{"id":8541,"date":"2026-09-02T15:13:40","date_gmt":"2026-09-02T13:13:40","guid":{"rendered":"https:\/\/juanacrespo.com\/?post_type=caso&#038;p=8541"},"modified":"2026-09-02T15:13:40","modified_gmt":"2026-09-02T13:13:40","slug":"when-the-uterus-is-the-challenge-from-14-years-of-infertility-to-a-full-term-pregnancy","status":"publish","type":"caso","link":"https:\/\/juanacrespo.com\/en\/case\/when-the-uterus-is-the-challenge-from-14-years-of-infertility-to-a-full-term-pregnancy\/","title":{"rendered":"When the uterus is the challenge: from 14 years of infertility to a full-term pregnancy"},"content":{"rendered":"<p>When the uterus is the challenge: from 14 years of infertility to a full-term pregnancy<\/p>\n<p>Following a thorough investigation, a significant <a href=\"https:\/\/juanacrespo.com\/en\/problem\/uterine-pathology\/\">uterine condition<\/a> associated with adenomyosis and bilateral hydrosalpinx was identified, requiring a comprehensive and personalised approach.<\/p>\n<p>The design of an individualised treatment strategy, combining medical treatment, uterine and tubal surgery, and subsequent specific preparation for <a href=\"https:\/\/juanacrespo.com\/en\/technique\/embryo-transfer\/\">embryo transfer<\/a>, ultimately led to a pregnancy that progressed to full term without complications.<\/p>\n<h3><strong>Medical history<\/strong><\/h3>\n<p>A 44-year-old patient with a 14-year history of infertility and a history of endometriosis.<\/p>\n<p>Throughout her reproductive history, she had undergone:<\/p>\n<ul>\n<li>Previous laparoscopy for bilateral endometriotic cysts.<\/li>\n<li>Hysterosalpingography (HSG), which revealed obstructive tubal pathology.<\/li>\n<li>Multiple endometrial receptivity tests and immunological treatments.<\/li>\n<li>Three surgical hysteroscopies for fundic metroplasty.<\/li>\n<li>One surgical hysteroscopy for uterine synechiae, with adhesiolysis.<\/li>\n<li>Subendometrial PRP administration.<\/li>\n<\/ul>\n<p><b>Previous assisted reproduction treatments<\/b><\/p>\n<p>The patient had undergone a total of <b>19 embryo transfers, with 22 embryos transferred<\/b>, without achieving a viable pregnancy.<\/p>\n<p>Her medical history included:<\/p>\n<ul>\n<li>9 IVF cycles and 10 transfers of frozen embryos using her own gametes.<\/li>\n<li>1 treatment involving egg donation and 3 transfers of frozen embryos.<\/li>\n<li>3 transfers of embryos from embryo donation.<\/li>\n<li>Two biochemical pregnancies using her own gametes.<\/li>\n<li>Three very early first-trimester miscarriages following treatments involving egg donation and embryo donation.<\/li>\n<\/ul>\n<h3><b>Diagnosis<\/b><\/h3>\n<p>The investigation carried out at our clinic identified a combination of factors that could compromise both uterine anatomy and embryo implantation:<\/p>\n<ul>\n<li><a href=\"https:\/\/juanacrespo.com\/en\/problem\/endometriosis\/\"><b>Deep endometriosis<\/b><\/a><b>.<\/b><\/li>\n<li><strong>Left hydrosalpinx and probable right hydrosalpinx.<\/strong><\/li>\n<li><strong>Uterus severely affected by adenomyosis.<\/strong><\/li>\n<li>Two adenomyomas protruding into the endometrium.<\/li>\n<li>History of endometrial pathology and uterine synechiae.<\/li>\n<\/ul>\n<p>To complete the investigation, a <b>pelvic MRI<\/b> was performed, which revealed a retroverted and flexed uterus and a small focal lesion of approximately 8 mm that partially occupied the lumen of the endometrial cavity in its anterosuperior region, consistent with a small adenomyoma.<\/p>\n<p>Furthermore, poor definition of the junction area was observed, particularly on the posterior surface, consistent with the presence of adenomyosis.<\/p>\n<p><img decoding=\"async\" class=\"alignnone wp-image-8511 size-full\" src=\"https:\/\/juanacrespo.com\/wp-content\/uploads\/2026\/09\/utero_sf.jpg\" alt=\"\" width=\"650\" height=\"149\" srcset=\"https:\/\/juanacrespo.com\/wp-content\/uploads\/2026\/09\/utero_sf.jpg 650w, https:\/\/juanacrespo.com\/wp-content\/uploads\/2026\/09\/utero_sf-300x69.jpg 300w\" sizes=\"(max-width: 650px) 100vw, 650px\" \/><\/p>\n<h3><strong>Treatment strategy<\/strong><\/h3>\n<p>Given the complexity of the case, a sequential treatment strategy was devised with the aim of optimising both the uterus and the conditions for a future embryo transfer.