Case Study: IVF in Patients with Endometriosis

Abstract

It is described as a chronic medical condition, appearing and growing endometrial tissue outside the uterus leading to infertility. The present case discusses a diagnosis of moderate endometriosis in a 32-year-old woman patient. The patient was treated for her infertility with the process of IVF. In this case report, the medical history, IVF process, and outcome are discussed in detail, thus reiterating the effects of endometriosis on fertility and the success of the IVF process. The outcome indicates that even though endometriosis presents difficulty in conceiving, IVF is possible for women suffering from this condition.

Introduction

Endometriosis is a condition found in an estimated 10% of women of reproductive age, and it accounts for most cases of infertility. Endometriosis is marked by pelvic pain, infrequent menstrual periods, and adhesions, among other symptoms that interfere with normal reproduction functions. For women with endometriosis, conceiving is rather challenging. Assisted reproductive technologies, with special references to IVF, seem to be a viable option for these women. Thus, this case study aimed to take a look at the clinical journey of a patient with endometriosis who opted for IVF, observing the treatment protocols, clinical processes, and patient results.

Patient Information

• Age: 32 years old

• Gender: Female

• Medical History: Diagnosed with moderate endometriosis (Stage III) via laparoscopy two years prior, History of pelvic pain and dysmenorrhea, Previous unsuccessful attempts at natural conception for two years

• Social History: Non-smoker, Moderate alcohol consumption, Regular exercise routine

Clinical Findings

Physical Examination

• Normal pelvic examination with mild tenderness noted on bimanual examination.

• No signs of pelvic masses or significant abnormalities.

Laboratory Investigations

• Hormonal profile: FSH: 8.0 IU/L, LH: 5.0 IU/L, Estradiol: 200 pg/mL (normal).

• AMH (Anti-Müllerian Hormone): 2.5 ng/mL (indicating a good ovarian reserve).

• Normal thyroid function tests.

Imaging Studies

• Transvaginal ultrasound showed small endometriomas on both ovaries, consistent with endometriosis.

Hysterosalpingography (HSG) confirmed patent fallopian tubes.

Timeline

Initial Diagnosis and Consultation (January 2023)

A patient suffered from infertility and was diagnosed with moderate endometriosis after a laparoscopic surgical procedure.

Decision for IVF (March 2023)

After two years of failed attempts at natural conception, the patient was referred for an IVF evaluation by a fertility specialist.

Ovarian Stimulation (May 2023)

Gonadotropins were utilized for controlled ovarian stimulation in the patient. The process of follicular development was monitored regularly.

Egg Retrieval (June 2023)

Egg retrieval was successful and retrieved 12 mature oocytes.

Embryo Transfer (June 2023)

Five embryos were created, out of which two high-quality embryos were chosen for transfer.

Follow-Up Pregnancy Test (July 2023)

The pregnancy test was positive and confirmed the existence of clinical pregnancy.

Final Follow-Up Visit (February 2024)

By term, the patient delivered a healthy female newborn with good outcomes for the IVF cycle.

Diagnostic Assessment

Laparoscopy

It confirmed the diagnosis of endometriosis and had the possibility of resecting endometriotic lesions, which would bring improvement in fertility potential.

Hormonal Assessment

Assessed ovarian reserve and hormonal profile to be optimized in the IVF protocol.

Ultrasound and HSG

Confirmed patency of the fallopian tube as well as the presence of ovarian cysts so that better planning of the IVF cycle could be done.

Follow-Up and Outcomes

Ovarian Response

In an excellent response to ovarian stimulation, a total of 12 mature oocytes was produced; this was indicative of a good response, particularly in the context of her age and history.

Embryo Quality and Transfer

Five embryos resulted, two being of high quality which were transferred on day 5 at the blastocyst stage.

Pregnancy Confirmation

Approximately 10-14 days post embryo transfer, she received a positive pregnancy test and an early ultrasound confirmed a single viable intrauterine pregnancy.

Delivery

Pregnancy was unremarkable, with a delivery of a healthy female baby at term, who was brought forth at 39 weeks through natural delivery.

Discussion

Endometriosis remarkably interferes with fertility, and in this case, a patient was greatly helped by the intervention of IVF. In this clinical situation, the patient was fully evaluated and received proper treatment by removal of endometriotic lesions through laparoscopy and followed by IVF.

Key Points

• Impact of Endometriosis: Endometriosis can impair ovarian function and egg quality, complicating the fertility journey. However, many women with endometriosis can achieve pregnancy through IVF, especially with appropriate pre-treatment interventions.

• IVF Protocol: The patient’s ovarian stimulation protocol was tailored to her needs, considering her endometriosis. The response to stimulation was favorable, resulting in a good number of oocytes for fertilization.

• Emotional and Psychological Considerations: The journey through infertility and assisted reproduction can be emotionally taxing. The patient expressed anxiety and uncertainty about the outcomes, highlighting the need for emotional support throughout the process.

Takeaway

This case study therefore cements the role of IVF in the management of endometriosis-related infertility. In itself, such a case puts into perspective the critical role of individualized plans of treatment, proper diagnostic assessments, and pre-treatment interventions in obtaining optimal results for patients suffering from endometriosis.

Key Lessons

• In case of significant endometriosis lesions, the latter should be operated on, as this may make IVF possible.

• Emotional and psychological support shall be given to infertility patients going through fertility treatments as part of overall care.

• IVF can indeed be successful among patients suffering from endometriosis, and most can be expected to have successful results with proper management.

Patient’s Perspective

Hopeful, and worried at different times as she followed the fertility journey, the patient shortly after diagnosis with endometriosis was overwhelmed by the lack of fertility but was to get more knowledgeable and empowered by her healthcare providers.

This was an extremely challenging yet fulfilling IVF cycle for the patient. She valued much of the emotional support provided by her healthcare professionals, which helped her move through the complexity of infertility. She said, "This is great, and I am very glad about this advancement regarding reproductive technology that made my dream possible."

Conclusion

This case study is eloquent testimony to the important role of IVF in the management of infertility associated with endometriosis. With appropriate pre-treatment assessment and individualized treatment strategy, a successful pregnancy can be achieved. Continued research and clinical development will only serve to enhance our understanding and management of endometriosis and bring hope to many such women.

References

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