Mrs. K. P. aged 46 visited Infertility
Centre with the complaints no living issue for 21 yrs. married life. They were
referred to infertility centre by a Senior Gynaecologist for their complicated
infertility problem.
They had two abortions at three to four
months gestation. The last abortion took place six years ago. Since then she
could not conceive but the details of the previous treatment was kept
confidential within the doctor & the husband. Their past treatment record
showed that she had artificial insemination of donor sperm because the husband
had no sperm in his semen. She did not know that she got pregnant by donor insemination.
During our counselling, the lady did not show any interest in treatment for
herself because her menstrual cycle was already getting late & she lost
hope of getting pregnant.
On examination, her physical built was
good with her body weight of 65 Kg. Her cycle interval was 23-43 days with flow
of 1-2 days scanty flow.
On the second visit however she was
ready only for Hysterosalpingography (HSG) which revealed normal looking uterus
with patent both fallopian tubes.
On third visit she brought her sister
& wanted us to examine her whom the lady forced to marry with her husband
for the sake of a child in their family.
The second wife Mrs. S. Paudel 31 yrs. married
five years ago & she also could not conceive. She was thin built with short
height but her general physical condition looked quite fair with body weight of
39 Kg. Her menstrual cycle was 28-30 days with 5-9 days of flow. On pelvic
examination the use of speculum could not clearly distinguish the cervix from
vagina. In addition, the vaginal cavity was also narrow. The outline of cervix
looked rather rudimentary. Careful surgical excision was done to separate the
vaginal flaps which covered the cervix. She was then asked not to try conception
for at least three months.
After surgical correction she was
properly investigated for conception.
Her
D2 hormone profile: FSH=7.4mIU/ml; LH=1.1mIU/ml; Estradiol=40.5pg/ml;
Prolactin=30.8ng/ml; TSH=3.3mIU/ml.
Hyperprolactinemia
was corrected with bromocriptin therapy.
This time, it was easy to access the
cervix to perform HSG. Her HSG showed normal uterine cavity with patency of
both tubes.
Semen was analysed which had no sperm.
Thus, the conception was only possible with donor insemination. With written
consent of the couple, Intra Uterine Insemination (IUI) of donor sperm was
planned. Ovulation was stimulated for recruitment of more follicles with cyclic
clomiphen citrate 50-150 mg. Development of follicles was serially monitored by
transvaginal ultrasound. When at least one follicle reached 18mm, Human
Chorionic Gonadotropin was injected & IUI was done within 30-48 hrs. Since
they lived far away, their treatment was not regular. However, she finally
conceived after total six months of IUI treatment. She was followed up by us till 30 wks of gestational
period & referred back to the same doctor for the delivery. She delivered a
healthy baby boy.
