#334 : Tackling Complex Infertility Patient: A Case Report
Background: Infertility is a common problem presented in women with endometriosis especially as it is often associated with poor quality of life. Therefore, surgical Intervention has been considered as the first-line treatment of choice. On the other hand, surgery itself has detrimental effects on o...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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World Scientific Publishing
2023-12-01
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| Series: | Fertility & Reproduction |
| Subjects: | |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661318223742911 |
| _version_ | 1797237039020638208 |
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| author | Putri Nabila Clifford E. John Christofani F.C Ekapatria |
| author_facet | Putri Nabila Clifford E. John Christofani F.C Ekapatria |
| author_sort | Putri Nabila |
| collection | DOAJ |
| description | Background: Infertility is a common problem presented in women with endometriosis especially as it is often associated with poor quality of life. Therefore, surgical Intervention has been considered as the first-line treatment of choice. On the other hand, surgery itself has detrimental effects on ovarian reserve and is associated with ovarian failure. Case Report: We present a case of a 39-year-old woman para 1 with multiple myoma uteri, bilateral endometriosis cyst, left hydrosalpinx, deep infiltrating endometriosis (DIE), and adhesion (Figure 1). She comes with a history of heavy abnormal uterine bleeding, lower abdominal pain, and unable to conceive 11 years after their first child despite adequate unprotected intercourse. The patient was anemic (Hemoglobin 7.30 g/dL) with low Anti Mullerian Hormone (AMH; 0.26 mg/ml). We decided to perform laparoscopic uterine myoma with multiple bilateral endometrial cysts, left salpingectomy, and adhesiolysis (Figure 2). Patient then underwent an ultra-long protocol with three cycles of leuprolide acetate 3.75 mg. Ovum pick-up was performed and we retrieved five M-II oocytes and from embryo culture, two embryos with good and moderate quality were collected for vitrification procedure. Prior frozen embryo transfer, extra acetylsalicylic acid 80 mg once a day and estradiol valerate 4 mg thrice a day were given for 18 days. The patient soon became pregnant after a few weeks of embryo transfer with βHCG of 185 mIU/m. Conclusion: Individualized treatment plans based on the patient’s symptoms and respective reproductive goals are important points to be discussed in endometriosis-associated infertility patients. Surgical intervention before IVF/ICSI is deemed as necessary to preserve ovarian reserve and to restore normal anatomy to increase the success rate of embryo implantation. |
| first_indexed | 2024-04-24T17:13:24Z |
| format | Article |
| id | doaj.art-02fe5fce4d194207873afb95008f516e |
| institution | Directory Open Access Journal |
| issn | 2661-3182 2661-3174 |
| language | English |
| last_indexed | 2024-04-24T17:13:24Z |
| publishDate | 2023-12-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Fertility & Reproduction |
| spelling | doaj.art-02fe5fce4d194207873afb95008f516e2024-03-28T07:54:17ZengWorld Scientific PublishingFertility & Reproduction2661-31822661-31742023-12-01050453553610.1142/S2661318223742911#334 : Tackling Complex Infertility Patient: A Case ReportPutri Nabila0Clifford E. John1Christofani F.C Ekapatria2Clinical Embryologist at Siloam Fertility and Minimal Invasive Center, Karawaci, IndonesiaGeneral Practitioner at Pluit Hospital, Jakarta, IndonesiaHead of Siloam Fertility and Minimal Invasive Center, Karawaci, IndonesiaBackground: Infertility is a common problem presented in women with endometriosis especially as it is often associated with poor quality of life. Therefore, surgical Intervention has been considered as the first-line treatment of choice. On the other hand, surgery itself has detrimental effects on ovarian reserve and is associated with ovarian failure. Case Report: We present a case of a 39-year-old woman para 1 with multiple myoma uteri, bilateral endometriosis cyst, left hydrosalpinx, deep infiltrating endometriosis (DIE), and adhesion (Figure 1). She comes with a history of heavy abnormal uterine bleeding, lower abdominal pain, and unable to conceive 11 years after their first child despite adequate unprotected intercourse. The patient was anemic (Hemoglobin 7.30 g/dL) with low Anti Mullerian Hormone (AMH; 0.26 mg/ml). We decided to perform laparoscopic uterine myoma with multiple bilateral endometrial cysts, left salpingectomy, and adhesiolysis (Figure 2). Patient then underwent an ultra-long protocol with three cycles of leuprolide acetate 3.75 mg. Ovum pick-up was performed and we retrieved five M-II oocytes and from embryo culture, two embryos with good and moderate quality were collected for vitrification procedure. Prior frozen embryo transfer, extra acetylsalicylic acid 80 mg once a day and estradiol valerate 4 mg thrice a day were given for 18 days. The patient soon became pregnant after a few weeks of embryo transfer with βHCG of 185 mIU/m. Conclusion: Individualized treatment plans based on the patient’s symptoms and respective reproductive goals are important points to be discussed in endometriosis-associated infertility patients. Surgical intervention before IVF/ICSI is deemed as necessary to preserve ovarian reserve and to restore normal anatomy to increase the success rate of embryo implantation.https://www.worldscientific.com/doi/10.1142/S2661318223742911EndometriosisInfertilityAdvanced AgeIVF/ICSILaparoscopy |
| spellingShingle | Putri Nabila Clifford E. John Christofani F.C Ekapatria #334 : Tackling Complex Infertility Patient: A Case Report Fertility & Reproduction Endometriosis Infertility Advanced Age IVF/ICSI Laparoscopy |
| title | #334 : Tackling Complex Infertility Patient: A Case Report |
| title_full | #334 : Tackling Complex Infertility Patient: A Case Report |
| title_fullStr | #334 : Tackling Complex Infertility Patient: A Case Report |
| title_full_unstemmed | #334 : Tackling Complex Infertility Patient: A Case Report |
| title_short | #334 : Tackling Complex Infertility Patient: A Case Report |
| title_sort | 334 tackling complex infertility patient a case report |
| topic | Endometriosis Infertility Advanced Age IVF/ICSI Laparoscopy |
| url | https://www.worldscientific.com/doi/10.1142/S2661318223742911 |
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