Evaluation of Uterine Cavity Abnormality using Saline Infusion Sonohysterography Before In Vitro Fertilization

BACKGROUND: Some studies suggested that saline infusion sonohysterography (SIS) has been used to detect uterine cavity abnormalities before in vitro fertilization (IVF) cycles to improve treatment success rates and decrease the number of cycle cancellations and embryo implantation failures. Some of the factors contributing to the dissemination and acceptance of the technique include the fact that it is a simple, less painful, less expensive, less invasive, and well-tolerated procedure when compared to hysteroscopy. AIM: The aim of the study is to evaluate uterine cavity abnormality with SIS performed before IVF. METHODS: A descriptive retrospective study involving 551 female partners who had SIS before IVF/ICSI treatment at private Halim Fertility Center from January 2014 until December 2017. Five hundred and fifty-one infertile woman was included in this study before IVF/ICSI cycles. Patients agreed to have an ultrasound assessment of the uterine cavity with the use of saline as the contrast medium. SIS procedure was scheduled postmenstrual period in the early-mid follicular phase and 1-3 months before starting IVF/ICSI treatment. RESULTS: From 551 patients, we found 527 (94.4%) cases with the normal uterine cavity. The uterine cavity abnormalities were detected in 5.56% of cases included in this study (28 (5.02%) cases with endometrial polyps, two (0.36%) cases with intrauterine adhesions, and one (0.18%) case with Müllerian duct anomalies). CONCLUSION: SIS before IVF treatment could be a good option for evaluating uterus cavity before IVF to improve success rates of pregnancy.

Bilateral tubal incarceration into the broad ligaments caused by pelvic endometriosis: A case report

Introduction: Endometriosis is characterised by the presence of functional endometrial tissue outside the uterus. Salpinges are a common location of endometriotic implants. Endometriosis located into the broad ligament is a rare event. Case description: A 38-year-old infertile woman presented to our attention with moderate left iliac fossa pain after menses and intermenstrual bleeding. Transvaginal ultrasounds and pelvic magnetic resonance evidenced the presence of bilateral haematosalpinges. At the laparoscopic pelvic exploration, fallopian tubes were absent. Opening and dissecting the apical portion of the broad ligaments, we identified bilateral haematosalpinges incarcerated in the homolateral broad ligaments. We performed bilateral salpingectomy. Histological examination confirmed the presence of endometriosis. Conclusion: Care must be taken to the diagnostic assessment, counselling about the surgical programme before the intervention especially in patients during the reproductive period when the possibility of ablative surgery and subsequent need for an assisted reproductive technique exists.

Engineering sperm-binding IgG antibodies for the development of an effective nonhormonal female contraception

Many women risk unintended pregnancy because of medical contraindications or dissatisfaction with contraceptive methods, including real and perceived side effects associated with the use of exogenous hormones. We pursued direct vaginal delivery of sperm-binding monoclonal antibodies (mAbs) that can limit progressive sperm motility in the female reproductive tract as a strategy for effective nonhormonal contraception. Here, motivated by the greater agglutination potencies of polyvalent immunoglobulins but the bioprocessing ease and stability of immunoglobulin G (IgG), we engineered a panel of sperm-binding IgGs with 6 to 10 antigen-binding fragments (Fabs), isolated from a healthy immune-infertile woman against a unique surface antigen universally present on human sperm. These highly multivalent IgGs (HM-IgGs) were at least 10- to 16-fold more potent and faster at agglutinating sperm than the parent IgG while preserving the crystallizable fragment (Fc) of IgG that mediates trapping of individual spermatozoa in mucus. The increased potencies translated into effective (>99.9%) reduction of progressively motile sperm in the sheep vagina using as little as 33 μg of the 10-Fab HM-IgG. HM-IgGs were produced at comparable yields and had identical thermal stability to the parent IgG, with greater homogeneity. HM-IgGs represent not only promising biologics for nonhormonal contraception but also a promising platform for engineering potent multivalent mAbs for other biomedical applications.

A Successful ART Treatment of Advanced Maternal Age Pregnancy with HRT Along with Donor Oocytes: A Case Study at Wardha Test Tube Baby Centre

