| |
Mrs. UF, 32 years, married for 5 years came to us on 23/10/2003 for primary infertility. Her menstrual cycles were regular. USG revealed a normal uterus and ovaries. Semen analysis of her husband revealed moderate oligoasthenozoospermia and his local examination, corroborated along with a doppler study, revealed bilateral grade II-III varicocele. A HSG performed on 29/10/2003 had shown normal cavity and patent tubes. She underwent 3 cycles of IUI which were not successful. Subsequently her husband underwent bilateral varicocelectomy and removal of a right epididymal cyst. She then discontinued the treatment and returned to us on 19/10/2004. Diagnostic hysterolaparoscopy was performed which revealed a normal picture. Repeat semen analysis did not show much improvement following surgery. She was then advised for ART programme. They underwent the first cycle of ICSI ET on 1/12/2004. We retrieved 5 oocytes, 4 of which fertilized and the embryo transfer was done on Day 2. Her ß -hCG levels on day 27th and 29th post procedure were 359.8 and 673.3 mIU /ml. On the 38th day a transvaginal sonography revealed quadruplet pregnancy. This underwent a natural reduction to twins at 9 weeks of gestation. She was admitted twice for hyperemesis gravidarum with one episode of bleeding per vaginum at 10-11 weeks of gestation, when she was also found to be anemic and was managed conservatively. At 13-14 weeks of gestation, during her routine antenatal scan, she was suspected to have molar pregnancy
|
|
and was referred to a centre for sonology and fetal therapy for a second opinion. They confirmed the presence of twin viable fetuses with molar degeneration anteriorly and in the septum. Possibilities of continuing pregnancy were weighed carefully against known complications of progressive hyperemesis, anemia, ante-partum hemorrhage and pregnancy induced hypertension. Finally the decision to terminate the pregnancy owing to maternal health was undertaken. Suction evacuation was done under the guidance of ultrasonography on 21/2/2005. Following evacuation, repeated serial ß-hCG were done at weekly intervals until the value fell below 10 mIU/ml. She was then prescribed oral contraceptives and asked to review 6 months later for further evaluation and advice.
|
|
