Abstract
A 38-year-old woman presented with secondary infertility persisting for four years, having previously conceived a child twelve years ago. Her medical history included bilateral ovarian cystectomies due to large dermoids. Investigations revealed a significantly reduced ovarian reserve, indicated by an AMH level of 0.50 ng/mL and FSH of 15. Her partner demonstrated satisfactory semen parameters. Initial attempts at ovarian stimulation with clomiphene citrate were unsuccessful, prompting a transition to in vitro fertilization (IVF) due to the patient's age and diminished ovarian reserve. However, two IVF cycles with high dose gonadotrophins showed very poor response Diagnostic hysteroscopy revealed a normal uterine cavity but histological evidence of chronic endometritis, for which the patient underwent a 14-day course of doxycycline. In a novel approach, the patient opted for ovarian platelet-rich plasma (PRP) injection, aiming for ovarian rejuvenation and improved response. Ultrasound-guided PRP injection was performed, administering two milliliters into each ovary. Following PRP therapy, a trial of ovulation induction with Letrozole resulted in the development of one dominant follicle, though subsequent ovulation trigger with hCG did not lead to pregnancy. Laparoscopic evaluation revealed bilateral periovarian adhesions, with the right fallopian tube densely adhered to the pelvic sidewall. Surgically, successfully mobilized adhesion, confirming tubal patency. Both ovaries exhibited reduced size, particularly the left ovary. A second round of PRP injection was administered laparoscopically into each ovary. One month post-laparoscopy, ovarian stimulation with Letrozole resulted in the development of a single follicle, followed by ovulation trigger with hCG and IUI. Subsequent confirmation of pregnancy via transvaginal ultrasound marked a successful outcome. The success of this case represents a combination of treatment strategies, including ovarian factor rejuvenation with PRP, selecting an appropriate stimulation regime and IUI, improving uterine receptivity by treating chronic endometritis, and performing tubolysis to confirm bilateral tubal patency followed by timed IUI.