Case Report on Early Pelvic Endometriosis and Infertility
A 36-year old woman “Vibha” and her husband “Sumit” came down to my clinic when they faced troubles conceiving again after their first child. The couples had been in the same situation before their first child. Vibha underwent laparoscopy when diagnosed with Stage 1 endometriosis. Also, she had normal ovulation, good functioning uterus and open fallopian tubes. Her husband had normal sperm parameters and after 1 year of timed intercourse, they were administered with Clomiphene citrate followed by intrauterine insemination. Luckily, they had a successful conception in third cycle of IUI and became happy parents of a healthy baby girl. Thereupon, when the couple decided to have another baby, they failed after three additional IUI attempts along with gonadotrophins for ovarian stimulation. At this point, they headed towards a consultation with me at my clinic – International Fertility Centre – located in New Delhi for IVF.
Besides Vibha having endometriosis, her evaluation showed no complications for IVF. She was tested for immunologic implantation dysfunction (IID) which showed negative results, this means she had no existing NKa (natural killer cells) and antiphospholipid antibodies (APA). Also her basal FSH and AMH testing indicated a normal ovarian reserve.
I advised her to go for an IVF treatment using a long pituitary down-regulation protocol and triggered her with hCG. A good amount of 14 fully mature eggs were aspirated from her ovaries and 11 eggs were fertilized through Intracytoplasmic Sperm Injection (ICSI). A total of 6 blastocysts were developed and 2 blastocysts were placed in her uterus and the leftover blastocysts were vitrified and banked for further use. Fortunately, she achieved a successful twin pregnancy and gave birth to two healthy full term male babies.
As you have read above, Vibha has stage 1 endometriosis with no indication of pelvic adhesions, ovarian endometriomas or immunologic implantation dysfunction (IID), the cause behind primary and secondary infertility may have been probably because of harmful pelvic environment. Let’s read further on why this happened:
‘Endometriosis one of the common factors leading to unexplained infertility and also causes “secondary infertility”. Women with normal ovulation and mild endometriosis and those having fertile male partners have unlikely lesser chances of improving pregnancy potential after undergoing IUI, ovarian stimulation by fertility medications and surgery.
Therefore, IVF is the best option to avoid toxic pelvic environment that affects the possibilities of eggs being implanted successfully.
It was just a matter of luck for Vibha that she conceived in the first time. She had a successful IVF twin pregnancy since her eggs were extracted right before ovulation. Also, her eggs were stored in conditions that prevented contacted with prior mentioned endometriosis-related toxins (found in pelvic secretions of women with endometriosis that is responsible for reducing fertility potential by 4-6 fold).
Women who have been treated with IUI, surgery to remove evident deposits without any treatment given have the same pregnancy rate.
Hence, only through IVF can help improve pregnancy chances and if any immunologic impediment due to activated natural killer (NKa) cells occurs, it can be cured by following selective immunotherapy with intralipid (IL)/IVIG and steroids.
Women having mild endometriosis are asked to repeat the treatment again since it worked before. They should be rather skeptical and reconsider their decision.
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