Case study 6 – Infertility, Hyperthyroidism (Thyrotoxicosis), Poor Ovarian Reserve, Low Body Weight Azoospermia and Finally Pregnancy

Dr. Suparna Bhattacharya
MBBS, DGO, TRAINED IN INFERTILITY Consultant

My Case:

Mrs PSR 33YRS married for 5 years with Primary infertility came to our clinic after trying naturally for 2 years. Post-marriage she was diagnosed with thyrotoxicosis for which she underwent treatment with radioactive iodine. She was advised to try for pregnancy after one year. She had irregular menstruation and was on thyroid medicine  88mcg.

On general examination, she had exophthalmos, weight -29.6kg, Height –140cms, BMI -15. Her vitals were stable and per abdomen examination were soft and nontender. On P/S examination –nothing abnormal was detected. Her first USG showed a normal uterus with 4-5 antral follicle counts in both ovaries. Her AMH level was 1.32 ng/ml along with raised antithyroid antibodies (ATPO/ATG), her HSG report showed patent tubes and her husband’s semen analysis showed azoospermia.

She was advised to follow up with an Endocrinologist regarding her thyroid status and her husband was asked to run the hormonal tests and prepared for Trial TESA. The hormonal reports for her husband came out normal but we did not get any sperms during TESA.

Management:

The couple was counseled regarding further options like Micro TESE for the husband after a few months of injections and medicines but he refused and gave consent to proceed with a sperm donor. The following treatment options were given 1) IUI with donor sperm and 2) self-IVF with donor sperm.

She agreed to the first option and went in for 2 cycles of IUI which were not successful.

We then went in for an IVF with donor sperm for her. She was given injections for 10 days in an Antagonist protocol. We got 6 oocytes out of which 3 blastocysts were frozen, each in a single crypto, with the intention of planning a single embryo transfer for her.

From the next cycle her endometrium was prepared and a single blastocyst was transferred and injectibles were used for luteal phase support along with the vaginal medicines. Her hcg 10 days after transfer was 35Miu/ml. She had a biochemical pregnancy. In the next cycle, she was given her 1st leuprolide depot 3.75 and underwent a Hysteroscopic evaluation of her uterus with TBPCR testing done. After all the reports came normal.

Her endometrium was prepared and this time 2 blastocysts were transferred keeping in mind the chances of having twins also a plan was in place with the Obstetrician to manage in case a twin pregnancy happened. The Endocrinologist was also a constant part of the team during treatment. Injectibles were used for luteal phase support along with vaginal medicines. Her hcg 10 days after transfer was 155Miu/ml which doubled after 48hrs. Her first USG showed a single live fetus at 6 weeks.

The patient had an uneventful pregnancy but was unable to carry after 8 months on account of the increased size of the abdomen, and difficulty in moving around, and delivered prematurely a 2.2 kg baby girl by LUCS.

To Summarise:

The patient had a history of Thyrotoxicosis treated with radioactive iodine with their husband “s reports showing azoospermia. She had a poor ovarian reserve and previous failed IUI cycles with donor sperm. After transferring 2 good blastocysts she had an uneventful pregnancy and delivered a 2.2 kg baby girl by LUCS prematurely.

About Me

Dr. Suparna Bhattacharya, has joined as a Consultant at Nova IVF Fertility, Kolkata.

Working Hours

Mon - Fri: 8.00 am - 6.00 pmSaturday: 10.00 am - 3.00 pmSunday: Appointment Only

Contacts

Phone: +91 98306 95240Nova IVF Fertility CenterCentral Business District, Before, 3B, Uttam Kumar Sarani, Kolkata, West Bengal 700017Get Directions