Secondary infertility with a history of vaginal childbirth: Ready to have another one?

Effect of Short Agonist Stop (SAS) Protocol in a Patient Having an Allergic Reaction From Conventional Ovarian Stimulating Hormone

The case study examined a 32-year-old female and her 35-year-old partner who had experienced infertility attributed to the wife's irregular ovulation. Despite the male partner demonstrating normal reproductive parameters, he had a medical history involving hypertension. The woman also had a history of hypertension and chikungunya, which was accompanied by fever and joint pain in 2019. Due to the woman's allergic reaction to traditional ovulation stimulatory medications, the approach to assisted reproductive technologies (ART) had shifted towards employing the short agonist stop (SAS) regimen. Controlled ovarian stimulation had been achieved by administering recombinant follicular hormone, gonadotropin-releasing hormone (GnRH), and estrogen. The SAS protocol had been introduced to counter premature ovulation and synchronize follicular development. Following two successful ovum pickup procedures resulting in the retrieval of six embryos, the initial frozen embryo transfer took place in April 2022. Daily progesterone supplementation had been administered to sustain the patient's luteal phase. A subsequent human chorionic gonadotropin (β-hCG) test performed on the 14th day post-embryo transfer confirmed a positive pregnancy diagnosis, with a measured outcome of 2026 mIU/mL. This case highlighted the potential impact of medication allergies on fertility outcomes and underscored the unique approach of the SAS protocol in managing allergic responses during in vitro fertilization (IVF) procedures. Despite the patient's history of allergic reactions to conventional ovulation stimulatory medications, the study concluded that the implementation of the brief agonist stop strategy had resulted in a successful clinical pregnancy.

Successful Outcome in a Middle-Aged Woman With Secondary Infertility Using Donor Oocyte In Vitro Fertilization: A Case Report From a Rural Infertility Clinic

We present the case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done at her hometown hospital. This is a case of secondary infertility. Before coming to our center, she visited another center for infertility treatment, where in vitro fertilization (IVF) was done using self-oocyte, but intracytoplasmic sperm injection (ICSI) was not done. Unfortunately, the treatment did not succeed. On hysteroscopy, adhesions were found in the cavity, which were possibly formed due to the D&C procedure performed for past abortions. This condition is known as Asherman’s syndrome. Hence, hystero-adhesiolysis was done on January 20, 2021. Her latest report showed an anti-Mullerian hormone (AMH) value of 0.252 ng/dL, which was very low. Low AMH was indicative of low ovarian reserve. Her follicle-stimulating hormone (FSH) was 23 mIU/mL, which was too high, suggestive of poor egg quality. The antral follicular count was assessed through transvaginal ultrasound; the total count was three (one on the right, and two on the left). Ovum pick-up was done on March 15, 2021. Only one oocyte was retrieved from the patient (MI grade). The husband’s sperm count was 12 million/mL with low motility, which is known as oligoasthenozoospermia; hence, ICSI was performed. However, the embryo could not be formed. Therefore, on April 1, 2021, oocytes were retrieved from the donor, and ICSI was done using the semen sample of the husband. On April 6, 2021, two embryos at the day six stage were transferred to the patient’s uterus. Before the embryo transfer, tablet estrogen 2 mg was administered thrice daily. This was started from day two of menses till day 14th. After 14 days, the patient was given a progesterone injection for six days daily. After embryo transfer, tablet estrogen 2 mg was given thrice daily, and tablet progesterone 2 mg twice daily was given as support. After 14 days of embryo transfer, a beta-human chorionic gonadotrophic hormone (βhCG) test was done. Her βhCG was positive, and the couple was delighted. Diagnostic challenges occurred due to previous abortions, previous failure of IVF, history of hypothyroidism, AMH value of 0.252 ng/dL, and presence of adhesions. This is a case of secondary infertility with cavity adhesions with low AMH and low antral follicular count. The outcome was favorable at our fertility clinic. Because the patient is a known case of hypothyroidism, levothyroxine tablets were also prescribed.