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Abstract: Female infertility is caused by women’s own factors, such as tubal and ovarian factors, and polycystic ovary syndrome is one of them, which is usually associated with staying up late, mental stress and unhealthy diet, and accounts for 5-10% of women of reproductive age. However, there are also patients with very persistent ovulation disorders, such as the patient in this case, who need in vitro fertilization to help them conceive.
Basic information】Female, 32 years old
Type of disease】Female infertility, polycystic ovary syndrome, abnormal glucose tolerance
Hospital】Shanghai Tenth People’s Hospital
Date of Consultation】March 2021
Treatment plan】Medication (metformin to improve glucose metabolism) + ovulation promotion (gonafen 225 units) + antagonist ovulation regimen (gonafen + cetrorelix acetate) + 1st generation IVF treatment
[Treatment cycle] 2 IVF inductions, 1 successful transfer
Results】Successful pregnancy with good embryo development
I. First interview
Ms. Yu, 32 years old, has been infertile for 7 years after marriage without contraception. She has been diagnosed with PCOS for more than 10 years. She started to go to several local hospitals for ovulation after marriage 7 years ago, and during 7 years, she had different protocols and nearly 20 cycles of ovulation. She complained that only 2-3 cycles had a single mature follicle development and cancelled intercourse for 4-5 cycles due to multiple follicle development, but the rest of her ovulation cycles were unsuccessful. Her menstrual cycle was 3-15 days/1-6 months, low volume, 0-0-0-0-0, meaning 0 pregnancies, 0 full-term births, 0 miscarriages, 0 surviving children. 165 cm in height, 78 kg in weight, BMI 28.6. ultrasound showed >20 follicles bilaterally. She has had a local examination for patent fallopian tubes. The male partner’s semen was generally normal.
The patient was examined for basal sex hormones FSH/LH: 6.43/7.41IU/L; T 1.27ng/ml; AMH 13.82ng/ml; fasting glucose 5.20mmol/L; fasting insulin 29.18uU/ml.
The patient was diagnosed with female infertility, polycystic ovary syndrome and abnormal glucose tolerance based on her examination results and her condition.
II. Treatment history
As the attending physician, I informed the patient that as a patient with 7 years of infertility and very stubborn ovulation disorder, IVF treatment was a better way to help her conceive. However, the patient was obese, with high fasting insulin level and obvious manifestation of metabolic syndrome, which would affect the effect of IVF promotion, and she was advised to improve her lifestyle, control her metabolic disorder and lose weight before starting IVF treatment. However, the patient couple was very anxious, so they decided to adjust their lifestyle and improve their glucose metabolism with metformin while choosing a higher dose of 225 units of gonafen to start ovulation. However, after 5 days of ovulation promotion, no significant follicle growth was found at the follow-up visit, so the dose of ovulation promotion was adjusted. After 5 days of ovulation promotion, she found no dominant follicle development and no increase in estrogen level. The IVF cycle was cancelled because of the failure of ovulation. Later, the patient adjusted her condition, actively lost weight, controlled her blood sugar, and underwent hysteroscopy to rule out any endometrial problems.
III. Treatment effect
The first failed IVF experience made the patient understand that IVF is not a cure for all diseases, but to optimize her condition in order to improve the endocrine disorder, increase ovarian sensitivity and obtain a satisfactory treatment outcome. In the following 3 months, the patient actively lost 12 kg of weight and her LH (luteinizing hormone) and insulin both decreased significantly. As the patient’s menses were very disruptive, the patient was then scheduled for hysteroscopy to rule out endometrial problems and another ovulation promotion with gonafemin + cetrorelix acetate antagonist, which went very well, with 12 eggs obtained, 2 high-quality embryos frozen on day 3 and 3 high-grade blastocysts obtained on day 5. The patient had a third-line A endometrial morphology with a thickness of 8.6 mm and normal hormonal levels. Therefore, we transferred 1 blastocyst to her on the 5th day after egg retrieval and the pregnancy went smoothly.
IV. Notes
As her attending physician, we are really happy for the patient to get pregnant successfully, but we need to pay attention to the following matters.
1.After the IVF pregnancy, it is recommended that mothers-to-be should have regular maternity checkups to check the mother’s own condition and observe the development of the fetus, and take folic acid supplements as prescribed by the doctor to prevent fetal malformations.
2, diet pay attention to a balanced diet, eat more fruits and vegetables, less spicy and additive food, more high-protein food at the same time to pay attention to weight control.
3, learn to self-regulate, maintain a comfortable mood, moderate exercise, avoid strenuous exercise to avoid the impact on the fetus.
4, pregnancy should not blindly use drugs, if you encounter uncomfortable symptoms promptly seek medical advice, under the guidance of a doctor reasonable use of drugs.
5, always pay attention to the situation of the fetus during pregnancy, learn to count fetal movements, and monitor their own blood sugar, blood pressure, weight and other indicators, if you encounter uncomfortable symptoms, promptly seek medical attention.
V. Personal insight
For female infertility caused by various reasons, the treatment plan is now very mature and the result of pregnancy assistance is quite satisfactory. However, in the process, patients still need to control their bad symptoms and habits to a certain extent in order to effectively improve the conception rate and avoid conception failure. Here, we need to remind you to control your diet and weight and stabilize your emotions in daily life, which can prevent your disease to a certain extent, reduce female infertility and improve the conception rate. In case of long-term infertility, do not be anxious and nervous, but first of all, adjust your mentality and life pattern, exercise actively, eat healthily, maintain normal weight and achieve healthy pregnancy preparation. If you have not conceived after a period of time, you should seek medical examination to identify the specific cause and actively treat it, which can effectively improve the conception rate.
If conception is successful, it is also necessary to take folic acid on time under the guidance of a doctor to prevent fetal malformations, take more rest during pregnancy, eat a healthy and reasonable diet, have regular maternity checkups, and seek medical attention promptly if uncomfortable symptoms appear.