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Patient Information:

Name: Mrs. MT

Age: 28

Marital Status: Married for 4 years

Obstetric History: 2 miscarriages

Clinical Presentation:

Mrs. MT presented with a history of infertility and recurrent miscarriages. Despite previous evaluations at three different hospitals, which reported normal findings, a detailed examination was warranted.

Diagnostic Workup:

A basic infertility workup was conducted, including a 3D ultrasound scan. The 3D scan revealed a partial uterine septum, a structural anomaly that can contribute to infertility and recurrent miscarriages.

Explanation to the Patient:

The diagnosis and its implications were explained to Mrs. MT and her family. Initially, there was disbelief as previous assessments at other hospitals did not detect the septum. It was emphasized that a 3D scan is crucial for accurate diagnosis in such cases.

Treatment:

A hysteroscopy followed by septum resection was performed to correct the uterine anomaly. This minimally invasive surgical procedure aims to restore the normal anatomy of the uterus.

Postoperative Course:

Mrs. MT was advised to allow a healing period of 2 months before attempting natural conception.

Outcome:

Three months after resuming natural conception attempts, Mrs. MT became pregnant. She successfully carried the pregnancy to term, delivering a healthy baby at 9 months. Two years later, she gave birth to another healthy child, further highlighting the success of the intervention.

Conclusion:

This case underscores the importance of advanced diagnostic techniques like 3D ultrasound in identifying uterine abnormalities that might be missed in standard evaluations. The successful hysteroscopy surgical correction of the uterine septum resulted in the resolution of the patient's infertility and recurrent miscarriages, leading to successful full-term pregnancies and a happy family

Patient Information:

Age: 34 years Mrs KS

Marital Status: Married for 14 years

Medical History: Known case of Polycystic Ovary Syndrome (PCOS)

Previous Treatments:

6 Ovulation Inductions

1 Intrauterine Insemination (IUI)

1 In Vitro Fertilization (IVF) attempt

All previous treatments were unsuccessful

Clinical Findings:

Oocyte Yield: Only 6 oocytes retrieved in previous IVF cycle, which is low for a patient with PCOS.

Intervention:

Genomic Evaluation:

Test Used: GeneFemina

Findings: Identified an issue with the Luteinizing Hormone (LH) receptor.

IVF Cycle Based on Genomic Results:

Treatment Modification: Additional dose of recombinant LH injection administered.

Outcomes :

Oocyte Retrieval: 16 mature oocytes retrieved.

Embryo Development: 8 embryos obtained and frozen.

Frozen Embryo Transfer (FET) :

Timing: Transfer performed in the following month.

Result: Positive pregnancy.

Delivery: Healthy baby weighing 2700 grams delivered at 39 weeks.

Conclusion :

The successful pregnancy was achieved by:

Identifying the low oocyte yield issue.

Arranging a genomic evaluation to pinpoint the LH receptor issue.

Administering the correct hormone at the appropriate dosage based on genomic findings.

Patient Information:

Name: Mrs GK

Age: 32

Clinical Presentation:

32 year old Mrs GK, having infrequent periods every 3 - 4 months, attended for fertility treatment. She already had 3 Ovulation Induction and 3 IUIs.

Procedure :

We counselled and proceeded with IVF. Obtained 36 oocytes, she developed OHSS and was treated too. Obtained 12 blastocysts. Initial 2 IVF cycles were unsuccessful

Genetic Testing :

Embryo biopsy was recommended. During the embryo biopsy, cells were removed from the blastocysts outer layer for genetic analysis. This step was essential given the previous unsuccessful IVF cycles.

Outcome :

By transferring genetically normal embryos identified through the biopsy, the third IVF cycle resulted in a successful pregnancy. Mrs. GK delivered a healthy baby at nine months.

IVF Cycle Based on Genomic Results:

Treatment Modification: Additional dose of recombinant LH injection administered.

Conclusion :

The implementation of embryo biopsy and subsequent genetic testing was instrumental in achieving a successful pregnancy for Mrs. GK after several failed fertility treatments. This approach maximised the likelihood of a positive outcome by ensuring only genetically healthy embryos were used for transfer.*

Patient Information:

Name: Mrs. UM

Age: 24 years

Condition : Turner Syndrome (45XO) - No ovarian reserve

Marital Status : Married, with spouse aware of and accepting her condition

Clinical Challenge :

Turner Syndrome often results in insufficient estrogen production, leading to difficulties in achieving a thick enough endometrial lining necessary for successful embryo implantation.

Treatment Strategy :

We did a trial HRT using Estrogen gel, tablet and growth hormone to make sure the lining is more than 7 mm and then proceeded with IVF with donor eggs and obtained 4 embryos.

Embryo Transfer :

First cycle was unfortunately unsuccessful and she conceived in second embryo transfer cycle. Went ahead and delivered a healthy baby at 34 weeks.

Key Points:

Endometrial Preparation:

Thorough and well-planned endometrial preparation is crucial for implantation success in Turner Syndrome patients.

The trial of HRT was done so that unnecessary IVF was not done

Conclusion :

The successful delivery of a healthy baby at 34 weeks underscores the importance of individualised treatment protocols and meticulous preparation, particularly in cases involving Turner Syndrome where inherent hormonal deficiencies pose significant challenges

Patient Information:

Name: AM

Age: 29 year-old female

Marital Status: Married for 2 years

Conceive History: Trying to conceive for 1 year

Clinical Presentation:

Mrs AM attended clinic distressed after being diagnosed with an endometrioma in the left ovary. She was Suggested laparoscopy and excision of the endometrioma followed by IVF

Pelvic Scan was done :

Right ovary normal, left ovary filled with an endometrioma.

Counseling and Decision :

it was essential to alleviate her distress by providing clear information on the condition and the treatment options. Explained the benefits of removing the endometrioma; she agreed to proceed with laparoscopy.

Treatment Strategy :

We did a trial HRT using Estrogen gel, tablet and growth hormone to make sure the lining is more than 7 mm and then proceeded with IVF with donor eggs and obtained 4 embryos.

At laparoscopy, a detailed review of the pelvis revealed that only the left ovary had an endometrioma while the rest of the pelvis was normal. A careful excision of the endometrioma was performed, confirming tubal patency and maintaining the tube-ovarian relationship.

Surgical excision of the endometrioma can preserve ovarian function and enhance natural fertility. Ensuring tubal patency and maintaining the tube-ovarian relationship is crucial in fertility management

The patient was advised to review after 3 months to plan pregnancy. She successfully conceived naturally within this period and delivered a healthy baby at term, underscoring the potential for pregnancy without immediate recourse to IVF.

Conclusion :

With appropriate laparoscopic intervention and counseling, women with endometriomas can achieve natural conception and successful pregnancy outcomes