In this compelling fertility case managed by Dr Fairy Saleche, Lavanya Nanduri, a 35-year-old with a long-standing history of infertility, successfully conceived through a carefully tailored IVF protocol addressing her key challenge: a persistently thin endometrial lining.
As a fertility specialist at our clinic, I recently coordinated a multidisciplinary approach to a challenging case involving Ms. Lavanya Nanduri (name changed for privacy reasons), a 35-year-old with a long history of infertility. Despite regular menstrual cycles and managed hypothyroidism, Lavanya struggled with a thin endometrium, which had undermined previous fertility treatments including three IUI cycles and one IVF attempt.
Our team, consisting of a gynecologist, reproductive endocrinologist, an embryologist (myself), counselors, and radiologists, collectively managed her case.
Our multidisciplinary team conducted a thorough evaluation of her medical and treatment history, which revealed that despite appropriate ovarian responses in past treatments, the critical challenge was her endometrial receptivity. Given her history and our clinical experience, we determined that her thin endometrium was the primary barrier preventing successful implantation.
Patient Background
– Patient Details: Lavanya Nanduri, 35 years old, married for 10 years
– Medical History: Regular menstrual cycles, hypothyroidism on medication, previous fertility treatments including ovarian stimulation, IUIs, and a failed IVF cycle
– Key Challenge: Persistently thin endometrial lining, identified as the primary barrier to successful pregnancy
Diagnostic Assessment
– Initial Evaluation: Extensive review of medical, surgical, and reproductive history
– Investigative Procedures:
– Hysteroscopy & Laparosophy: Confirmed normal uterine cavity and tubal patency
– Blood Tests: Normal hormone levels including FSH, LH, serum prolactin, and TSH
– Ultrasound: Normal antral follicle count (AFC) and uterine morphology
Treatment Protocol
– Approach: Individualized treatment plan focusing on optimizing the endometrial environment for implantation
– IVF/ICSI Cycle:
– Ovarian Stimulation: Antagonist protocol utilized to harvest eggs
– Egg Retrieval: 12 eggs collected, 10 matured and fertilized using ICSI
– Embryo Cryopreservation: Due to inadequate endometrial thickness during stimulation (5mm)
Endometrial Priming
– Medication: Estradiol hemihydrate, adjusted doses to enhance endometrial growth
– Initial Dose: 2 mg three times daily, resulting in 4.2 mm thickness
– Increased Dose: 4 mg three times daily after one week, achieving an optimal thickness of 8.7 mm
– Monitoring: Regular ultrasounds to track endometrial development and blood flow
Frozen Embryo Transfer (FET)
– Procedure: A single blastocyst transferred after achieving suitable endometrial thickness
– Luteal Support: Initiated vaginal progesterone post-transfer
Outcome & Follow-Up
– Pregnancy Test: Positive beta-HCG (497 mIU/ml) two weeks post-transfer
– Ultrasound: Confirmed a single live intrauterine pregnancy at six weeks
Clinical Insights
– Estradiol Efficacy: Estradiol hemihydrate significantly improved endometrial thickness and receptivity compared to valerate, correlating with higher implantation and ongoing pregnancy rates as supported by clinical studies.
– Personalized Care: Tailored pharmacological approach and treatment timing were crucial in overcoming the patient’s specific reproductive challenge.
The successful outcome of Lavanya’s case underlines the importance of a customized and carefully monitored fertility protocol. It demonstrates the effectiveness of advanced pharmacologic strategies in managing patients with complex reproductive issues such as a thin endometrium. Our clinic remains committed to employing the latest evidence-based treatments to enhance our patients’ chances of achieving successful pregnancies.
Dr Fairy Salecha
Embryologist
PhD (Infertility Genetics)
Fellowship in Clinical Embryology
Androplus Clinic, Hyderabad.
