Patient Profile
- 41 year old woman
- Infertility history: 7 years
- 7 Failed IVF Attempts
- Referral from an experienced colleague in the field of infertility
- wife of 53 years
History of surgeries
- 1st Laparoscopic surgery for fibroid removal
- 2nd Laparoscopic surgery for endometrioma removal and extensive endometriosis
- 3 Hysteroscopies for the restoration of extensive adhesions and scar tissue after the first surgery
clinical challenge
- Extensive intrauterine adhesions
- Severe deformation of the endometrial cavity
- Loss of normal pyramidal shape of the uterus
- Minimally apparent normal endometrial tissue
- Multifactorial and highly demanding incident
- Particularly burdened psychological load after years of failure
Psychological state of a couple
Disappointment, alternating with anger and exhaustion, was evident to the woman, while the husband looked more passive and emotionally detached.
Although both were visibly good people, they were deeply influenced by the long-term infertility course and constant failures.
The words of the colleague who referred by the couple were typical:
“Do what you think… as long as I never see them again.”
In our first meeting it was clear that they didn't really believe that something positive could happen.
The patient was visibly disappointed, almost detached from the process itself, wondering why she was there and why she should expect something different.
I remember assuring her that this time things would be different — and even today I don't know where that certainty came from.
diagnostic findings
The couple showed me the video of the last hysteroscopy.
The picture was particularly shocking.
The endometrial cavity had completely lost its normal pyramidal shape and, due to its extremely extensive adhesions, had acquired the form of a narrow lumen.
There was virtually no apparent normal endometrial surface.
It was one of the most difficult hysteroscopic images I had faced.
Diagnostic & Therapeutic Approach
- Complete reassessment of the incident
- Analytical evaluation of previous interventions and failed IVF cycles
- Specialized hysteroscopic surgical repair
- Detailed adhesion solution and cleaning of the endometrial cavity
- Attempting to "nearize" and optimize the endometrial tissue
- Restoring as best as possible functional anatomy
hysteroscopic intervention
We proceeded to an extremely demanding hysteroscopic surgery.
With a particularly detailed and careful technique, the adhesions were resolved and the endometrial cavity was cleaned.
Despite the restoration, the uterus never acquired a completely normal shape.
However, the best possible conditions were created for a new implantation attempt.
IVF Strategy
- Personalized treatment design
- Careful selection of excitation protocol
- Optimization of endometrial conditions after surgical repair
- Close monitoring of each stage of treatment
- Focus on the maximum possible implantation
Result
Two months after surgical repair, the patient underwent a new IVF cycle.
To the surprise of all of us, two gestational sacs appeared on the first ultrasound.
The pregnancy went smoothly and the couple had a caesarean section in MITERA two healthy children — a boy and a girl.
Today he is 8.5 years old.
A few days before this text was written, I saw the mother again, who said to me:
“We are all grateful to God for the life we are finally living.”
It was one of the most beautiful things I could hear.
clinical conclusions
- Proper reassessment can reveal critical causes of underestimated failure
- Intrauterine adhesions can decisively affect implantation
- Specialized hysteroscopic surgery can substantially change prognosis
- Even after multiple failed IVF attempts, personalization can lead to success
- Experience, detail and the right strategy often make a difference in the most difficult cases
Final message
Even in the most difficult cases, where everything seems lost, the correct diagnosis, persistence and targeted intervention can completely change the course of a couple.
Because many times the difference lies in the details — and in the decision not to give up.
