previous infertility center which resulted in the same outcome. Then, I recommended her for genetic testing to know the root cause of infertility.
Hysteroscopy was advised to look for any infections which were causing thin endometrium and it revealed severe infection (chronic endometritis). The adhesions and fibrosis in the endometrium were cleared in the same sitting and the patient was put on strong antibiotics to treat the infection.
Genetic testing was positive for genes causing poor response and pregnancy loss.
Chronic endometritis is a chronic inflammation of the endometrium (lining of the womb).
10-15% of women have a low-grade infection caused by a pathogen and most women won’t have any symptoms. It can cause infertility, recurrent implantation failure (IVF failures), recurrent pregnancy loss (multiple abortions). In cases with infections, antibiotics improve the success rate of getting pregnant as well as continuing the pregnancy till the term.
In the next cycle after hysteroscopy, hormonal injections were given to induce more follicles to grow. We tracked her ovulation and IUI (Intrauterine Insemination) was done accordingly. Tablets and injections were given after the IUI to support pregnancy in view of the risk for pregnancy loss. 15 days later, Serum Beta HCG is 1600!!! Strongly positive for pregnancy! An ultrasound, later on, showed a single live baby!!!
Sometimes, it takes time to identify the reason for infertility. Additional testing may help to identify the right diagnosis and helps to plan for the proper treatment. Infertility treatments are never the same as every patient’s need for treatment is different. Sometimes, we must think outside the box to get the results. Patients' cooperation and trust help the doctor to perform better and guide them to success.
Forever thankful to our wonderful patients for making us part of their successful journey towards parenthood!!