A rare case of successful reproductive outcome after IVF following endometrioma resection in a patient of arcuate uterine anomaly and urinary bladder wall endometrioma in women with primary infertility

Endometriosis is a common gynecologic disease in women of reproductive age. However, endometriosis within the bladder is rare. We present a rare case of a 38-year-old woman who presented with dysmenorrhea and primary infertility. Transvaginal ultrasonography showed an arcuate bulky adenomyotic uterus and left ovarian cystic mass along with urinary bladder endometrioma. Cystoscopic examination was done and removal of endometrioma was attempted, which failed. Afterwards laparoscopic exploration of abdomen was done and a partial cystectomy was performed and it was confirmed that the mass on the bladder wall was a 3.5 cm endometrioma invading the vesical wall on the final pathologic report. Post-operatively, she underwent in vitro fertilization due to both causes i.e. primary infertility and male factor (severe oligo-asthenospermia) and she conceived. We report this case of a patient with primary infertility and bladder endometriosis which was managed successfully with a surgical approach and briefly review the relevant literature

Poor ovarian reserve and male infertility in a rural in vitro fertilization setup: a case report

Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35. In the female, the number of oocytes decreases with age until the menopause. Oocyte quality also diminishes, due in part to increased aneuploidy because of factors such as changes in spindle integrity. Although older male age affects the likelihood of conception, abnormalities in sperm chromosomes and in some components of the semen analysis are less important than the frequency of intercourse. Age is as accurate as any other predictor of conception with assisted reproductive technology

Serum estradiol concentrations as a predictor of successful outcome in artificial frozen-thawed embryo transfer cycles

Background: The role of late follicular serum estradiol monitoring in artificial FET cycles remain unclear. The purpose of this study was to evaluate the correlation between serum estradiol levels on the day of starting progesterone supplementation with clinical pregnancy rates in FET cycle.Methods: This was a non-interventional observational cohort study of patients undergoing ICSI followed by FET at Nadkarni hospital and test tube baby center, Killa-Pardi, Gujarat during the period of January 2021 to May 2021. Total 64 cycles were studied and serum estradiol levels were analyzed on the day of starting progesterone supplementation. They were divided into 3 groups based on serum E2 levels (0-25th centile, 25th-75th centile and >75th centile). Chi square/Fisher exact test were used to compare the clinical pregnancy and implantation rates between these groups.Results: Clinical pregnancy and implantation rates in group A, B and C were 68.8%, 78.1%, 75% and 36.98±9.06, 32.03±4.48 and 29.69±5.69 respectively.Conclusions: Serum estradiol levels before progesterone supplementation in FET cycles do not predict the outcome of FET cycle therefore making routine monitoring of serum estradiol in FET cycle of questionable value

Intrauterine platelet rich plasma versus injection G-CSF for treatment of thin endometrium in infertility

Background: For success in IVF treatment, it is essential that the patient has a responsive endometrium together with many other factors. Inspite of numerous treatments available today for growth of endometrium, there is lack of any ideal drug or protocol for increasing endometrial thickness. The study is an attempt to evaluate the role of two drugs for increasing endometrial growth before embryos transfers.Methods: This study is a retrospective cohort study including 50 patients with previously diagnosed as thin endometrium patients who may or may not have failed previous cycles of IVF. Patients were randomly divided into two groups. First group-Group A (n=25) are patients randomly selected to undergo intrauterine PRP instillation for increase in endometrial thickness before embryo transfer. Second group-Group B (n=25) are randomly selected from a retrospective cohort of thin endometrium to take injection GCSF  as intrauterine infusion (total dose 300mcg) on day of trigger or day 11 of cycle followed by 60 units subcutaneously after embryo transfer. The difference in endometrial thickness during transfer and the pregnancy outcomes were compared.Results: Injection GCSF was found to be more effective than intrauterine PRP in improving endometrial thickness in patients with thin endometrium with a p-value of <0.0001.  It was found that the chemical and clinical pregnancy rates were comparable as the p values were 0.77 and 0.37 respectively and hence statistically not significant. Although patients given injection GCSF had a slightly higher clinical pregnancy rate (44%) as compared to patients given intrauterine PRP which was 28%. All other variables were comparable.Conclusions: In the study it was proven that injection GCSF, is more effective for the treatment of thin endometrium patients as compared to intrauterine PRP infusion. Though the clinical and chemical pregnancy rates were comparable, a higher percentage of women were clinically pregnant in the group given injection GCSF.  Intrauterine PRP can also be a good alternative for thin endometrium.  More studies and RCTS are needed for comparison to prove the effectiveness of these drugs for treatment of thin endometrium