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Pregnancy in a case of adenomyosis and multiple fibroids!

Couple History of Infertility

  • Mrs. ST and Mr.BD, 35 and 40 years old respectively, presented as a case of primary Infertility.
  • There was a history of failed AID ( IUI with donor sperms)- 3 cycles outside.
  • Mrs. ST had undergone laparoscopy myomectomy with endometriotic cyst excision.

Investigations

  • AMH :3.9
  • Semen analysis: Azoospermia
  • USG: Adenomyotic uterus, adherent, high ovaries, low antral follicular count
  • Hysteroscopy: normal cavity.

Impresssion

  • Azoospermia, adenomyosis, endometriosis
  • Couple was advised self ICSI. Option of embryo donation was also discussed in view of adherent ovaries, endometriosis, low AFC on scan and anticipated difficult egg retrieval.
  • Couple opted for embryo donation.

IVF cycle

  • During Embryo donation cycle, three day 3 embryos were transferred after laser assisted hatching. Beta Hcg done 15 days post transfer was positive. However after initial rise in value, beta HCG dropped resulting in biochemical pregnancy loss.
  • Second embryo donation cycle was done later which resulted in failure.
    Patient underwent laproscopic myomectomy with adenomyoma excision , esxcision of endometriotic spots and adhesinolysis later. After surgery hormonal injections were given for 2 cycles for disease suppression.
  • Third cycle of Embryo donation was done later with transfer of three blastocysts.

Positive Outcome

  • Beta Hcg done 15 days later was positive and doubled well. Scan done at 6weeks showed twin live pregnancy.