Case file

When the 35-year-old patient came to our clinic for the first time, she had already undergone surgery for her Endometriosis, a laparoscopy had been performed to remove a myoma and a 10-cm Endometrioma, in addition to release of adhesions. Her Anti Mullerian hormone level prior to surgery was 6.28ng / ml and her male partner had Oligoasthenatozoospermia.

They had carried out an In Vitro Fertilization cycle in another centre, fresh transfer and subsequent Cryotransfer, in both cases embryos were transferred on Day 3 that presented quality B and C respectively. She also presented hyperstimulation symptoms that required hospital admission.

Treatment program

We started the study of the couple and given that there was a male factor and poor embryonic quality, a semen FISH study (a study of chromosomal abnormalities in sperm in which 9 chromosomes are studied) and double-stranded DNA fragmentation in sperm (related to embryonic blockage and poor embryonic quality), both results were normal.

During the study, the patient was kept on a continuous gestagen-only pill program. A count of antral follicles was performed, it was 16 and we started a stimulation regimen with FSH r 225 IU, a short cycle with antagonist and trigger with GnRH analogues. After which a prolonged embryo culture was performed and two blasts, one A and one C, were cryopreserved, subsequent Cryotransfer with a hormonal replacement regimen, Cryotransfer with a negative drug cycle was performed.

A continuous contraceptive pill treatment was maintained and a new stimulation cycle was programmed, this time Corifollitropin 150 IU and HMG were prescribed in a short cycle with antagonist analogues and 16 oocytes were obtained. A prolonged culture was carried out with low oxygen concentration, sperm selection was then carried out with annexin columns (it eliminates those sperm bearing markers of apoptosis or programmed cell death, without fertilizing capacity) MACS, and four blasts 3 of type A and one B were obtained They were vitrified and the Cryotransfer was programmed in a medicated cycle, a biochemical gestation was obtained.

The importance of a detailed study of each case

An Endometrial study was indicated, Endometritis screening (more frequent in women with a diagnosis of Endometriosis) by immunohistochemical study with CD 138, which was negative in addition to an endometrial receptivity study, ERA test, with a pre-receptive endometrial result, which resulted in the patient requiring one more day of impregnation with progesterone prior to transfer.

A subsequent Cryotransfer was carried out according to the ERA test, and the luteal phase was supplemented with vaginal progesterone and two daily doses of subcutaneous progesterone due to a progesterone level the day before the Cryotransfer being lower than 9.2ng / ml (related to a higher incidence of miscarriage and implantation failure) with a positive result, evolutionary gestation and a healthy, baby girl was born at full term.
A dream comes true!

In this case, despite the previous Endometrioma surgery, which can darken the prognosis, the detailed study, the prolonged culture, the delayed transfer following the recommendations of Chapron and other authors and an adequate Endometrial evaluation, as well as a study of the luteal phase, allowed us to make this family’s dream come true.

At Fertia Clinic we strive to evaluate each case individually, applying the latest knowledge and technology in our daily clinical practice.
If you have been diagnosed with Endometriosis or have been trying to get pregnant for a while, we encourage you not to lose hope, book your appointment and tell us about your story.

In our fertility clinic we are specialized in Endometrium and highly complex cases.
Trust in personalized reproductive medicine.