Case Report- A challenging case of severe Asherman’s syndrome in Reproductive MedicineFollowed by twin delivery

Mrs. A was first seen with infertility and secondary amenorrhea. She was nulliparous with history of two surgical evacuations.

Her pelvic scan showed very thin endometrium of 2.5mm. She had hysteroscopy done 3 times to manage intrauterine adhesions in other centers.

When she then attended to start IVF treatment at St. Mary’s her FSH/LH level was very high and she was diagnosed premature ovarian failure. She underwent In Vitro Fertilization (IVF) cycle with donor eggs and partner’s sperm, had hormone replacement therapy (HRT) & fresh embryo transfer with single blastocyst but this was unsuccessful. Three blastocysts were frozen in that cycle.

First frozen embryo transfer with single embryo was unsuccessful. Prior to next embryo transfer scan showed fluid in endometrium. Diagnostic hysteroscopy diagnosed recurrence of Asherman’s Syndrome. Following this yet another operative hysteroscopy at our centre was done using versa point mainly and cold knife dissection towards the corneal ends. Hyalo-barrier gel was instilled, and copper coil was inserted, high dose estrogen was given for 6 weeks post operatively. Coil was removed after 3 months. She then had frozen embryo transfer with two blastocysts.

This transfer was successful and confirmed twin gestation. However, she had preterm prelabour ruptured membranes at 28 weeks gestation and delivered by Caesarean Section at 29+4 weeks. The birthweights of the babies were normal centiles for that gestation and were discharged home in good condition.