Assisted Reproduction · Outcomes and Effectiveness
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
Boyle, P. C., Stanford, J. B., & Zecevic, I. (2022). 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. Journal of Medical Case Reports, 16(1), 246. https://doi.org/10.1186/s13256-022-03465-w
Boyle PC, Stanford JB, Zecevic I. 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. J Med Case Rep. 2022;16(1):246. doi:10.1186/s13256-022-03465-w
Boyle, Phil C., et al. "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." Journal of Medical Case Reports, vol. 16, no. 1, 2022, pp. 246.
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Restorative medicine led to a live birth after 16 years of infertility
A 2022 case report describes a healthy full-term live birth after restorative reproductive medicine in a 35-year-old Croatian woman with 16 years of infertility. She also had three miscarriages and eight unsuccessful embryo transfers with IVF/ICSI. Her evaluation found six diagnoses, among them a uterine septum.
Study at a glance, case report of 35-year-old Croatian woman: Live birth followed restorative care after 16 years of infertility. Source: Boyle PC et al., 2022, PMID 35729591.
Key Findings
The patient presented at age 35 with 16 years of infertility, a diagnosis of polycystic ovary syndrome (PCOS, now renamed PMOS, Polyendocrine Metabolic Ovarian Syndrome), and eight unsuccessful embryo transfers with IVF/ICSI.
Charting with the Creighton Model FertilityCare System showed that her first 2 cycles did not include ovulation, with lengths of 45 and 53 days and no identifiable peak day or luteal phase.
The second medicated cycle produced a pregnancy that ended in miscarriage at 7 weeks 4 days and was managed medically.
Further investigation found a balanced Robertsonian translocation (13, 14), and hysteroscopy in June 2020 found a uterine septum that earlier ultrasounds had not shown. The septum was resected.
After septum resection, a third medicated cycle in September 2020 led to a singleton pregnancy, an elective cesarean at 39 weeks for fetal malpresentation, and a healthy mother and infant.
Interpretation
A case report follows one patient in detail, from her first visit in May 2019 to a full-term birth. Her evaluation widened over time. Poor follicle function and suboptimal progesterone levels came first, then a chromosomal translocation and a uterine septum. The authors propose a full evaluation and up to 12 cycles of cycle optimization for subfertile patients (infertility or miscarriage).
RRM Context
Restorative reproductive medicine is a cause-based, holistic approach that uses fertility charting to guide evaluation and treatment. The patient's charts showed cycles without ovulation at the start of treatment. The approach treats infertility and recurrent miscarriage as signs of underlying conditions that call for diagnosis and correction. This case shows several of them in one patient.
Our editorial summary of this paper, not the article's abstract.
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.
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