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Suggest treatment for amenorrhea and severe Asherman's syndrome

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Posted on Thu, 10 Sep 2015
Question: Dear Doctor,

Over the last 7 years, I had 2 myomectomies which resulted in amenorrhea. Investigations revealed severe Asherman's syndrome which was taken care of by a hysteroscopy. However, i still suffer from amenorrhea and my endometrium lining is very thin (usually 3 mm). To help me get pregnant, i have had 1 IVF (with own eggs) and 2 FETs with donor eggs (the last FET was in May 2015) which all failed even though my lining was 10mm at the time of the ET, during all 3 cycles. I used progynova tabs and progesterone in oil to prepare my lining.

What could be the cause of the implantation failure? as all 3 times, we had excellent embryo quality and my doctors were happy with my endometrial thickness. We have 2 frozen embryos left and would like to proceed for FET in November this year but we are scared that the embryos will not implant. What can we do to ensure embryo implantation this time? All 3 times, ICSI, Assisted hatching were used.

Thank you.
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Answered by Dr. Mahesh Koregol (1 hour later)
Brief Answer:
Surrogate and PGS are options

Detailed Answer:
Hello,

Thanks for your query.

I have read you query and I understand your concerns about FET.

Following is my reply:

1) Your endometrium seems to be the problem as per your description.

2) Asherman's syndrome is a condition where endometrial adhesions are more and is a reason for patches of avascular endometrium which does not have blood supply.

3) Though endometrium looks good on ultrasound scan, blood supply is likely to have been impaired causing implantation failure.

4) I suggest you can use surrogate mother as an option for embryo transfer.

5) If you are not willing for surrogate , another option would be to test embryos for any genetic abnormality by doing PGS ( Preimplantation Genetic Screening) and check genetic health embryos thogh they look. Chromosomal problems in embryos are also associated with implantatin failure.

I hope I answered you query and addressed your concerns.

Let me know if you wish to ask any further questions. I will be glad to help you.

Regards,
Dr. Mahesh Koregol.
IVF & Infertility Specialist.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3797 Questions

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Suggest treatment for amenorrhea and severe Asherman's syndrome

Brief Answer: Surrogate and PGS are options Detailed Answer: Hello, Thanks for your query. I have read you query and I understand your concerns about FET. Following is my reply: 1) Your endometrium seems to be the problem as per your description. 2) Asherman's syndrome is a condition where endometrial adhesions are more and is a reason for patches of avascular endometrium which does not have blood supply. 3) Though endometrium looks good on ultrasound scan, blood supply is likely to have been impaired causing implantation failure. 4) I suggest you can use surrogate mother as an option for embryo transfer. 5) If you are not willing for surrogate , another option would be to test embryos for any genetic abnormality by doing PGS ( Preimplantation Genetic Screening) and check genetic health embryos thogh they look. Chromosomal problems in embryos are also associated with implantatin failure. I hope I answered you query and addressed your concerns. Let me know if you wish to ask any further questions. I will be glad to help you. Regards, Dr. Mahesh Koregol. IVF & Infertility Specialist.