March 27, 2018
Fertility & Pregnancy
Recently, I had the opportunity to help a couple in their late 30s conceive and carry a baby to term; the wife was 37 and the husband was 38, and they had been married for 6 years. 3 years prior, they had managed to conceive but the pregnancy had sadly ended in miscarriage in the second month. They had been trying for a baby ever since and had undergone extensive testing and 4 cycles of intrauterine insemination (IUI), all of which had proved unsuccessful.
Despite having tried for six years, no treatment had helped S and R so far, and they were devastated that they had already lost so much time. After conducting a preliminary work-up, I noticed that S’s egg reserve was very low, and she also had a tubal blockage. I advised the couple in vitro fertilisation in view of these factors. Understandably, they were worried about the possibility of another miscarriage. I assured them that we had enough alternatives; we could always layer IVF with other state-of-the-art technologies, should the need arise. After contemplating the thought, they agreed.
We began by starting a medication plan to help S respond better to IVF treatment because her egg reserve suggested a lower likelihood of being adequately stimulated through ovulation induction. When the IVF cycle began, her response was poor and 5 days of injections later, she had developed only one follicle. S and R were crushed that even IVF hadn’t borne the fruit they so desperately wanted. However, I had another treatment plan in mind that I felt could elicit the outcome we were after. I counselled S and R, and gave them confidence that we would try with a different protocol after a gap of 1 or 2 months.
This time, I tailored an IVF protocol keeping S’s history in mind. I performed a blastocyst culture to improve the results, and we ended up with 4 good to moderate quality blastocysts. S had responded well. We went ahead with the transfer of 2 blastocysts, but when we checked for a pregnancy two weeks later, we found that the procedure had failed. No matter; we decided to dip into the frozen embryo reserve that we had. However, even after one frozen embryo transfer, there was still no good news. The commonest cause of pregnancy failure and early miscarriage is chromosomal aneuploidy in the embryo, a condition where the embryo has an abnormal number of chromosomes (the normal chromosomal count is 46). Embryos with abnormal chromosomes fail to implant, and often, even implanted embryos lead to miscarriage.
Since the reason for the recurrent failed embryo transfers was not known yet, we decided to go ahead with pregenetic screening (PGS) to reduce the chance of miscarriage and to give the final embryo a fair chance of live birth. After conducting PGS, we found that the last embryo showed a normal chromosomal count. The transfer was successful and today, S and R are 24 weeks into their pregnancy.
Dr Uma Maheshwari
JP Nagar, Bellandur