Blog Doctors Dr. Maheshwari

An interesting POR case study

Case Study
A couple, wife aged 41 years and husband aged 43 years, came to our hospital with history of primary infertility for 9 years. Her cycles were regular. She underwent diagnostic Hysteroscopy and Laparoscopic Myomectomy in 2004. Husband was a known case of type 2-Diabetes Mellitus since 3 years and was on medication. Following investigations were made during follow up. Wife: Hemogram, OGCT, Prolactin hormones were normal. AMH was 0.9, TSH 1.51, D2: FSH 9.8, LH: 7.8, Baseline USG showed 4 follicles on right side and two on left side. Husband: Semen analysis showed Asthenospermia with DFI 25%. Hemogram, OGCT, TSH was normal. Couple were counseled in detail about poor ovarian reserve and need for IVF treatment. Wife was started on DHEA 75mg per day, 2 months prior to starting IVF cycle. IVF stimulation was started using antag protocol. Started with inj. rFSH 187.5 IU and inj HMG 75IU. Later total dose of GnRH increased to 325IU per day, total 14 days of stimulation was done. E2 response was adequate. Dual trigger using Inj HCG 5000IU & Inj Lupride 1mg was given when follicles were >18mm. 3 oocytes were obtained. ICSI procedure was done, 1 good quality embryo was frozen. She was prescribed transdermal testosterone gel 12.5 mg daily application to upper arm and outer thighs for 3 weeks prior to starting next IVF cycle. No systemic or local adverse effects were noted. During 2nd IVF cycle mild stimulation protocol was used. Aromatase inhibitors dose of 2.5mg twice a day was given for 5 days from D2 to D6 along with rFSH 225IU per day, total 10 days of stimulation. Dual trigger using Inj HCG 5000IU & Inj Lupride 1mg was given when follicles were >18mm. E2 response was adequate. 9 oocytes were obtained. In that, 8 oocytes were mature( M2). ICSI procedure was done, five good quality embryo were frozen. After two month, frozen embryo transfer was done using HRT. Three good quality embryos were transferred and the patient conceived. Its a ongoing pregnancy now. Rationale: Experimental studies have shown that treatment with testosterone increased FSH receptor expression in granulosa cells, promoting the initiation of primordial follicle growth, improving the number of growing preantral and antral follicles. Androgen treatment amplifies the effects of FSH on ovaries requiring less dose of FSH, shorter duration of treatment and better pregnancy rate. Aromatase inhibitors increase intraovarian androgen level. Successful treatment for the poor ovarian responder remains a challenge. Still good RCT are required with adequate sample number to provide information on the use of transdermal testosterone gel effectiveness in poor responder.

About GarbhaGudi:

GarbhaGudi is a chain of New-Generation Infertility Treatment Hospitals equipped with state-of- art-infrastructure & cutting-edge IVF Technology to address infertility issues & their emotional & mental effects on couples. We have a team of qualified & experienced doctors; their in-depth knowledge & expertise leaves no stone unturned to solve all your infertility issues. The Supportive & caring staff is always by your side to motivate & guide you throughout the journey. GarbhaGudi IVF, the best fertility treatment hospital in Bangalore, provides emotional support to couples facing infertility issues and sexual problems
For further details, you can also write to GarbhaGudi at or directly talk to our team at 8880000909 Follow us on Facebook Twitter LinkedIn Instagram Pinterest

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