Dr. Suparna Bhattacharya
MBBS, DGO, TRAINED IN INFERTILITY Consultant
Mrs. PG 32YRS married for 8 years with primary infertility but no living issues came to our clinic. She had a normal BMI and a previous history of Koch”s for which received treatment outside for 9 months Her history also revealed that she was diagnosed 5 years ago with SLE according to the American College of Rheumatology criteria. For SLE she was daily treated with low-dose corticosteroids.HSG done (outside) on the patient showed a bilateral tubal block.
Her vitals were stable, with her blood pressure being normal. Her per abdomen examination was soft and non-tender On P/S examination –the cervix was normal. Her first USG showed a normal uterus with B/L ovaries normal and B/L 5-6 antral follicle count. Her AMH level was 0.72 ng/ml and her husband’s semen analysis was normal.
She was counseled regarding bilateral tubal block, poor ovarian reserve, and SLE systemic lupus erythematosus, and an IVF treatment option was given.
Systemic lupus erythematosus (SLE) is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies, and is associated with antiphospholipid syndrome (APS). Patients with SLE have a poor prognosis of pregnancy since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, preeclampsia, intrauterine growth restriction, fetal death, and preterm delivery.
She agreed to self-IVF. After going through the requisite blood tests, fitness from her physician, and after a PAC we started a mild stimulation for her in an antagonist cycle with letrozole to keep the estradiol level low. She was given an agonist trigger and all embryos were frozen to avoid ovarian hyperstimulation. We got 11oocytes from her which resulted in 2 good blastocysts.
She was prepared for frozen transfer in a natural cycle. After taking proper precautions with LMWH and ecosprin from the day1 of the period. Her endometrial lining was prepared and when the lining was more than 8mm, triple line with good blood flow and with proper progesterone reports a single embryo transfer was done keeping in mind the pregnancy complications in SLE .
Her Hcg report after 10 days was 286Miu/ml. The values doubled after 48hours and is waiting for scan after 2 weeks.
This case report indicates that in assisted reproductive technology conception on patient with controlled SLE without hypertension may evolve without complications under adequate anticoagulant, immunosuppressant, and subsequent proper antenatal care.