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Mrs NC .34YRS married for 8 years with secondary infertility but no living issues(previous
biochemical pregnancy with self ivf and a failed cycle with ovum donation in another centre)came to
our clinic. She had a normal BMI and a previous Laparoscopy done to remove bilateral chocolate
cysts and underwent adhesiolysis.Her vitals were stable and per abdomen examination was soft and
nontender .On P/S examination –a hypertrophied cervix with severe erosion (she gave a history of
spotting and severe white discharge post transfer in previous cycles).Her first USG showed an
adenomyotic uterus with recurrent bilateral endometrioma and nil antral follicle count .Her AMH
level was 0.32 ng/ml and husband’s semen analysis was normal.
Management—She was counselled regarding adenomyosis and recurrent endometriomas and the
following treatmen options were given 1)ovum donation 2)self IVF .She agreed for ovum donation
and did not wish for self IVF .From the next cycle she was given her 1 st leuprolide depot 3.75 and
underwent a hysteroscopic evaluation of her uterus with TBPCR testing and a PAP smear with HPV
DNA was done.After all the reports came normal a donor was recruited for her and the embryos
were frozen.She was given 2 more dose of injection Leuprolide 3.75 at a monthly interval and
subsequently treated for cervical erosion.a month after her 3 rd depot her endometrium was
prepared and 2 good blastocysts were transferred and injectibles were used for luteal phase support
avoiding the vaginal medicines.Her hcg 10 days after transfer was 590Miu/ml. The patient had an
uneventful pregnancy and delivered a 3.01kg baby boy by LUCS.
To summarise—The patient had severe adenomyosis with grade 4 endometriosis with husband “s
reports normal.She had a poor ovarian reserve ,and with previous failed own and donor
cyclesheopted for donor cycle again.After transferring 2 good blastocycts she had an uneventful
pregnancyand delivered a 3.01kg baby boy by LUCS.