Introduction: This case report refers to 54 years old infertile woman who visit ACHARYA VINOBABHAVE RURAL HOSPITAL for her ARTHRITIS PROBLEM with her husband (age 61-year-old). During her treatment, she got to know about IVF/ART procedures. As she belongs to a rural area and is not so educated, she was not aware of this and start investigating it and found it interesting. After knowing about all these procedures, a new ray of hope was awakened in her that, she can also give birth to her baby after so much waiting and facing so much criticism by society as a barren woman. In the 36th week of gestation, one healthy baby girl has been delivered by Cesarean section. In this way, the faith between patient and doctor was built-up and inevitably, we can appreciate this case of postmenopausal gestation (Geriatric Pregnancy) As A Therapeutic Victory For Wardha Test Tube Baby Centre and for the patient as well. This infertile couple was not that financially strong and even this all procedure is too much unaffordable to them still after all these, their urge to having a baby is so high that, they invest financially as well as emotionally and also mother put her health in peril while going through IVF/ART procedure. Being an infertile woman, she has to face a lot, and in such conditions, women go through psychological torture, and from this depressive phase, many health issues arise. Main Symptoms and/or Important Clinical Findings: Menopausal woman, qualitative analysis of AMH show 0 ng/ml, means diminished ovarian reserve (DOR). The Main Diagnoses, Therapeutic Interventions, and Outcomes: The woman is pinpointed with primary infertility for 26 years. The couple suggested going for IVF/ICSI treatment with donor oocytes(frozen) and self-sperm sample, ICSI is performed and sequential embryo transfer is done and gets conceived in the first cycle of ART. As being a menopausal woman, the dose of oral intake of estrogen hormone tablets doubles as an HRT treatment. Conclusion: Intake of the double dose of estrogen orally (hormone replacement therapy, HRT) than the normal women whose age is not much and who is not menopausal, increases the endometrium thickness and its receptivity which helps the woman to conceive in the first cycle through ART.

Case Report on Hypothyroidism in Infertile Woman with IVF Conception

Introduction: Hypothyroidism affects 2–4% of women in their reproductive years. Anovulatory cycles, luteal phase defects, hyperprolactinemia, and sex hormone imbalances are all symptoms of sex hormone imbalances are all consequences of hypothyroidism on fertility. Main Symptoms/or Important Clinical Findings: A 33 years old female admitted in AVBRH on date 19/1/2021 with chief complaint of infertility with hypothyroidism since 8 year, pain in abdomen, irregular menses. Obstetric History: Patient had obstetric history of menarche start age of 15 year and flow of bleeding in slow/light. After irregular menses, she received IVF cycle and she was conceived the pregnancy in 1st IVF cycle. The Main Diagnoses, Therapeutic Intervention, and Outcome: After physical examination and investigation, doctor was detected a case of primary infertility with hypothyroidism. Patient was treated with tab.thyronom50 mg drug to reduce the symptoms of hypothyroidism. Nursing perspective: Administered flued replacement i.e. DNS, RL, monitored fetal heart rate and vital sign per 4 hourly. Conclusion: Pregnancy conceived with in vitro fertilization increasing the more risk of gestational hypothyroidism as well as fetal complication. Treatment and management improves the outcome of pregnancy.

Embryo transfer can be performed in either uterine horn. Two successive pregnancies in a patient with uterus didelphys: a case report

Background Uterus didelphys results from a failure in Mullerian duct fusion and may be associated with complete or partial vaginal septa. Most cases of uterus didelphys are discovered incidentally during the workup of infertility or recurrent miscarriage. The incidence of uterus didelphys has been reported to be 0.2% in the infertile population. Case presentation A 35-year-old white Arab woman, gravida 0, parity 0, with a history of primary infertility of 8 years (a well-known male factor) presented to our infertility center. She was diagnosed as having uterus didelphys with severe male factor. The patient had three previous failed in vitro fertilization/intracytoplasmic sperm injection cycles outside our center. This is a case report of an infertile woman with uterus didelphys who conceived twice following single embryo transfer in both uterine horns successively. After the first successful pregnancy in the left uterine horn, the initial decision was to transfer the embryo to the same horn (left) because of the previous successful transfer. The very deep and long vagina forced us to reach one of the cervices, in which the embryo was placed in the right uterine horn, followed by the second successful pregnancy in the other, smaller horn. The patient gave her informed consent, both verbal and written, to use her information and images for medical publication. Conclusion Pregnancy is possible in women with uterus didelphys using single embryo transfer in in vitro fertilization/intracytoplasmic sperm injection cycles. It is recommended that both horns be given a chance.

Successful pregnancy after operation in an infertile woman caused by luteinizing hormone-secreting pituitary adenoma: case report and literature review

Background Functional gonadotroph adenomas (FGAs) are rare adenomas that most commonly secrete FSH. However, solitary LH-secreting pituitary adenomas are unusual. Case presentation A 30-year-old woman with elevated LH and normal FSH presented with inability to conceive. An MRI revealed an enlarged sella turcica and an intrasellar mass. Treatment with transsphenoidal resection led to normalization of LH and estradiol, as well as successful pregnancy. And we reviewed 6 cases of LH-secreting pituitary adenomas from 1981 to 2020. Conclusions Our case is unique because of the LH-secreting pituitary adenoma without FSH hypersecretion. This case indicates that pituitary adenoma should be considered when other diseases causing infertility have been excluded.