RESUMEN
Managing a thin endometrium is a common challenge in assisted reproductive treatments. The thickness of the endometrium is crucial for embryo implantation, with younger patients generally having higher success rates even with a thinner lining. A frozen embryo transfer cycle often allows for a more thorough assessment of the endometrium compared to a fresh transfer. We present a case of a 36-year-old woman who presented to our fertility center with primary infertility for six years. Despite having regular menstrual cycles, her endometrial thickness consistently measured between 5 and 6.0 mm on ultrasonography. She underwent ovarian stimulation using an antagonist protocol, resulting in the retrieval of oocytes and the freezing of three embryos. However, three frozen embryo transfer cycles were cancelled due to inadequate endometrial thickness (ranging from 4.3 to 5.2 mm). In the fourth cycle, she was treated with gonadotropins with the goal of achieving two to three follicles and improved endometrial thickness. Triggering was performed on day 15, followed by the transfer of one frozen embryo at an endometrial thickness of 5.7 mm. Her beta-human chorionic gonadotropin (hCG) level was positive, with an initial value of 136.9 mIU/mL, and she subsequently delivered a healthy baby. This case highlights the challenges of managing a thin endometrium in assisted reproductive techniques. Through persistent efforts and tailored treatment protocols, a successful live birth was achieved despite recurrent thin endometrium. This case underscores the importance of individualized treatment strategies in overcoming endometrial challenges in infertility treatments.
RESUMEN
We present a case of subfertility due to isthmocele and cesarean scar endometriosis with a successful pregnancy following laparoscopic repair. This case report is of a 35-year-old female (para 1, living 1) who presented to the gynecological outpatient department with complaints of lower abdominal pain, irregular vaginal bleeding for three months, and subfertility. She was suspected to have isthmocele and endometriosis at the site of the cesarean scar with seroma formation. She underwent a hysteroscopy and laparoscopic excision of the cyst at the site of the cesarean scar with the repair of the cesarean scar defect. Diagnosis of scar endometriosis was confirmed on histopathology. She successfully became pregnant after one year and had a full-term pregnancy and delivered via cesarean section. Cesarean scar defect, also known as isthmocele, emerges as a notable complication following cesarean delivery, often linked with secondary infertility. Other associated complications of scar defect are prolonged menstrual bleeding, dysmenorrhea, dyspareunia, and chronic pelvic pain. The laparoscopic reparation of the uterine scar defect proves to be a successful approach in addressing secondary infertility and subfertility issues. Individuals with a prior cesarean section history, expressing concerns about secondary infertility and distressing complaints, require a thorough examination of the uterine scar before embarking on future pregnancy plans. Scar endometriosis is an uncommon medical condition and can worsen patient symptoms and lead to further complications. Diagnosis is often established following the excision of the lesion and subsequent histopathological examination. Prompt management can relieve patient symptoms and prevent further complications.