我们介绍了一名42岁(gravida2,流产2(G2A2))不孕妇女的情况,该妇女与丈夫(42岁)一起去了不孕症诊所。她已经结婚八年了,在此期间两次堕胎。第二次流产后,在她的家乡医院进行了扩张和刮宫(D&C)。这是继发性不孕症。来我们中心之前,她参观了另一个不孕症治疗中心,体外受精(IVF)是用自体卵母细胞完成的,但未进行卵胞浆内单精子注射(ICSI).不幸的是,治疗没有成功。在宫腔镜检查中,在腔中发现粘连,这可能是由于过去堕胎执行的D&C程序而形成的。这种情况被称为Asherman综合征。因此,2021年1月20日进行了宫腔粘连松解术。她的最新报告显示抗苗勒管激素(AMH)值为0.252ng/dL,这是非常低的。低AMH指示低卵巢储备。她的促卵泡激素(FSH)为23mIU/mL,太高了,暗示鸡蛋质量差。通过经阴道超声评估窦卵泡计数;总计数为三(右边一个,和两个在左边)。橄榄采摘于2021年3月15日完成。仅从患者中取出一个卵母细胞(MI级)。丈夫的精子数量为1200万/毫升,活力低,这被称为少弱精子症;因此,进行ICSI。然而,胚胎无法形成。因此,2021年4月1日,从捐献者中回收了卵母细胞,ICSI是使用丈夫的精液样本完成的。2021年4月6日,将第六天的两个胚胎转移到患者的子宫中。胚胎移植前,每天三次服用片剂雌激素2mg。这是从月经的第二天开始直到第14天。14天后,患者每天注射黄体酮6天.胚胎移植后,每天三次服用片剂雌激素2毫克,和片剂黄体酮2mg每日两次作为支持。胚胎移植14天后,进行了β-人绒毛膜促性腺激素(βhCG)测试。她的βhCG阳性,这对夫妇很高兴。诊断挑战是由于以前的流产而发生的,先前的试管婴儿失败,甲状腺功能减退症病史,AMH值为0.252ng/dL,和粘连的存在。这是一例继发性不孕,具有低AMH和低窦卵泡计数的腔粘连。结果在我们的生育诊所是有利的。因为病人是已知的甲状腺功能减退症,左甲状腺素片也被处方。
We present the
case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done at her hometown hospital. This is a
case of secondary infertility. Before coming to our center, she visited another center for infertility treatment, where in vitro fertilization (IVF) was done using self-oocyte, but intracytoplasmic sperm injection (ICSI) was not done. Unfortunately, the treatment did not succeed. On hysteroscopy, adhesions were found in the cavity, which were possibly formed due to the D&C procedure performed for past abortions. This condition is known as Asherman\'s syndrome. Hence, hystero-adhesiolysis was done on January 20, 2021. Her latest report showed an anti-Mullerian hormone (AMH) value of 0.252 ng/dL, which was very low. Low AMH was indicative of low ovarian reserve. Her follicle-stimulating hormone (FSH) was 23 mIU/mL, which was too high, suggestive of poor egg quality. The antral follicular count was assessed through transvaginal ultrasound; the total count was three (one on the right, and two on the left). Ovum pick-up was done on March 15, 2021. Only one oocyte was retrieved from the patient (MI grade). The husband\'s sperm count was 12 million/mL with low motility, which is known as oligoasthenozoospermia; hence, ICSI was performed. However, the embryo could not be formed. Therefore, on April 1, 2021, oocytes were retrieved from the donor, and ICSI was done using the semen sample of the husband. On April 6, 2021, two embryos at the day six stage were transferred to the patient\'s uterus. Before the embryo transfer, tablet estrogen 2 mg was administered thrice daily. This was started from day two of menses till day 14th. After 14 days, the patient was given a progesterone injection for six days daily. After embryo transfer, tablet estrogen 2 mg was given thrice daily, and tablet progesterone 2 mg twice daily was given as support. After 14 days of embryo transfer, a beta-human chorionic gonadotrophic hormone (βhCG) test was done. Her βhCG was positive, and the couple was delighted. Diagnostic challenges occurred due to previous abortions, previous failure of IVF, history of hypothyroidism, AMH value of 0.252 ng/dL, and presence of adhesions. This is a
case of secondary infertility with cavity adhesions with low AMH and low antral follicular count. The outcome was favorable at our fertility clinic. Because the patient is a known
case of hypothyroidism, levothyroxine tablets were also prescribed.