Mr and Mrs NS visited Dr Mamta Dighe at Xenith Advanced Fertility centre, for the first time in 2020. They had been trying to get pregnant for the last 5 years since their marriage but were unable to conceive naturally. The couple had taken treatment at many centres however, getting to develop her follicles was a major challenge faced everywhere resulting in failures and a negative result. The patient was completely devastated and though she lived out of Pune , she decided to travel to Pune and meet Dr. Mamta Dighe.

Major Challenges: PCOS, Irregular Periods along with Hypogonadotropism:

Polycystic Ovarian Syndrome (PCOS) refers to the fact that this syndrome results in the formation of small cysts or fluid-filled sacs on the rim of the ovaries. Other symptoms include excessive body hair, sudden weight gain or development of male pattern baldness. There is disrupted ovulation due to abnormal release of Leutinizing hormone (LH) from pituitary. The eggs do not mature properly. As a result, the follicle sacs containing these eggs turn into cysts around the inner rim of the ovaries. Disrupted ovulation also leads to irregular periods, making it difficult for women with PCOS to calculate their fertile windows accurately. This leads to difficulty in conceiving.

Though at first glance the case seemed a straightforward case of PCOS what had been missed was that she also had hypogonadotropic hypogonadism. This is a condition in which the hormones required for egg development are not released from the brain. On complete assessment at Xenith she was detected as the case of hypogonadotropic hypogonadism (HH) along with PCOS. That was the reason she didn’t respond to oral ovulation induction which were given to her as they depend on release of gonadotropin hormones from pituitary gland in brain which is absent in HH.

Hypogonadotropic hypogonadism (HH) is a condition in which the female ovaries produce little or no stimulating hormones which is due to a problem with the pituitary gland or hypothalamus. There is impairment of neuroendocrine function and presents with amenorrhea and small ovaries with arrested folliculogenesis.  This condition needs proper assessment and management before doing a stimulation which was done at Xenith.

Management at Xenith: After detailed discussion and counseling, decision for IVF treatment was taken. :

It was a really challenging case as in patients with hypogonadotropic hypogonadism with PCO; the endocrine milieu is completely different from patients with only PCOS. These patients need to be managed very meticulously as patients with HH may need high dose of gonadotropin injections after priming. In this case because of the PCOS  there also was a risk of excessive ovarian response and ovarian hyperstimulation syndrome. In such cases, sonographic findings and hormonal monitoring needs to be correlated very finely. 

The couple underwent IVF using their own gametes and 18 mature eggs were obtained. These eggs were fertilized using ICSI, and this resulted in 12 good embryos were formed. All the embryos were frozen to avoid the risk of ovarian hyperstimulation.

In next cycle, after preparing endometrium with oestradiol, the frozen embryo transfer was done. Two excellent blastocysts were transferred.

Treatment outcome:

After 15 days, BHCG was detected as positive. Scan at 7 weeks showed single live intrauterine gestation. Her pregnancy was uneventful and she delivered a healthy full term term baby.

They are extremely grateful to the Xenith doctors and extended team for excellent support and guidance in their entire fertility journey.

At Xenith, we deal with every patient differently and adapt treatment protocols accordingly, and implement a more individualised approach to every case.

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