Case Study

menopauseMrs H 36 years , married since 12 years came with history of amenorrhoea (absent menses ) since 5 years. She had a long list of treatments done so far almost 8 years. Initially she was treated with oral medications for 4-5 years Subsequently she had undergone a laparoscopy procedure to check the uterus and fallopian tubes which was normal.

2cycles of Intrauterine insemination were also done (IUI is placement of good motile sperms after processing into the uterus at the time of ovulation ). Since past 5 years, the periods had been highly irregular and had completely stopped since last 3 years. Hailing from a middle class family with both husband and wife working, she felt completely devastated as she got no answers medically .

She was referred to Aarush IVF and Endoscopy Centre by her friend. On examination her hormones , FSH and LH were very high , almost in the post menopausal range. Her uterus was half the normal size 4cms x3.5cms x 3.2cms. She was diagnosed as premature ovarian failure, (condition in which the ovary fails to function and form eggs , leading to cessation of menses )

She underwent blood investigations and thereafter was put on cyclical estrogen and progesterone treatment for 5 months, during which there was marked improvement of uterine size to 6 cmx4cms x3.5 cms and also she started getting regular menses.

She underwent a treatment of donor egg cycle (where eggs are retrieved from an unknown donor female and fertilized with husband’s sperm).

She is now happy with 2 children she conceived by the treatment.

Mrs Surekha a 30 year old lady MS 6 years, suffered from irregular menses right from the onset of menstrual cycles. Time and again she had taken pills for regularization from 5-6 different doctors. She was totally frustrated with the superimposed problem of infertility.

She had a weight gain of 8 kgs post her marriage. Although her diet was limited she failed in her attempts for weight loss. The couple lived in a joint family and she used to perform all the household chores. Her husband was understanding and did accompany her for all her doctors visits, but in the family she did face the pressure of not able to conceive; all the more as husband’s semen tests were absolutely normal.

pcos-labeled

She had taken few cycles of Clomifene (tablets for Ovulation induction ) but these also failed to give her egg development , let alone pregnancy.

She came over for consultation at Aarush IVF and endoscopy Centre.

Her examination confirmed the diagnosis of Polycystic Ovarian Syndrome, in which basically there is a genetic defect , which coupled with lifestyle and obesity, lead to defective insulin action. The resultant is raised Insulin levels as well as blood sugars ,also there is conversion of female dominant hormones (estrogen) to male dominant hormones (testosterone) resulting in menstrual irregularity, increased hair growth with male pattern and ovaries showing typical cystic pattern.

She was advised hormonal screen. Correction of hormonal issues was done for 2 months. Also she underwent counseling by dietician who provided valuable tips of weight reduction.

After 2 months she underwent a cycle of ovarian stimulation (formation of eggs ) with injections. After about 18 doses , it lead to development of single follicle. Injection hCG was given. An IUI was done on follicular rupture which then lead to a single pregnancy diagnosed 15 days later.

She is now settled happily with her family and also having got a true insight into the disease keeps her weight in check and leads a fitter life.

Thus a resistant case of ovarian stimulation was treated with good cycle planning.

low-spermMr and Mrs Bagul were married since 7 years , their ages being 35and 32 years respectively. Mr Bagul had a high profile job which involved pleanty of travelling. He was a nonsmoker and would consume alcohol at social events only .Diagnosed with High blood pressure since 2 years, he was on medications for the same. The couple had been trying for conception since past 4 years seeking medical intervention.

All tests done for Mrs Bagul were normal and she had regular menses whereas Mr Bagul had sperm count of 7 M/ml (Normal is 15M/ml) with motility at 20%.

He was clinically evaluated, blood tests with hormonal screen was done.

Lifestyle modifications like healthy diet, exercise, minimal use of mobile and laptop close to body, were advised. He was put on medications for the low counts

The couple was given 2 cycles of IUI where wife received injections for ovarian stimulation.

Few of the advantages of doing IUI at Aarush IVF and Endoscopy Centre :

Monitoring of the female partner with follicular study done by doctors themselves and there is no need to go to the sonologists elsewhere. Also semen sample processing and insemination in the uterus is all done at the centre, so precious time is not lost in transportation of semen sample.

Availability of density gradient method for processing semen sample which is superior technique for IUI.

Necessary intervention in terms of any medications is done based on the ovarian response during the cycle.

Separate Semen collection room at the centre with vibrator in cases of difficulty in giving sample.

Mrs Bagul persisted in her treatment and eventually conceived in the 2nd cycle of IUI.

The family has now moved to another city and has realized the importance of healthy lifestyle and continues to maintain it.

Mr and Mrs Borkar were Married since 12 years and had no children . Husband was a rickshaw driver and wife a homemaker. Restricted by the financial situation, they tried treatment with medications from various doctors. Most of the time medications included pills and a ultrasound and semen analysis was done which was said to be normal.

When they consulted at Aarush IVF and Endoscopy Centre, they were advised initial tests after which a Hysteroscopy and Laparoscopy of the wife was suggested.

Being an operative procedure , they had a lot of family discussions . The need of the procedure , the risks , the finances spent on it was all debated . Fortunately they were ready with all the answers due to the thorough counseling by the doctors.

In the procedure she was diagnosed to have both fallopian tube blockage. Opening up of the tube by cannulation was tried but it was unsuccessful.

She was then advised test tube baby treatment . After a gap of 3-4 months , they finally managed to garner the fundus for the treatment . An ICSI cycle was done in which she conceived in first attempt.

She delivered at Palghar hospital and has a bonny baby now.

She is relieved that she could overcome the misconceptions about IVF and fear of spending on the treatment given its uncertainty.

Mr V was a dynamic 35 year old male Married since 5 years now was diagnosed as a case of Azoospermia, that is absent sperms in semen . He had done this test from multiple labs and everytime it was the same result. There was no problem in intercourse and he did not have any past medical or surgical illnesess. He felt reluctant to discuss the issue and he felt desolate at times and was tempted to try

He was given medications by his family doctor but when the couple visited their local gynecologist, she referred them to Aarush IVF and Endoscopy Centre for further evaluation.

Husband was examined and physically he was found to be normal . There was proper hair growth (androgenisation ) and development of male genitals. The testes were normal in size but the cord (vas ) was absent on both sides . His condition was diagnosed as Congenital Bilateral Absence of Vas Deferens (CBAVD).

He was suggested hormonal tests and other routine tests as a part of fertility workup . At the same time Mrs V was recommended investigations.

A test tube baby procedure with surgical sperm retrieval , that means, sperms are obtained from the upper pole of testis called the epididymis . These were used for fertilizing the wife’s eggs and the embryo so formed was placed inside the womb (uterus).She conceived with this treatment.