For 2009, here is the first exciting story that I would like to share. J.M. is a healthy 36 year old lady with primary infertility (previously never been pregnant) who came to me in June, 2008. Her HSG showed a right hydrosalpingx (a blocked tube full of embryo toxic fluid), that was clearly preventing her from conceiving. In July, a laparoscopy confirmed the hydrosalpingx and the tube was removed as it was irreparably damaged.
Because J.M. was 36 years old, she also had an age factor and was showing some diminished ovarian reserve on both her sonogram and with her serum antimullerian hormone level (AMH) which was only 0.7. She wanted to be aggressive in treating her infertility but she did not wish to immediately go through IVF because of the stress, costs and fertility drugs. So, I suggested Natural Cycle IVF as a less stressful, less costly alternative which does not use any ovarian stimulating drugs either.
On November 26, we obtained a single egg produced in her normal natural menstrual cycle, in our office with minimal conscious sedation. The egg collection took less than 3 minutes once the needle was placed into her follicle. During her monitoring, she had only 4 total office visits.
The egg fertilized but on day 3 after the aspiration, the embryo was developing slowly with only a 4-5 cell embryo. Typically, on day 3 a normal embryo would be 8 to 10 cells. Therefore, we continued to culture her embryo to see if the embryo was healthy or whether it had arrested in its growth. Fortunately for JM the embryo continued to grow and a healthy blastocyst embryo was easily transferred back to the patient's uterus. On December 30, a transvaginal ultrasound exam confirmed a 7 week normal appearing pregnancy. The patient could not believe how simple the entire process was.
JM was my last obstetrical sonogram for 2008, and I am most pleased for her. The lesson we learn here is that "what you see may not be what you get". On day 3 her embryo was clearly lagging behind in its development but this does not necessarily mean that all is bad. By allowing the embryo to continue to culture in our lab, it was later evident that there was hope and JM's hope is quickly becoming her reality!
We must remember that we are dealing with biologic systems and not hard sciences such as math, physics or chemistry. And so, we often see situations that may initially not seem to be optimal but by persisting or by applying a slightly different approach, we can frequently get the desired outcome. And that is why I love my job!!!! DrD