Private gynaecologist | The Surrey Park Clinic

Case Studies

Chloe and James had been trying to conceive for three years when they came to The Surrey Park Fertility Clinic. The couple were fit and well and in good health. The couple had been using predictor kits which showed that she was ovulating on most cycles and James's semen analysis was normal. The tests showed that Chloe was immune to Rubella and had not been infected with Chlamydia.

A laparoscopy was organised to check the ovaries and fallopian tubes under general anaesthetic and a hysteroscopy was performed at the same time to check that there were no polyps within the uterus or any abnormality which may be affecting implantation of an embryo. At laparoscopy all appeared normal apart from failure of the blue dye to travel along the right fallopian tube. There seemed to be some scar tissue around that area, possibly as a result of an infected appendix abscess that Chloe had had some years before. The left tube however looked completely normal and both ovaries looked healthy. The uterus was also normal with nothing of worry to account for her irregular bleeding.

Having established that all was normal the couple were then embarked upon an ovulation induction program to stimulate good quality eggs with timed intercourse. Chloe underwent three cycles of Clomiphene with very little response on regular scan to assess the development of the eggs. She then underwent a further cycle of follicle development with injections and by day 13 of her cycle had developed two good size follicles. According to her predictor kits she ovulated on day 15 and was asked to have intercourse that night and the next. Day 21 progesterone showed good levels of ovulatory progesterone and a pregnancy test two weeks after ovulation was positive. A viability scan at 8 weeks gestation showed that all was healthy and Chloe delivered at 41 weeks gestation by water birth after a completely normal pregnancy.

Case Study 2

Anna and Matthew had been trying to conceive for six years since the birth of their first child when Anna was 29 years of age. That pregnancy was straight forward and there had been no obvious problems since then. Anna's cycle was regular. She had had no infections and Matthew's health was unchanged. Anna's GP had done a baseline hormone test at the beginning of her cycle and this had shown that the LH was slightly higher than the FSH. Ovulation charts showed no obvious ovulation.

The couple went for a consultation at The Surrey Park Fertility Clinic where the consultant performed a pelvic scan to assess the uterus and ovaries. Both ovaries were seen to be extremely cystic with no evidence of a developing follicle despite Anna's regular cycle. The lining of the uterus (endometrium) was thin consistent with low oestrogen levels from poor quality follicular development which is part of PCOS.

Anna had already had a glucose tolerance test with insulin levels organised prior to her consultation and the results of this were reviewed with her consultant. She had this as she had suspected that she may have PCOS as she was beginning to put on weight around her abdomen and developing quite bad hormonal symptoms despite her regular cycle. The results showed high fasting levels of insulin as well as a very high secretion of insulin following a glucose drink. This indicated that the excessive amount of insulin that Anna was producing was the possible cause in affecting her follicular development. This was all discussed with her consultant who explained that to improve her follicular development she would benefit from changing her diet and adding in some medication to reduce her insulin levels and help the eggs develop correctly. She was given ovulation charts to fill in and had an appointment with one of our specialist dieticians to discuss how to improve her diet to reduce her insulin levels.

After three cycles a combination of medication and diet improved the development of her eggs according to follicle tracking scans and on the third cycle she was given an HCG injection to help ovulation. She was found to have a positive pregnancy test two weeks later and was advised to continue with the Metformin to keep the insulin levels steady and help the pregnancy to implant correctly. She was also given progesterone supplements to maintain the pregnancy up until 14 weeks gestation. She was given dietary back up advice to ensure that her insulin levels stayed steady throughout pregnancy as they naturally rise at this time and this can affect the baby's connection with the mother. She had a successful pregnancy and delivered at 39 weeks gestation, a healthy baby boy.