Bicornuate uterus with recurrent miscarriage treated with Sitagliptin and PRP: A Case Report of a Successful Pregnancy

Abstract

Research has shown that recurrent miscarriage can be due to loss of endometrial mesenchymal stem-like progenitor cells (eMSC) and excessive decidual senescence. Sitagliptin has been shown to increase eMSC in the endometrial tissue and decrease decidual senescence. Case This is a case report for a 31-year-old woman with a bicornuate uterus who suffered recurrent miscarriages with IVF treatment. IVF treatment was done due to male factor infertility in a modified stimulation protocol using oral clomifene and human menopausal gonadotrophin. A total of 10 blastocysts were cryopreserved. The couple could not afford to do a PGT-A testing on the cryopreserved embryos. Initial three frozen embryo transfers were done in a natural cycle but resulted in biochemical pregnancies. Thyroid function test and Anti-phospholipid Syndrome tests were negative. Her Protein C level was slightly low at 63%. Hysteroscopy showed no abnormalities in both the uterine horns. A fourth embryo transfer was done in a medicated cycle which resulted in no pregnancy. She was started on oral Sitagliptin 100mg once daily for 3 months. Following this, a fifth embryo transfer was done in a natural cycle. Endometrial PRP infusion was done in this cycle. She successfully became pregnant and delivered a baby girl via LSCS in August 2023. Conclusion Sitagliptin can be a cost-effective adjunct treatment for patients with recurrent miscarriage. While the absence of PGT-A may raise questions regarding the underlying cause of her recurrent miscarriages, oral Sitagliptin can be an option in cases of financial constraint or limited resources.