Xiaotong, 33 years old, medium height (167cm, 56kg) has regular menstruation and dysmenorrhea. Got married 3 years ago, married after marriage, the couple lived together, had a normal sex life, and never got pregnant. At the first visit in November 2022, the density and motility of the husband** examination were normal, and the sperm DNA fragmentation rate was high. Ultrasound reveals uneven endometrial echogenicity. Diagnosing primary infertility, dysmenorrhea, endometrial polyps? May 2023 blood amh 212ng/ml。Due to the local hyperechogenicity of the endometrium detected by multiple ultrasound examinations, hysteroscopy + hysteroscopic tubal intubation and fluid passage were performed in May 2023, and multiple polyps in the uterine cavity were found during the operation, endometrial polyp removal was performed, and bilateral fallopian tube blockage was found during the operation. Complementary diagnoses: endometrial polyps, insulin resistance, bilateral tubal occlusion, thyroiditis. Dr. Wang Bo gave insulin sensitizer**, Eunail, and selenium yeast tablets to maintain stable thyroid function, and recommended IVF to help you conceive.
In August 2023, the progesterone adjuvant program induced ovulation, 6 eggs were obtained, and one frozen embryo (day3) was obtained. In September, ovulation was induced again with progesterone adjuvant program, 4 eggs were obtained, and 2 embryos were frozen (day3). Ultrasonography during ovulation induction shows uneven endometrial echogenicity. At the beginning of November 2023, after preparing the endometrium in the natural cycle, a frozen and thawed embryo was transferred, and she was not pregnant. After the menstrual period in the same month, hysteroscopy was performed again, and endometrial polyps** were found, and polyp removal and diagnostic curettage were performed. On December 30, 2023, the second embryo transfer in the natural cycle and the implantation of two frozen and thawed embryos. Intravenous immunoglobulin infusion before transplantation, anticoagulation with subcutaneous injection of low molecular weight heparin, and oral immunomodulatory drugs. On January 10, 2024, 12 days after transplantation, blood HCG 44411nmol/l。On 3 February, ultrasound confirmed that there were twin live fetuses in the uterus. On February 17, the second ultrasound showed that the twin fetuses were alive if they were 9 weeks gestation+ in size. Follow-up will be continued in the obstetric clinic shortly.
After more than half a year of active efforts, Xiaotong finally achieved her wish. Dr. Wang also reminded that when twin pregnancies reach the second and third stages of pregnancy, pregnant mothers will experience more hardship and discomfort, and prenatal check-ups should be more frequent than those of singleton pregnant women. Looking forward to the successful birth of the baby dragons!
Tips: Multiple polyps in the endometrium are related to special constitution and are easy to **; The use of gonadotropins in ovulation induction** causes the development of multiple follicles and the secretion of estrogen in superphysiological concentrations, which is one of the causes of polyps**. It is recommended that women who have previously found uterine polyps and have fertility requirements should have a pregnancy as soon as possible, and if they are infertile for a long time (6 December), hysteroscopy should be performed to remove polyps, and the patency of the fallopian tubes can be assessed with ** during the operation. The doctor of the fertility center will give advice on fertility based on the factors of both husband and wife.
Figure 1: 20234.9 Hysteroscopy preoperative ultrasound examination: endometrial hypertrophy, local hyperechoic mass.
Figure 2 **Flow chart.
Fig.3 Ultrasound report of Xiaotong embryo 48 days after embryo transfer.