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INFERTILITY

1. Introduction: (i) Couple married for 10 years. No history of infertility in both partners’ family
2. Female Partner:(i) Female partner’s age 35yrs
(ii) Normal menstruation period observed (28 – 30 days)
(iii) Not diabetic
(iv) Mild Obesity
(v) Laparoscopy done on May 2002 and March 2008. Observations made in May 2002 is Endometriosis Grade – I. Taken Bromocryptine for 4-5months, thereafter. Observation made on Mar 2008 cycle, the size of fibroid is 34 X 36mm at the ant-wall of uterus. No adhesive, no endometrosys p.O.D clear. Both tubes and ovaries normal.
(vi) Detected Elisa for TB during the test conducted in June 04 and taken refamicyn for six months. Thereafter, PCR of endometrium carried out and found PCR negative.
(vii) Hystroscope done on 07 May 04. No abnormality found.
(viii) Harmonal test reports carried out as on Nov 08
(a)TSH 1.35µIU/mL (b) LH 4.93 (D3) µIU/mL
(c) FSH 5.04 µIU/mL (d)Prolactin (ng/ml)2.39
(e) Estradiol (pg/ml) 55.9 (f) Anti-Toxoplasma(IgM) 0.11
(g) HIV 1+2 (index) 0.06 (h) HBs Ag (index) 0.04
(i) Anti-HCV antibody (index) 0.24
(j) Anti-Rubella (IgG) 141 (k) Anti rubella(IgM) 0.25
(ix) VDRL Test  Non Reactive
(x) Hemoglobin  10.5gm (72.5%) (100%=14.5%)
(xi) TVS report of the pelvis as on Nov 08
(a) TVS of the pelvis shows the following:-
I. uterus is bulky.
II. Two subserous fibroids measuring 5.44cm X 5.87 cm (ant-wall), 0.95cm X 1.28cm (post wall) and four intramural fibroids measuring 1.05cms X 1.32cms, 0.62cms X 0.87cms (both in post wall), 1.39cms X 1.61cms (fundus) and 1.19cmsX1.36cms (ant-wall) are seen.
III. Endometrium measures 5.0mm in thickness
IV. Cavity is clear.
V. Right overy measures 5.54cms cubes in volume and contains 8 antral follicles
VI. Left overy measures 6.70cms cube in volume and contains 10 antral follicles.
VII. Both overies appear polycystic. Tubes are not visualized.
VIII. No free fluid or S.O.L. is seen on P.O.D
IX. On doctor’s study of uterine artery R.I-0.58, P.I-1.01 and Vs-16.11cm/s
[COLOR="red"][B][I][U]IMP: Fibroid Uterus /Polycystic Ovaries[/U][/I][/B][/COLOR]3. Male Partner: Age: 38yrs HIV 1+2 (index) 0.07
HBs Ag (index) 0.03
Anti-HCV antibody (index) 0.22
Hemoglobin 13.5gm
Semen Analyis: Liquefsction  satisfactory
Blad  Nil
Sperm count  20million/ml
Motility  20%
Actively Motile 15%
Morphology  32% mature forms
Other features: Roundcell +
Grade of linear movement  good
RBC  nil
WBC  7-8 1.h.p.f
Functional Assesment: Hypoosmotic swelling test: Satisfactory
Nuclear chromatin decondensition text  satisfactory

Treatment during Jul 03 – Mar 09:

(i) IUI – 7 times
(ii) IVF – 3times (ICSI – 1 time)
(iii) ET(with the help of donor’s egg) – 1 time.

NB: Last IVF carried out on Feb –Mar 09 cycle.

[B][I][U][COLOR="Red"]Final Conclusion :But never conceived yet[/COLOR][/U][/I][/B]



[B][I][U]Requested for the possible problem with solution and place where the medical facilities are available in India[/U][/I][/B]





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