Patient Profile
- 38 year old woman
- Infertility history: 7 years
- 12 previous IVF cycles
- History of laparotomy, i.e. open surgery, for removal of fibroids 5 years ago
effort history
- Long-term infertility lasting 7 years
- 12 Failed IVF Cycles
- Previous Open Surgery for Fibroid Removal
- Aggravated history of uterus due to fibroids and previous surgical intervention
clinical challenge
During the first evaluation, the presence of multiple fibroids was found, with dimensions up to 7 cm.
At the same time, the endometrial cavity showed adhesions, which seem to have been related to both the presence of the fibroids and the previous surgery.
The incident was particularly demanding, as the uterus had already been burdened by a previous open surgery. Choosing a new operation to remove fibroids could cause further burden on the endometrial cavity and negatively affect the chances of implantation.
It is a multifactorial infertility incident, where the main challenge was not only the presence of fibroids, but also the need to protect as much as possible the functionality of the endometrial cavity.
diagnostic assessment
The assessment of the case showed that the intrauterine cavity had been significantly affected.
The adhesions, combined with the history of previous laparotomy, created unfavorable conditions for implantation and probably explained part of the repeated IVF failures.
In this context, the strategy could not be aggressive or standardized. A careful, targeted and completely individualized approach was needed, with the main goal of improving the endometrial cavity without further injury.
Therapeutic decision
After analytical discussion and reassessment of the data, it was decided to avoid a new extensive surgery to remove fibroids.
This decision was based on the risk of further burden on the uterus and the endometrial cavity.
Instead, a more conservative but targeted approach was agreed:
- Hysteroscopic solution of intrauterine adhesions
- Renewing the endometrium during hysteroscopy
- Avoiding unnecessary surgical injury
- Subsequent medication
- Careful planning of the next cycle of extracorporeal
Diagnostic & Therapeutic Approach
Hysteroscopy was aimed at restoring the endometrial cavity and creating better implantation conditions.
In a detailed and careful way, the adhesions were dissolved and the endometrial tissue was neatized, with the aim of improving the receptivity of the endometrium without causing new damage.
The approach was particularly careful, as in such cases excessive intervention can be as aggravating as insufficient treatment.
IVF Strategy
After the hysteroscopic restoration, an individualized IVF cycle was designed.
The strategy was based on:
- Improvement of the intrauterine cavity before embryo transfer
- Avoiding additional surgical trauma in the uterus
- Careful pharmaceutical support
- Targeted endometrial preparation
- Utilizing every detail that could increase the chance of implantation
Result
The patient achieved pregnancy with the first IVF attempt after hysteroscopic rehabilitation.
Two years later, he achieved a second pregnancy through frozen embryo transfer.
After 7 years of infertility and 12 previous IVF cycles, this development was particularly moving.
Perhaps even the patient herself finds it difficult to believe that, after so many failures and so much mental fatigue, all this finally happened.
clinical conclusions
- Repeated IVF failures require a complete revaluation rather than a mere repetition of the same strategy
- Fibroids and endometrial adhesions can decisively affect implantation
- Previous uterine surgery may create additional difficulties in the endometrial cavity
- The most extensive surgical solution is not always necessary
- In selected cases, targeted hysteroscopic intervention may be more beneficial than a new major intervention
- Protecting the endometrial cavity is critical to the success of IVF
- The personalized approach can change the prognosis even after many failed attempts
Final message
Even after many years of infertility and repeated failures, the solution does not always lie in doing more.
Sometimes it lies in doing the right thing, with precision, attention and respect for detail.
In difficult cases, the correct diagnosis, avoiding unnecessary interventions and targeted rehabilitation can change not only the prognosis, but also the life of a couple.
