Subtotal $0.00
Dr. Suparna Bhattacharya
MBBS, DGO, TRAINED IN INFERTILITY Consultant
My Case:
Mrs MG 40 Yrs married for 8 years with primary infertility came to our clinic in December 22. She had a history of having been diagnosed with Papillary carcinoma of Thyroid in 2016. She underwent a thyroidectomy and was given radiotherapy .She was advised against pregnancy for two years.
She had regular normal menstruation flow of 3 days,normal BMI and was on Thyronorm 125mcg . Her vitals were stable and per abdomen examination was soft and nontender .On P/S examination –nothing abnormal was detected .Blood reports done showed her AMH was 1.25ng/ml and rest were within normal limits. Her first USG showed a normal uterus with a subserous fibroid of 2 cms on the anterior wall of uterus and AFC of 3-4 follicle in each ovary .Endometrial cavity (3D) showed an multiple endometrial polyps in mid cavity.
Husband was 43 yrs , non smoker with a history of Diabetes for 5yrs and on treatment. No previous semen analysis was done .He was asked do run some blood tests and a semen analysis was advised. Reports were EAG—278,HbA1c—11.3%,FBS-111,TSH-3.93.And he was unable to give a semen sample repeatedly with all measures .He was referred to an Endocrinologist who treated him for his uncontrolled sugars . After the endocrinologist gave a go ahead for the procedure he still could not give a semen sample .We ran his hormonal tests and planned him for a Trial TESA. Hormonal tests were normal and we got good sperms in trial TESA which were frozen.
Management:
She was counselled regarding her age , poor ovarian reserve, her past history and her husband’s situation. She was advised a self IVF which she agreed .We started stimulation for her in the next cycle with FSH 300 and LH 75 for 10 days in an antagonist protocol. She was given a dual trigger and 7 oocytes were retrieved which resulted in 5 blastocysts which were cryopreserved.
In the next cycle she was given her 1st Leuprolide depot 3.75 and underwent a Hysteroscopic Polypectomy with TBPCR testing which was normal. Her endometrium was prepared in the next cycle and 2 good blastocysts were transferred. Injectibles were used for luteal phase along with the vaginal medicines. Her beta HCG 10 days after transfer was 286 Miu/ml and the doubling report after 48 hrs was 599 Miu/ml. Her first sonography revealed a single live foetus with good cardiac activity at 6 weeks. She has been asked to follow up regarding her thyroid status after 2months of pregnancy with her Oncosurgeon.
To Summarise:
The patient was elderly with a past history of treated Papillary Carcinoma of Thyroid, a poor ovarian reserve with husband being Diabetic and unable to provide a semen sample . After transferring 2 good blastocycts she had in first sonography revealed a single live foetus with good cardiac activity at 6 weeks.