<\/p>\n<p><strong>1. Medical treatment<\/strong><\/p>\n<p>Firstly, anti-oestrogen treatment was initiated, with the aim of assessing the response of the uterine condition to medical treatment.<\/p>\n<p>Following treatment, a <b>significant reduction in the size of the adenomyoma<\/b> was observed.<\/p>\n<p><strong>2. Surgical treatment<\/strong><\/p>\n<p>Once the response to medical treatment had been assessed, a <a href=\"https:\/\/juanacrespo.com\/en\/treatment\/restoring-fertility\/\">combined surgical approach<\/a> was performed:<\/p>\n<ul>\n<li>Laparoscopy for bilateral salpingectomy, aimed at treating the hydrosalpinx.<\/li>\n<li>Surgical hysteroscopy for drainage of the adenomyoma, with administration of PRP during the same surgical procedure.<\/li>\n<\/ul>\n<p>The aim was to improve the uterine anatomy and eliminate factors that might interfere with embryo implantation.<\/p>\n<p>The histopathological examination of the specimens obtained via salpingectomy confirmed the presence of <b>hydrosalpinx with foci of chronic salpingitis<\/b>.<\/p>\n<p><strong>3. Uterine preparation<\/strong><\/p>\n<p>Following completion of the surgical treatment, specific preparation of the uterus and endometrium was carried out with the aim of achieving the best possible conditions prior to embryo transfer.<\/p>\n<p>Subsequently, anti-oestrogenic treatment was administered and embryo transfer was performed in a natural cycle.<\/p>\n<h3><strong>Result<\/strong><\/h3>\n<p>The first embryo transfer performed following completion of the therapeutic strategy was <b>successful<\/b>.<\/p>\n<p>The pregnancy progressed favourably and <b>reached full term without complications<\/b>.<\/p>\n<h3><strong>Conclusion<\/strong><\/h3>\n<p>This case illustrates the complexity that some cases of infertility can reach when <b>endometriosis, adenomyosis, abnormalities of the uterine cavity, tubal pathology and a prolonged history of reproductive failure<\/b> coincide.<\/p>\n<p>After 14 years of infertility, 19 embryo transfers involving a total of 22 transferred embryos, and multiple previous medical and surgical treatments, a comprehensive anatomical assessment identified the factors that were compromising the patient\u2019s reproductive prospects.<\/p>\n<p>The combination of an <a href=\"https:\/\/juanacrespo.com\/en\/treatment\/your-fertility-diagnosis\/\"><b>accurate diagnosis<\/b><\/a><b>, personalised surgical planning and a specialised medical approach<\/b>, tailored to each patient\u2019s specific characteristics, made it possible to optimise uterine conditions and finally achieve a viable pregnancy that was carried to term.<\/p>\n<p><strong>This case demonstrates the importance of treating infertility from a holistic perspective, focusing not only on the embryo but also on the uterus and the conditions that enable implantation and the successful progression of the pregnancy.<\/strong><\/p>\n","protected":false},"featured_media":5933,"template":"","meta":{"_acf_changed":false,"content-type":"","inline_featured_image":false},"categoria-de-caso":[372,384],"class_list":["post-8541","caso","type-caso","status-publish","has-post-thumbnail","hentry","categoria-de-caso-adenomyosis","categoria-de-caso-uteruses"],"acf":[],"_links":{"self":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso\/8541","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso"}],"about":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/types\/caso"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media\/5933"}],"wp:attachment":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media?parent=8541"}],"wp:term":[{"taxonomy":"categoria-de-caso","embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/categoria-de-caso?post=8541"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}