Case Study 3
Endometriosis, male factor, IVF-ICSI

Mr and Mrs B only started trying for a child after 11 years of marriage. By then she was 36 years old. On investigation, inspite of patent fallopian tubes, she was unable to conceive probably owing to her history of endometriosis. Her husband’s sperm quality was also poor. In view of Mrs B’s age, IVF (in-vitro fertilization) and ICSI (Intracytoplasmic sperm injection) were recommended to the couple.

After 14 days of high dosage of stimulation (450 I.U. of Gonal-F plus 2 days of 525 I.U of Gonal-F), three mature eggs were obtained of which two were fertilised the following day. The two embryos were transferred into Mrs B’s womb. Mrs B was pregnant thereafter but unfortunately no fetal heart was detected in the gestation sac at 6th to 7th week. Mrs B had to terminate the pregnancy.

The couple did not give up and returned to TFC for another IVF attempt. In view of the poor response despite a high dosage, “natural cycle” IVF was suggested. This means minimal stimulation with Clomiphene tablets at 150 mg daily for 5 days from day 3 of the cycle. Three eggs were obtained and all three were fertilized by ICSI. Two embryos at 4-cell, grade one stage and one embryo at 4-cell, grade 1-2 stage were transferred on day 2.

Two weeks later, Mrs B tested positive in her pregnancy test. The happy couple saw the birth of a 3.5 kg daughter 9 months later.