Zero count to millions of joy
A miraculous, yet science driven journey of a young couple towards parent hood
Mrs AS and Mr S non consanguinously married for 4 years visited Garbhagudi IVF centre with infertility issues in July 2019. The couple were trying for pregnancy since their marriage and had no history of pregnancy or abortion in the past.
On history taking, Mrs AS was having irregular cycles since 2 years for which she was not evaluated. The couple were not having any past history of medical or surgical issues, no history of hospitalization or long term drug intake. The couple had no history of smoking or alcoholism. After trying naturally for a year, couple visited an IVF centre in Bangalore for treatment in 2018. Initial investigations of Mrs AS were normal but Mr S was diagnosed with Azoospermia (absent sperms in ejaculate) after doing semen analysis thrice. Mr S was advised trial TESA/ PESA (surgical retrieval of sperms) which he underwent and found to have no sperms. The couple were advised to use donor sperms for treatment which shattered them. A year later, the couple visited us to seek information about further treatment.
Mr S was investigated further at Garbhagudi and found to have non obstructive Azoospermia with normal hormonal profile. His genetic tests which were not done previously revealed a balanced translocation between chromosome 7 and 22 (a genetic disorder where 50% children can get affected, 25% will be carriers and only 25% will be normal). However, there were no Y chromosome microdeletions in Mr S which could have worsened the chances of sperm production and pregnancy. Mrs AS was found to have normal karyotype and normal blood tests except that she was having anovulatory cycles. Mr S underwent a repeat trial PESA at Garbhagudi IVF centre where few sperms were retrieved and frozen.
The couple underwent genetic counselling where it was advised to test the embryos before transferring into uterus to avoid carrying genetically abnormal babies. Hence the couple were given thorough counselling about doing ICSI (intracytoplasmic sperm injection) with surgically retrieved frozen PESA sperms and PGD (pre-implantation genetic diagnosis) to ensure a genetically normal baby.
Mrs AS underwent conventional IVF stimulation in August 2019. We retrieved 13 eggs, out of which 10 were mature eggs. All 10 mature eggs were injected frozen- thawed- processed sperms of Mr S. All 10 eggs were fertilized and resulted in 10 grade A embryos on day 3 which were cultured to day 4. Laser assisted hatching was given on day 4 to facilitate the embryos for easy hatching in order to obtain biopsy from embryos. Seven embryos reached blastocyst stage on day 5 which were hatched. Biopsy was taken from trophectoderm (hatched out outer covering cells of embryo) of each of the embryo, labeled and sent for PGD. Each embryo was labeled and stored in individual freezing devices.
Mrs AS underwent a routine diagnostic hysteroscopy in September 2019 which revealed normal cavity. Reports of PGD revealed 5 normal euploid embryos (having normal chromosomal composition of humans) and two abnormal embryos with multiple chromosomal abnormality which were eventually discarded.
Mrs AS underwent mild hormonal stimulation as a part of endometrial preparation for frozen embryo transfer in December 2019. She achieved a endometrial thickness of 9mm and posted for embryo transfer with appropriate progesterone supplements. Two euploid blastocysts were thawed on the day of embryo transfer which survived. Both the blastocysts were transferred smoothly under aseptic precautions under scan guidance. 14 days later, she tested positive for pregnancy with beta HCG value of 717 mIU/ml which doubled normally 48 hours later. A transvaginal scan done between 6-7 weeks revealed a single live intrauterine pregnancy with normal cardiac activity. Currently Mrs AS is 9 weeks pregnant and is due for CVS (chorionic villous sampling) at 12weeks with chromosomal microarray to rule out mosacism.
Assisted Reproductive Technologies has made huge advances in recent years. With introduction of PGS/ PGD, couple with known genetic disorders can now dream of having healthy children through IVF. This case is the best example of how lack of sperms, genetic disorders are no hindrance to achieve a healthy pregnancy through IVF.