Top

Journal of Medical Case Reports

Published in:

Open Access 01-12-2022 | Fertility | Case report

Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report

Authors: Phil C. Boyle, Joseph B. Stanford, Ivana Zecevic

Published in: Journal of Medical Case Reports | Issue 1/2022

Abstract

Background

Restorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization.

Case presentation

A 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5–6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021.

Conclusion

We propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.

Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy singleton pregnancies from restorative reproductive medicine (RRM) after failed IVF. Front Med (Lausanne). 2018;31(5):210. https://doi.org/10.3389/fmed.2018.00210.CrossRef

Stanford JB, Carpentier PA, Meier BL, Rollo M, Tingey B. Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study. BMC Pregnancy Childbirth. 2021;21(1):495. https://doi.org/10.1186/s12884-021-03946-8.CrossRefPubMedPubMedCentral

Ecochard R, Boehringer H, Rabilloud M, Marret H. Chronological aspects of ultrasonic, hormonal, and other indirect indices of ovulation. BJOG. 2001;108(8):822–9.PubMed

Najmabadi S, Schliep KC, Simonsen SE, Porucznik CA, Egger MJ, Stanford JB. Menstrual bleeding, cycle length, and follicular and luteal phase lengths in women without known subfertility: a pooled analysis of three cohorts. Paediatr Perinat Epidemiol. 2020. https://doi.org/10.1111/ppe.12644.CrossRefPubMedPubMedCentral

Siklosi GS, Banhidy FG, Acs N. Fundamental role of folliculo-luteal function in recurrent miscarriage. Arch Gynecol Obstet. 2012;286(5):1299–305. https://doi.org/10.1007/s00404-012-2433-0.CrossRefPubMed

Blackwell LF, Cooke DG, Brown S. The use of estrone-3-glucuronide and pregnanediol-3-glucuronide excretion rates to navigate the continuum of ovarian activity. Front Public Health. 2018;6:153. https://doi.org/10.3389/fpubh.2018.00153.CrossRefPubMedPubMedCentral

Check JH. Understanding the physiology of folliculogenesis serves as the foundation for perfecting diagnosis and treatment of ovulatory defects. Clin Exp Obstet Gynecol. 2012;39(3):273–9 (In eng).PubMed

Chuong CJ, Coulam CB, Bergstralh EJ, O’Fallon WM, Steinmetz GI. Clinical trial of naltrexone in premenstrual syndrome. Obstet Gynecol. 1988;72(3 Pt 1):332–6 (PMID: 3043289).PubMed

Hilgers TW, Stanford JB. Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness. J Reprod Med. 1998;43(6):495–502 (PMID: 9653695).PubMed

10.

Hilgers TW, Prebil AM. The ovulation method–vulvar observations as an index of fertility/infertility. Obstet Gynecol. 1979;53(1):12–22.PubMed

11.

Bansal S, Goyal M, Sharma C, Shekhar S. Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: a randomized controlled trial. Int J Gynaecol Obstet. 2021;152(3):345–50. https://doi.org/10.1002/ijgo.13375 (Epub 2020 Oct 14 PMID: 32920843).CrossRefPubMed

12.

Isaacs JD Jr, Lincoln SR, Cowan BD. Extended clomiphene citrate (CC) and prednisone for the treatment of chronic anovulation resistant to CC alone. Fertil Steril. 1997;67(4):641–3. https://doi.org/10.1016/s0015-0282(97)81359-3 (PMID: 9093187).CrossRefPubMed

13.

Amer SA, Gopalan V, Li TC, Ledger WL, Cooke ID. Long term follow-up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod. 2002;17(8):2035–42.CrossRef

14.

Zohni KM, Gat I, Librach C. Recurrent implantation failure: a comprehensive review. Minerva Ginecol. 2016;68(6):653–67 (Epub 2016 Mar 16 PMID: 26982235).PubMed

15.

van der Steeg JW, Steures P, Hompes PG, Eijkemans MJ, van der Veen F, Mol BW. Investigation of the infertile couple: a basic fertility work-up performed within 12 months of trying to conceive generates costs and complications for no particular benefit. Hum Reprod. 2005;20(10):2672–4. https://doi.org/10.1093/humrep/dei157 (Epub 2005 Jun 24 PMID: 15979991).CrossRefPubMed

16.

Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev. 2010; (1): CD000057.

Title: Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report
Authors: Phil C. Boyle
Joseph B. Stanford
Ivana Zecevic
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Fertility
Infertility
Infertility
Miscarriage
Progesterone
Letrozole
Published in: Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-022-03465-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report

Abstract

Background

Case presentation

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Uterovaginal prolapse in a primigravida presenting in active first stage of labor: a case report

Anti-PD-L1 monoclonal antibody for the management of chronic disseminated intravascular coagulation secondary to a urothelial carcinoma: a case report

Coronavirus disease 2019 on routine testing in eclampsia: a case report

Niemann-Pick type A disease with new mutation: a case report

Varicella zoster-associated progressive lower cranial and upper cervical polyneuropathy: a case report

Guillain–Barré/Miller Fisher overlap syndrome in a patient after coronavirus disease-2019 infection: a case report